The ketogenic diet is basically a low-carb diet. A low-carb, adequate protein, high-fat diet is applied. The body's calorie needs are directed to different sources. The aim here is to burn the ketone formed in the liver from the stored fat with high fat intake and to obtain calories. The need for glucose is met by the conversion of proteins. For this, it is enough to take some protein. Therefore, there is no need for sugar and carbohydrates.

Ketogenic Diet

The ketogenic diet is basically a low-carb diet. A low-carb, adequate protein, high-fat diet is applied. The body’s calorie needs are directed to different sources. The aim here is to burn the ketone formed in the liver from the stored fat with high fat intake and to obtain calories. The need for glucose is met by the conversion of proteins. For this, it is enough to take some protein. Therefore, there is no need for sugar and carbohydrates.

This diet is actually used to reduce the frequency of epileptic seizures in children. It is also known that it can be beneficial in some diseases such as Alzheimer’s, diabetes mellitus (to reduce insulin sensitivity). In fact, in the history of humanity, which started with hunting, nutrition was referred to with this diet. Since agricultural activities were limited, carbohydrate intake was also limited. Until recently, this diet was used indirectly, albeit in a limited way, due to the principle of eating the products in season. However, an increasing trend in recent years is the use of this nutrition model as a form of diet for weight loss.


Despite the growing number of supporters, it has been a concern by experts due to its high fat content. Although effective results can be obtained in the short term, it is not known what the consequences will be in the long term, and experts warn that there may be a potential for possible complications related to some diseases.

How does the ketogenic diet work? 

About half of the foods taken under normal conditions are carbohydrates. Carbohydrates are found in almost all foods except meat and fat-containing products, but are mainly taken with grains and grain products. If it is taken more than necessary and the energy consumption is not sufficient, it is stored as fat in the body and prepares for problems such as obesity, cardiovascular diseases, diabetes mellitus, high blood pressure, high cholesterol.

Carbohydrate is mainly taken as glycogen and starch. Digestion begins with salivary amylase in the mouth and ends with pancreatic amylase in the small intestine. At the end of digestion, glucose, galactose and fructose are released. Glucose is distributed throughout the body with cell membrane proteins, brain, blood cells, liver, kidney, skeleton, muscle cells, etc. Here, it is destroyed in the mitochondria parts of the cells and produces energy.

If there is not enough glycogen, the body first breaks down fats in the liver, and if this is insufficient, other body fats are produced, ketone products are produced and these are used for energy production.

Types of ketogenic diets: 

Ketogenic diet applications can be applied in different ways according to the characteristics of the person and the activity level. The type of application should be decided with the support of a dietitian. The dietitian calculates a ketogenic ratio (the ratio of fat, protein and carbohydrate in the diet) according to these characteristics and decides on the type of diet. Types of ketogenic diets currently practiced include:

  • Standard ketogenic diet: A nutrition program containing 75% fat, 20% protein and 5% carbohydrates is applied. It is the most applied and oldest type.
  • High protein ketogenic diet: A nutrition program consisting of 60% fat, 35% protein and 5% carbohydrates is created.
  • Cyclic ketogenic diet: A standard ketogenic diet is applied five days a week, and a high-carb diet program is applied for the remaining two days.
  • Targeted ketogenic diet: A standard ketogenic diet program is applied, but carbohydrates are added in training according to exercise programs. It is mostly used by athletes and bodybuilders. It is recommended to be applied under the supervision of an expert.

False hunger: 

It may not be correct to mean that you are always hungry when the urge to eat comes. Feeling hungry even though you have eaten recently may be due to different reasons. The right thing is to eat when you’re really hungry. It is necessary to be careful about the factors that make you feel hungry and encourage you to eat. Sometimes false hunger can push you to eat. In particular, the basis of snacks taken outside of the main meals lies in false hunger.



Possible factors affecting your urge to eat may include:

