Ketogenic diet: what is it and how does it work?

ketogenic diet
The ketogenic diet was first used in 1920 to treat patients suffering from frequent epileptic seizures. Seizures were reduced during fasting. More recently it is used in weight loss diets for major obesity and in those clinical situations where rapid weight loss is necessary. The goal is achieved by reducing the intake of glucose present in carbohydrates and the consequent increase in ketone bodies and acidity (pH) in the blood (ketosis).
Ketogenic diet

How the ketogenic diet works

The main sources of energy are proteins and fats, from which ketone bodies are formed and used by the muscles and brain. Carbohydrates are almost completely absent. Ketone bodies are normally formed in case of prolonged fasting or during high fever. In these cases, the breath smells like garlic. This slimming regime must necessarily be applied with the advice of a nutritionist for a few months to avoid adverse health effects.

Indications and contraindications of the ketogenic diet

The ketogenic diet is indicated, in addition to epilepsy, in athletes who need to “bulk up”, in severe obesity, migraine, nocturnal apnea, diabetes, hypercholesterolemia, hypertriglyceridemia. The reduced presence of carbohydrates in the diet inhibits the synthesis of cholesterol (inactivation of the HMG-CoA enzyme), which is activated by insulin when blood glucose rises after a meal rich in carbohydrates, sugars.
The increased introduction of protein in the diet contraindicates the diet in subjects with compromised renal function, arterial hypertension, hepatic insufficiency, diabetes I, pregnancy, constipation.
In order not to incur deficiency syndromes due to deficiency of fruits and vegetables (carbohydrates), it is necessary to resort to supplements to cover the daily needs.

Why the weight is lost

Many people ask me why the ketogenic diet causes such rapid weight loss compared to other diets. According to more recent research, the most likely mechanism leading to weight loss is the increased introduction of protein compared to carbohydrates. This stresses and activates the metabolism, which “burns more calories”. In summary, these are the hypothesized mechanisms:
Reduction of appetite due to the satiating effect of proteins.
Action on the hormones that control appetite with less hunger
Appetite-suppressant action due to ketone bodies formed when fats are used (oxidation) as an energy source
Reduced-fat formation due to low sugar intake
Ketones can have positive effects on the mood of overweight people, excluding the first week when there may be fatigue, drowsiness, which are short-lived.
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Foods to eat and foods to avoid on the ketogenic diet

The basic principles of the ketogenic diet are essential:
Reducing the introduction of carbohydrates – Carbohydrates contain carbohydrates and are the fuel for our cells, especially neurons. Lacking the carbohydrates from fruits and vegetables, the body “burns” fats to get the energy it needs.
Increased protein and fat intake without increasing total calories. Fats should be rich in polyunsaturated fats (from nuts, extra virgin olive oil). The amino acids present in animal proteins are necessary to produce the glucose needed by the organism.
Foods to introduce for a correct ketogenic diet:
Proteins: red and white meats, sausages (bresaola, lean raw ham), blue fish, salmon, low-fat cheeses.
Fats: nuts, extra virgin olive oil.
Low glycemic index carbohydrates: broccoli, asparagus, mushrooms, celery, strawberries, melon, avocado.
High glycemic index carbohydrates are forbidden: wheat derivatives (pasta, bread, cookies, pizza), rice, legumes, ice cream, fruit juices.
typical weekly ketogenic diet

The typical weekly ketogenic diet

The aim of this diet is to not introduce carbohydrates in order to use fats as a source of energy achieving ketosis in the blood. Here are some examples to help you understand what a ketogenic diet can be:
Breakfast: yogurt or milk 200 g with cereal. If you prefer savory: bresaola or ricotta cheese with almonds or walnuts.
Snack: Yogurt or parmesan cheese.
Lunch or dinner: White/red meat 150 g – Grilled or baked fish 150 g – Sliced meats about 100 g. Serve as a side dish with broccoli or green beans. Yogurt or strawberries are allowed.
I have deliberately not gone into the details of food portions because I do not want to replace the advice of the doctor or specialist who are necessary for the integrity of the person undergoing this diet.


Once the desired weight is reached, you will gradually reintroduce carbohydrates and reduce the percentages of proteins and fats. You will start with those with a medium glycemic index until you move to those with a high glycemic index (wheat derivatives).

Alternating the ketogenic diet with the Zone diet

A period of low-carbohydrate ketogenic dieting can help control hunger and improve oxidative fat metabolism while reducing body weight. If you are following a weight loss program with the Zone diet or the Mediterranean diet you can improve compliance by alternating a few weeks with the ketogenic diet. This is only on the advice of the medical specialist following you.

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Duration of the ketogenic diet

According to most authors, the minimum period is 3 to 4 weeks. The weight loss regimen should not exceed 12 months. It is advisable, during the diet, to take rest days with a more balanced diet, such as the Zone diet, to restore glycogen reserves, which is a reserve sugar.

Is weight regained after the ketogenic diet?

Discontinuation of the diet should be done carefully to avoid the risk of rapid weight regain and a halt in weight loss.
In the short term, the weight loss obtained is maintained for at least 6 months. In later years, it has been shown that the total weight loss is 10% of the initial weight. With patients who have followed the ketogenic diet, I prefer, at the end of the eating plan, to switch slowly to the Zone diet so as not to incur an abrupt weight regain. This stabilizes the weight achieved and allows you to switch to a healthier, more balanced eating plan, such as the Zone diet.


The ketogenic diet should not be practiced for many months. It would be better to alternate short periods with a balanced diet containing no more than 40% carbohydrates, as in the Zone Diet.
The body, especially the nervous tissue, needs about 200 g of carbohydrates per day for a good psychophysical balance. For this reason, if you undertake this diet you may complain of tiredness, attention, and less concentration, especially in the first week.
In short, I can tell you that in this diet the only problem you will not have is the introduction of carbohydrates: in fact, you can not introduce them except low amounts of those with a low glycemic index, which are very few in any case.
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