What to Expect on a Keto Diet

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Ketogenic or keto meal plans have been used by medical professionals for nearly 100 years to manage certain medical conditions. But more recently, the high-fat, low-carbohydrate eating style has become popular among athletes, fitness enthusiasts, and people looking to lose weight.

If you decide to go on a keto diet, you can expect to make substantial changes to your eating style. This diet eliminates or severely restricts many foods that you are probably used to eating.

What to Eat

A ketogenic diet, or keto diet, is a very low carbohydrate eating plan that forces the body to use fat rather than glucose as a primary energy source. When you follow the plan, you build meals around fatty foods and significantly restrict your intake of carbohydrates and protein.

As a result of that macronutrient balance, acids called ketones are produced in the body. When ketone levels are high enough, you are in a state of ketosis. Getting your body into (and staying in) a state of ketosis is the goal of a keto diet.

While no specific foods are off limits, you'll have a hard time including many common foods in your meal plan when you are trying to reach the macronutrient balance required to maintain ketosis.

Compliant Foods

  • Full fat dairy

  • Poultry

  • Fatty fish and shellfish

  • Low-carb vegetables

  • Plant-based oils

  • Olives, nuts, and seeds

  • Avocado, butter, peanut butter

Non-Compliant Foods

  • Most fruit

  • Starchy or high fiber vegetables

  • Grains and grain products such as bread, pasta, or baked goods

  • Beans and lentils

  • Whole grains (like quinoa, farro, bran) and rice

  • Sugary beverages and most alcohol

  • Candy or sweet desserts

Compliant Foods

Full Fat Dairy

Dairy products such as eggs, most cheese, butter, and heavy cream are used for cooking and in recipes. Full fat cottage cheese, full fat plain yogurt, and whole milk are also commonly consumed.

Poultry

Chicken and turkey can be included in meals on the keto diet. Dark meat is preferred because it tends to be higher in fat. Also, dark meat (such as thighs and legs) is higher in myoglobin—an oxygen carrying protein.

Fatty Fish

You might also build meals around fatty fish. Varieties such as salmon or tuna are high in heart-healthy omega-3 fatty acids. Shellfish, shrimp, mussels, and scallops and shellfish are also protein sources that may be consumed on a keto diet.

Low-Carb Vegetables

While many vegetables are high in fiber and starch, some are low enough in carbs to be included in a keto meal plan. These include asparagus, kale, tomato, cucumber, eggplant, and spinach.

Plant-Based Oils

People following a keto diet use oils regularly to increase their fat intake. Coconut oil and other oils that contain medium-chain triglycerides (MCTs) are widely promoted. MCTs are quickly absorbed and are believed to help get the body into ketosis. Other plant-based oils include sesame oil, avocado oil, and olive oil.

Olives, Nuts, and Seeds

Snack foods can be tricky on a ketogenic diet. People following the plan generally consume nuts and seeds that contain a small amount of protein and healthy fat. Pumpkin seeds, almonds, chia seeds are commonly consumed, along with olives.

Avocado, Butter, and Peanut Butter

Those following a keto diet don't often use spreads because they don't consume bread or crackers. When spreads or toppings are consumed, butter and avocado are top choices. Peanut butter is also consumed, but only if it does not contain sugar or another sweetener.

Non-Compliant Foods

Most Fruit

Fruit is a source of both fiber and naturally-occurring sugar. Because fruit is high in carbohydrates, it is generally not consumed on a keto diet. However, some people can consume small amounts of berries (such as raspberries) and stay in ketosis.

Starchy or Fiber-Rich Vegetables

Vegetables including sweet potatoes, carrots, potatoes, onions, beets, and peas are generally avoided as they contain too much sugar and too many carbs.

Grains and Grain Products

Whole grains including quinoa, farro, and bran provide too much fiber and carbohydrate for the keto diet. Also, products made from grains including bread, pasta, or baked goods are not consumed. Rice, rice products and snack foods (chips, pretzels, crackers) are not recommended. These foods are usually lower in fiber, but high in starch (another form of carbohydrate).

