Weight Loss

Dr.Kim’s Ultimate Beginners Guide to Nutritional Ketosis for Weight Loss

By Kim Crawford, M.D. Last updated: September 6, 2018
beginners guide to nutritional ketosis for weight loss

So, you want to lose weight?

If you’re looking for the ultimate beginners guide to nutritional ketosis for weight loss, you’re in the right place. Perhaps, you’re a “dieting” veteran, but still, that doesn’t mean you are versed in how to get ketotic, stay ketotic, and know exactly what to eat and when to eat it. You are also likely unaware of how long you can safely “do” ketosis, how to prevent side effects, and so on. Don’t fret—I’ve done all of the heavy lifting for you. In this article, find out why “going ketotic” is good for your health and follow the guidelines to achieve ketosis.

Be careful you don’t drop weight you don’t plan on dropping if you have an illness you are helping by following this diet.

The new way to “do ketosis” is similar to the Atkins diet, which also boosts the body’s fat-burning abilities through eating only low-carb foods, and getting rid of foods high in carbs and sugar. Removing glucose and fructose from “carb foods” will allow the body to burn fat for energy instead of glucose. The major differences between the standard keto diet and the Atkins diet are the use of only healthy fats, less overall protein and no bacon or other processed or seared meat. (Never sear or burn your meat. High temperatures make for toxic fats. This topic is so long I’ll save it for another time).

The Standard Ketogenic Diet

There are several ketogenic diets “out there” for people with mitochondrial based disease, for athletes, and so on. However, for weight loss, we use the standard ketogenic diet. The guidelines are as follows: 70-80% healthy fats, 10-20% protein and 5% carbohydrates. I’ll later translate this into a menu of what you should be eating. Also, remember there is no set limit to fat intake because energy requirements vary from person to person.

This article will be followed by others focusing on the benefits for health which ketosis can confer. In fact, if you came here for the beginner’s guide to nutritional ketosis for weight loss, you might read subsequent articles and decide that you want to make intermittent ketosis part of your permanent lifestyle. Research over the past 3 years has proven that it’s a must for those with mitochondrial dysfunction. In fact, even mainstream doctors are suggesting ketotic diets for an entire host of patients including those with metabolic syndrome to chronic fatigue, to some types of cancer!

You might want to review a variety of weight loss solutions to implement along with your nutritional ketosis diet plan, as cravings might be rampant when you first get started (or when you do your weekly “carb flush”), and you might want to control inflammation as you lose weight, too. If you are following my anti-inflammatory diet plan, you will notice the foods are quite similar. However, the noticeable difference is a significant increase in your intake of healthy fats. The key to this eating plan is that you will not feel hungry. Let me explain why.

Using Ketosis to Suppress Appetite

Ketosis is one of the best natural appetite suppressants. If you are eating a typical high-carb American diet, you are experiencing blood sugar swings that cause you to have bouts of intense hunger sometimes within two hours of eating a meal!  When you start burning fat for fuel (ketosis) rather than using glucose for fuel (“regular eating”) your blood sugar will stabilize at a lower, healthier level and the ketones made by your liver will suppress your hunger via two major mechanisms.

Ghrelin and Leptin levels in Ketosis

Leptin gets a lot of publicity as being the “hunger hormone, ” but it’s really more of a “fat storage hormone.” Ketosis doesn’t suppress leptin when you first start this diet. At first, you might get hungry and have cravings. It’s not super common, but it’s possible. This is why I always like to have patients or clients amp up their dopamine levels with l-tyrosine and SAMe just in case. It helps with any energy loss initially too.

When it comes to the bulk of hunger pangs, we’re talking about ghrelin. Ghrelin increases appetite. When you eat a meal, ghrelin levels drop, but less so if you are overweight. When you lose weight, your body senses starvation and ghrelin levels increase, but they do not increase if you are in ketosis.

