Did our previous keto articles leave you with a thirst for more? You are not going to want to miss what we have for you today.
We are going to review the different types of therapeutic ketogenic diets. We’re also going to touch upon the net carbs versus total carbs debate.
Are you looking for a specific example of what a well-formulated one-day ketogenic diet plan entails? Perhaps you were wondering whether you should taper off of keto once you’ve reached your desired goal? We’ve got you covered.
This article is going to review general information on the ketogenic diet for weight management. The use of keto as medical nutrition therapy for epilepsy or another medical condition is beyond the scope of this article.
In epilepsy treatment, the primary goal is to maintain a state of nutritional ketosis to reduce or eliminate seizures. The target in weight management is to reduce body fat or maintain a healthy weight. Using fat as a primary fuel source is not the primary goal in weight management.
After reading this article, you’ll be better able to recognize an ideal ketogenic pattern. We’ll answer the following questions:
- What are the types of ketogenic diets that are part of conventional medical nutrition therapy?
- Why are there so many types of ketogenic diets?
- Should total carbs or net carbs be counted on a ketogenic diet?
- Is the keto diet appropriate for children and adolescents?
- What does a healthy meal plan for the ketogenic diet look like?
- Should you taper off of keto when you reach your goal?
What are the types of ketogenic diets that are part of conventional medical nutrition therapy?
Macronutrient grams in keto diets for epilepsy have traditionally been calculated based on the total number of calories that an individual requires in a day. The carbohydrate target will vary among individuals based on age, sex, body size, activity level, and other factors.
As mentioned in a previous article, the macronutrient targets used in ketogenic diets differ from the recommended ranges in the Dietary Guidelines. For the healthy adult population, aiming for 20-35% calories from fat, 45-65% calories from carbohydrates, and 10-35% calories from protein is the guideline. In comparison, here is the macro breakdown of some of the most common types of therapeutic ketogenic diets (from Practice Paper of the AND: Classic and Modified Ketogenic Diets for Treatment of Epilepsy):
- 4:1 Ketogenic Diet: 90% calories from fat, 2-4% calories from carbohydrate, 6-8% calories from protein
- 3:1 Ketogenic Diet: 85-90% calories from fat, 2-5% calories from carbohydrate, 8-12% calories from protein
- 2:1 Ketogenic Diet: 80-85% calories from fat, 5-10% calories from carbohydrate, 10-15% calories from protein
- Modified Atkins Diet (MAD): 60-65% calories from fat, 5-10% calories from carbohydrate, 25-35% calories from protein
- Low Glycemic Index Treatment (LGIT): 60-70% calories from fat, 20-30% calories from carbohydrate, 10-20% calories from protein
The diets above are listed in order from most restrictive (top of the list) to least restrictive (bottom of the list). The meal plan below fits the macronutrient profile of the Modified Atkins Diet protocol. However, the net carbs are slightly higher than what you would typically see with MAD.
For weight loss, you should not have to put much worry into the type of ketogenic diet you are following. Just stick to a diet that mostly consists of a balanced array of the foods listed in our Keto 101 article. A person utilizing this way of eating for weight management should not have to track their macronutrients.
Why are there so many types of ketogenic diets?
The most restrictive forms of the ketogenic diet (4:1, 3:1) have the highest ketogenic potential. Unfortunately, they may also be the most difficult to adhere to, since you must carefully measure all foods and beverages on a scale. These diets also typically require hospital admission and are not generally recommended as a tool for weight management.
Implementation of Modified Atkins and LGIT first took place in the early 2000s to help increase patient adherence to ketogenic diets. Protein is not restricted to these plans since targets fall within the Dietary Guidelines recommendations.
However, there is a concern that pushing protein too far above needs may negatively impact the individual’s ability to remain in ketosis. A target of 0.8-1.2 grams of protein per kilogram bodyweight in adults is how “needs” are defined here. The amount of protein a person can eat while still retaining the ability to remain in ketosis will ultimately vary by person.
Should total carbs or net carbs be counted on a ketogenic diet?
There is some controversy as to whether to pay attention to total carbohydrate or net carbohydrate intake while following a ketogenic diet. Net carbohydrates are equal to the total grams of carbs, minus the total grams of fiber. The essence of this debate is, should fiber count?
For epilepsy treatments, Modified Atkins aims for a net carbohydrate goal of 20 grams in adults. The LGIT limits daily carbohydrates to 40-60 grams from foods with a glycemic index below 50. But what about the individuals who are using this way of eating for weight management?
In the paper Position of the AND: Interventions for the Treatment of Overweight and Obesity in Adults, low-carbohydrate diets are described as containing 20-50 grams of carbohydrates per day. A recent consensus report put out by the ADA described very low-carbohydrate diets as having a goal of 20-50 grams of net carbohydrates per day “to induce nutritional ketosis.”
A third option that some dietitians have taken is to ask patients only to apply net carbs to whole and unprocessed foods. The foods that have undergone more processing use total carb counts.
There is an RDA for carbohydrates for healthy adults of 130 grams per day based on carbohydrate’s role as the primary fuel for the brain. However, the body’s metabolic processes can fill this requirement. Carbohydrate is not essential as a dietary component.
That does not mean you should skip the carbs entirely. Including adequate fiber in the diet (a type of carbohydrate) may promote satiety, the feeling of fullness between meals that may help with weight loss. The water in fiber-rich foods may also help with satiation.
