The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[5]

Ketone bodies, acetoacetate, and β-hydroxybutyrate (βOHB), are byproducts of fatty acid oxidation in the mitochondrial matrix of the hepatocytes. There are many theories about the role of KB, but the existence of an anticonvulsant effect is controversial. Some authors have found no relationship between KB and synaptic transmission and seizure control.
The ketogenic diet for epilepsy (KDE) was developed in the 1920s by Dr. Hugh Conklin in Michigan. But once effective medications were developed, the diet was used less frequently. It has regained recognition and study and is now a standard backup plan for children whose epilepsy symptoms are difficult to control with medication. With over 300,000 children in the U.S. with seizure disorders, this has become an important addition to the arsenal of treatments for epilepsy. Researchers are beginning to see how it might help adults and people with a variety of neurologic disorders.
As the Atkins diet makes abundantly clear, problem foods like gluten and dairy can slip into the strictest low-carb or keto plans. I often see patients "doing keto" with massive amounts of cheese or processed meats full of fillers, which is a terrible idea. These potential top food sensitivities increase inflammation and create problems with gut permeability, leading to leaky gut syndrome.
Lazy keto diet: Last but not least, the Lazy keto diet often gets confused with dirty keto … but they’re different, as the “lazy” refers to simply not carefully tracking the fat and protein macros (or calories, for that matter). Meanwhile, the one aspect that remains strict? Not eating over 20 net carb grams per day. Some people find this version less intimidating to start with or end with … but I will caution that your results will be less impressive.
Clinical improvement was observed in Alzheimer’s patients fed a ketogenic diet, and this was marked by improved mitochondrial function. (15) In fact, a European Journal of Clinical Nutrition study pointed to emerging data that suggested the therapeutic use of ketogenic diets for multiple neurological disorders beyond epilepsy and Alzheimer’s, including headaches, neurotrauma, Parkinson’s disease, sleep disorders, brain cancer, autism and multiple sclerosis. (16)
Check the nutrition labels on all your products to see if they’re high in carbs. There are hidden carbs in the unlikeliest of places (like ketchup and canned soups). Try to avoid buying products with dozens of incomprehensible ingredients. Less is usually healthier.Always check the serving sizes against the carb counts. Manufacturers can sometimes recommend inconceivably small serving sizes to seemingly reduce calorie and carb numbers.
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.

Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions.[19] Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.[18]
What an excellent and helpful article! I had great cholesterol numbers before starting Keto and now my cholesterol is high. My HDL is good and my Triglycerides are low, but my LDL is high. I'm really questioning what I'm doing. I do experience many benefits of Keto, but I have a family history of heart disease and I'm worried and confused. Unfortunately my doctor is no use. She just says follow a Mediteranean Diet. End of story. Or go on Statins, which I would never do. Thanks to your article, I have some new resources to research.
A side benefit of the diet is that many parents say their children are more alert and make more progress when on the diet, even if seizures continue. If the diet seems to be helping, doctors will usually prescribe it for about two years. Then, they may suggest that parents slowly begin including regular food in the child’s diet to see if the seizures can still be controlled, even with a normal diet.
There are thousands of people out there who have healed cancer naturally. I meet natural survivors constantly and even share their stories on this site. Most natural cancer healing protocols involve a radical change of diet and lifestyle that includes “overdosing on nutrition” with juicing, lots of raw plant food, little to no animal food, supplements, and herbal cleanses along with detox protocols. Those are all time-tested methods validated by a large body of long-term survivors.
This week we’re introducing a slight fast. We’re going to get full on fats in the morning and fast all the way until dinner time. Not only are there a myriad of health benefits to this, it’s also easier on our eating schedule (and cooking schedule). I suggest eating (rather, drinking) your breakfast at 7am and then eating dinner at 7pm. Keeping 12 hours between your 2 meals. This will help put your body into a fasted state.
The ketogenic diet can reduce the frequency of seizures. In clinical trials of people with treatment-resistant epilepsy — meaning they’ve tried a number of antiepileptic medications and continued to experience seizures — the ketogenic diet typically reduces the number of seizures by 50 percent or more in half of patients. The number of patients that will go on to become seizure-free after adopting a ketogenic diet is much smaller — some studies say it’s as low as 0 percent of patients and in others it’s closer to 20 percent.
In part, keto diet weight loss is a real thing because high-fat, low-carb diets can both help diminish hunger and boost weight loss through their hormonal effects. As described above, when we eat very little foods that supply us with carbohydrates, we release less insulin. With lower insulin levels, the body doesn’t store extra energy in the form of fat for later use, and instead is able to reach into existing fat stores for energy.
The "classic" ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. It is prescribed by a physician and carefully monitored by a dietitian. It is usually used in children with seizures that do not respond to medications. It is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. Foods are weighed and measured.
How ketosis helps with epilepsy isn't known, but it does. Researchers at Johns Hopkins University studied 150 children with epilepsy in one important study. After a year on the ketogenic diet, half of children had 50% fewer seizures. One fourth of the children reduced their seizures by 90%. After a few years on the diet, many of these children no longer needed medications at all.
If you have a history of hypothyroid issues, you may also struggle with unhealthy cholesterol levels as well — and the keto diet can make them even worse. However, for those of you who are being treated for your hypothyroid condition or who have an autoimmune thyroid condition, you may be able to follow the keto diet without any problems. In fact, many keto dieters with autoimmune thyroid conditions have found that the keto way of eating improved their quality of life more than any other diet.
Unfortunately, there’s no long-term data on ketogenic diets versus other diets. In a 2015 Italian study, those on a ketosis diet lost 26 pounds in three months. About half of the participants stayed on the diet for a year but lost little additional weight in the next nine months. People in a 2014 Spanish study who followed a very-low-calorie ketogenic diet lost an average of 44 pounds in a year—but a third of them dropped out, possibly because it was too hard to maintain.
The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[43] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[19] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]
Regardless of the efficacy of the KD, most patients discontinue the diet because of its unpalatable and restrictive features. In the last 20 years, new variants of the KD diet have emerged, including the Modified Atkins diet (MAD), a low-glycemic-index diet, which although it has a high fat content, allows more protein and does not restrict calories and fluids. Several studies have shown that the new variants of the KD have a similar efficacy to the CKD (Kossoff et al., 2006; Tonekaboni et al., 2010; Coppola et al., 2011; Miranda et al., 2012; El-Rashidy et al., 2013). As presently understood, the KD is involved in multiple mechanisms responsible for biochemical alterations, including cellular substrates and mediators responsible for neuronal hyperexcitability. However, it is not yet known with certainty whether the success of the KD is due to a single or several mechanisms (Bough and Rho, 2007; Lutas and Yellen, 2013; Rho, 2017; Youngson et al., 2017).
“Your liver produces ketones all the time, but the rate depends on carbohydrate and protein intake,” says Jeff Volek, Ph.D., R.D., a professor of human sciences at Ohio State University. When the majority of your diet is made up of of carbs and protein, ketogenesis slows. Replacing carbs and protein with fat will put your body into ketosis, thus ramping up ketone production. This takes about three days to induce.
All of this talk about energy metabolism leads us to another important finding in the cancer literature: healthy cells can also become cancerous if their mitochondria (the primary energy producer of the cell) is dysfunctional for an extended period of time. Furthermore, if the cell is already cancerous, the mitochondrial dysfunction will make the cell’s genes vulnerable to additional mutations.
7. Raygan, F., Bahmani, F., Kouchaki, E., Aghadavod, E., Sharifi, S., Akbari, E., . . . Asemi, Z. (2016). Comparative effects of carbohydrate versus fat restriction on metabolic profiles, biomarkers of inflammation and oxidative stress in overweight patients with Type 2 diabetic and coronary heart disease: A randomized clinical trial. PMID: 28607566
Insulin is a hormone that lets your body use or store sugar as fuel. Ketogenic diets make you burn through this fuel quickly, so you don’t need to store it. This means your body needs -- and makes -- less insulin. Those lower levels may help protect you against some kinds of cancer or even slow the growth of cancer cells. More research is needed on this, though.
The ketogenic diet appears to enhance mitochondrial function via a number of potential pathways. Given the important role of mitochondrial dysfunction in many neurodegenerative diseases, it is important to outline potential mechanisms of apparent disease-modifying effects of the ketogenic diet. It is unclear whether there is something specific or direct about the ketogenic diet (ie, provision of ketone bodies or fatty acids) or, perhaps more importantly, the metabolic changes it induces.
The end result of the “ketone diet” is staying fueled off of circulating high ketones (which are also sometimes called ketone bodies) — which is what’s responsible for altering your metabolism in a way that some people like to say turns you into a “fat-burning machine.” Both in terms of how it feels physically and mentally, along with the impact it has on the body, being in ketosis is very different than a “glycolytic state,” where blood glucose (sugar) serves as the body’s energy source.
The ketogenic diet is consistently reduced in carbohydrates, adequate in protein, and high in fat which mimics this fasting state and also produce ketones. Ketones are an indicator of an important metabolic change but alone cannot explain the anti-seizure effect. Researchers are studying additional mechanisms of action to better explain why this diet reduces seizures.
In its 2016 report “Healthy Eating Guidelines & Weight Loss Advice,” the Public Health Collaboration, a U.K. nonprofit, evaluated evidence on low-carbohydrate, high-fat diets. (The Keto diet falls under the LCHF umbrella.) Among 53 randomized clinical trials comparing LCHF diets to calorie-counting, low-fat diets, a majority of studies showed greater weight loss for the Keto-type diets, along with more beneficial health outcomes. The collaboration recommends weight-loss guidelines that include a low-carbohydrate, high-fat diet of real (rather than processed) foods as an acceptable, effective and safe approach.
Leigh Tracy, RD, a dietitian and certified diabetes educator at The Center for Endocrinology at Mercy Medical Center in Baltimore, also advised people to remember that the study did not focus on whether or not the keto diet prevented or inhibited cancer growth — only on changes to the body including the fact that the diet reduced that patients’ central body fat, improved insulin levels, and improved lean body mass.
To identify which genes might be involved, the researchers used microarray "gene chips" to examine changes in gene expression for more than 7,000 rat genes simultaneously. They focused on the hippocampus, a region of the brain known to play an important role in many kinds of epilepsies. More than 500 of the genes they examined were correlated with treatment with the KD. The most striking finding was the coordinated up-regulation of genes involved in energy metabolism. 