Beans and Lentils

Beans, peas, lentils, peanuts, and other types of legumes are often consumed by those following a vegetarian or vegan diet because they are a rich source of protein. However, they are not advised on a ketogenic diet because they provide too much carbohydrate, primarily in the form of fiber.

Sugary Beverages and Most Alcohol

A common source of sugar in a typical American diet is sweetened beverages including sodas, sweetened teas, sports drinks, and juice. These drinks are not advised on the keto diet because they add carbohydrate without providing any valuable nutrients. Zero-calorie sweeteners are also not recommended because they can increase your cravings for sweets.

In general, alcohol is not advised. But some keto followers drink low-carb alcohol in moderation. For example, hard alcohol (including rum, vodka, gin, tequila, and whiskey) provides zero grams of carbohydrate. Wine generally contains about 3–4 grams of carb per serving. Most beer is high in carbs and is avoided.

Candy and Desserts

As you might imagine, candy and other sweet treats are not consumed on a keto diet. Most traditional desserts are high in fat but also very high in sugar. Even though artificial sweeteners are generally not recommended, some people following a keto diet make fat bombs and other treats using keto-specific baking products such as specially marked confectioners sugar and chocolate chips.

Recommended Timing

There is no specific timing that needs to be followed when you follow a ketogenic diet. Most people maintain a typical two- or three-meal-per day eating style. However, some people on the ketogenic diet practice intermittent fasting and either skip a meal during the day or only eat during certain windows of time during the day.

If you consume three meals per day, these meal plans will give you an idea of what eating a keto diet looks like. If you are considering the ketogenic diet, you can evaluate each day's meals and think about whether or not the foods look palatable and if the eating style seems manageable.

Keto Diet Meal Plan #1

The first sample keto diet plan comes from a full-time adventurer and elite athlete who uses the eating style to improve and maintain his sports performance. Patrick Sweeney also lectures on the ketogenic diet at conferences around the country and coaches others to adopt a life of adventure.

His sample meal plan is great for people who like to cook and experiment in the kitchen.

Keto Diet Day 1

  • Breakfast: Adventure coffee (a unique recipe that combines coffee with coconut oil, heavy cream, an egg, butter, and occasionally cocoa powder) alone, or add breakfast cheese blintzes. Mix a cup of cream cheese with three egg whites in a blender. Cook the blintzes like pancakes, then add cream cheese and smoked salmon, or fresh raspberries.
  • Mid-morning snack: Full-fat greek yogurt
  • Lunch: Green salad with either salmon, chicken, or grilled shrimp and cheese.
  • Afternoon snack: Apple with almond butter
  • Dinner: Grilled salmon, spinach, green beans, or cauliflower baked with shredded cheddar cheese.
  • Dessert: One square of dark ( >72 percent cacao) chocolate

Keto Diet Day 2

  • Breakfast: Adventure coffee alone or add volcano eggs. Whip two egg whites to standing, top with a piece of smoked salmon and a few spinach leaves. Grate cheddar cheese on top and indent the top with a spoon. Bake for 5 minutes at 350 then put the yoke in the indent and let it drizzle down the browned sides.
  • Mid-morning snack: Goat's milk yogurt with a handful of almonds
  • Lunch: Goat cheese salad with walnuts and bacon
  • Afternoon snack: Almonds
  • Dinner: Turkey chili with beans, onions, tomatoes, peppers, and grated cheddar cheese. Optional: add a fried egg on top. Eat with a side salad.

Keto Diet Day 3

  • Breakfast: Adventure coffee alone or with a nutrient dense omelet. Saute garlic, red and green peppers, cherry tomatoes and avocado in a pan. When they are lightly cooked, take them out, add olive oil and mix in two eggs for an omelet. Add your favorite cheese and fresh spinach.
  • Mid-morning snack: Apple with peanut butter
  • Lunch: Leftover chili from the previous night
  • Afternoon snack: Brie and a Wasa cracker (a very low carbohydrate cracker)
  • Dinner: Duck on the barbecue with grilled eggplant and zucchini

Macronutrient Balance

Sweeney does not stick to a specific macronutrient balance when he begins his own ketogenic diet plan. Instead, he maintains a diet that includes no more than 50 grams of carbohydrate per day.

