Ketogenic diet, begun in the early 1900s as a therapeutic diet for epilepsy, has now become a popular option for weight and blood sugar management. The diet plan consists of very low intake of carbohydrates, but is accounted for by moderate intake of proteins and high consumption of fats. Like all diets, the safest way to follow through a ketogenic diet is to take some guidelines into consideration.

Below are five points of guidance for beginners on ketogenic diet:

1. Calculating Macros

The term ‘macros’ is a shortened term for the word ‘macronutrients.’ To reach nutritional ketosis through ketogenic diet, calories (measured in kcal) of each of the 3 macronutrients are suggested to be consumed in the following ratio: 55-60% fat : 30-35% protein : 5-10% carbohydrate. A simple math can calculate the ratio of macros. Simply, divide [calories consumed for each macronutrient] by [total calories], then multiply by 100%. An example calculation has been done based on an assumption of 1800-calorie diet plan:

• 600 kcal/1800 kcal protein x 100% = 33.33% protein
• 1050 kcal/1800 kcal fat x 100% = 58.33% fat
• 150 kcal/1800 kcal carbohydrate x 100% = 8.33% carbohydrate

*As a general rule, these are the conversion standards from grams to calories (kcal) for each macronutrient:

• Carbohydrates: 4 kcal/gram
• Protein: 4 kcal/gram
• Fat: 9 kcal/gram

2. Counting Net Carbohydrates

There are two ways to count carbohydrate intake: total carbohydrates and net carbohydrates. Net carbohydrate is simply the remainder of [grams of total carbohydrate] minus [grams of dietary fiber and sugar alcohol]. The two components that are excluded from the calculation, fiber and sugar alcohol, are not readily digested in the body into glucose, having negligible or minimal effect on blood sugar levels. Those pursuing the ketogenic diet simply for weight loss or blood sugar control may count net carbohydrates rather than total carbohydrates, given that they stay within the range of <20-50g carbohydrates/day.

3. Considering Electrolyte Balance

In the initial stages, ketogenic dieters are frequently met with unpleasant symptoms, collectively known as keto flu. Many of these symptoms are thought to be related to electrolyte imbalance and dehydration in the body. One of the explanations for this is decrease in blood sugar leading to lower insulin levels. Lower insulin levels are known to be associated with a diuretic effect that excretes water, potassium, and sodium through urine. Ketogenic dieters, therefore, are advised to stay hydrated and to replenish minerals, such as sodium, potassium, and magnesium, through diet or supplements.

4. Choosing Healthy Fats

There are concerns of long-term safety of a high-fat ketogenic diet. Indeed, not all ketogenic diets are the same. Ketogenic dieters are encouraged to be mindful of choosing ingredients higher in healthier forms of fat, such as monounsaturated and polyunsaturated fats (ex. omega-3 fatty acids), and lower in unhealthier forms like saturated or trans fatty acids. Common sources of unsaturated fats include various kinds of seeds and nuts, oils from plants (olive, canola, flaxseed, etc.), avocado, fatty fish, and shellfish. A study done in 2004 showed that a polyunsaturated fat-enriched ketogenic diet was efficient in reaching ketosis with better metabolic profiles, such as lower total and LDL cholesterol levels and higher serum beta-hydroxybutyrate (BHB) levels, compared to a saturated fatty acid-enriched ketogenic diet.

5. A Word on Artificial Sweeteners

While it is true that many artificial sweeteners offer low to zero calories and glycemic index compared to sugar and natural sweeteners, there are controversies surrounding their use. One of the leading concerns is related to their impact on gut health. Proportion of gut microbiota composition is essential to one’s well-being, especially in the context of metabolism and immunity. A change in the population or diversity of microbiota may, for example, lead to glucose intolerance. Among rodent studies, the most controversial artificial sweeteners included sucralose, aspartame, and saccharin. Further studies on human trials are needed to elucidate the impacts of different artificial sweeteners on the human gut microbiome and their corresponding effect on sugar and weight control. Nonetheless, many professionals agree that not all artificial sweeteners are the same. Even so, dieters are advised to use all artificial sweeteners in moderation and to gradually reduce their dependence on sweet flavors.