B — systematic reviews with limitations 8 sources · checked 2026-09-04

Ketogenic diet

What it is

A diet with carbohydrate held below the level at which the body switches to producing ketones from fat as a major fuel — nutritional ketosis. The definition this site uses puts the threshold at under about 50 grams of carbohydrate a day, or under ten percent of energy; that is the number from the published definition, not an engineering guess, and it is the line that separates "ketogenic" from merely low-carbohydrate (under 130 grams or 26 percent). Fat becomes most of the energy by default, because something has to; protein stays moderate, because a great deal of it is turned into glucose and can blunt ketosis.

How it works in practice

Meat, fish, eggs, cheese, oils, nuts and seeds, non-starchy vegetables, small amounts of berries. No bread, pasta, rice, potatoes, sugar, most fruit, beer. The first week is where most of the experience happens: glycogen is used up and the water bound to it leaves — two or three kilograms on the scale that are not fat — and many people report tiredness, headache and cramps as the body adapts and as sodium, potassium and magnesium go out with the water. Salt and fluids ease most of it. After that, appetite is often lower than on other patterns, which is the practical mechanism by which people hold a deficit on it.

What the evidence shows

The network meta-analysis of named dietary programmes found low-carbohydrate programmes losing roughly four to five kilograms more than usual diet at six months — about the same as low-fat programmes — and at twelve months the differences between named diets had shrunk to small and mostly non-significant amounts, with low certainty. The Cochrane review of low-carbohydrate against balanced-carbohydrate diets reaches the same place: little to no difference in weight at up to two years. A 2024 review of the ketogenic meta-analyses adds the methodological caveat that matters most here: ketosis is rarely verified in the trials, dropout is high, and "ketogenic" often means "was assigned to". The honest reading is that the pattern works as well as the deficit it produces, starts faster on the scale, and shows no advantage that survives a year.

Who it tends to suit

People who find carbohydrate the food they cannot stop eating, and for whom the blunted appetite is worth the loss of bread. People who cook, and who eat mostly at home. People without the medical conditions below, and without a history of restriction-and-binge.

How it most often fails

Socially, at the table — the pattern is visible at every meal and every celebration, and it is the one most often abandoned at a wedding. Nutritionally, in fibre: vegetables have to be deliberate, or the diet becomes meat and cheese. And on the scale in reverse: the first carbohydrate meal after weeks of ketosis restores glycogen and its water, and the two kilograms that "came back overnight" are the same two that left in week one.

What to watch

Electrolytes in the first weeks — salt is not the enemy here — and fibre throughout. Anyone on diabetes medication needs a doctor before starting, not after: insulin and sulfonylurea needs fall quickly, and SGLT2 inhibitors carry a specific ketoacidosis risk on this pattern.

In the app

The app knows the ketogenic policy code and treats it as a preference the planner takes into account; it does not verify the carbohydrate threshold or ketosis, because that policy revision has no documented review yet. The site says the same thing, and will change the wording the day the app can verify the rule.

Sources

  1. Feinman RD et al., „Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base“, Nutrition 2015;31(1):1–13 — critical review with published definitions
    Limitation: авторите са застъпници на въглехидратното ограничение (диабет контекст); **ползва се за дефиницията/прага, не за клиничните претенции** — това е източникът, който AGENTS.md изисква за кето прага
    cited, not reproduced
  2. Szendi K et al., „Methodological challenges and confounders in research on the effects of ketogenic diets: a literature review of meta-analyses“, Foods 2024;13(2):248 — literature review of meta-analyses
    Limitation: това е източник за **ограничението**, не за ефекта; **прагът на въглехидрати още няма източник** — чака C-KETO-DEFINITION (Feinman 2015 или еквивалент)
    cited, not reproduced
  3. Ge L et al., 14 popular named dietary programmes, network meta-analysis, BMJ 2020;369:m696, PMID 32238384 — systematic review + network meta-analysis (121 RCT, 21 942 участници)
    Limitation: между-диетните разлики са малки и с ниска до умерена сигурност; отпадането е високо; не казва нищо за придържането на конкретен човек
    cited, not reproduced
  4. Naude CE et al., „Low-carbohydrate versus balanced-carbohydrate diets…“, Cochrane CD013334, 2022 — Cochrane systematic review
    Limitation: „балансирани“ е дефиниция на прегледа; повечето проучвания с високо отпадане; **Cochrane: cite-only, никакъв копиран abstract или PLS**
    cited, not reproduced
  5. Fernández-Elías VE et al., „Relationship between muscle water and glycogen recovery…“, Eur J Appl Physiol 2015;115:1919–1926 — physiological measurement study (n=9, biopsy)
    Limitation: 9 тренирани мъже след упражнение в жега; съотношението е порядък за обяснение на скоковете на кантара, не калкулатор
    cited, not reproduced
  6. CDC, Weight Gain During Pregnancy — official public-health guidance
    Limitation: не е weight-loss solver за pregnancy
  7. National Academies DRI: macronutrients — official consensus report
    Limitation: general healthy population range; не индивидуална weight-loss prescription
    cited, not reproduced
  8. Наредба № 1 от 22.01.2018 г. за физиологичните норми за хранене на населението, МЗ, ДВ бр. 11/02.02.2018 — national normative act (Bulgaria)
    Limitation: популационни норми за здрави хора, не за отслабване; отменя Наредба № 23/2005

Educational information, not medical advice. It does not replace a consultation with a doctor or a registered dietitian. Not for people under 18, during pregnancy or breastfeeding, or with a history of an eating disorder — talk to a professional first.