When he goes over 0.6 on the ketone meter (a device used to measure blood for the presence of ketones) he goes up to 70 grams of carbohydrates and takes a ketone supplement. Ketone supplements are believed to help fat cells to break down more effectively, although the science to support their use is lacking.

Keto Diet Plan #2

This two-day keto meal plan comes from a registered dietitian who prescribes the diet for clients who are looking to reach a variety of health goals. Pegah Jalali, MS, RD, CDN, is an adjunct professor at New York University, works at the NYU Langone Comprehensive Epilepsy Center, and is a private practice dietitian at Middleberg Nutrition, a New York City health and wellness practice.

"I used to only treat children with epilepsy with the ketogenic diet," she says. "In the last year, I have had an increase in referrals for the ketogenic diet for clients ranging from weight loss, cancer, PCOS, diabetes, and dementia." Jalali adds that she does not believe in a one-diet-fits-all dietary approach.

"I do not think most of the general population would benefit from a ketogenic diet, although it can be very beneficial for some. The diet can be extremely challenging to stay compliant on long term so I find that clients who are very motivated and have a strong support system seem to be most successful."

—Pegah Jalali, MS, RD, CDN

Jalali's sample ketogenic meal plan includes a variety of foods but requires less cooking.

Keto Diet Day 1

  • Breakfast: Two eggs scrambled with two tablespoons of heavy cream, 1/2 cup of cooked spinach with one tablespoon of coconut oil. One cup of coffee with one tablespoon of butter and dash of cinnamon.
  • Mid-morning snack: Six macadamia nuts with six raspberries
  • Lunch: Tuna salad (tuna with mayo, plus salt and pepper) in romaine lettuce
  • Afternoon snack: One-half avocado sprinkled with flax seed meal
  • Dinner: Pecan crusted salmon with one-quarter cup of cauliflower creamed with two tablespoons of heavy cream

Keto Diet Day 2

  • Breakfast: Chia seed pudding made with full-fat coconut cream
  • Mid-morning snack: Pork rinds
  • Lunch: Flax seed crusted chicken tenders with one-half cup of roasted broccoli (add one to two tablespoons of butter)
  • Afternoon snack: Seaweed snacks
  • Dinner: Cauliflower crust pizza with mozzarella and bacon
  • Snack: Heavy whipped cream and four strawberries

Macronutrient Balance

Each person on the keto diet will have different macronutrient needs. Jalali says typically the diets are about 65–85 percent fat, 15–25 percent protein, and about 5 percent carbohydrates.

"Some of my patients/clients find it easier to keep track of the foods they consume over the day, others prefer to keep track per meal since it holds them more accountable," she says.

"I recommend designing the meal around the fat and protein sources since the carbohydrates are very limited. For example, if someone is having tuna for lunch, they may consider adding mayo to it."

Jalali says it's a common mistake for individuals to focus on reducing carbohydrates, without increasing their fat adequately, which makes it difficult to go into ketosis, especially if they are consuming too much protein. Some adults can be on a stable ketogenic diet consuming 50 net carbs whereas some may need to restrict to 15 net carbs, she explains.

Another common mistake that she sees is that people focus too much on macronutrients.

"Micronutrients are really important too as ketosis is metabolically demanding and the diet is not nutritionally adequate most of the time," she says. Most of her clients take multivitamins, carnitine supplements, calcium supplements, and sometimes selenium or zinc.

Resources and Tips

As part of her practice, Jalali offers the following advice to her clients who wish to follow a ketogenic diet.

Communicate With a Healthcare Provider

Jalali recommends that her clients work with a medical professional who is familiar with the diet to get the best results. She recommends having regular blood work done to avoid vitamin and nutrient deficiencies and imbalances which she says are typical. Working with a healthcare professional who is familiar with the diet can also help manage side effects which may cause a lot of people from dropping out of the diet.

Plan Ahead

Make plans for what you will eat when traveling and socializing. For example, if you are traveling, pack an avocado, can of tuna, and packets of mayo to make an emergency meal if you can not find any foods.

Also, ask ahead if you are invited to someone's house and see what they plan to serve. Ask if you can bring a keto-friendly side or dessert.

