The Dead-Simple Guide to Starting a Ketogenic Diet

Why did your keto diet fail?

Not because you lacked willpower. Not because keto "doesn't work for you." And not because you're broken.

You failed because nobody told you about the salt.

About 80% of people who quit keto in the first two weeks do it for the same reason: they feel terrible. Headaches. Brain fog. Fatigue. Legs like bricks. They think their body is rejecting the diet. What's actually happening? Their kidneys are dumping sodium, their electrolytes are crashing, and nobody warned them to replace it.

When patients in my Central Texas practice go through this correctly — cut the carbs, hit your protein, and get four to six grams of sodium daily — the response is almost always the same: "Why didn't anyone tell me this before?" Blood sugar drops within weeks. Doctors start talking about pulling meds.

The internet has made keto way more complicated than it needs to be. Macro calculators, ketone meters, bulletproof coffee, fat bombs. All of that noise obscures something that is, at its core, incredibly simple.

What We're Actually Doing

When I talk about a ketogenic diet with patients, I'm talking about one thing: changing what fuel your body runs on. Your body can burn sugar or it can burn fat. Most people have been running on sugar for so long that their cells have essentially forgotten how to burn fat. We call that being metabolically inflexible.

When you restrict carbohydrates enough, your liver starts producing something called ketones from fat. And ketones turn out to be remarkable. They're anti-inflammatory. They're a cleaner fuel for your brain. And the process of generating them means your body is burning through stored fat.

So we're not just talking about weight loss — though that happens. We're talking about reducing inflammation, improving energy production at the cellular level, and giving your brain fuel it actually prefers. This is therapeutic nutrition, not a trend.

Three Rules. That's It.

I use a specific approach in my clinic that comes from Dr. Eric Westman at Duke University. He's been doing research into low-carb diets for over 25 years. He runs the keto clinic at Duke. The surgeons there literally send him their sickest patients — the ones who are too metabolically unhealthy for surgery — and say, "Fix them so we can operate." And he does.

He created something called the Page Four Diet. Three rules:

​Rule 1: If you're hungry, eat meat and eggs.

​Rule 2: Two cups of leafy greens every day — spinach, lettuce, mixed greens, whatever you like.

​Rule 3: One cup of non-starchy vegetables every day — onions, bell peppers, zucchini, broccoli, Brussels sprouts.

That's it. No carb counting. No macros. No apps. If you follow those three rules strictly, you'll never break 20 grams of total carbohydrates in a day. And 20 grams of total carbs is the target.

One thing I'm firm on: I count total carbs, not net carbs. The internet keto guys will tell you to subtract dietary fiber from the total. I say no. Total carbs are total carbs. But on the Page Four Diet, you don't even have to think about it — the math just works if you follow the rules.

What's Off the Table

Let me be direct. There is no bread, pasta, rice, or grain of any kind. No fruit — at least not during the therapeutic phase. No potatoes. No tortillas. No oatmeal.

But here's the thing — you don't have to give up your life. You can still eat at restaurants. Order the steak and vegetables. Get tacos and eat the filling — eggs, bacon, cheese, sausage — and leave the tortilla behind. The restriction is on the food, not on living.

A little cream and cheese in your world is fine. Butter on your vegetables? Please. Coffee? I don't care — just not a frappuccino. Get an americano with some heavy cream, no sweetener. Or use stevia if you want something sweet. If you're craving something sweet, a few bites of keto ice cream are fine — get your hit and move on. Then go back to eating your meat and eggs.

The Sodium Problem

This is where most people crash and burn, and it has nothing to do with willpower.

When you go low-carb, your insulin levels drop. That's the whole point. But insulin does more than manage blood sugar — it also tells your kidneys to hold on to sodium. This is established physiology: insulin stimulates sodium reabsorption in the kidneys (DeFronzo, Diabetologia, 1981). When carbs drop, insulin drops, and your kidneys start releasing sodium. Fast.

What people call "keto flu" — the headaches, the fatigue, feeling like you're going to pass out, brain fog, legs like bricks — that's not your body rejecting the diet. That's a sodium problem. Every time a patient comes in telling me they feel terrible on low-carb, I say one word: salt. And they come back a week later and say, "Yep. That was it."

Your goal on low-carb is four to six grams of sodium per day. This comes from the doctors who've been doing this the longest — Phinney and Volek have over 200 published papers between them and run the Virta Health clinical program with thousands of patients. Their recommendation: roughly 5 grams sodium daily — about 3 grams from food, 2 grams from bouillon, broth, or supplementation. Westman's handout recommends bouillon up to twice a day.

For reference, a full teaspoon of salt has 2.3 grams of sodium. Half a teaspoon in eight to ten ounces of water gets you a little over a gram. Do that a few times a day and you're in good shape. Or use bouillon cubes — they're cheap, effective, and you can keep them in your desk.

