Draft v1.0.0.a, 2013-12-28, a joint post by Zooko and Amber
How to try a keto diet
Many people have asked me and Zooko where to begin with a ketogenic diet, or how to troubleshoot a ketogenic diet that hasn't given all the benefits they were hoping for. On our science blog (The Ketogenic Diet for Health), we have talked a lot about why, but have not said much about how. This is our current advice, based on our reading of science literature, our personal experiences, those of our friends, and our reading of other people's stories.
Our recommendation is simple: eat nothing but meat for 30 days.
Disclaimer 1: Use at your own risk!
You are the only person responsible for any effects on your health that might result from taking actions like those described here. It is your job to pay attention to yourself and take care of yourself. We can't take any responsibility for the consequences, and we can't even give you advice about it through the Internet. Good luck!
Disclaimer 2: You are entering the “Citation Needed” zone.
On our science blog (The Ketogenic Diet for Health) — we strive to include detailed scientific references showing why we believe each claim that we make. See Apologia about our practice of careful citations. However, for this article, we've decided that we need to tell you what we believe, even though we haven't yet written down all the reasons why we believe it. It would take a book to catalogue those reasons (and we're working on writing that book!), but in the meantime we feel it necessary to tell you our straight opinion.
You should, of course, treat all such claims, by us as well as by anyone else, with skepticism, so we're not asking you to accept everything we write here as fact. We're asking only that you understand that this is where we're coming from and this is why we are making these recommendations.
Why 30 days?
Thirty days is long enough to get through the keto-adaptation phase (see below), and then to start experiencing the profound benefits of the keto diet. Thirty days is also short enough that you can commit to doing it and see the whole thing through, and then evaluate what you experienced.
Many people continue to experience further benefits as their body further adapts to the diet, even after the first 30 days. So do not think of the results of from your 30-day experiment as the whole story! But it should be enough to tell if you were heading in the right direction.
On the other hand, knowing that you are making only a short time-commitment can help you stay the course. You aren't giving up anything indefinitely.
"This aspect was critical for my own initial experimentation. I had been on a very low carb diet off-and-on (but mostly on) for many years before trying it, and even then it was an intimidating idea. Knowing that it was temporary made it possible for me to make important discoveries." — Amber
The strategy: temporary extremism
You're not going to practice moderation! You're going to practice extremism. (But only for a moderate amount of time.)
By practising a very simple and absolute form of the diet, you maximize the chance of success, and you maximize how much you can learn from the experience. There will be plenty of time after for exceptions and experimentation, to find the perfect fit for your life. But the first step to do that is to get the experience of being ketogenic. In our opinion, the most reliable way to get that experience is to follow the strict regime of eating only meat for 30 days.
It is certainly possible to eat ketogenically while including plants in your diet. It is even possible to formulate a vegan diet that is ketogenic. However, we think that not eating plants can help you avoid certain pitfalls in your 30-day experiment. Moreover, even if your current diet is already ketogenic, you may experience further benefits from the experiment of eating only meat.
(See also Wait — why eat only meat? for a follow-up on this point.)
Before you start
Choose a 30-day span on your calendar.
Look it over for “special occasions”—birthdays, holidays, special parties or dates, etc. You have to commit to attending these special occasions without partaking of the food there. (Except, of course, for any offerings there which are pure meat.) Of course, if there is a special occasion coming up, and you want to partake of the food there and then begin your 30-day experiment, that's fine, but in our experience there is always another special occasion coming up! Special occasions seem to come along every week or two. If that's the case for you, then you'll have to decide what's more important to you: partaking of the food at special occasions, or trying this 30-day health experiment.
Mark on your calendar the 30th day of your experiment.
That's the day of evaluation! On that day, you'll think over what changes you've observed in yourself during the course of your experiment, and you'll decide what to do next.
Mark on your calendar what effects you will be watching for. See What to look for for some suggestions.
Write down a note about your “baseline measurements”:
- your weight on a bathroom scale
- your girth, as shown by how tight are your tightest pants (see Things we're pretty sure of)
Prepare your space.
To the extent you can, rid your home of things you don't want to eat or put them away out of sight — whatever it is, you can always have it after the trial. Stock your kitchen with lots of choices that are part of your plan. Surprisingly often people have broken their commitment because they were hungry and didn't have what they needed.