Ketones and CCK—the feel full hormone

CCK is a hormone released by your intestines after you eat. It seems to be a pretty intense regulator of food intake. In clinical studies, CCK injections make people stop eating. The normal decrease in CCK secretion with weight loss is circumvented when you eat a ketotic diet. So, another benefit of “going ketotic” to lose weight is that you shouldn’t experience those annoying plateaus that occur with regular diets.

Your metabolism in Ketosis:

You’ll be happy to learn that you don’t have to count calories. Eat until you are full and don’t snack. Ketosis is a natural metabolic booster, so don’t be afraid of the “fat calories.” You’ll convert the fat to brain-healthy ketones and use them for fuel, with the excess being excreted in your urine. If you still would like to add healthy metabolism boosting supplements, go ahead. Do watch you are not adding excess carbs which could throw off your ketosis. For more details on how ketosis helps weight loss, please refer to the article just linked when you’re done with this one.

Is this diet safe?

Ketosis is safe if you are a healthy adult. If you have Type 1 diabetes, check with your doctor. If you have any lower GI issues such as Chrohn’s or leaky gut, you need to be very careful of food choices and length of time in ketosis. I always advise patients with “gut issues” to take the right supplements to heal the gut, watch for flares and add a good fiber supplement to their morning reds/greens drink. During the first two weeks of your diet, it’s common to have some fatigue and brain fog.

Some people also develop dry eyes and sinuses. There is evidence that it might disrupt mucous production in the gut. I’ll give you my recommendations below. Meanwhile, if the level of ketosis is too much for you, then you’ll just adjust your level as I’ll instruct you to do further in the article.

Get rid of these foods:

Those of you reading this are coming from many different food worlds. Some of you are already trying to follow a healthy diet. Others may have been hoodwinked by commercial diet plans and are now eating a lot of processed (just like junk) foods from the diet plan. Still, others might be eating what they think are healthy foods such as whole grain bread.

Sadly, whole grain bread cranks up blood sugar more than eating sugar! Lastly, there may be some of you who are still eating a typical American diet filled with processed and fast foods, sugar, and starchy, processed carbohydrates. No matter what food world you are coming from, you need to clear your pantry and your life from a host of unhealthy and decidedly weight-gainer foods so you can lose the pounds once and for all. Please clean out the sugars, starches, packaged and processed foods from your pantry and freezer. You are going to eat whole, fresh, real food. Guess what? You will feel satisfied, and you’ll love it!

Other no-no’s that liken this diet to the Paleo diet include the elimination of most dairy products (high in the sugar galactose) and all grains. Recall you will only consume “healthy fats” so hydrogenated vegetable oils (cottonseed, canola, sunflower, etc.), peanut butter and soy products need to go. Don’t worry about the peanut butter because you can have healthy (raw, sprouted) cashew butter and some almond butter too. I get mine at WiseChoiceMarket.

The beginner’s guide to nutritional ketosis for weight loss (how-to’s):

  1. Throw out the bad foods and get psyched.
  2. Get a ketosis meter or urine strips that measure ketones. Check morning and evening: .5-3.0 mmol/l is the range you’ll want to be in. I’ll discuss where “you should be” when I discuss the keto flu in the next section.
  3. Get a scale and weigh yourself in the morning, before consuming anything.
  4. Make a grocery list, health food store list, and online purchase list for the products and foods you will need for success. Find out local sources of organic, non-GMO vegetables, grass fed meats, wild caught seafood, grass fed butter and pastured organic eggs. Source out good, guar gum and carrageenen-free coconut milk. Source out natural shredded coconut, and raw non-pasteurized nuts and nut butters. If you are going to get fancy and start baking, you will need to source out nut flours. You can get some of these things in health food stores including MCT oil and a delicious casein free butter called ghee. I love ghee. It adds a depth of buttery flavor to vegetables and even eggs.
  5. Secure your healthy fats and the one type of fat that will get you into ketosis faster than any fat, MCT oil. Coconut oil has a fair amount of medium chain triglycerides, but for best results, you’ll need some MCT oil.

