What is the ketogenic diet and how does it work?
Priyanka Wali
But the keto diet is not for everyone  so I sought medical supervision.  Dr. Priyanka Wali  is an internal-medicine physician with specialty training in obesity medicine.  She  uses the keto diet routinely for  her  patients who have insulin resistance  pre-diabetes  and diabetes. In 2014   Wali  was moonlighting at a weight-loss clinic in San Francisco  where  she  saw  her  patients struggle to stick to their strict diet programs and maintain their weight loss.  She  started reading studies on low-carb diets and became convinced it was the solution.  Wali  made  herself  a guinea pig before  she  prescribed the diet. And it worked.  She  said  she  "expected to feel a lot of adverse side effects" from eating so much fat  "but what ended up happening was I felt great. I started to have more energy and concentration. I didn't lose weight  but my fat distribution changed  so I lost weight from my hips."
After asking me about my family history and my reasons for trying the keto diet   Wali  determined I was an "optimizer " like the healthy tech workers who rely on the diet. Tech workers living in the Bay Area sometimes go to extreme lengths to improve their bodies and minds. For example  at the supplements startup HVMN (formerly known as Nootrobox)  most employees don't eat on Tuesdays â a ritual they say improves ketone production and productivity. Intermittent fasting has been shown to assist ketosis. To see if I was a good fit for the keto diet   Wali  requested I have some lab work done  including a cholesterol panel and a fasting insulin level test. My results came back normal  which meant there was no medical necessity for me to go on the diet. If I were pre-diabetic or insulin-resistant   Wali  would have been more likely to make the keto diet part of my treatment.
 Wali  introduced me to the "keto food pyramid " via this image that went viral on Reddit. We agreed that for my first week on the keto diet  I would aim for 30 to 50 grams of carbs during the day and eat regular  carb-heavy dinners  even if they took me over the limit. "Sugar addiction is a real thing  " Wali  warned me in our first meeting.  She  wanted me to ease into ketosis to avoid "carbohydrate withdrawal " which can cause irritability  depression  headaches  lethargy  and nausea. I was happy to take it slow. As I was learning the carb loads of different foods in those first few weeks  I tracked my meals on the Fitbit and Weight Watchers apps  but  Wali  says paper and pen works just as well.
 She  taught me how to count carbs the smart way: Carbohydrates - dietary fiber = net carbs. Fiber is a carbohydrate that the body can't digest. It doesn't raise blood-sugar levels  so there's no use in counting grams of dietary fiber toward a daily carbohydrate goal. A cup of almonds has approximately 20 grams of carbohydrates  but 12 of those come from dietary fiber. As a result  I had to count only 8 grams for the serving. What a bargain!
When I got home from my visit with  Wali   I was forced to rethink all my dietary staples. I let my boyfriend finish off our supply of apples  bananas  bread  pasta  rice  and potatoes.
Our office has the best snacks â Goldfish  Nature Valley bars  animal crackers  and peanut-butter-filled pretzels (my personal brand of indulgence). I thought of them often. I used to snack every hour between 10 a.m. and dinner. Food was always on my mind. In my first week  I dug up the willpower to resist those sugar binges. But it was not without consequences. My headaches pounded for hours on end. My mind said  "Eat something."  Wali  recommended I drink more water and salt my food to ease the headaches.
During Week 2  my ketone testing meter kit arrived in the mail. The pocket-sized medical device uses a small blood sample to measure the presence of ketones. People diagnosed with diabetes can have a ketone testing meter prescribed by a doctor  but it may not be covered by insurance. Optimizers like me turn to Amazon for third-party sellers. I bought the Precision Xtra Glucose Meter Kit (which also measures ketones) for $22  and a 10-pack of ketone testing strips for $42. The meter has since gone up to $99 on Amazon. Keto adherents use ketone testing meters to check that they're in a state of nutritional ketosis  which is generally considered above 0.3 millimoles per liter of blood  according to  Wali . Entrepreneurs sometimes share their ketone levels on social media. It's the biohacking community's equivalent of posting photos of a bathroom scale to celebrate recent weight loss.
