Overall, 12 studies including 1257 patients examined the impact of a VLCKD on HDL cholesterol. When assessing the data, the individuals assigned to a VLCKD achieved an average increase in HDL of 0.12 mmol/L. This was double the average increase in HDL of the low-fat dieters who achieved an average increase in HDL of 0.06 mmol/L. [11] As a result, the authors concluded that carbohydrate-restricted diets confer cardiovascular benefits because they improve levels on HDL in the body. [11]
One study assessed the effect of dietary interventions on quality of life, cognition and behavioural functioning, reporting participants in the KD group to be more active, more productive and less anxious after four months, compared to the control group. However, no significant difference was found in quality‐adjusted life years (QALYs) between the KD group and control group at four or 16 months (GRADE rating very low).
After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]
Uh, no. Not exactly. Preclinical experiments are intriguing but fairly limited in applicability, and the case reports demonstrate nothing of the sort. There’s more to Dr. Seyfried’s hypothesis, for example, his idea that metastatic cancer comes about because of alterations in glutamine metabolism, but unfortunately he appears to misunderstand the genetics of metastasis when he bases part of his conclusion on observations that metastatic cancers often have the same genetic derangements as the primary tumor. It’s been a longstanding question whether clones of tumor cells possess the ability to metastasize as an intrinsic part of the process of becoming cancer cells or whether they acquire it later. Given that evolution is a major force driving cancer cells to become more invasive and that tumors are very heterogeneous, full of lots of different clones with different sets of genetic mutations, Dr. Seyfried’s hypothesis is at best simplistic. Also disappointingly, the evidence for any diet as a treatment for cancer is weak at best.

In my opinion, Bob Atkins knew more about the theory and practice of the ketogenic diet, its benefits and limitations, including as applied to cancer patients, than anyone in the history of medicine. For him, the concept was hardly the musings of a PhD laboratory scientist, but the practical observations of a physician who treated thousands of patients over decades. And for cancer, the ketogenic diet just did not seem to work.
But what surprised me – and what began to concern others I knew in the medical community – was some time later the deafening silence about the trial’s outcome, and what seemed to be a blackout about the actual data. Eventually, the study results were published indicating that 42 subjects had been ultimately recruited for the trial, not the planned 70, and not a single one of these had responded to the drug.
Our normal healthy cells, be they situated in the brain or the skin of our feet, do prefer glucose as their primary energy source, obtained from the sugar circulating in the blood. That “blood sugar” comes from a variety of sources, including dietary carbohydrates occurring in fruits, starchy vegetables like potatoes, and grains. The complex carbohydrates in such foods are broken down into glucose during the digestive process, catalyzed by a variety of carb-specific enzymes like amylase.

Cyclical ketogenic diet (CKD): If you find it difficult to stick to a very low-carb diet every day, especially for months on end, you might want to consider a carb-cycling diet instead. Carb cycling increases carbohydrate intake (and sometimes calories in general) only at the right time and in the right amounts, usually about 1–2 times per week (such as on weekends).
Jimmy Moore: That’s a loaded question and we could probably go 3 hours just on that but I’ll give you the nut shell. Most medical professionals have been taught to look at 2 primary numbers on your cholesterol panel. Total cholesterol, and this number called LDLC, which is your LDL cholesterol that you’ve heard about. You’ve heard LDL is bad and you’ve heard if you’re total cholesterol level is over 200, oh my god you are at great risk for heart disease. Exactly.
By the way, the relative heaviness of stored glycogen is why many people report fast weight loss on a ketogenic or low-carb diet: their body has dumped a little extra weight in the form of glycogen and water (which tags along with glycogen in a 3 parts water to 1 part glycogen ratio). Unfortunately, this water and glycogen comes right back once we start eating normally again.
Chapter 4 mentions specific issues related to use of a ketogenic diet in cancer treatment. It discusses goals, benefits, potential side effects, and monitoring progress of treatment. Chapter 5 discusses the details of planning a ketogenic diet, including the contribution of the macronutrients plus a section on fasting and intermittent fasting. The section on macronutrients includes definitions of saturated, monounsaturated, and polyunsaturated fats. This book’s acknowledgment of the importance of the inflammatory properties of omega-6 fatty acids and advice that the omega-6 and omega-3 in the diet should be balanced are worthy of note. To our knowledge, there are no popular diet books that mention the nutritional requirements for essential fatty acids. Imbalances in the ratio of omega-6 to omega-3 could negate the benefits of a ketogenic diet.
If your LDL cholesterol has significantly increased on a keto or low-carb diet, it's completely understandable if you're at least somewhat concerned. However, you might be reluctant to make any changes to your diet given the benefits you've experienced. On the other hand, you may decide that you want to try to lower your LDL values while still following a keto/low-carb lifestyle.

In my previous articles, I discussed my friend, the late Dr. Robert Atkins, the famed diet doctor, who long before Dr. Seyfried appeared on the scene hoped his “ketogenic” diet might be an answer to cancer. During the late 1980s and right through most of the 1990s, Dr. Atkins treated hundreds of cancer patients, many, though not all, with a ketogenic diet, along with a variety of supplements and intravenous vitamin C.


