Keto Diet 101

Natalie Stein
January 11, 2019

Complete with sample keto menus

Eating right is one of the best treatments there is for prediabetes and diabetes. The right prediabetic diet can help you lose weight, lower blood sugar, and prevent or delay type 2 diabetes, but which one is right for you? If low-carb is good, is very-low-carb better? What about a ketogenic, or “keto,” diet?

A keto diet puts your body into ketosis. This diet has been used for nearly a century to reduce seizures in people with epilepsy. Recently, it has gained attention for other possible benefits, including its potential to lower blood sugar and help in weight loss.

The keto diet is literally a fat-burning diet, since it puts your body into a metabolic state called ketosis. That means your body’s main fuel source switches from carbohydrates to fat. The goal can be to burn more fat for weight loss or to reduce the blood sugar swings caused by the foods you eat. The keto diet is very low in carbs, moderate in protein, and high in fat.

What is Ketosis?

Isn’t ketosis an emergency? Not necessarily. Ketosis as the result of a ketogenic diet is one thing. It is quite another thing – and yes, an emergency – if you have diabetic ketoacidosis, or DKA. With DKA, ketosis is not due to a low-carb diet. Instead, it happens when your body is not processing sugar properly and can only use fat for fuel. Without 

Why Follow a Keto Diet?

You might choose to follow a keto diet if you are hoping that it could help you lose weight or control your blood sugar. There is some evidence that a keto diet can help with weight loss, possibly by:

  • Reducing the number of calories you eat by limiting your food choices.

  • Reducing hunger because fat and protein are more satisfying than refined carbs.

  • Reducing carb and sugar cravings.

Still, many studies find no difference in weight loss when people follow a low-fat diet compared to a low-carb, ketogenic diet. 

You might also follow a keto diet to manage treat prediabetes or manage diabetes. A very low-carb diet may help lower blood sugar levels, glycated hemoglobin (A1C), and insulin resistance.[1] It could also reduce “bad” LDL cholesterol in the short term.

Still, a keto diet needs more research. We still do not know its long-term effects. It does not appear to lead to better weight loss than a low-fat diet over the course of a year or more, and questions remain about its safety for your heart, liver, kidneys, and bones. 

There are also concerns about eliminating certain foods for the long term. The following are high in nutrients, such as antioxidants, fiber, and potassium. They have been linked to a lower risk for diabetes and other chronic conditions.

  • Whole grains

  • Many kinds of fruit

  • Beans and other legumes

  • Sweet potatoes and other starchy vegetables

As always before starting any special diet, you should consult your doctor before starting a keto diet.

How Many Carbs on a Keto Diet?

You need to keep your carb consumption very low to stay in ketosis. A very low-carbohydrate ketogenic diet has about 20 to 50 grams of carbohydrates per day. [2] It might get about 5 percent of total calories from carbs. 

In comparison, a typical American diet might include 300 or more grams of carbs per day, with 45 to 65% of calories from carbs. A moderately low-carb diet (or “reduced-carb” diet) has about 130 to 300 grams of carbs, or 30 to 40% of calories from carbs. 

The rest of your calories come from protein and fat. A traditional keto diet has about 80% of calories from fat and 15% from protein. A high-protein keto diet gets about 60% of calories from fat and 35% from protein. Far more research is necessary, but it seems as though the higher-fat, traditional keto diet may be more effective.[3]

Keto, Atkins, and Paleo – Not the Same!

There is a lot of hype about Atkins, paleo, and keto diets. Maybe you have been trying to decide which one to follow. They all are reduced-carb diets with strict rules, but they have many differences, too.

Ketogenic Atkins Paleo
Stay in ketosis to lose weight and control blood sugar
Kick off weight loss in ketosis and increase carbs eventually
Eat like a caveman to prevent modern-day chronic diseases
Major rule
Stay in ketosis
Count net carbs
Avoid certain food groups
None – continue at 20 to 50 grams of carbs per day
Four stages, with progressively higher carb intake, from ketogenic to maintenance (100 or more grams of carbs)
None – continue to avoid forbidden food groups
Sugary, starchy foods, most fruits, unhealthy fats, alcohol
Processed sugary, starchy foods. Depends on stage.
Processed and fried food, potatoes, dairy, grains, legumes, refined oils and sugar

How to Follow a Keto Diet: What to Eat and Avoid

A keto diet is high in high-fat foods, moderate in high-protein foods, and very low in carbs.

