What does "modified" keto mean?

Carbohydrates are reduced to about 20–50 g a day, with enough protein and healthy fats. It does not mean unlimited processed meat and butter.

The plate

• Half the plate low-carbohydrate vegetables: cucumber, lettuce, courgette, aubergine, peppers, spinach, broccoli.
• Palm-sized protein: fish (kingfish, sheri, sardines), grilled chicken, eggs, unsweetened laban or yoghurt.
• Healthy fats: olive oil, avocado, a small handful of nuts.
• Paused for now: rice, bread, dates, sweets, juices and sweetened drinks.
• Limit red and processed meat, ghee and fatty cheese to protect the heart and cholesterol.

The gut on keto

• Constipation is common: add a spoon of chia seeds, ground flaxseed or psyllium daily, and drink 2.5 litres of water.
• "Keto flu" (headache and tiredness in week one): water and lightly salted vegetable broth, unless your doctor has restricted salt.
• Diarrhoea or bloating can come from very high fat intake or sugar alcohols in "keto" products; avoid these, especially with IBS.
• Heartburn may ease in some people with reflux May help, but large fatty meals can worsen it in others.

• Rapid weight loss raises the risk of gallstones; see a doctor for upper-right abdominal pain after meals.
• A multivitamin is useful during this restrictive diet, and for persistent constipation your doctor may prescribe magnesium oxide; not with kidney disease without advice.

Duration and transition

A defined phase of 3–6 months with dietitian follow-up, then a gradual return of whole carbohydrates (legumes, oats, small rice portions, fruit) and a move to a lower-carbohydrate Mediterranean diet long-term. Blood fats and kidney tests are checked at 3 months.