  • Social pressure: Being invited to eat in environments such as visits, meetings, meetings, insistence on food, Turkish delight served on sightseeing tours, etc.
  • Advertisements: Encouraging advertising of food, dessert, drinks in television, newspapers, and social media, such as advertising a delicious sausage at a barbecue late at night,
  • Insomnia: It can give a feeling of hunger due to the deterioration of the hormonal balance,
  • Thirst: Hunger and thirst are controlled by the hypothalamus in the brain. You may also feel hungry when you are dehydrated. When you drink a glass of water, your feeling of hunger will disappear.
  • Emotional pressure : Emotional reasons such as depression, panic attacks, fear, stress can cause you to feel hungry. On the other hand, fluctuations in blood glucose levels during these periods affect your hunger. When the blood glucose level decreases, you feel hungry and unhappy.
  • Difficult periods: Difficult periods of one’s life, such as exam periods for students, inspection periods for employees, job applications, preparation for a difficult conference, house cleaning days, can also increase the feeling of hunger.
  • Menstrual period: Especially in the premenstrual period, with the effect of the decrease in the estrogen hormone, a desire to eat sweets occurs in women.
  • Thinking about food: Sometimes thinking or seeing food will activate your hormones and reveal the desire to eat. Especially in attractive foods such as sweets, the hormonal balance will change more quickly.
  • Smelling food: Like seeing food, smelling food can also create a feeling of hunger. When you come back from work, the smell of a nice dry bean meal spread throughout the house will make you want to eat even if you are not hungry.
  • Emptying the stomach: When you empty your stomach for various reasons or on your own will and your stomach is used to being full, a feeling of hunger will emerge.
  • Travel: Refreshments given during the trips, even if you are not hungry, depending on your habits, sometimes the limitation of your access to food on the bus / train / plane journey may develop a desire to eat.
  • Habits: Drinking high-calorie drinks, desserts or coffee regularly with meals becomes a habit over time. Even if you are not hungry or eat a high-calorie meal, you may want to continue these habits.

Ketogenic diet principles: 

  • When you feel hungry, question whether you are really hungry or fake hunger. Do not respond to every feeling of hunger by eating.
  • Do not take any food other than the diet menu given to you. Consume foods by weighing them if necessary for full compliance with the diet menu.
  • Observe meal times, do not consume food other than this.
  • Drink plenty of water during the diet. During the use of ketone bodies as an energy source in the ketogenic diet, bad breath, change in urine odor and frequent urination are expected effects.
  • Ketogenic diets may require rearrangement of some of the medications you are currently using. In particular, medications related to high blood pressure may need to be reviewed. For this, it is useful to consult your doctor.
  • Natural sources of fat are recommended in the ketogenic diet. In addition to fresh village butter, coconut oil, avocado oil, fish oil etc. can be recommended. Consumption of these types of oil, which may not be suitable for your taste, may force you. Starting with the one that suits your taste and giving your body time to get used to it will be beneficial for the effectiveness and continuity of the diet.
  • In the initial phase of the ketogenic diet, returning to ketones will not be easy for the body, which has been using glucose from carbohydrates as the main energy source for many years. During this transition period, flu-like symptoms (ketone flu) may develop. It is a temporary situation.
  • The basis of the ketogenic diet is to reduce carbohydrates, not cut them completely. Reducing carbohydrates too much will restrict fiber intake and may cause constipation. To prevent this, it may be recommended to take green vegetables.
  • During pregnancy or in children, the ketogenic diet can sometimes lead to vitamin and mineral deficiencies. The needs of these periods should be taken into account when preparing ketogenic diet programs. The ketogenic diet may not be suitable for pregnant women and children.
  • Treatment plans of patients with diabetes mellitus need to be reviewed. The insulin requirement will also change, as the glucose taken previously, albeit in a controlled manner, is reduced thoroughly. This situation should be evaluated together with the follow-up physician.



Recommended foods on the ketogenic diet: 

According to the type of ketogenic diet, the nutrition program is planned by taking into account the carbohydrate, protein and fat ratios. Some suggestions for foods that can be consumed in the nutrition program are as follows:

  • Meat: Red meat, steak, meat products (ham, salami, bacon, sausage), chicken meat, turkey meat, fish (trout, mullet, herring, carp, anchovy, salmon, tuna, mackerel etc. oily fish),
  • Seasonings: Salt, spices (black pepper, paprika, thyme, etc.),
  • Egg: Especially large eggs,
  • Nuts and seeds: Almonds, walnuts, hazelnuts, seeds (sunflower seeds, pumpkin seeds), flax seeds, chia seeds,
  • Fruit and vegetables: Vegetables such as onions, peppers, tomatoes, limited amount of avocado,
  • Dairy products: Cheddar cheese, mozzarella cheese, feta cheese, cream cheese, tulum cheese, goat cheese, additive-free butter, sugar-free cream,
  • Fats: Extra virgin olive oil, coconut oil, avocado oil,
  • Snacks: Dark chocolate, boiled eggs, nuts, cheese, meat, nut butter.

Foods not recommended on the ketogenic diet: 

The products that are not recommended to be consumed in ketogenic diet programs are:

  • Condiments: Mayonnaise, ketchup, salad dressings, honey mustard,
  • Alcohol: Beer, wine, liquor etc. alcoholic beverages,
  • Sugary foods: Coke, soda with added sugar, fruit juice, tea or coffee with added sugar, ice cream, cake, sweets, chocolate, syrups, sweeteners,
  • Fruits and vegetables: Small fruits such as strawberries and all fruits except avocados, vegetables such as potatoes, carrots,
  • Legumes: Kidney beans, lentils, chickpeas, beans, peas,
  • Cereal products: Bulgur, pasta, wheat bread, rice.