Plenty of High-Fat Foods Some High-Protein Foods Some Non-Starchy Vegetables and Spices
Olive oil
Other plant-based oils
Nuts and nut butter
Peanuts and peanut butter
Seeds, such as pumpkin, sunflower, flax, and chia
Fish, such as salmon, tuna, halibut, trout, and anchovies
Chicken, turkey, lean beef
Cheese, such as blue, feta, swiss, cheddar, goat, mozzarella, and jack
Salad greens
Other leafy greens (e.g., kale)
Zucchini and yellow squash
Bell peppers
Broccoli and cauliflower
Herbs and spices

A keto diet prohibits high-carb foods, whether “healthy” or not. That is because having too many carbs will put your body out of ketosis.

High-Carb, Low-Nutrient Foods High-Carb, High-Nutrient Foods
  • Sugar-sweetened beverages
  • Sugar-sweetened foods, such as ice cream, cake, cookies, candy, jam, flavored yogurt and oatmeal, and tomato soup
  • Refined grains, such as white bread, pasta, crackers, and rice
  • Alcoholic beverages
  • Whole grains, such as oatmeal, brown rice, and whole-wheat bread
  • Sweet potatoes, carrots, beets, and other starchy or root vegetables
  • Fruit
  • Beans, lentils, and split peas

Box: making healthy choices. Good fats, good proteins

Sample Keto Menu

If you decide to try a keto diet or you want to see what you might eat if you followed one, these menus can give you a general idea.

Sample Day 1

Meal Foods
Ground turkey sauteed in olive oil with an egg and a handful of spinach
Cooked chicken breast, shredded cheddar cheese, and sliced almonds on a bed of mixed greens with balsamic vinaigrette
Baked salmon topped with an egg and served with oven-roasted broccoli with olive oil
Hard-boiled egg, string cheese (cheese stick), olives

Sample Day 2

Meal Foods
Feta cheese and spinach omelet with olives and thyme
Tuna casserole with mushrooms, cream soup, and cooked spaghetti squash instead of noodles, topped with cheddar cheese and chopped nuts
Keto fajita plate with chicken or beef cooked in olive oil with onions and bell peppers, served in lettuce leaf wraps instead of tortillas, plus avocado and salsa
Tomato and mozzarella slices with olive oil and basil, sunflower seeds

Prediabetic Diet Help

A keto diet may help control blood sugar and it could help you lose weight, but it may not be the healthiest choice for everyone. If you believe a keto diet may be right for you and your doctor agrees, your best option may be to plan to go keto for a while before adding back in those higher-carb superfoods from blueberries and pumpkin to oatmeal and lentils.

Lark DPP can help with your prediabetic diet in a personalized program to lose weight and control blood sugar. Along with setting weight loss goals and keeping track of your physical activity and diet, your Lark coach can offer insights such as instant feedback on your meal choices and motivational reminders to keep up the good work.


  1.  Boden G1, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005 Mar 15;142(6):403-11.
  2.  Franziska Spritzler. A Low-Carbohydrate, Whole-Foods Approach to Managing Diabetes and Prediabetes. Diabetes Spectrum Nov 2012, 25 (4) 238-243; DOI: 10.2337/diaspect.25.4.238
  3.  Mobbs CV1, Mastaitis J, Isoda F, Poplawski M. Treatment of diabetes and diabetic complications with a ketogenic diet. J Child Neurol. 2013 Aug;28(8):1009-14. doi: 10.1177/0883073813487596. https://www.ncbi.nlm.nih.gov/pubmed/23680948
Natalie Stein

Exercise, Fitness & Nutrition Expert | Assistant Professor of Public Health