Nine Things to Know Before Kick Starting a Keto Diet

The ketogenic diet became well-known in the 1920s as a therapy for epilepsy. It’s a low carb, high fat diet designed to help reduce seizures in children and adults that don’t respond well to anti-epileptic medications.  

In 1921, an endocrinologist discovered three compounds (called ketone bodies) are produced by the liver if you eat foods rich in in fat and low in carbohydrates. By increasing fat and reducing sugar in your diet, you’re forcing your body to burn fat for energy rather than sugar. When your body burns fat, it produces the ketone bodies, which can protect against seizures.

Health experts aren’t sure how or why the ketogenic diet works for people with epilepsy, but they do know you have to follow it exactly to see results. 

This diet is not for everyone. It’s very strict and requires extreme discipline.

According to John’s Hopkins Epilepsy Center, the criteria for considering the ketogenic diet include:

  • Have epilepsy
  • Have tried multiple medications in the past with limited success
  • Have a vagus nerve stimulator
  • Have been on diet therapies in the past with benefit and would like to try again
  • Are overweight
  • Are awaiting epilepsy surgery or another new treatment that is not yet available

Getting started on the keto diet can be overwhelming because it’s usually a dramatic shift in eating habits. Dr. Philip Lee with Mercy Clinic Neurology has nine things you should know about the ketogenic diet.

  1. Ask your doctor. It’s important to consult your physician before starting a diet, especially one like this. Your doctor can help you develop your diet plan of action and will be your partner along the way.
  2. Chew the fat. Healthy fat, that is. Olive oil, coconut oil, palm oil, egg yolk, avocado, cocoa butter and some nuts are considered healthy fats.
  3. Think green. The ketogenic diet emphasizes vegetables that are high in nutrients and low in carbohydrates, like broccoli, spinach, asparagus, green beans, green bell peppers, spinach, etc.
  4. Incorporate more protein. Red meat, pork, poultry and fish are a key component of the ketogenic diet.
  5. Buy full fat dairy. Greek yogurt, cottage cheese, cream cheese, sour cream, and soft cheeses like mozzarella and brie are fine. You can also cook with heavy whipping cream to add flavor.
  6. Avoid grains. Products with wheat, like bread, pasta, cereal and rice are loaded with carbs and can unravel the hard work you’re doing on the diet.
  7. Stay away from sugar. Fruit, candy, chocolate, ice cream and anything processed/sweet are off the table.
  8. Stay hydrated. Drink as much water as you can and limit your caffeinated beverages. Diet soda is not recommended because it can lead to sugar cravings.
  9. Take your vitamins. The diet can cause vitamin and mineral deficiencies, so talk to your doctor about what supplements you should consider.

After starting the diet, you may feel tired or have headaches, sniffling, irritability and even nausea. It’s what some people call the “keto flu,” and it’s only temporary as long as you eat more sodium and electrolytes. Try salting your food, drinking soup broth and eating plenty of salty foods like bacon or packaged lunch meat.

Other side effects of the diet can include digestive problems, high cholesterol, kidney stones, low energy and slower growth rates in children.

Dr. Lee emphasizes that the ketogenic diet is only neurologically used for people with epilepsy that’s difficult to control, and it must be done under a doctor’s supervision. Talk to your Mercy doctor about whether or not the ketogenic diet is right for you or your child.

Sample Ketogenic Diet Menu


  • Egg omelet with spinach, cheese, tomato and sausage


  • Taco salad (minus the tacos, of course). Beef, full fat sour cream, cheese, lettuce and tomatoes. You’ll never even miss the shell.


  • Ribeye steak
  • Mushroom cream sauce
  • Steamed broccoli
  • Salad greens with high fat dressing
Written by Philip Lee, MD

Dr. Philip Lee is a fellowship-trained neurologist practicing at Mercy Clinic Neurology in St. Louis. Learn more.