Acquire a box of 30 (or more) test strips for measuring ketones in urine. These are available from on-line stores (e.g. this product from Amazon.com) or from your local pharmacy.
Use one of the test strips to measure ketones in your urine. If you are on a glycolytic (sugar-burning) diet, this measurement will show little or no ketones, like this:
Be ready for the keto-adaptation period.
This is a time period at the beginning of a keto diet in which some people feel tired, low in energy, and possibly even headachey or nauseated. This usually lasts between a day and a week, and it varies a lot among people. There are tips and tricks below for minimizing the duration and the discomfort of keto-adaptation. Once you get past it, everything gets easier. Cravings go away. So if you feel bad or have strong cravings and don't know how you could possibly last 30 days, understand that it should get better very soon.
What to eat
There are five simple rules.
Rule 1: Eat nothing but meat.
You can also optionally have eggs, and optionally a little high-fat dairy such as butter or heavy cream.
Prefer “pure” meats like beef, pork, chicken, fish, turkey, lamb, etc. over “processed” meats like sausage or cold cuts. Don't eat meat with high-carb additives in it, such as hot dogs which come with added sugar, or with added corn syrup (which is another word for sugar).
Be aware that some people do not fare as well with a lot of dairy in their diet, and so it is wiser to wait and add it after the initial trial.
Rule 2: Eat fatty meat.
Have some delicious, juicy steak; not dry, lean beef! Eat tender, juicy chicken thighs; not dry, low-fat chicken breasts. Try the hamburger made from 85% lean instead of the 93% lean ground beef. Juicy salmon is better than dry white fish, and so on.
Juicy meat with plenty of fat tastes better and is more satisfying and filling, but more importantly, you need healthy animal fat to maintain a good energy level and mood, regular bowels, and good maintenance of your brain, heart, and joints.
Rule 3: Eat plenty of it.
Do not limit your consumption of healthy, fatty, whole cuts of meat. Whenever you sit down to a meal, just eat until you are completely satisfied and you naturally lose interest in having any more. This is even more important if you are overweight and are trying to lose weight by following the ketogenic diet. In any case, this is one of the rules: eat to satiety, at every meal. If you are still hungry after a meal during this 30-day experiment, then you are doing it wrong.
Rule 4: Drink water.
If you regularly drink coffee, you don't need to quit for this experiment, but do not drink any sweet beverages, even if they are low in carbs. This means no diet soda drinks. Stick to water, and drink it in response to thirst.
Rule 5: Get plenty of salt.
Don't skimp on salt. Eat extra, even. As explained in our article on keto-adaptation, people in the initial stages of a keto diet need to eat extra salt. Don't worry about salt having a bad effect on your blood pressure; the widely touted idea that you should reduce salt intake in order to lower your blood pressure is controversial and may not even be true. In fact, if you have high blood pressure, this dietary experiment might actually lower it, even though you will be eating extra salt. If this is a concern for you, then measure your blood pressure before you start (another “baseline measurement”) and again afterward.
What to look for
Here are some effects you may notice. These are the kinds of things you should think back on, at the Day of Evaluation.
Things we're pretty sure of
These effects are very common among people who try a keto diet. They have been observed in multiple scientific experiments or clinical observations, or are widely reported in anecdotal reports of people's personal experiences.
You might not experience all of these benefits. You might not experience any of them! But if you don't experience any of them, then something is unusual. Maybe you're unwittingly getting some hidden carbohydrate in your diet, or maybe there is something unusual about your body so that it doesn't respond to ketosis like most bodies do.
ketones in your urine
You can test with cheap little test strips from your local pharmacy. Do it — it is cheap and simple to do. If the test strips don't show a purple color within seven days of beginning this experiment, then you may not actually be in ketosis.
no more cravings
People who have weight-control issues or eating disorders often report that they have intense cravings for carbohydrates. When your body switches over from glycolytic mode to ketogenic mode, the cravings suddenly and completely disappear. You still get hungry on a ketogenic diet, but it is a clean sensation of being ready to take in more fuel, not an addiction-like craving.
