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Food Plan Prepared for [XX] on [xx-xx-xx]Requirements: Ketogenic + MDLSuggested time on therapeutic food plan: [x] weeksQuick overview of plan: The focus of your food plan should be on high amounts of fats and oils, low glycemic vegetables and high-quality meats and fish, as well as some nuts and seeds, herbs and spices, and low glycemic fruits. On a ketogenic diet, the majority of your caloric intake will come from fat (50%+, depending on your specific needs).Special considerations on this plan: A ketogenic diet allows your body to transition from using glucose as the main fuel source for cell energy to using ketones, which are produced from fats. This has been shown to aid in weight loss and also produces an anti-inflammatory effect in the body. After a few days on this diet, hunger should stabilize, and you should feel satiated, even if you are eating less food. You will be eating a lot of fat on this diet, and it’s important to choose high quality and varied sources including oils and fats from olives, avocados, flaxseed and coconut, oily fish and grass-fed/organic animal fats. For the first two weeks, it will be important for you to track calories, carbohydrates, proteins and fats while you get used to following the diet. You should also track how effectively you are achieving ketosis by monitoring your urinary ketones first thing each morning with urine ketone strips available at most pharmacies. After the first two weeks, you may be able to rely on just using the urinary ketone test as a guide to whether you are on the right track, rather than tracking your daily intake.We have also highlighted sources of vitamin B5 (pantothenic acid) which we would like you to focus on incorporating into your plan while you are on a ketogenic diet. B5 is essential for your body to properly use ketones for fuel, and we have found emphasizing it to be helpful.Carnitine is important on the ketogenic diet for metabolizing/utilizing fats. Animal products like meat, fish, poultry, and milk are the best sources. A variety of protein (including red meat, organ meats, and game) will help optimize carnitine levels. Daily goals:Aim to drink half your body weight (lbs.) in fluid ounces of water each day.Aim for 4-6+ cups of varied and colorful, non-starchy vegetables per day.Choose organic produce whenever possible.Choose grass-fed, free range, antibiotic / hormone free animal products whenever possible.If avoiding dairy, include non-dairy foods that are high in calcium, including almonds, Bok choy, broccoli, dark leafy greens, fish (with bones) and sesame seeds/tahini. Choose calcium-fortified non-dairy milks.When opting for packaged foods, choose the least processed options available (e.g., short ingredient list, natural / recognizable ingredients, minimal preservatives / additives / flavorings / colorings). This table specifies what you can include and exclude as part of your Food Plan. Foods in bold are high in one or more of the Methylation Diet and Lifestyle (MDL) nutrients and adaptogens. Methylation is a foundational metabolic process necessary for healthy cellular function, detoxification, hormone balance. Read more about methylation here. Food Include Exclude Vegetables Choose organic produce whenever possible. Serve raw, steamed, sautéed, blended, or lightly-roasted. Dark leafy greens (min 3 cups/day): Arugula, beet greens, bok choy, collard greens, dandelion greens, kale, mustard greens, parsley, purslane, rainbow / Swiss chard, spinach, turnip greens, watercress. Colored vegetables (as wide a variety as possible): Green: Artichokes, asparagus, bamboo sprouts, broccoli, broccoli rabe, broccoli sprouts, Brussels sprouts, celery, chives, cucumbers, escarole, green beans, green bell peppers, green cabbage, green cauliflower, green olives, kohlrabi, lettuce (Bibb, endive, green leaf, red leaf, romaine), okra, scallions, tomatillo, zucchini. Red: Radicchio, radish, red bell