A Practical Guide to the Ketogenic Diet, Why Formulation Matters, and How a Nutrient-Dense Approach Can Unlock Its Full Therapeutic Potential.
As research continues to uncover the therapeutic potential of ketogenic diets across metabolic, inflammatory, and neurological conditions[*][*][*], the focus increasingly shifts to how these diets are implemented. Keto isn’t just one “diet.” It’s not just about reducing carbohydrates at the expense of nutrient density or food quality; it’s about creating a sustainable, nutrient-rich approach that supports long-term health. A well-formulated ketogenic diet (WFKD) can make all the difference, turning the promise of improved outcomes into a lasting reality.
A WFKD is designed to sustain nutritional ketosis while providing nutrients to support long-term health. While often confused with low-carb or high-fat diets, a WFKD is structured to maintain metabolic balance, as opposed to solely focusing on macronutrients.
Dr. Jeff Volek, Professor in the Department of Human Sciences at The Ohio State University and a renowned expert in ketogenic research, shares that a WFKD should focus on food quality and metabolic outcomes more so than simply tracking macronutrient intake.
With that said, in his clinical work, Dr. Volek has found the following guidelines to be effective in achieving a ketogenic state resulting in blood ketones (β-hydroxybutyrate) above 0.5 mM[*]:
- Carbohydrates: <50 grams per day
- Protein: ~1.5 g/kg of reference body weight
- Fat: Remaining calories, with an emphasis on whole-food sources of saturated and monounsaturated fats
Encouraged Foods
In addition to achieving a ketogenic state, a WFKD puts a strong emphasis on high-quality foods that nourish your body and support overall well-being. This includes:
- Proteins: Beef, chicken, pork, lamb, fish (esp. salmon and sardines), eggs
- Fats: Olive oil, avocado oil, coconut oil, butter, cream, cheese
- Produce: Non-starchy vegetables, low-glycemic fruits like berries, tomatoes, olives, citrus
- Others: Nuts, seeds
During the early stages of ketogenic adaptation, when the body transitions from using glucose to ketones as its primary fuel source, many people experience a significant loss of electrolytes, particularly sodium. This occurs due to the natriuretic effect, a natural process in which the body excretes more sodium as insulin levels decrease. To counter this loss and support overall well-being, it is important to replenish electrolytes through supplements and foods rich in sodium, calcium, and magnesium[*].
Differences Between a WFKD and Keto and Low-Carb Diets
There are several different forms of low-carb diets out there, and many of them can help you achieve a ketogenic state. A common misconception, however, is that all low-carb or ketogenic diets are the same.
First, let’s look at the difference between “low-carb” and “ketogenic.”
While a ketogenic diet is always going to be low in carbohydrates, restricting carbohydrates alone won’t necessarily put you into a ketogenic state. To achieve ketosis, your glucose intake and stores must be low enough to trigger a metabolic switch. If your low-carb diet contains too much protein or simply isn’t low enough in carbohydrates, your body may continue to produce enough glucose to trigger a significant insulin response, and you’ll miss that ketogenic window.
For a low-carbohydrate diet to provide therapeutic value in chronic disease and insulin resistance, reaching a ketogenic state is often crucial.
Another key difference between a WFKD and other low-carb or keto diets is food quality. Due to the rising popularity of keto and low-carb diets, there has been a surge of processed foods that are low in carbohydrates but high in additives. Will these foods help you cut carbs? Yes. But are they formulated for optimal metabolic health? Typically not.
Therefore, in addition to ensuring that your diet will help you get into a ketogenic state, a WFKD will also focus on whole, nutrient-dense foods while limiting processed ones.
The good news is that a well-formulated ketogenic diet can work regardless of your dietary preferences. As long as you follow the guidelines below, you can achieve a therapeutic ketogenic state, whether you’re vegan, vegetarian, carnivore, and so on.
Core Elements of a WFKD
According to Dr. Jeff Volek, the following elements are central to achieving and maintaining a well-formulated ketogenic diet for therapeutic purposes.
1. Sustains Nutritional Ketosis
Sustaining nutritional ketosis is the primary goal of any WFKD. What this looks like on an individual basis can vary greatly depending on your food preferences, your current metabolic condition, and how well you tolerate carbohydrates.
While carbohydrate sensitivity can vary, most people find that keeping carbohydrates below 70 grams per day is necessary to achieve ketosis. In rare cases, you may be able to consume as much as 100 grams per day; however, starting with a goal of 50 grams is recommended, and as low as 30 grams for those who are insulin-resistant.
Enjoying the food you eat is critical to long-term success, so it’s essential to consider taste and dietary preferences.
2. Supports Lean Body Mass and Performance
Due to the potential gluconeogenic effect of protein, a WFKD keeps dietary protein in moderation. However, it’s also crucial that you provide your body with enough protein to support healthy levels of lean body mass. For most people, this translates to 1.2 to 2.0 grams of protein per kilogram of body weight[*][*].
