The keto diet changes the way your body converts food into energy. Eating a lot of fat and very few carbs puts you in ketosis, a metabolic state where your body burns fat instead of carbs for fuel. When your body is unable to get glucose from carbs, your liver converts fatty acids from your diet into ketones, an alternative source of energy. Burning ketones in place of glucose reduces inflammation and spurs weight loss.[1]
A love/hate relationship with weight loss emerged in 2018. The most recent Centers for Disease Control survey found that almost 50 percent of Americans tried to lose weight in the past year—a time when anti-diet sentiment was just as strong. As you can see from popular search terms, we’re clearly not ready to ditch dieting just yet, and that’s okay. Though the word “diet” puts some people off, reaching a healthier weight to feel better, manage your health with fewer medications, or to experience more energy, better sleep, and more confidence are worthwhile goals to pursue. Clearly, I discourage restrictive eating, but if you want to follow a plan that’s more inclusive than exclusive, includes generous servings of veggies, and helps you develop a framework for establishing sustainable, healthier eating habits that also encourages weight loss, I’m not going to knock it.
The Mayo Clinic Diet provides practical and realistic ideas for including more physical activity and exercise throughout your day — as well as finding a plan that works for you. The diet recommends getting at least 30 minutes of exercise every day and even more exercise for further health benefits and weight loss. The diet also emphasizes moving more throughout the day, such as taking the stairs instead of an elevator.
Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and kidney stones.[18] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[38] About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[39] The stones are treatable and do not justify discontinuation of the diet.[39] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in one-seventh of the incidence of kidney stones.[40] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[39]

Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
If you eat fewer calories than you burn, you'll lose weight. But when you're hungry all the time, eating fewer calories can be a challenge. "Studies show people who eat 4-5 meals or snacks per day are better able to control their appetite and weight," says obesity researcher Rebecca Reeves, DrPH, RD. She recommends dividing your daily calories into smaller meals or snacks and enjoying most of them earlier in the day -- dinner should be the last time you eat.
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