losing excess weight
Note that the first 5 lbs or so of weight loss is due to losing water. (People on a glycolytic diet need to carry around about 5 lbs of extra water just to hold their glycogen stores. Keto dieters don't need that.) But if you are overweight, then in addition to losing that first 5 lbs of water, you should also experience rapid loss of excess body fat, as your body starts burning stored body fat for energy.
better and more stable energy levels
When your body uses stored body fat for energy, then energy is abundant and steady. See keto-adaptation for a more detailed explanation.
losing excess body fat around the waistline
Your waistline is actually a better measure than your weight on a scale, because the scale tells you the combined weight of body fat, muscle, and water but the waistline tells you what you really want to know: am I starting to look better?
Also, excess body fat around the waistline or belly is an important warning sign of life-threatening problems such as heart disease, and is a more important warning sign than is overall body weight. See our article on metabolic syndrome for more information about that.
The easiest way to notice changes to your waistline is just to ask yourself “Are these pants looser then they used to be? Can I fit into these pants that I couldn't fit into at the start?”.
reduction in heartburn, bloating, gas, and other digestive ills
reduction or cessation of seizures (if you suffer from seizures / epilepsy)
improved mood, if you suffer from depression (or possibly even if you don't)
improved focus, and mental endurance
Things we're less sure of
We've heard a lot of anecdotal reports of beneficial effects from people who've tried this diet. There are plausible mechanisms which would explain these effects, or known correlations to the affected condition and excess insulin. However, we haven't yet read scientific studies demonstrating that these effects happen reliably, in most people. They may not turn out to be real, common effects. These include:
- elimination of snoring
- elimination of joint pain, arthritis, asthma, or other "autoimmune" conditions
- improvement of acne, and other skin conditions
- elimination of migraines
prevention and treatment of cancer
There is recent evidence suggesting that a keto diet might actually cure cancer in some people. This has not been proven to work in humans — several clinical trials are currently in progress to test how well it works in humans. In mouse experiments it has been amazingly successful, and there are several published reports of “case studies” in which human cancer patients underwent a keto diet and experienced a dramatic remission, and even in some cases permanent cure.
We intend to write more about this in the future, but if this is important to you, the first reference we would offer is the home page of Thomas Seyfried at Boston College. And yes, if you have cancer, then we strongly advise you to go on this all-meat diet immediately.
Don't make these mistakes!
Myths, misunderstandings and misplaced fears about a keto diet are common. Here are some of the mistakes we've most commonly seen.
Mistake 1: going low-fat
There is a long-standing myth that eating animal fat is bad for your health, so a lot of people who are trying a health experiment naturally assume that they should add in a low-fat component while they are at it. Nothing could be further from the truth! Limiting your intake of fat, or preferring lean, low-fat meat during a keto diet can lead to hunger, nausea, constipation, weakness, and can cause the failure of the 30-day trial. It is also, in our opinion, unhealthy in the long term. Do not try to go low-fat during your 30-day trial.
Mistake 2: limiting your calorie intake
A lot of people think that it is healthy to limit or control the total amount of food that they eat. This is an especially common concern among overweight people. Do not do this. Limiting your calorie intake makes it harder to succeed in your 30-day trial, and it is unhealthy. Also it doesn't work for long-term, healthy weight loss. If you're overweight, do this 30-day experiment, exactly as described here, with no limitation on total calorie intake, and see what happens.
Mistake 3: eating a “moderate” diet with a little bit of carbohydrate
“Moderation in all things.”, they say. Well, not in this experiment! Even a small amount of carbohydrate in your diet can delay or prevent the process of keto-adaptation and cause the failure of your 30-day trial. Even a small amount of carbohydrate intake can also stimulate hunger and cravings in many people. For the purpose of this experiment, limit your carbohydate intake as strictly as possible. See our article on keto-adaptation for more details about the physiology behind this effect.
Mistake 4: making exceptions
In the long term, you're going to make exceptions to whatever practices you follow. But making an exception during this trial can ruin the whole experiment, because it can reset your metabolism to the glycolytic (sugar-burning) state, which means you have to start over in the keto-adapation process before you can experience what a ketogenic diet is like. For your 30-day trial, make no exceptions.