For best results and overall health, you should not stay in ketosis more than 2 weeks in a row. Recall I discussed changes in GI mucous above. When GI mucous is disrupted, so is the microbiome, or gut bacterial protection. We don’t know the long-term ramifications of prolonged uninterrupted ketosis, but studies suggest possible leaky gut. In addition, studies show that one day of very low protein is likely a great health practice for the body to detox itself. Some people notice drying out of mucous membranes as well, and this isn’t good for prolonged periods, either. I do this diet intermittently for mitochondrial health and experience wicked dry eyes even at low ketotic levels. So if you experience dry eyes, it’s not “in your head.” Our eye drops do help during the day and a good thick eye gel at night allows you to awaken with refreshed eyes.

For all of these reasons, you will do the “ketosis thing” for 2 weeks, and then each week, you’ll pick a day when you’ll go very low-protein (less than 10 grams) and high-carb (up to 200-300 grams-but only with “allowed foods”). To follow, the next morning you’ll get back into ketosis with your MCT oil. If you are having trouble on this diet with weight training days, you can do a high carb day 2-3x per week and still lose weight. Obviously, the high-carb days would be the “lifting days.”

Will I Get the “Keto Flu”?

The ketogenic diet will change your metabolism by putting you into ketosis and turning you into someone who uses fat for fuel rather than sugar for fuel. You’ll notice some (hopefully) minor issues in the first two weeks. The following symptoms have been named the keto flu.

Keto flu symptoms can include having difficulty sleeping, feeling lethargic, getting constipated, being moody, losing sex drive, getting foggy-headed and having bad breath. Fortunately, these side effects don’t affect everyone and usually only last for 1-2 weeks. Symptoms will abate as your body adjusts to being in ketosis. Remedies include reducing your levels of ketosis and finding a balance of hunger control and symptom relief. Note that the ingestion of ketone pills makes keto flu worse.

Melatonin helps the sleep. Acetyl-l-carnitine helps preserve muscles and increases energy. Fiber and water help constipation. Lastly, “cold-shocks” (see mitochondria article referenced earlier) help brain fog and energy levels.

Specific foods

Healthy Fats:

Healthy fats include saturated fats such as grass-fed butter, ghee, the MCT-containing coconut oils and palm oils, and even things such as lard, chicken fat and duck fat. Monounsaturated fats such as olive oil and avocado oil are also quite healthy fats, but should not be used for cooking. MCT oil can be used for cooking and can be taken on a spoon or added to drinks. I put mine in my morning reds/greens drink. Omega-3 fatty acids are very healthy and should be supplemented if healthy seafood is not plentiful.

All fat should be used liberally except for omega-6 fatty acids found in animal products. You should consume more omega-3s than omega-6s. If you supplement with DHA/EPA omega-3 supplements, you don’t have to “watch everything” you eat regarding the 1:1 or ideally the 2:1 ratio of omega-6 to omega-3 fats. Introduce MCT oil slowly, or it will upset your stomach. Start with a daily teaspoon.Your goal is 2-3 TBSP of MCT in the mornings to help power you throughout the day. Some people only need 1 TBSP—That would be me, but I am running my ketones at about .35 and have minimal body fat. Don’t hate me. You will reach your goal soon enough! The average “fat goal” is up to 2-3 TBSP, 3x/day. You don’t need to worry about how much fat you are consuming other than to consume enough! Stop thinking about the calories, right now!


Animal proteins contain few carbs but can be used by the body to make glucose, so don’t over-do it on these foods. This particular diet isn’t “open bar” regarding meats as you might be used to if you have followed the Atkins diet in the past. However, with all the hunger-suppressing fats you will be consuming, you shouldn’t have to worry about the amount especially during the first two critical blast-off weeks of the diet.