Bob, who knew Stefansson’s work well, told me during more than one dinner together in the late 1980s that the ketogenic diet might represent the ultimate solution to cancer. He thought, as Donaldson and Stefansson had claimed before him, that all humans should be following a ketogenic diet to achieve ultimate ideal health. But were they right? Or was there another, perhaps more accurate way, to look at the human dietary condition?
Its hard to find any information about hyper responders, even harder for me as my total cholestorl levels increased extremely after I went on the keto diet, from an already high 5mmol/dL to extremely high (14mmol/dL or 538mg) which is unheard of, even in the many hyper responder cases I've studied. But my HDL increased to 2.7mmol and my trigicerides stayed the same at good 0.9. Nobody 've seen has such a high total cholestrol. Even as i research how cholestrol doesn't have much link to heart disease mortality, there's no research on anything as high as my case.
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
Of course, we know that genes alone are not responsible for cancer because we share many of the same genes as our hunter–gatherer ancestors and even just the same genes as our ancestors several generations ago, and yet the rate of cancer keeps going up. It’s expected to overtake cardiovascular disease as the number one cause of death in the U.S. fairly soon, and so that can’t be explained by genes alone.
I’m not going to shell out 20k to know my LDL-P. I’d rather assume that I’m part of the 30% who reacts to saturated fat with elevated LDL-P. Should I be worried, considering all my other markers point to the right direction? Expert after expert say that we don’t know what these mixed signals mean until there is a study of people doing low-carb high-fat diets, correlating their lipid profiles with incidence of cardiovascular disease.

Dr. Campos, it is unfortunate that you retain the medical community’s negative stance on the ketogenic diet, probably picked up in medical school when you studied ketoacidosis, in the midst of an obesity and type II diabetes epidemic that is growing every year, especially among populations who will never see the Harvard Health Letter. The medical community has failed in reversing this trend, especially among children, and the public is picking up the tab, in the form of higher health insurance premiums to treat chronic metabolic diseases which doctors cannot cure. The ketogenic diet does not bid its adherents to eat unhealthy processed meats, and the green leafy vegetables that it emphasizes are important in a number of nutritional deficiencies. People lose weight on the ketogenic diet, they lose their craving for sugar, they feel more satiety, they may become less depressed, their insulin receptors sensitivity is improved, and these are all the good outcomes you fail to mention. There is a growing body of research which demonstrates the neuroprotective effects of the ketogenic diet to slow cancer progression, as well as diseases like Parkinson’s and Alzheimer’s, for which there are no effective medical treatments. Please respect your patients by providing them with evidence-based medical outcomes, not opinions.
To make sure the diet is nutritionally balanced, an experienced dietitian works out exactly how much of which foods the person can eat each day. To help with this, people have individual recipes, are given support on how to plan meals, and are guided on which foods should be avoided. As the diet can be quite restrictive, the dietitian will recommend any vitamin and mineral supplements that are needed.
Ketogenesis has existed as long as humans have. If you eat a very low amount of carbohydrates, you starve your brain of glucose, its main fuel source. Your body still needs fuel to function, so it taps into your reserve of ketones, which are compounds the liver creates from fat when blood insulin is low. This process is known as ketosis: It’s like when a hybrid car runs out of gas and reverts to pure electricity.
Kidney stones have occurred in about 6 percent of patients and may be increased in younger patients (<3 years of age), and those with hypercalciuria and low urine volume. Oral potassium citrate as a preventative supplement results in urine alkalinization, decreasing the prevalence of kidney stones. Universal supplementation appears to drop the risk of stones to nearly zero.
There are indications that the way the ketogenic diet produces “ketones”, or the “ketogenic effect”, is being studied in order to produce pharmaceutical products (drugs or vaccines) that can mimic the same effect. With years of experience now documented in using the ketogenic diet with children suffering from seizures, one of the most common complaints is that the diet is difficult to adhere to, as the child has to abstain from refined carbohydrates and typical childhood sweets such as cakes and candies.  The reasoning is that a drug would make life more bearable instead of following such a strict diet.
In contrast, some pathologies are considered contra-indicated for KD. Absolute contraindications have been described and summarized by Kossoff et al. (2018) (Table 3). The surgical epilepsies, whenever the patient or caregivers are having difficulty maintaining compliance with the diet, are relative contra-indications for KD (Table 4) (Kossoff et al., 2018).
Leanne Vogel has experienced success in using her recipes and keto-based diet. It works with her lifestyle but there are no assurances or representations of any kind made by Leanne Vogel or Healthful Pursuit Inc. that you will attain any success in using the same recipes or adopting a keto-based diet. Healthful Pursuit provides information in respect to healthy living, recipes, nutrition, and diet and is intended for informational purposes only. The information provided is not a substitute for medical advice, diagnosis, or treatment nor is it to be construed as such. We cannot guarantee that the information provided by Healthful Pursuit reflects the most up-to-date medical research. Information is provided without any representations or warranties of any kind. Please consult a qualified physician for medical advice, and always seek the advice of a qualified healthcare provider with any questions you may have regarding your health and nutrition program.
On a “normal” American diet, carbohydrate intake is high (about 40-60% of calories) while fat intake, and especially saturated fat, is limited. In contrast, carbohydrate intake on a keto diet is only about 2-4% of calories. When carb intake is low, meals are delicious and satiating. Hunger goes away, and more importantly, this dietary change has some powerful and beneficial metabolic effects on the human body, in part because it lowers blood sugar and insulin levels. 
Interventions with keto diet have proven their effects on plasma lipoproteins both in short-time and long-term studies and among adults with various characteristics, such as age, body mass, gender, type of disease. Moreover, ketogenic diets result in weight loss and fight obesity, one of the main risks of high cholesterol. Therefore, keto diet could eventually decrease the risk of cardiovascular diseases.
One potential confounder of ketogenic diet studies is another direct effect of the diet—increased levels of fatty acids. Dietary supplementation of essential fatty acids can improve cognitive dysfunction, including in patients with AD [44, Class II]. This suggests that something other than ketone bodies (in this case, essential fatty acids) may have beneficial effects in neurodegenerative diseases. Essential fatty acids may have a beneficial effect on learning in rodent models, raising the possibility that they may have neuromodulatory properties of their own [45,46]. 