peppers, rhubarb, tomatoes. Blue/Purple/Black: Black olives, eggplant, purple cabbage, purple cauliflower, purple kale.Orange: Orange bell peppers.Yellow: Summer squash, yellow bell peppers. White/Tan/Brown: Cauliflower, celeriac, daikon radish, garlic, jicama, leeks, mushrooms (shitake and portabella), rutabaga, shallots, sprouts, turnips, water chestnuts. In moderation (up to ? cup total per day): Beets, carrots (purple and orange), onions (red/white), pumpkin, winter squash.Sea vegetables: Seaweed (dulse, kelp, nori, wakame), algae (blue green, chlorella, spirulina).Fermented vegetables: Kimchi, pickles, sauerkraut.Ketogenic: All starchy vegetables including cassava / tapioca / yucca, parsnips, peas, potatoes (blue/purple, fingerling, red, Russet, white, yellow), snow peas, sugar snap peas, sunchoke, sweet corn, sweet potatoes, yams. Animal protein Choose organic/free-range/grass-fed/wild/hormone-free/antibiotic-free/lean products whenever possible. Grass-fed/wild animal products are leaner and have higher omega-3 content. Fish in italics are good low-mercury, high omega-3 choices. Choose eggs that are omega-3 enriched whenever possible.Animals protein is a great source of carnitine.Fish: Low mercury: Anchovies, catfish, flounder, haddock, herring, mackerel (Atlantic), salmon, sardines, sole, tilapia, trout, whitefish.Moderate mercury: Bass (black, striped), carp, cod, halibut (Atlantic, Pacific), mahi mahi, monkfish, sablefish, skate, snapper, tuna (canned chunk light, Skipjack). High mercury (in very limited quantities, 1x per month): Bluefish, Chilean sea bass, grouper, mackerel (Gulf, Spanish), tuna (canned albacore, yellowfin). Shellfish: Crustacea (crab, crawfish, lobster, shrimp), mollusks (clams, mussels, octopus, oysters, scallops, squid). Red meat: Beef, bison / buffalo, elk, goat, lamb, veal, venison.PorkPoultry: Chicken, Cornish hen, duck, pheasant, quail, turkey. Organ meats: Liver, marrow, sweetbread, tongue. Eggs including chicken, duck and goose.Processed meats: Canned meats (except for fish or seafood), cold cuts, frankfurters, sausage. Highest mercury fish: Mackerel (King), marlin, orange roughy, shark, swordfish, tilefish, tuna (Ahi, Bigeye). Vegetable protein Protein powders: Chia, hemp, pea, pumpkin seed, rice. Ketogenic: All legumes including beans (adzuki, black, butter, cannellini, garbanzo / chickpeas, lima beans, mung beans, pinto, navy, red kidney, refried), lentils, peas; hummus.Processed soy products: All soy products, including fermented soy (miso, natto, tamari, tempeh) andnon-fermented soy (soybean oil including in processed foods, soy milk, soy sauce, textured vegetable protein, tofu).Nuts & seeds Choose unsalted/unsweetened nut and seed butters whenever possible. Limit to 2 servings per day.Nuts: Almonds (6-8), Brazil nuts (1), cashews (5-7), coconut (meat or shredded, unsweetened, 3 tbsp.), hazelnuts (6-8), macadamia nuts (10-12), peanuts (5-7), pecans (7-8), pine nuts (2 tbsp.), pistachios (8), walnuts (7-8).Nut butters (1 tbsp.): Almond, cashew, coconut butter/manna, hazelnut, peanut. Nut flours (1/4 cup): Almond, Brazil nut, cashew, chestnut, coconut, hazelnut, macadamia nut, peanut, pecan, pistachio.Seeds (1 tbsp.): Chia, flax, hemp, poppy, pumpkin, sesame, sunflower.Seed butters (1 tbsp.): Hemp, pumpkin, sunflower, tahini (sesame paste). Highly processed nut / seed products: Nut or seed butters made with hydrogenated oils or added sweeteners.Oils Choose cold-pressed, organic, unfiltered oils whenever possible.Low heat (<225 °F, for finishing): Butter, extra virgin olive oil, flax, ghee, hazelnut, macadamia nut, MCT, walnut.Medium heat (~250-350 °F, for sautéing): Butter, coconut, ghee, hazelnut, macadamia nut, pastured animal fats (duck, lard, tallow), olive, sesame.Medium–high heat (~350-425 °F, for roasting, baking and pan / stir frying): Almond, avocado, butter, coconut, ghee, olive, palm, peanut, sunflower.High heat (>425 °F, for broiling and grilling): Avocado, safflower.Highly processed fat