High omega-3 fish include reliably sockeye salmon and sardines (in water) as the best choices. Beware of other fish unless you are sure it’s not farmed. Wild bass, mackerel, flounder, mahi-mahi, dolphin (no-not Flipper-the fish!), and anchovies are all healthy choices.

beginners guide to nutritional ketosis for weight lossAny and all meats which are grass fed, organic and certified to be such are acceptable.

Grass-fed organic meats are higher in omega-3s and just plain healthier for you.

Organ meats are technically permitted, but I’m not crazy about recommending part of the body such as a liver or a kidney because they are the toxin-filtering organs of the body.

Cage-free “pastured” eggs are full of healthy cholesterol and consumption of these products is no longer restricted. Poultry is the “least reliable organic” meat, but everything from chicken to quail, duck, goose, pheasant, and turkey is permitted.

I allow all nuts other than peanuts. The reason other keto diets restrict nuts and seeds is due to the amount of protein people eat when they consume nuts. However, you are all adults and can budget for the protein of walnuts, pecans, macadamia nuts, hazelnuts and even high-protein almonds. Coconut can be consumed liberally and is encouraged.

Yes, I did say that dairy was a no-go, but you can budget a little bit of raw cheese and yogurt into your diet after the first 2 weeks.

Non-Starchy and Starchy Vegetables:

During your first two weeks, you want to limit your veggie consumption to the very low carb group with some of the low carb group carefully included. After week 2, add in the moderate and high-moderate carb groups of foods and use the high carb veggies for your high carb day(s).

Very low carb: Fresh herbs—close to 0 grams net carbs per 1-2 tablespoons. All leafy greens such as romaine lettuce, endive, escarole, radicchio, spinach, collards, turnip greens, chicory, fennel, chard, and kale are most of the veggies in this group.

Low carb: Cucumber, zucchini, leeks, and chives, as well as onions and (my fave) scallions, make up this flavorful group.

Moderate carb: Healthy and tasty cruciferous vegetables such as cabbage, cauliflower, broccoli and brussels sprouts.

High-moderate carb: Asparagus, bell peppers, radishes, jicama, green beans, wax beans, water chestnuts, bean sprouts, bamboo shoots and wax beans. Eggplant, bell peppers and tomatoes are at the high end of the carbs and sometimes questioned as to their consumption during ketosis as “nightshade vegetables.” (Those with leaky gut should not consume nightshade vegetables and so this question is “out there” as to whether or not they should be consumed in ketosis. I choose not to, personally).

High carb: All types of squashes, sweet potatoes, carrots, turnips, beets, parsnips, and rutabagas.


You can consume berries and citrus in small amounts, starting after the first two weeks. You should know by now to exclude fruit juices if you have been following this blog. If not, now you know! Let me do a big shout out to the fruit many people think of as a vegetable, the avocado. It has up to 8 grams of carbs per whole avocado. Try to work this in as much as you can as it is one of the healthiest foods you can eat.


Spices and herbs, apple cider vinegar, hot sauce (with no additives or sweeteners), unsweetened mustards, homemade mayonnaise (egg yolks, lemon juice, apple cider vinegar, extra virgin olive oil) and homemade salad dressings. Check out Dave Asprey’s book for some great recipes on everything including a fabulous salad dressing which uses slightly cooked blended carrots, fresh ginger, apple cider vinegar, EVOO (extra virgin olive oil) and is amazing. He also has some delicious desserts including a great pumpkin pie and a crazy-good chocolate mousse. Sweeteners considered safe include stevia. I’ll begrudgingly include xylitol (toxic for dogs! pick up your gum!) and erythritol.


Of course, you can drink water and unflavored sparkling water. I find that lemon wedges save me when it comes to consuming enough water. Coffee doesn’t need to be black and unsweetened or filled with “bulletproof” butter and MCT oil. I love my morning coffee, and I cannot stand oil in my coffee, no matter how good it might be to get me into ketosis or whatever.