The mechanism is published science. The specific intake target is expert consensus from the researchers who've been treating thousands of patients with this approach for decades. And it works.

What This Does to Your Brain

This is the part that honestly excites me the most.

There's an entire new field emerging within psychiatry called metabolic psychiatry. Researchers at places like Harvard, Oxford, and Stanford — over 50 researchers at top institutions — are investigating what ketones do for the brain. The running theory is straightforward: ketones are a better and cleaner fuel for your brain than sugar. The ketones themselves also carry an anti-inflammatory effect that helps with neuroinflammation.

This traces back to the 1920s, when the original ketogenic diet was developed for epilepsy. They could stop seizures with an 80 to 90 percent success rate just by changing what people ate. The diet was pretty miserable back then — but it worked.

The breakthrough that really launched metabolic psychiatry came from Dr. Chris Palmer, a Harvard psychiatrist at McLean Hospital. He published case studies documenting remission of psychotic symptoms in patients with schizophrenia and schizoaffective disorder on a ketogenic diet (Palmer CM, Schizophrenia Research, 2017 and 2019). These are conditions we've always believed meant something was fundamentally broken in the brain. But when these patients went on keto, their paranoia, hallucinations, and delusions resolved. Then when carbohydrates were reintroduced, symptoms returned. In medicine, that's one of those "what just happened" moments.

These are published case studies showing remission, not randomized controlled trials — but the framework Palmer lays out in his book Brain Energy (2022) is being pursued by dozens of researchers now. The field is early, but the mechanism makes sense and the clinical observations are compelling.

The research now covers ADHD, depression, anxiety, bipolar disorder — the whole spectrum. Studies on ADHD showed roughly 80 to 90 percent of patients had clinically relevant improvement, and about half to 70 percent actually met criteria for remission. Not just better — no longer classifiable as ADHD.

What we see in clinic mirrors the research. Patients with ADHD report better focus, less mental fog, improved executive function. Patients with anxiety and depression describe feeling more stable, less reactive. The brain just works better on ketones for a lot of people — not all, but a significant portion. And the only way to know if you're one of them is to try it.

The Honest Timeline

When patients ask me how long this takes, I give them the real answer: plan for six months.

What we're doing underneath the surface is retraining your mitochondria — the little power generators inside your cells. If you're insulin resistant, your mitochondria are stuck in sugar-burning mode. They've forgotten how to burn fat. The whole purpose of this diet is to teach them to be metabolically flexible again — meaning if we feed you sugar, you can burn it, and if we feed you fat, you can burn it.

That process takes about six months. That's where people see most of their weight loss and body composition change.

To give you context on how fast the metabolic piece moves: Dr. Westman's general rule for his diabetic patients is to cut their diabetes medication in half on day one. Day one. Within the first 48 hours, your insulin numbers are dropping significantly.

This Isn't Forever

I'm not sold on keto being the best diet for the rest of your life. But I am sold on the fact that it's one of the most powerful interventions we have for weight loss, inflammation, and mental clarity.

For a time — while we repair your metabolism — it's probably the best approach we know of. But the goal is metabolic flexibility. Once we get you there, we can expand your carbohydrate intake carefully. Some people reintroduce carbs successfully and maintain their results. Others find they feel better staying lower-carb long-term. Your experience will be your own.

Getting Started: The Checklist

If you're ready to try this, here's what I tell every patient:

​Protein target: Take your goal body weight in pounds — that's your daily protein goal in grams. A good whey protein isolate with close to 30 grams per scoop can help you get there.

​Carb limit: 20 grams total per day. Follow the Page Four Diet and you'll hit this without counting.

​Fat: Whatever comes with your food is fine. I don't set fat goals.

​Salt: Four to six grams of sodium daily. Non-negotiable.

​Give it 90 days. Be strict. After that, we'll have a real conversation about where you are and what comes next.

What I see clinically: patients with early metabolic dysfunction — brain fog, memory issues, pre-diabetic numbers — who come in on multiple medications. Six months on this diet and many of them are off blood pressure meds, off diabetes meds, thinking more clearly. Not every case resolves this dramatically, but the pattern repeats often enough that it's no longer surprising.

That's not a sales pitch. That's what I see. And it starts with three simple rules.

If you want help implementing this — especially if you're dealing with diabetes, metabolic dysfunction, or you've tried before and it didn't stick — that's exactly what we do at Rooted Health Clinic. We walk you through it, monitor your labs, adjust your medications as things improve, and make sure you're not white-knuckling through something that should feel sustainable.

Give us a call at 254-780-0023 or visit rootedhealthclinic.com.

Rooted Health Clinic — Salado, TX