Duchess was diagnosed with cancer in her right anal gland. When the cancer was removed it had spread to her left anal gland and was attached to her bowels. She was given 3 months to live. Since then I have had 2 vets check her glands and have had complete physical. She has a clean bill of health. I am so grateful to you. We are going to start on a maintenance program. I tell everyone how she has done. Thanks
Teens and young adults who are becoming more independent often find the ketogenic diet too difficult to follow. Dietary options for epilepsy have expanded in recent years to include the modified Atkins diet and the low-glycemic index treatment diet. The latter diet does not necessarily cause ketosis, and may instead curb seizures by lowering glucose levels in the blood and possibly in brain cells.
I am a board-certified medical oncologist with 30 years experience in caring for cancer patients and another 20 years of research in cancer medicine dating back to 1963. Seyfried’s “Cancer as a Metabolic Disease” is the most significant book I have read in my 50 years in this field. It should be required reading of all cancer specialists, physicians in general, scientific researchers in the field of cancer and for medical students. I cannot overstate what a valuable contribution Thomas Seyfried has made in writing this masterpiece.

A: The most common ways to track your carbs is through MyFitnessPal and their mobile app. You cannot track net carbs on the app, although you can track your total carb intake and your total fiber intake. To get your net carbs, just subtract your total fiber intake from your total carb intake. I have written an article on How to Track Carbs on MyFitnessPal.
Keto flu symptoms and side effects can include feeling tired, having difficulty sleeping, digestive issues like constipation, weakness during workouts, being moody, losing libido and having bad breath. Fortunately, these side effects don’t affect everyone and often only last for 1–2 weeks. (And yes, you CAN build muscle on keto.) Overall, symptoms go away as your body adjusts to being in ketosis.
Feldman’s theory about why this happens is based on research he’s conducted on himself and hundreds of other low-carbers over the past two years. He states that the higher energy demands, lower body fat stores, and lower glycogen stores in these LMHRs trigger the liver to increase production of lipoprotein particles so that triglycerides (fat) can be transported to cells for use as fuel. Since cholesterol travels along with the triglycerides, blood cholesterol levels rise as the liver pumps out more lipoproteins to keep up with the body’s energy demands.
Ketogenic diets are low-carbohydrate, high-fat diets that alter the body's metabolism to produce ketones, which puts the patient into a state called ketosis. The state of ketosis has been linked to reduced seizure frequency in some adults with epilepsy. Studies have shown that approximately 50 percent of patients on this diet experience a 50 percent or greater reduction in seizures.
In my book "Fat for Fuel," I sought to educate readers about the benefits of using healthy fats as a catalyst to bring about improved mitochondrial function, thus allowing you to achieve better health. In essence, the book answers WHY it is important for you to consume healthy fats. However, you still need to know HOW to prepare the right ketogenic foods in an appetizing way.