However, if you want to try putting grass-fed butter and MCT oil in your coffee, go right ahead. Just heat your blender and blend this concoction. Power to you if you like it. I just don’t like it and can only “go so far” when it comes to healthy practices. For me, my morning cup of coffee is just plain sacrosanct. You can have coffee with stevia and either coconut creme or a blend of coconut creme and almond milk which I get via Thrive Market. You just need to account for the carbs. Drink all the organic (not teabag) tea you want, but the same rules apply. You’ll be happy to note that on my diet you can have dry wine, champagne or clear alcohol such as vodka in moderate amounts. As always, you need to account for the carbs.

How to calculate how much protein you need per day:

You’ll need to keep re-calculating as your fat mass goes down and lean mass goes up. You can calculate this by figuring out your lean body mass. If you don’t have access to calipers or other body fat measuring scales, do an estimate. If you are unable to take a “real” body fat measurement use this calculator and then just experiment with amounts of protein, carbohydrate, and fat which can keep you in ketosis. It isn’t hard at all. Stick to the right foods and eat enough fat, for the most part.

The Formula

Do you have your % of bodyfat? Your % of lean body mass is 100 – your % of body fat. Figure out what you weigh in kilograms by dividing your weight in pounds by 2.2. Take that number and multiply it by the % of lean body mass you have. That gives you the amount of lean body kilos you weigh in with and tells us how much protein you need. You need a gram of protein per kilo of lean body mass.

An example is a 120 lb woman with 30% body fat, meaning by definition, 70% lean body mass. 70% of 120 is 84. 84 divided by 2.2 is 38. She only needs 38 grams of protein per day. This might be shocking as you are probably familiar with much higher quantities of protein in low-carbohydrate diets, right? Well, if you eat too much protein, it will convert to glucose. As a result, it will kick you out of ketosis.

So, watch the protein. It adds up really quickly. An almond has a gram of protein! One egg has 6.3 grams. A piece of meat or fish the size of a deck of cards (4 ounces) has 20-25 grams. Be careful not to load up your protein into one meal, either. Your liver will kick you out of ketosis with more than around 20-25 grams of protein at one sitting. All of this is obviously individualized. Everyone is unique. Figure out what you need and how much protein is in what you like to eat. Make a list if it helps.

How many carbs?

This is where you get to do some personal experimenting. Most people do the best eating somewhere between 20-50 (sometimes more) grams of net carbs daily. “Net carbs” means you can subtract fiber and sugar alcohols (like xylitol) out of your daily carb count, but now that I’ve told you that- you can forget it; eat what’s allowed. I know this flies in the face of advice to “weigh everything,” measure everything and count all grams of everything at all times. I have read that sort of advice, and it makes me fatigued just reading and imagining doing all of that. Doing this my way (which I’ll re-iterate at the end) just makes it all easier and more doable. Note that it is typical to lose a lot of water weight the first two weeks and experience thirst. Make sure to drink plenty of water during this time.

How much fat?

Let’s just say it’s going to be more fat than you have ever eaten if you are a chronic dieter. It will feel quite odd eating so much fat, and you’ll wonder “how can this be?” Well, let me assure you that the process of ketosis does indeed increase your metabolic rate and you can just get yourself into ketosis and stay there with fat at every meal.  Again, you want to eat what amounts to up to 2-3 TBPS of fat at every meal. Couple this with the fat in your meat, eggs and so on. I am not kidding.

What should your week and day look like?

Your week: Eat high fat, very low carb (<50g net carbs/day) 6 days a week, then have a carb re-feed on day 7 (150-250 grams of net carbs). Remember this day is your low-protein day to help your body detox. This is 5-10 grams of protein only and it “goes quickly!” If you have carb cravings on your re-feed days (it happens), have l-tyrosine and the SAMe handy to amp up your dopamine. If you can’t do the 6 and 1 as suggested for athletic (or just plain intolerance) reasons, do re-feeds as many as 2-3 days per week on your training days. Only restrict protein one day, though. These instructions assume you have done your first two weeks of ketosis where you eat controlled protein, high fat and very low and low carb veggies only.