Since including fiber-rich foods in the diet is likely optimal, the meal plan below will utilize net carb counts. Fiber is helpful not only for satiety but also for health benefits such as supporting healthier cholesterol levels.
Using net carbs in the meal plan also makes it easier to include a wider variety of foods. Having a more extensive range of foods to choose from will aid the keto dieter in covering all of their micronutrient needs.
Is the keto diet appropriate for children or adolescents?
Children or adolescents should only use keto while under medical supervision, and preferably as part of prescribed medical nutrition therapy. Unfortunately, there have been multiple cases where children have come into harm while on this diet, sometimes even while under medical care.
A few children have died due to heart complications secondary to selenium deficiency while on a ketogenic diet. There have also been published cases of scurvy, a severe vitamin C deficiency, in children using ketogenic diets (read case reports here and here).
Many children go through a stage of picky eating. Layering the restrictions of a ketogenic diet on top of the child’s self-imposed diet restrictions may create unnecessary risk.
What does a healthy meal plan for the ketogenic diet look like?
Just like well-formulated Paleo, a well-planned keto meal plan can meet your needs for all of the essential vitamins and minerals. It can also cover the essential amino acids and fatty acids, and provide plenty of non-essential but beneficial components. These health-promoting components include fiber, the various phytochemicals, and the omega-3 fatty acid DHA.
As mentioned previously, many different dietary patterns can help a person to reach their health goals. Below is a one-day meal plan which demonstrates an optimal keto diet for weight management.
This 1,700 calories keto-friendly meal plan was analyzed using NutriBase software. The general recommendation for weight loss is a target of 1,200-1,500 calories per day for adult women and 1,500-1,800 calories per day for adult men. Some individuals may need to sustain different ranges to meet their goals.
Keep in mind that the plan that follows may or may not provide adequate energy to meet your individual needs. It offers the following nutritional attributes:
- The macronutrient breakdown is 26% calories from protein, 9% calories from carbohydrate and 65% calories from fat. This macronutrient composition fits the Modified Atkins Diet plan.
- The plan provides 39 grams of net carbs, a level that would put many in nutritional ketosis if consistently followed.
- It offers at least 100% of the Dietary Reference Intake (DRI) for the following essential micronutrients: vitamin A, thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, folate, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K, calcium, magnesium, phosphorus, copper, manganese, selenium, and zinc.
- This meal plan contains 3,280 mg of potassium. This amount is above the current potassium DRI of 2,600 mg for adult females, but below the DRI of 3,400 mg for adult males. Males may wish to focus on including more potassium-rich foods in their diet plan.
- This meal plan contains 16 mg of iron. This amount is above the iron RDA for adult males of 8 mg, but below the iron RDA for females aged 50 and under 18 mg. Females under age 50 should consider adding more iron-rich foods to their meal plan.
Breakfast (4 grams net carbs)
- Two eggs scrambled in 1 T of olive oil with a ½ cup of cooked spinach, a ½ cup of diced mushrooms, and topped with 1 ounce of feta cheese
Lunch (11 grams net carbs)
- Salad made with 3 ounces of salmon (canned with the bones), 3 ounces of extra firm tofu (chopped), one small sliced red pepper, a ½ cup of avocado, and 1.5 cups of baby kale
- Dressing of 1 T of olive oil and 1 T of red wine vinegar
Afternoon Snack (15 grams net carbs)
- 1 cup of fresh raspberries
- 1 ounce of cashews
Dinner (3 grams net carbs)
- 3 ounces of braised pork sirloin, sliced
- 1 cup of spiralized zucchini, lightly sautéed in 0.5 T of olive oil
- 2 T of basil pesto (for topping pork and zucchini “noodles”)
Evening Snack (6 grams net carbs)
- 0.5 cup of plain Greek whole milk yogurt topped with 1 ounce of pumpkin seeds
As with Paleo, water is the optimal beverage to accompany your keto meals; skip the butter coffee. Adequate potassium can be a challenge to obtain with this way of eating if you do not make an effort to include potassium-rich foods in your meal plan. Also pay attention to your intake of other electrolytes, particularly sodium and magnesium, to ensure that you are consuming enough.
Should you taper off of keto when you reach your goal?
The ketogenic diet for epilepsy is typically implemented anywhere from 3-6 months to several years. After that, the patient tries adding more carbs to help determine the level at which they can still maintain seizure control.
If you have met your weight management goals with this way of eating, you could also try experimenting. Add back some of the healthier carbohydrate choices (e.g., fruit, starchy vegetables, milk, and possibly whole grains) if you wish.
Keep in mind that you may gain some water weight as you deplete your glycogen stores with an increase in carbohydrate intake. Weaning off the ketogenic diet gradually may give you more time to assess how this change is affecting your body. Making small changes may help you to determine the diet pattern that will best help you to maintain your weight.
Final Thoughts On Keto Diet Review
In closing, you can meet your micronutrient needs with a well-planned ketogenic diet. Consider getting support and input from your physician and a registered dietitian before making changes.
Since there is no ethical agenda attached to this diet, there is no need to adhere to it correctly if it is not working out for you. (If it is not your medical nutrition therapy, of course.) Feel free to tweak the diet as needed in a way that best helps you to meet your goals.
Summer is a registered dietitian located in Avon, Connecticut where she specializes in weight management, special diets, general nutrition, and avoidant/restrictive food intake disorder (ARFID). She is the developer and content creator behind the Summer Yule Nutrition website, where she shares evidence-based information on hot topics in food and nutrition.