Benefits of the ketogenic diet: 

  • It reduces the incidence of seizures in children with epileptic seizures,
  • It is claimed that it reduces the symptoms of Alzheimer’s disease and contributes positively to the development process of the disease.
  • When the recommended products are followed regularly, it seems possible to lose weight. Although it is difficult at first, it can be easier than other diets over time.
  • It reduces risk factors for some diseases (cardiovascular diseases, neurological diseases, metabolic diseases, etc.).
  • It is possible to keep the blood insulin level under control, thus reducing the need for insulin in diabetes. In this way, a positive contribution can be made to diseases such as Parkinson’s, polycystic ovary syndrome, acne vulgaris.
  • Few studies claim that this diet contributes to controlling high blood pressure.

More studies are needed to determine the benefits of the diet. Based on these claims, using it in the treatment of diseases and changing treatment plans may cause more serious problems. For this reason, such diets, especially if you have a chronic disease risk or a diagnosed disease, should be consulted with the specialist who follows them, and should be used under his recommendations and follow-up.

Possible side effects of the ketogenic diet: 

The ketogenic diet is not an all-natural, healthy diet. There is a possibility of developing some side effects. Sometimes, they may have risks such as exacerbating existing diseases, increasing their severity, disrupting the treatment plan or developing complications.

  • During the initial period of the diet, a keto flu picture may develop. It usually returns to normal within a week.
  • It increases the risk of developing kidney stones 50 times.
  • May cause growth retardation in children.
  • It is harmful for pregnant women and the fetus.
  • In long-term applications, there may be an increase in blood cholesterol levels and, accordingly, the risk of atherosclerosis.
  • Blood glucose level can be difficult to control. Treatment plans of diabetic patients may be disrupted and complications may develop.
  • Constipation, nausea, digestive problems may occur.
  • Fatigue, weakness, sleep problems may develop.
  • Exercise performance may decrease.
  • There may be odor in the urine and breath.
  • Liquid electrolyte balance may be disturbed, liquid electrolyte monitoring should be performed under expert control.
  • There is a risk of exacerbation of the disease and the development of complications in people with liver disease.
  • There may be a risk of osteoporosis.
  • It may be difficult to adjust the vitamin and mineral balance, and nutritional problems may occur. Vitamin and mineral supplements may be required.
  • Cardiac arrhythmias may develop in the long term.

Groups for which the ketogenic diet is not recommended: 

Although the ketogenic diet is beneficial for weight loss, it may be inconvenient for some groups in terms of nutritional requirements.



The groups that are not recommended to follow the ketogenic diet are:

  • Pregnant women: Pregnancy is a special period that requires balanced nutrition and the needs of the fetus are calculated. In this period, it is obvious that not only the ketone diet, but also other types of diets can cause problems in terms of pregnant and infant nutrition. During pregnancy, a nutrition program specific to the pregnant woman and pregnancy should be prepared under the control of a dietitian.
  • Children: Children in the developmental age, adolescents should be fed specific to the period they are in. Not getting the nutrients needed during these periods will bring along serious problems such as developmental delays and mental retardation. The diets applied during these periods should be carried out with the approval and support of a dietitian.
  • Heart diseases: Diets high in fat can be a risk for diseases that progress with occlusion in the arteries over time. In people who were previously at risk for cardiovascular diseases, such diets may aggravate the current situation and lead to the development of new complications.
  • Those with eating disorders: Eating disorders are important psychiatric problems in which the nutrients the body needs cannot be taken sufficiently. Individual nutrition programs and treatment plans should be created in eating disorders such as anorexia nervosa and bulimia nervosa.

Apart from these, there is a possibility of aggravating the existing disease of the ketogenic diet in diabetes mellitus disease, liver or kidney failure, those who are prone to kidney stone formation, hypertension and gastrointestinal diseases against the possibility of insulin resistance. In addition, in those with chronic diseases, the ketogenic diet may affect the effectiveness, dose and type of drugs used. All these issues should be evaluated by a dietitian together with relevant experts.

Ketogenic diet duration: 

The start and duration of the ketogenic diet is decided under expert control. The duration of the diet is determined according to your current diseases, the level of compliance with the diet, and the success of the diet. It usually does not exceed 24 months. However, there is a high risk of loss of gains in diet programs that are stopped for less than 3 months or interrupted for 3 months.

 


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