People often ask me what particular things to consider before starting a low carb ketogenic diet. I strongly believe that the ketogenic diet is NOT a fad diet that will disappear again in a few years’ time like so many other dietary approaches.

There is a lot of solid evidence behind it that shows us what predictable metabolic changes happen when someone starts reducing carbohydrates and upping fat intake. BUT there are definitely a few caveats that are worth mentioning and that everybody needs to take on board before starting out.

So, here you go, 8 things to consider before starting a low carb ketogenic diet:

#1 Get Professional Support

I know I keep saying it but ideally you’re able to find an experienced healthcare practitioner that can set up or fine tune a meal plan for you, save you from the major pitfalls at the beginning and make sure you’re set up with your macronutrients depending on your needs.

Trust me, it’s not complicated at all once you know what you’re doing but figuring it all out by yourself can turn a lot of people off the diet.

Epileptic patients definitely have to discuss the ketogenic diet with their neurologist- never just “give it a go” without telling him or her! Medication might need to be adjusted and many other factors need to be taken into consideration, especially with children.

Because I know that it’s not always possible to afford/find a suitable practitioner if you want to try a ketogenic diet for general health or weight loss, I do my best to guide you through the process and make sure you’re off for a good start!

#2 Blood Tests

Please get some blood work done before you get started to make sure you don’t suffer from any underlying conditions. I always have a standard battery of tests that I require from each client before we start working together. Based on a questionnaire about signs and symptoms, I add some other tests.

An example: I always require a full blood count, kidney/liver function, lipid panel, inflammatory markers and a thyroid panel. But if somebody suffers from extreme fatigue I add for instance Vitamin B12 to exclude anaemia. Many labs don’t routinely test for this. There are also other functional tests that can be very useful, like for instance a comprehensive stool analysis.

#3 Taking it Easy

Take it easy in the initial stages. I didn’t cut down my carbs to 12g straight away. On the contrary, at the time the recommendation was to go down to 60g, where I stayed for a few months and still got good results.

If you have to implement a ketogenic diet straight away and you’re used to eating lots of processed foods and sugar, make sure you have good support from a healthcare professional. It can be a radical change for many.

Some doctors recommend doing a fast to go into nutritional ketosis very quickly. Please don’t do this on your own if you’ve never done it before.

#4 Choose your Timing

Don’t start this diet when you’re going through a busy time of your life- be it physically, psychologically or emotionally.

First of all, you will be too stressed out cooking and getting used to new foods, meals and preparation methods. You set yourself up for failure because starting off will disrupt your usual routine for a little while.

Secondly, it can be incredibly challenging- if not impossible- to lower your blood sugar levels when you’re stressed and don’t have time to relax.

For example, if you’re a cancer patient who has just started chemotherapy, I suggest you wait for a little bit and just work on “cleaning up” your diet from processed and sugary foods. That’ll probably be difficult enough. Many chemotherapy drugs are glucose-based and I sometimes get calls from people on chemotherapy trying to implement the ketogenic diet. They’re desperate because their glucose is at a constant high level and they can’t produce ketones. Relax and focus on a good balance of exercise, nutritious food, good company and rest.

Then there’s the athlete: Making radical dietary changes a few weeks before your most important competition of the season isn’t a good idea! Do it when you’re off season and when your focus isn’t on intense training sessions. That way you give your body a chance to become properly fat adapted and to see whether this approach suits you or not. By all means, you can do some preparatory races while you’re testing ketosis and you probably find out whether your performance is enhanced or decrease. But always leave enough time to tweak before important competitions.

#5 Plan ahead!

Don’t just start the diet one morning because you know you have a couple of eggs in the fridge but then get stuck at lunch time because all you’re left with at home is bread and jam… Before you start properly, try some ketogenic meals, incorporate new foods and experiment around for a few days- or even weeks.

I sometimes even get people to experiment with certain foods that they suspect they might be intolerant to. Maybe you get super tired about 1-2 hours after eating eggs? Or you get really bloated and sluggish once you’ve eaten a good portion of nuts?

Another sign is an increase in heart rate: if it goes up a lot more for no reason after a meal, then this could be a sign of a food sensitivity, too. Other symptoms could be constipation and other digestive problems, mood swings or depressed immune system. The only reliable way to find out if that’s what’s going in is to do elimination and challenge of the suspected foods.

The good news is that on a ketogenic diet, a number of the so-called “allergenic foods”- i.e. the ones that are responsible for the most problems- will be eliminated anyway. For instance wheat, milk and soya. Although soya is okay to eat on a ketogenic diet, I hardly ever use it because of the controversial research, and if so only in fermented form in small amounts.

Once you have a better idea of what is actually involved in making the dietary changes and you have found out what foods are good for you, you’re ready to go. Do the shopping, calculate your macros, draw up a rough meal plan for the week and get started properly.

#6 Social Life

Be prepared when you eat out, socialise or go travelling. I’ll be writing more about this in another blog but this can be a tricky part of keto life. Depending on where you live, keto foods are more or less easy to buy. So when you start making changes towards a ketogenic lifestyle, make sure it’s not a week before a big trip or also before a big birthday bash, for instance.

Also, be ready to put on a thick skin… There will be many people watching you and commenting on the foods you eat. Isn’t it funny, but people think it’s perfectly normal to dig into a huge slice of shop-bought chocolate cake (full of sugar and trans fats) but get genuinely concerned people get when they see me pour lots of olive oil onto my salad, for instance. Or add butter to a soup.

They want to “protect” me from all sort of things: putting on weight, heart attack, having cancer again- I’ve heard it all! A relative of mine got really upset when he saw me have a handful of berries with a big dollop of double cream for dessert at Christmas (instead of the Christmas pudding).

It WILL happen to you, I’ve warned you 😉

#7 Get Essentials

If you (have to) take the diet very seriously, buy a ketone/glucose meter (e.g. Abbott Laboratories diabetic kit- see this blog post where I mention it, too) and weighing scales to get a clear idea of what your food weighs. You will very quickly get the hang of portion sizes.Other handy kitchen tools are a good strong blender, a steamer oven (or steamer basket), good non-toxic frying pans and lots of containers suitable for freezing so that you can batch cook.

#8 Find Reliable Sources that keep you going

Once you’ve achieved nutritional ketosis and you’re feeling well on it, keep tweaking and adapting your diet. A constant stream of new recipes will keep you from being bored and losing interest in continuing. You can also search the internet for recipe inspirations but beware! I’ve come across many recipes called “ketogenic” and they were everything but that. Fat too low, carbs or protein too high or everything at once…Make sure you follow people you know you can trust and who really know their stuff. Because the diet is becoming more popular, there will be more “experts” out there who claim they know everything about keto but in reality, they’ve probably read one book but still don’t know enough about designing meal plans or recipes. The best thing is to get educated yourself on the most important aspects and nothing will be able to get you off track!

Ketogenic diets can indeed be tricky, but if you do them the right way – and more importantly, if you pay attention to people who have actually spent lots of time researching, implementing the diet with patients and also following it themselves – there can be some significant health benefits.