Your ketotic day at a glance:

Breakfast: If you get yourself right into a high level of ketosis each morning, you’ll have more “brain energy” and absolutely no hunger all day. I suggest having a nutritional drink such as the AWS reds/greens mix, adding a scoop of collagen protein, and adding your MCT oil to this. Use this drink to take your morning supplements. Have your coffee as described above. After the first two weeks, if you want to add some eggs, that’s fine.

Lunch: Since this all “works better” and is healthier if you confine all eating to a 6-8 hour window, and you will not be hungry until 3-5 P.M. anyway, delay lunch until 3ish. Then have what will be a ton of low carb veggies with a 1/2 card deck size of meat protein. I’m just approximating here.

Dinner: How does dinner at 8 sound? After the first two weeks, we can really have fun with this meal. Have some olives or a deviled egg made with your special mayo. Enjoy a cocktail; no mixers, but just as listed above. Have a lovely salad with homemade dressing. If you are at a restaurant, then ask for EVOO and lemon. Give back the bread basket. Have tons of vegetables, drenched in ghee and seasoned well.

Make them creamy by taking 1/3 of whatever you made, put it into a blender, then blend it back into the veggies. Yes, you’re back home again. Now, go ahead and have some dessert. You can make “jello” by using flavored herbal tea, gelatin (WiseChoiseMarket) and stevia. You can make Dave’s pumpkin pie and shave a teensy bit of dark chocolate and top it with whipped coconut creme.

Indeed, have dessert every night! In my world, that makes this eating plan 100% doable. You won’t miss chips if you can have chocolate mousse and/or specially made ice cream every night, will you? You can shave 85% chocolate on top of your coconut whipped cream every single night if you budget correctly!

I didn’t list “it” as I don’t want to encourage dairy, but you certainly can budget for some real whipped cream, stevia-sweetened, once in a while too. Search the internet, look for “keto bombs,” find a good cookbook and go to town. You will enjoy losing weight, and I hope you read more about this eating style as a lifetime health plan. If you enjoyed this blog, I’d appreciate a comment.


  1. Useful information for lost weight!!! Thank you for sharing it

  2. A year ago, I was diagnosed with fibromyalgia. After years of going to see the doctor,and getting drugs and more drugs I finally got some answers from Dr. Kim. She figured out what the REAL root cause was-I had CIRS as do (I have learned) MOST pts with fibromyalgia. We detoxed gently (I did a consult with her) with my FIR and the great moorbaths. Doing the nutritional ketosis was super helpful to boost my mitochondria. She explained to me that the same ketosis plan for weight loss was crucial for my health. Indeed it was. If you have fibromyalgia I implore you to get a consultation with Dr Kim. It will change your life. Thank you Dr.Kim!!

    • I am so happy you are feeling better Anetta! Dr.Kim
      Keep the comments coming!!

  3. Couple of questions.. how do you keep a keto diet interesting so it’s sustainable long term? And what’s the best way to stay satisfied? Thanks

    • Hi Sreeraj! You haven’t tried a ketotic diet if you’re asking about staying satisfied! The high amount of fat leaves you in a better mood, having a sharper brain, and being super satisfied. You can do virtually anything with meats and veggies that you have never thought of. There are several great cookbooks out there and I’m certainly not a cook-recipes on keto shouldn’t be too complex. I love the Bulletproof cookbook and if you look online, you’ll see tons of stuff. I’m finding this way of eating a lot more interesting and satisfying than a “regular diet” that is healthy but includes grains. With all the mounting evidence that grains are brain-toxic I’m perfectly happy to eat this way forever. Try it! Best, Dr.Kim

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