Understanding how to check your ketone levels and determining whether your current protein intake is sufficient to maintain ketosis is key. Everyone’s body is different, so a WFKD will help you hit that sweet spot of muscle maintenance while sustaining ketosis.
3. Manages Electrolytes and Hydration
Adequate sodium, potassium, and magnesium intake is an essential aspect of a WFKD due to the natural loss of electrolytes that can occur, particularly when transitioning into ketosis. These electrolytes play crucial roles in circulation, adrenal health, and neuromuscular function, making them essential for combating common “keto flu” symptoms like fatigue, cramps, and dizziness.
Due to accelerated renal sodium excretion, the requirement for daily sodium intake is often increased to 4 to 5 grams per day on the ketogenic diet. That said, individuals taking medications for hypertension or heart disease should work closely with a healthcare professional to determine their electrolyte needs.
4. Fat Provides the Majority of Energy
During all phases of a ketogenic diet, fat serves as the central source of fuel. Primarily focusing on healthy fats, such as those from avocados, nuts, seeds, and animal sources, will provide a mix of monounsaturated and saturated fats. Omega-6 fats can come naturally from plant and animal sources instead of omega-6-rich oils like vegetable oils.
As glycemic control improves over time, you may be able to add slightly more carbohydrates while maintaining a ketogenic state; however, protein intake will remain relatively stable throughout.
5. Calorie Counting is Not Required
By focusing on satiety and hormonal regulation, a WFKD naturally supports appetite control without requiring strict calorie tracking. For people accustomed to low-fat dieting, this may feel new and can be a bit disorienting, particularly if they’re not familiar with listening to their body’s satiety signals. Working with a healthcare professional can help you distinguish between feeling “full” and feeling “satisfied,” which will help prevent the overeating patterns often associated with low-fat diets.
6. Whole Foods-Based Approach
While there are plenty of processed food options that can keep you in a ketogenic state, a WFKD will focus primarily on whole, real foods as opposed to highly processed ones. These include high-quality proteins like meat, dairy, and eggs, healthy fats from nuts and high-quality dairy sources, and non-starchy vegetables.
A whole-food approach ensures that your body receives the variety of micronutrients it needs for optimal health. Maintaining a ketogenic state alone, without nourishing your body with the essential nutrients it requires, will not produce the long-term results that are available with a high-quality ketogenic diet.
7. Avoids Short-Term Very Low-Calorie Diets
Extreme calorie restriction, defined as consuming fewer than 1,000 calories a day, may promise quick results but often compromises long-term health. These diets often lack essential nutrients, leaving the body undernourished and fatigued. In contrast, a well-formulated ketogenic diet ensures adequate calorie intake to support metabolic health, preserve muscle mass, and promote sustainability.
8. Requires A Maintenance Phase That Can Be Followed For Years
If your ketogenic diet is intended to treat or manage a chronic health condition, it should include a maintenance phase that can be easily followed for years to come. Moving in and out of a ketogenic state is unlikely to produce optimal long-term results, particularly in those with metabolic conditions like insulin resistance. Therefore, sustainability is key.
When considering a sustainable diet, satiety is crucial for assisting with adherence. Calorie restriction, severe dieting, and other drastic approaches often lead to constant hunger and cravings, which ultimately hinder the diet’s success.
9. Requires Medical Supervision for Chronic Conditions
While the ketogenic diet is a safe and effective strategy for health maintenance in most conditions, working with a healthcare provider is important, especially if you have type 2 diabetes, hypertension, or other metabolic imbalances. Due to the effectiveness of the diet, medication management is paramount when following a ketogenic diet, as your metabolic state is likely to change, and therefore, your medication needs may shift as well. A healthcare professional can guide you on your journey as your metabolism shifts and your prescriptions change along with it.
With this in mind, strategies like extended fasting (more than 24 hours) or carb cycling may not be beneficial for people who are dealing with serious metabolic issues and, in some cases, may even make matters worse[*].
10. Does Not Necessarily Adhere to Traditional Dietary Guidelines
A WFKD will challenge the conventional dietary recommendations that we see today, which emphasize a diet high in carbohydrates and low in fat. To effectively reach and sustain a ketogenic state, you’ll need to drastically reduce your carbohydrate intake (including whole grains and otherwise healthy starchy vegetables). At the same time, you’ll need to focus on higher-fat foods that many mainstream nutrition experts deem unhealthy, such as animal meat and dairy.
Conclusion
A well-formulated ketogenic diet is more than just a low-carb approach to eating; it’s a carefully structured nutritional strategy designed to optimize metabolic health. Using a ketogenic state therapeutically requires individualized planning and medical supervision, particularly for those managing chronic conditions. Following the above guidelines is your best bet for both short-term and long-term results, as they provide a blueprint for sustained nutritional advantages, as well as key factors that contribute to adherence.