products: Hydrogenated fats (in many condiments, packaged goods and fast foods), processed vegetable fats (margarine, shortening), processed vegetable oils (canola, corn, cottonseed, soybean).Fruits Choose organic produce whenever possible. Choose unsweetened whole fruits, either fresh or frozen. Combine with protein/fat for lowered glycemic response.With the exception of avocado, berries, lemons, limes and olives, all fruit should be avoided for the first two weeks. After that, slowly incorporate up to 2 servings of fruit per day, closely monitoring its effect on ketosis.Be mindful of your total amount of net carbs coming from this category.High Fat Fruits: Avocado, Coconut meat, olivesUse in moderation (1/4 cup, 2 servings per day total)1: Aronia berries, blackberries, black raspberries, blueberries, cranberries, currants (red/black), elderberries, lemon, lime, raspberries, strawberriesUse sparingly only once keto adapted ( 1 serving per day): Cherries (5 whole), green kiwi (1/4 cup), guava (1 whole), mango (1/4 cup cut pieces), plum (1/2 cup cut pieces), papaya (1/4 cup cut pieces), pomegranate (1/4 cup). Superfruits (Acai berries (1 cup) , camu camu, Goji berries (2 Tbsp), goldenberries (1 Tbsp), mulberries). Ketogenic1: Green (green apple, green grapes, green pear, melon), red (blood orange, pink/red grapefruit, red apple, red grapes, watermelon), blue/purple/black (Concord grapes, purple grapes), orange (apricots, cantaloupe, clementine, honeydew melon, mandarin, nectarine, orange, peach, persimmon, tangerine), yellow (Asian pear, passionfruit, pineapple, starfruit, yellow apple, yellow watermelon), white / tan / brown (dragon fruit, lychee, pear, white peaches, white nectarines). Higher glycemic fruit including dried fruit (dates, dried currants, figs, prunes, raisins), plantain. Fruit juice.Higher glycemic fruits (in moderation): Banana, dried fruit (dates, dried currants, figs, prunes, raisins, shredded/sweetened coconut), plantain.Highly processed fruit products: Fruit juice, fruit snacks. Grains None.Ketogenic: All gluten-free grains including amaranth, buckwheat, corn, millet, oats, quinoa, rice (basmati, black, brown, red, wild), sorghum, teff; all gluten-containing grains including barley, oats, rye, triticale, wheat (durum, farro, kamut, spelt), wheat products (bulgur, couscous, semolina).Highly refined grains (often in packaged foods): Cakes, cereals, cookies, crackers, dough, instant oatmeal / rice, mixes (desserts, pancakes, waffles, etc.), muffins, packaged snacks, pastries, white bread, white pasta, white rice. Dairy & Dairy substitutes Choose full fat and unsweetened dairy products.Whole milk is a good source of carnitine.Dairy products: Butter, cheese, cream, cream cheese, cultured dairy (cottage cheese, cow’s milk kefir, sour cream, yogurt), ghee, half & half, whey, whipped cream.Non-dairy alternatives (in moderation): Coconut milk kefir, non-dairy unsweetened milk (almond, cashew, coconut, hemp, rice), non-dairy yogurt (almond, cashew, coconut).Ketogenic: Buttermilk, condensed milk, evaporated milk, milk (cow, goat, sheep). Highly processed dairy products: Flavored creamer, frozen desserts (bars, cakes, ice cream, yogurt), powdered milk.Drinks Non-caffeinated herbal teas (chamomile, ginger, hibiscus, jasmine, mint, peppermint, rooibos; hot or cold), vegetable juices, water (mineral, filtered or distilled; still or carbonated).Limit (max daily amount): Alcohol (1 for women or 2 for men x 1.5 oz spirits, up to 2x per week), club soda / seltzer (1 cup per day), green/oolong tea or coffee/black tea (1-2 cups).Ketogenic: Beer, coconut water, wine Highly caloric, high glycemic or caffeinated drinks: Caffeinated tea, coffee drinks, energy drinks, fruit juice, juice drinks, soft drinks, sports drinks.Condiments All spices and herbs (ensure no gluten-containing fillers are added): Allspice, anise, basil, black pepper, cardamom, carob, cayenne, celery seed, chili powder, cilantro, cinnamon, cloves, coriander, cumin, curry, dill, fennel, garlic, ginger (dried and fresh), marjoram, mint, mustard seed, nutmeg, oregano, paprika, parsley, rosemary, sage, salt (preferably Celtic sea salt or Himalayan pink salt), spearmint, tarragon, thyme, turmeric.Sauces: Apple cider vinegar, guacamole, mustard, pico de gallo / salsa (sugar-free). Highly processed sauces: Barbecue sauce, chutney, fruit sauces, horseradish, jam / jelly, ketchup, mayonnaise, pesto, relish, salad dressing, soy sauce, steak sauce, tartar, teriyaki, and other condiments with undesirable additives5.Sweeteners Ideally, eliminate all sweeteners except stevia, erythritol for the first two weeks, after which you can test out the effects of adding back limited caloric sweeteners. In limited quantities: Erythritol / swerve, monk fruit/luo han, stevia.Cocoa/Raw Cacao powder (75% dark, not Dutch Processed).Ketogenic: Agave, blackstrap molasses, brown rice syrup, candy, coconut sugar, dried fruit, fruit juice concentrate, high fructose corn syrup, honey, maple syrup, sugar.Highly processed sweeteners: Artificial sweeteners (acesulfame-K, aspartame, saccharin, sucralose).For Further Resources on Ketogenic DietThe Ketogenic Kitchen (also a book)KetoDietThe Ketogenic Diet by Kristen MancinelliThe Ketogenic and Modified Atkins Diets by Eric Kossoff et alDiet DoctorAuthority NutritionSlenderKitchenWhat to ExpectDietary changes can be a difficult and sometimes confusing process. We’re here to guide you through the changes and give you the support you need to be successful. Some tips and tricks from others who have done this before are:You may use leftovers for the next day’s meal or part of a meal (e.g., leftover cooked salmon and broccoli from dinner) as part of a large salad for lunch the next day.Fat bombs are particularly helpful snacks on a ketogenic diet and there are a variety of flavor profiles available to experiment with; if you use one of these blog recipes, please ensure that the ingredients used match with your food plan listed above. It may be helpful to cook extra protein (e.g., chicken, beef) and vegetables (e.g., green beans, sautéed greens, roasted mushrooms, etc.) that can be reheated for snacking or another meal.Many foods freeze well and can be frozen in individual portions for easy combining and taking “on the go.”Try to plan ahead so that you are not caught out in situations where the only food available does not fit your food plan. Keep suitable snacks on hand and bring meals with you if needed.You may find it useful to invest in portable food containers that keep food cold/hot; choose stainless steel or glass if possible.If eating out, call restaurants ahead of time to discuss suitable menu choices. You’ll likely find that restaurants that cook from scratch with fresh/local ingredients are most able to meet your needs. In our experience, we have found the process of dietary change to be overwhelmingly well tolerated and extremely beneficial. We hope that you will find it useful too. There is really no “typical” or “normal” response. Different responses to dietary change can be attributed to biochemical differences among individuals as well as lifestyle factors. Most often, individuals report increased energy, mental alertness, decreased pain, improved skin conditions, improved metabolic markers (such as fasting glucose, insulin, cholesterol), and a general sense of improved well-being. However, some people report some initial reactions to dietary change, especially in the first week, as their bodies adjust to a different dietary program. Symptoms you may experience in the first week or so can include changes in sleep patterns, fatigue, lightheadedness, headaches, joint or muscle stiffness, and changes in gastrointestinal function. Such symptoms rarely last for more than a few days, so persevere! Always let Dr. Fitzgerald, Dr. Litwin or the nutrition team know if you experience any negative symptoms. ................
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