The low glycaemic index treatment (LGIT)[49] is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[5] Although it is also a high-fat diet (with approximately 60% calories from fat),[5] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[18] However, the types of carbohydrates consumed are restricted to those that have a glycaemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]
If you have chronic inflammation and/or stress, you may also have persisting high cholesterol levels which, in most cases, isn’t doing anything but causing more problems. The preponderance of this chronic inflammation and stress is typically caused by a variety of lifestyle factors, from eating foods that trigger inflammation to sleeping poorly. [27]
In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[54]

Spices are an easy way of adding more flavor, vitamins and antioxidants into your food. Furthermore, they are low in carbohydrates. Make sure that you're using fresh, organic spices for maximum flavor and nutrients. Some spices sold in packets found at the local grocery should not be used, as they often contain fillers that can increase your carbohydrate consumption, thus putting you out of ketosis.26
Because epilepsy is a metabolic disease (Clanton et al., 2017), interest in studies of alterations of metabolism by anticonvulsants such as the KD has increased, as has their importance for the treatment of drug-resistant epilepsy. This contribution reviews the use and effects of the KD and its variants for the treatment of adults and children with intractable epilepsy.
The diet is also effective for children with infantile spasms. For this condition, about 70% of children will have seizure reduction with 35% becoming seizure-free. There has been one study using the ketogenic diet as initial treatment for infantile spasms. At the end of 1 month, 8 of 13 (62 percent) infants were seizure-free. Time to spasm freedom was 6.5 days, suggesting that, if the ketogenic diet is used as initial treatment, a 2-week trial period is sufficient to judge efficacy for infantile spasms.
Weight Loss – Part of the resurgence in interest in the ketogenic diet is due to the work of Dr. Atkins and his low-carb diet for weight loss. There is strong evidence to support the use of a ketogenic diet as a weight loss therapy.18 19 People following a low-carb diet tend to lose more weight in the first 3-6 months than those following a more traditional diet.20 Part of the benefit likely comes from the fact that ketogenic diets tend to suppress appetite and lead to a natural decrease in calorie intake.21 But even in studies where participants on a low carb diet ate the same number of calories per day as those on a lowfat diet, significant differences in weight loss were observed.22 This is likely due to the fact that ketosis relies on fat from the diet and body fat to produce ketones for energy.

If you need to eat more or fewer calories per day, you can adjust accordingly by simply taking out or adding a bit more of the ingredients already included in a recipe. For example, adding/removing a tablespoon of olive oil or butter will add/remove about 100 calories. If you like or dislike certain recipes, feel free to shift things around. Make sure to keep an eye on the calories so you’re still falling within an acceptable range of your daily goal.


Normal dietary fat contains mostly long-chain triglycerides (LCTs). Medium-chain triglycerides (MCTs) are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[18] leading to more food choices and larger portion sizes.[4] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[15] Consuming that quantity of MCT oil caused abdominal cramps, diarrhea, and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[18]
A more recent clinical trial comparing a ketogenic diet (33.5% protein, 56% fat, 9.6% carbohydrate) to a low-fat diet (22% protein, 25% fat,55.7% carbohydrate) among 55 obese adults, showed that the ketogenic diet resulted in improved cholesterol levels compared to the low-fat diet. More specifically, the group following the ketogenic diet reported higher increases in HDL cholesterol and higher decreases in triglyceride levels compared to the control group (15).
A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as maltodextrin, sorbitol, starch, and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]
High levels of triglycerides in the blood are thought to be a sign of poor metabolism. Poor metabolism, or metabolic disorders, are associated with obesity, diabetes, heart disease and cancer. Often times, elevated triglycerides are a byproduct of insulin resistance. In these cases, a ketogenic diet is an excellent strategy to improve those numbers.
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