By the way, the relative heaviness of stored glycogen is why many people report fast weight loss on a ketogenic or low-carb diet: their body has dumped a little extra weight in the form of glycogen and water (which tags along with glycogen in a 3 parts water to 1 part glycogen ratio). Unfortunately, this water and glycogen comes right back once we start eating normally again.
One way to tell if the keto diet may not be ideal for you is if your total-to-HDL cholesterol ratio is above 4 and/or your LDL-P remain high or increase after starting the keto diet. If this is the case for you, then it may indicate that you have a particular condition that requires you to make adjustments to your keto diet or follow a completely different diet altogehter. [27]
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.
Carbohydrates have been linked to this skin condition, so cutting down on them may help. And the drop in insulin that a ketogenic diet can trigger may also help stop acne breakouts. (Insulin can cause your body to make other hormones that bring on outbreaks.) Still, more research is needed to determine exactly how much effect, if any, the diet actually has on acne. 

I enjoyed reading this book. The book takes you from the fact that cancer cells addict glucose to why and how ketogenic diet (low carbohydrate high fat diet) can help to fight and cure cancer. It also helps patients to customize their diet and provides cooking techniques. As I lost my uncle due to cancer, I felt Ellen Davis words "I wish with all my heart that I had known then what I know now"

We’re also going to keep it simple here. Most of the time, it’ll be salad and meat, slathered in high fat dressings and calling it a day. We don’t want to get too rowdy here. You can use leftover meat from previous nights or use easy accessible canned chicken/fish. If you do use canned meats, try to read the labels and get the one that uses the least (or no) additives!
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. Some evidence of synergistic benefits is seen when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[18]

Meat – like grass-fed selections – and fresh veggies are more expensive than most processed or fast foods. What you spend on Keto-friendly foods will vary with your choices of protein source and quality. You can select less-expensive, leaner cuts of meat and fatten them up with some oil. Buying less-exotic, in-season veggies will help keep you within budget.

To date, evidence from randomized controlled clinical trials is lacking, but needed, to answer the question of whether an adjuvant KD would benefit specific cancer patients. Human data pertaining to KDs and cancer are mostly based on single case reports and a smattering of preliminary clinical studies with small study cohorts, heterogenous study designs, poor compliance to the diet, noncomparable regimens, or without standardized dietary guidance. Even so, results of the first clinical studies support the hypothesis of an anti-tumor effect of KDs. For example, 10 of the 24 (42%) clinical studies included in a recent review [1] provide evidence for the anti-tumor effect of KDs, whereas seven (29%) showed no effect and only one study reported a pro-tumor effect of the KD. The currently available medical literature presents strong scientific evidence for the safe application of a KD only in patients with glioblastoma. However, a clear recommendation for adjuvant use of the KD in glioblastoma patients still requires results from ongoing randomized controlled clinical trials.

Because people with type 2 diabetes are at an increased risk for cardiovascular disease, there’s a specific concern that the saturated fat in the diet may drive up LDL, or “bad,” cholesterol levels, and further increase the odds of heart problems. If you have type 2 diabetes, talk to your doctor before attempting a ketogenic diet. They may recommend a different weight-loss diet for you, like a reduced-calorie diet, to manage diabetes. Those with epilepsy should also consult their doctor before using this as part of their treatment plan.


Leanne: Yeah totally, chill out. Do a little meditation if you need to get into the zone. Exactly. You mentioned vegetable oils causing inflammation, are there specific fats that will help us, like we’ve talked a little bit about saturated fats, we all know trans fats don’t even go there … the mono poly saturated, unsaturated, is there a certain ratio that we should be aiming for. I know you’re the guy that will just slice off butter and eat it … I am too, a little bit of Himalayan rock salt on there never hurt anyone. Are there specific facts that we should be focusing on?
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