When I splurged on a bagel or pizza  which did happen  I wanted to curl up under my desk and nap within 30 minutes of eating. I felt uncomfortably full and groggy. The worst part of cheating was that it had the potential to reverse a state of nutritional ketosis. When my parents came into town over one weekend and I went rogue  I wound up with a ketone reading of 0.3 mmol/L  which meant my body was burning more carbs than fat. I returned to the diet on Monday  but it takes an average of five days for the body to use up the leftover glycogen reserves and return to nutritional ketosis  according to  Wali .
After eating mostly fat  protein  and leafy vegetables for one month  I reached my peak ketone reading of 0.9 mmol/L â a strong indication that I reached a state of ketosis. By this point in my journey  most of the negative side effects had subsided. (I experienced leg cramps and tingling sensations in my feet  which  Wali  explained was from eating too little salt.  She  suggested I try magnesium supplements  and the problem went away within days.) A ketone reading of 0.9 mmol/L indicates a mild state of ketosis. Dieters can reach higher levels â "go deeper" into ketosis â by restricting carbs to fewer than 20 grams a day or fasting. But there isn't consensus in the medical community that doing so unlocks additional benefits. Geoff Woo  the cofounder and CEO of HVMN  said he aimed for 3.0 mmol/L or higher  which he achieves through intermittent fasts that spike ketone production  for "optimal mental flow." When I started to obsess over the numbers my ketone testing meter gave me   Wali  encouraged me to focus on how I felt instead.
It was then that I realized why I loved eating keto â it made me feel like a superhero. When I lost 30 pounds on Weight Watchers in college  I celebrated the numbers on the scale and how my clothes fit. But because I continued to eat carbs in smaller portions  I was still prone to sugar crashes and afternoon "brain fog." The transformation was incomplete. The keto diet made over my mind and my body. The sense of mental clarity and energy that came on about three to four weeks into eating keto was unlike anything I've experienced. I woke up feeling strong  confident  and capable of taking on whatever the day threw at me. "This is how you're supposed to feel as a human being  " Wali  said during a follow-up visit.
But the keto diet is not for everyone  so I sought medical supervision.   [TGT] is an internal-medicine physician with specialty training in obesity medicine.   [TGT]   uses the keto diet routinely for   [TGT]   patients who have insulin resistance  pre-diabetes  and diabetes. In 2014   Wali  was moonlighting at a weight-loss clinic in San Francisco  where   [TGT]   saw   [TGT]   patients struggle to stick to their strict diet programs and maintain their weight loss.   [TGT]   started reading studies on low-carb diets and became convinced it was the solution.   [TGT] made   [TGT]   a guinea pig before   [TGT]   prescribed the diet. And it worked.   [TGT]   said   [TGT]   "expected to feel a lot of adverse side effects" from eating so much fat  "but what ended up happening was I felt great. I started to have more energy and concentration. I didn't lose weight  but my fat distribution changed  so I lost weight from my hips."
After asking me about my family history and my reasons for trying the keto diet    [TGT] determined I was an "optimizer " like the healthy tech workers who rely on the diet. Tech workers living in the Bay Area sometimes go to extreme lengths to improve their bodies and minds. For example  at the supplements startup HVMN (formerly known as Nootrobox)  most employees don't eat on Tuesdays â a ritual they say improves ketone production and productivity. Intermittent fasting has been shown to assist ketosis. To see if I was a good fit for the keto diet    [TGT] requested I have some lab work done  including a cholesterol panel and a fasting insulin level test. My results came back normal  which meant there was no medical necessity for me to go on the diet. If I were pre-diabetic or insulin-resistant    [TGT] would have been more likely to make the keto diet part of my treatment.
  [TGT] introduced me to the "keto food pyramid " via this image that went viral on Reddit. We agreed that for my first week on the keto diet  I would aim for 30 to 50 grams of carbs during the day and eat regular  carb-heavy dinners  even if they took me over the limit. "Sugar addiction is a real thing  "  [TGT] warned me in our first meeting.   [TGT]   wanted me to ease into ketosis to avoid "carbohydrate withdrawal " which can cause irritability  depression  headaches  lethargy  and nausea. I was happy to take it slow. As I was learning the carb loads of different foods in those first few weeks  I tracked my meals on the Fitbit and Weight Watchers apps  but   [TGT] says paper and pen works just as well.