Learn to Cook

Learning how to cook can be helpful as well. There are many keto-friendly cookbooks that provide recipes for snacks, desserts, and satisfying keto-friendly meals.

Many low-carb recipes are keto-friendly, although you'll need to check the total carb count per serving to make sure that it fits within your personalized plan. The more delicious keto meals you can make, the more likely you are to stick to the program.

Try These Recipes

Contraindications and Concerns

There is scientific evidence that supports the use of a ketogenic diet to help manage certain neurologic conditions. There are also medical, nutrition, and fitness professionals that recommend the eating program for patients and clients who have other health goals.

But just because the program works for some, doesn't mean that it's the best diet for you. Certain people should take extra caution before going on a keto diet.

Heart Disease and Other Medical Conditions

According to medical researchers, the ketogenic diet is contraindicated in patients with pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency. 

Additionally, those with a heart condition or metabolic disorders should get advice from their healthcare team before starting this eating program. Weight loss from a keto diet may improve risk factors for these conditions, but research suggests that more studies are needed to better understand the effects of long-term use of a ketogenic diet on metabolic diseases and cardiovascular risk factors.

Diabetes

While a low-carb diet is often recommended for those with diabetes or pre-diabetes, the keto diet may affect medications if you are taking them. Experts advise that those taking diabetes medications speak to their healthcare provider to adjust dosing if necessary if they choose to follow the diet.

Pregnancy

There are conflicting studies about the impact of a ketogenic diet on women who are pregnant or wishing to become pregnant. While some research has suggested that a low-carbohydrate diet may improve hormonal balance to achieve pregnancy, other animal studies have suggested that following a ketogenic diet during pregnancy may have negative effects on the developing fetus.

A Word From Verywell

For most people, this eating style is a significant departure from the diet that they are comfortable eating. Most of us build meals around lean protein and carbohydrates, not fat. So before you decide to adopt the diet, it's smart to evaluate keto meals plans and think about whether or not you think you can stick to it for the long term.

For example, if you are an eater who loves to include plenty of fresh fruits and vegetables at every meal, you might not be able to maintain this eating style.

If you decide to try a ketogenic diet, talk to your health care provider or registered dietitian to see if there are modifications you should make to keep your health on track.

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Article Sources

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  2. Taylor MK, Swerdlow RH, Burns JM, Sullivan DK. An Experimental Ketogenic Diet for Alzheimer Disease Was Nutritionally Dense and Rich in Vegetables and Avocado. Curr Dev Nutr. 2019;3(4):nzz003. doi:10.1093/cdn/nzz003

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  4. Rallis S. Optimizing glycemic control in type 2 diabetic patients through the use of a low-carbohydrate, high-fat, ketogenic diet: a review of two patients in primary care. Diabetes Metab Syndr Obes. 2019;12:299-303. doi:10.2147/DMSO.S195994

Additional Reading

  • Kosinski, C., & Jornayvaz, F. R. (2017). Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. Nutrients9(5), 517. doi:10.3390/nu9050517

  • McGrice, M., & Porter, J. (2017). The Effect of Low Carbohydrate Diets on Fertility Hormones and Outcomes in Overweight and Obese Women: A Systematic Review. Nutrients9(3), 204. doi:10.3390/nu9030204

  • Stafstrom, C. E., & Rho, J. M. (2012). The ketogenic diet as a treatment paradigm for diverse neurological disorders. Frontiers in pharmacology3, 59. doi:10.3389/fphar.2012.00059

  • Sussman, D., Ellegood, J., & Henkelman, M. (2013). A gestational ketogenic diet alters maternal metabolic status as well as offspring physiological growth and brain structure in the neonatal mouse. BMC pregnancy and childbirth13, 198. doi:10.1186/1471-2393-13-198

  • Sussman, D., van Eede, M., Wong, M. D., Adamson, S. L., & Henkelman, M. (2013). Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC pregnancy and childbirth13, 109. doi:10.1186/1471-2393-13-109

  • Wajeed Masood,  Kalyan R. Uppaluri. Ketogenic Diet. StatPearls Publishing LLC. 2019