If you are a complete newbie to this way of eating, please take the time to inform yourself. The best thing to do in this case is to “clean up your diet”, before you overwhelm yourself with carb counting and introducing new foods at every single meal. I suggest reducing carbohydrates gradually so that your system has a chance to adapt and you get plenty of opportunity to get your head around new foods, cooking methods and shopping lists! However, some people prefer making radical changes and starting the diet straight away, provided they do not have any underlying health issues (e.g. malnutrition, thyroid, cardiovascular problems). I have good experience with the following steps before starting proper carbohydrate restriction (daily carbohydrate intake of 50g or lower). You choose the pace:
1. Eliminate sugar in all forms and shapes. This includes fruit juices, sports drinks, honey, agave and all the other sweeteners. Educate yourself around the subject.
2. Replace the sugar calories with healthy fats like avocadoes, coconut oil, olive oil, grass-fed butter, ghee and MCT oil.
3. Eliminate gluten in any shape or form. This includes wheat, spelt, kamut, rye, barley and oats.
Remove grains in general as well as grain-derived and vegetable oils (corn, soy and rapeseed/canola). Be careful with unstable polyunsaturated oils (walnut, flax, peanut oil) and always store them in the fridge.
4. Eliminate all synthetic additives, colourings and flavourings- basically any names on an ingredient list that you do not recognise! This includes aspartame, MSG, dyes and artificial flavourings.
5. Eatwild caught seafood and pastured, grass-fed meatwithin the limits recommended by the World Cancer Research Fund (details see page 12). My favourite red meat is lamb- here in Ireland we are very lucky that it is grass fed, readily available and inexpensive. To balance this, also have (oily) fish, free range or organic eggs, some chicken, duck and shellfish.
6. Eliminate legumes such as beans and lentils. Small amounts of sprouted lentils or beans are fine. Use peanut butter as a condiment in sauces if you tolerate it well and are not following a Paleo diet but otherwise replace it with sesame paste, for instance.
7. Remove all processed, homogenized and pasteurized dairy. Full fat, whole butter from goats or grass-fed cows are the exceptions.
8. Switch to organic fruits and vegetables as much as your budget allows. This is more important for some plants than others. Google “Dirty Dozen and Clean Fifteen” and you will find a list provided by the Environmental Working Group.
9. Cook your food gently, if at all. Always have a good amount of raw food in your daily diet if well tolerated. Prefer steaming, slow cooking and baked at 180C/350F or lower. Incorporate water into your cooking whenever possible and use low temperatures. Do not use a microwave or deep fry. Burnt, blackened or charred foods need to be thrown out.
10. Limit fruit consumption to 1-2 small servings (i.e. one handful) per day. Go for low fructose containing fruits like berries and lemons over watermelon and apples.
11. Add spices and other flavourings. Start experimenting withherbs and spices such as turmeric, oregano, parsley, coriander thyme or rosemary. Bear in mind that these contain carbohydrates, too.
12. Enjoy your food, preferably in great company!
Once you are ready to embrace a ketogenic diet, begin with some technicalities. I strongly recommend buying weighing scales for weighing your food- I do give rough measurements in e.g. tablespoons/cups but this is nowhere near as exact as a measurement in grams, which the software uses to calculate nutrient values. If you want to monitor your nutrients as closely as possible, do purchase weighing scales and start measuring in grams.
Calculate your daily calorie requirements based on your basal metabolic rate (BMR). I am no fan of counting calories at all but most hospitals and consultants feel that it is important to keep an eye on them, especially if a cancer patient is losing weight too quickly.
In order to achieve a faster “metabolic switch-over”, some people prefer to do a 2- or 3-day fast. However, experts do not recommend doing this if your nutritional status is compromised, you are weak and/or are in advanced stages of the disease. Intermittent fasting, where the window of time during which food is consumed is gradually restricted to about 8 hours, can be another effective tool in reaching and maintaining nutritional ketosis. A realistic schedule would be to have dinner at 6pm for instance and then not eat anything until 10am the following day. Intermittent fasting is generally easier and more efficient for men whereas it can pose problems for some women, especially if thyroid issues are present.