Mistake 5: making sure you get fruits and vegetables
Some authors who advocate low carb diets emphasize plant foods. We suppose they are trying to dispel the image of low-carb as a fad diet that is effective for weight loss but inherently unhealthy, by appealing to the widespread belief that eating fruits and vegetables is important for health. The thing is, we've looked for evidence the eating fruits and vegetables is important for human health, and haven't found good evidence that it is true ¹, ²! Many fruits and vegetables come with carbohydrates which can put your body back into the glycolytic state and undo the whole experiment. In addition, some people may be adversely affected by some of the natural chemicals present in fruits and vegetables even when they are low-carb. There is also the possibility that eating plant matter could have a bad effect on humans through an interaction with the human gut microbiota, as we speculated in our recent blog post on germ-free mice.
In any case, you'll be fine without any fruits or vegetables for 30 days.
Q. Do I need to eat organ meats?
Q. Do I need to eat raw meat?
Q. Can I have sauces and spices?
A. Avoid any sauce with sugar, such as ketchup or commercial dressings. Salt is advised. Minimise spices — they confuse your palate, and many report that they eat more than hunger would dictate if their food is heavily spiced. Do not trust any sauce from a restaurant. Pour the drippings back on — that's the best sauce.
Q. Is bacon okay?
A. Yes. You can eat as much bacon as you like during this experiment.
Q. What about salamis and cheeses?
A. Better save those til after the initial 30-day experiment. Some people who are trying to lose excess body fat with diet report that eating a little cheese stops their fat loss even though the cheese has very little carbohydrate content. Also, many people have reported that cheese and processed meats are “gateway drugs” that seem to stimulate cravings for carbohydrates.
Q. How about coffee?
A. Yes, you can drink coffee. No sweetener of any kind! A little heavy cream in it is probably okay for most people, but may or may not be okay for you.
Q. Do I need to exercise?
A. No, you don't need to. You can if you want, and if you do so during the first few days, it might shorten the duration of the keto-adaptation period. But exercising isn't necessary to get the benefits of the all-meat diet experiment, so consider it optional. In fact, if you are very overweight, exercise can be dangerous, because of the added stress to your joints.
Q. If I'm doing intense exercise, do I need to eat carbs?
A. No, you can do intense physical exercise, even things like competitive running, and weight lifting while on a ketogenic diet. More and more people are doing that nowadays. The old idea that hard exercise requires eating carbohydrate turns out to be not exactly true. There are a lot of details that go into that, of course, which we don't go into here. The only exercise regimens we know of which may not be sustainable on a ketogenic diet are those that involve high intensity interval training on a daily basis.
Q. Is this diet unsafe or unhealthy?
A. No. There are many claims being made that a diet like this one can be bad for your health in various ways, but every such claim that we have investigated has turned out to be a myth. Please see our science blog (The Ketogenic Diet for Health), and in particular the Myths section of it, for why we say that.
Q. Any other miscellaneous tips?
- Join a discussion board (for example, this one of ours) and get ideas and encouragement from your fellow keto dieters.
- Cook with a barbecue grill.
- Cook with a crockpot.
What to do after
Now that you know what a ketogenic diet is like, you can stay on it indefinitely if that serves you well, or you can do different experiments to optimize your life.
If you are doing well on the strict version of this diet, and then you try changing your diet and you start faring worse, then by all means go back to doing what works! There is no reason why you can't stay on a pure all-meat diet indefinitely, or can't depart from it and then go back to it whenever you feel the need. It is a safe, healthy, and sustainable diet which you should treat as a tool that you can use anytime you need it.
Thank you to our intrepid “beta-testers” who tried out early variants of this “how to” and gave us feedback, and other reviewers. All remaining errors are, of course, still our fault. Responsibility for all decisions affecting your own health is, of course, still all yours.
- Olene Harris (Zooko's mom)
- Zachary Voase
- Sebastian Kuzminsky
- Jonathan Lange
- Pavel Pergamenshchik
- Sonya Trejo
- Rose Smith
- Ash Simmonds
We also thank Charles Washington, whose work collecting literature on the health benefits of carnivory and organising people to discuss their experiences in one place was a critical step in Amber's health journey.