  [TGT]   taught me how to count carbs the smart way: Carbohydrates - dietary fiber = net carbs. Fiber is a carbohydrate that the body can't digest. It doesn't raise blood-sugar levels  so there's no use in counting grams of dietary fiber toward a daily carbohydrate goal. A cup of almonds has approximately 20 grams of carbohydrates  but 12 of those come from dietary fiber. As a result  I had to count only 8 grams for the serving. What a bargain!
When I got home from my visit with   [TGT] I was forced to rethink all my dietary staples. I let my boyfriend finish off our supply of apples  bananas  bread  pasta  rice  and potatoes.
Our office has the best snacks â Goldfish  Nature Valley bars  animal crackers  and peanut-butter-filled pretzels (my personal brand of indulgence). I thought of them often. I used to snack every hour between 10 a.m. and dinner. Food was always on my mind. In my first week  I dug up the willpower to resist those sugar binges. But it was not without consequences. My headaches pounded for hours on end. My mind said  "Eat something."   [TGT] recommended I drink more water and salt my food to ease the headaches.
During Week 2  my ketone testing meter kit arrived in the mail. The pocket-sized medical device uses a small blood sample to measure the presence of ketones. People diagnosed with diabetes can have a ketone testing meter prescribed by a doctor  but it may not be covered by insurance. Optimizers like me turn to Amazon for third-party sellers. I bought the Precision Xtra Glucose Meter Kit (which also measures ketones) for $22  and a 10-pack of ketone testing strips for $42. The meter has since gone up to $99 on Amazon. Keto adherents use ketone testing meters to check that they're in a state of nutritional ketosis  which is generally considered above 0.3 millimoles per liter of blood  according to   [TGT]  . Entrepreneurs sometimes share their ketone levels on social media. It's the biohacking community's equivalent of posting photos of a bathroom scale to celebrate recent weight loss.
When I splurged on a bagel or pizza  which did happen  I wanted to curl up under my desk and nap within 30 minutes of eating. I felt uncomfortably full and groggy. The worst part of cheating was that it had the potential to reverse a state of nutritional ketosis. When my parents came into town over one weekend and I went rogue  I wound up with a ketone reading of 0.3 mmol/L  which meant my body was burning more carbs than fat. I returned to the diet on Monday  but it takes an average of five days for the body to use up the leftover glycogen reserves and return to nutritional ketosis  according to   [TGT] 
After eating mostly fat  protein  and leafy vegetables for one month  I reached my peak ketone reading of 0.9 mmol/L â a strong indication that I reached a state of ketosis. By this point in my journey  most of the negative side effects had subsided. (I experienced leg cramps and tingling sensations in my feet  which   [TGT] explained was from eating too little salt.   [TGT]   suggested I try magnesium supplements  and the problem went away within days.) A ketone reading of 0.9 mmol/L indicates a mild state of ketosis. Dieters can reach higher levels â "go deeper" into ketosis â by restricting carbs to fewer than 20 grams a day or fasting. But there isn't consensus in the medical community that doing so unlocks additional benefits. Geoff Woo  the cofounder and CEO of HVMN  said he aimed for 3.0 mmol/L or higher  which he achieves through intermittent fasts that spike ketone production  for "optimal mental flow." When I started to obsess over the numbers my ketone testing meter gave me    [TGT] encouraged me to focus on how I felt instead.
It was then that I realized why I loved eating keto â it made me feel like a superhero. When I lost 30 pounds on Weight Watchers in college  I celebrated the numbers on the scale and how my clothes fit. But because I continued to eat carbs in smaller portions  I was still prone to sugar crashes and afternoon "brain fog." The transformation was incomplete. The keto diet made over my mind and my body. The sense of mental clarity and energy that came on about three to four weeks into eating keto was unlike anything I've experienced. I woke up feeling strong  confident  and capable of taking on whatever the day threw at me. "This is how you're supposed to feel as a human being  " Wali  said during a follow-up visit.