In the present study, 83 obese patients (39 men and 44 women) with a body mass index greater than 35 kg/m(2), and high glucose and cholesterol levels were selected. The body weight, body mass index, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, fasting blood sugar, urea and creatinine levels were determined before and after the administration of the ketogenic diet. Changes in these parameters were monitored after eight, 16 and 24 weeks of treatment.

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.
As you might suspect, this metabolic theory of cancers is controversial in the mainstream cancer paradigm, but there’s already promising initial evidence to support it, and most traditional cancer specialists concede that this metabolic theory has merit, and it may be a piece of the puzzle. I would say that the dominant paradigm idea right now is that metabolic dysfunction is likely one of the pieces of the puzzle, but that cancer is multifactorial and probably does involve genetic mutations that may be independent of metabolic dysfunction and that there are other causes that may not be directly related to metabolic dysfunction.
It’s understandable that you may be wondering how to sort out the facts and interpret the latest research. Who is a good candidate for keto, and who should avoid it? How does someone successfully adhere to a ketogenic diet? In this article, I’ll answer these important questions and others so you can make an educated decision about whether keto is right for you.
Contemporary researchers like Dr. Thomas Seyfried and Dominic D’Agostino have argued that this dysregulated cellular energy production, or cellular metabolism, is actually what induces malignancy and that by extension, if we limit the fuels available for this process of fermentation, and the fuels are glucose, which is derived from carbohydrate in the diet, and glutamine, which is derived from protein in the diet, then we can actually starve cancer cells and either improve the results of conventional treatment or perhaps even address some cancers independently without conventional treatment.

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]
Thank you, Dr. Jockers. I really appreciate your reply. I was wondering if insulin resistance would make my cholesterol go up on the ketogenic diet from a total of 220 before I went on it to 378 after being on it for six months. I have always been in a healthy weight range for my height, but I have always been extremely hungry most of the time. I really got on the ketogenic diet hoping that this would be regulated after being on it for some time, but it hasn’t helped that much. Would this signify that insulin resistance may be the culprit for my sudden rise in cholesterol even though I am following the ketogenic diet perfectly?

The keto diet (also known as ketogenic diet, low carb diet and LCHF diet) is a low carbohydrate, high fat diet. Maintaining this diet is a great tool for weight loss. More importantly though, according to an increasing number of studies, it helps reduce risk factors for diabetes, heart diseases, stroke, Alzheimer’s, epilepsy, and more1-6.On the keto diet, your body enters a metabolic state called ketosis. While in ketosis your body is using ketone bodies for energy instead of glucose. Ketone bodies are derived from fat and are a much more stable, steady source of energy than glucose, which is derived from carbohydrates.


Animal research indicates that a ketogenic diet reduces levels of brain amyloid-beta, a misfolded protein that contributes to Alzheimer’s disease, while also restoring mitochondrial function and improving learning and memory. (18, 19, 20) Although fewer studies on a ketogenic diet have been done in humans with Alzheimer’s disease, a recent trial found a ketogenic diet to be both safe and effective for mild Alzheimer’s disease. (21)
An overwhelming majority (90%) of parents said that they would. Even though the keto diet is extremely restrictive, time consuming, and requires rigid maintenance, most parents found the potential benefits outweighed its drawbacks. Many parents in the study were more concerned about the side effects of the medications―and were grateful for the opportunity to explore an alternative option. Further, 55% would consider trying the diet again.
In both patients, levels of blood glucose decreased to low/normal levels and ketones increased by 20 to 30 times within seven days of starting the ketogenic diet.  Results from scans indicated that there was a 21.8% decrease in glucose uptake at the tumor sites in both subjects. Lower glucose uptake is a strong indicator that a tumor is shrinking in size.
Although the ketogenic diet has been around for a long time and may be efficacious in many medical conditions, there is a surprising dearth of long-term studies on its safety. The bulk of the information comes from children using a ketogenic diet for epilepsy. Negative effects seen in children on a ketogenic diet long-term (≥2 years) are poor growth (while on the diet), kidney stones, and dyslipidemia (elevated cholesterol and/or triglycerides). Many of these effects can be overcome with careful attention to mineral intake while on the diet and/or termination of the diet.52 Most long-term studies evaluating adults using a ketogenic diet for weight loss have found very few serious adverse effects.53 54 55 56 However it should be noted that these studies only looked at one year duration on the diet, and poor adherence to the diet was frequently noted as a problem.
Now, in this view, it’s the mitochondria that are particularly to blame for cancer, and there are studies in the ’70s and ’80s that support this. They showed that if you transfer the cytoplasm, which is where the mitochondria is, from a healthy cell into a cell that has the potential to develop cancer, that potential is suppressed, or that tendency to develop cancer is suppressed in that cell. On the other hand, if you transfer the nucleus of a malignant cell into the cytoplasm, which, again, is where the mitochondria is, of a healthy cell, then the tumor potential of that initially malignant cell is inhibited. Both of these lines of evidence suggest that the issue may be with the mitochondria or the cytoplasm of the cell rather than the cell nucleus, which is what the traditional view of cancer is.
Dave Feldman recently demonstrated that increasing net carb intake from 30 grams to 95 grams per day – (going from 4% of total calories to 13% of total calories) led to a significant drop in his LDL cholesterol level. Obviously, this level of carb intake isn't ketogenic; however, it is still moderately low carb. On the other hand, this will likely increase your blood sugar and insulin levels to some extent.
^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.
Since my numbers were high my doc ordered a calcium scoring test which shows some mild calcium increase in my lower depending artery which is not normal for a female of my age and health.  Initially he wanted me to abandon the diet and follow a Mediterranean low fat diet.  I suggested I eat more monounsaturated fats but stay on the low carb diet and he agreed. I have seen a great deal of benefit from the low carb diet and am unwilling to give it up at this time.
Within 7 days of initiating the ketogenic diet, blood glucose levels declined to low-normal levels and blood ketones were elevated twenty to thirty fold. Results of PET scans indicated a 21.8% average decrease in glucose uptake at the tumor site in both subjects. One patient exhibited significant clinical improvements in mood and new skill development during the study. She continued the ketogenic diet for an additional twelve months, remaining free of disease progression.
Jimmy Moore: Saturated fats are like butter and coconut oil, there’s actually more saturated fat in coconut oil than butter. People don’t realize that coconut oil is like 90% saturated fat, whereas butter something like 60 something. Full fat meats and cheeses, full fat dairy, real food of course is what we’re talking about here. Don’t just read labels on boxes, “Oh Jimmy said.” So, no.
In his books and in his office working with his own patients, Dr. Atkins warned that to reap the benefits of his diet, one must reach and stay in a state of ketosis, much like the traditional Eskimos. Even a slight deviation from the diet, some ill-advised cheating with a cookie or candy, could stop ketosis in its tracks, and with it, the value of the diet.
Low-carbohydrate high fat diets (LCHF diets) consistently improve all other markers of cardiovascular risk — lowering elevated blood glucose, insulin, triglyceride, ApoB and saturated fat (especially palmitoleic acid) concentrations, reducing small dense LDL particle numbers, glycated haemoglobin (HbA1c) levels, blood pressure and body weight while increasing low HDL-cholesterol concentrations and reversing non-alcoholic fatty liver disease (NAFLD).

There are three instances where there’s research to back up a ketogenic diet, including to help control type 2 diabetes, as part of epilepsy treatment, or for weight loss, says Mattinson. “In terms of diabetes, there is some promising research showing that the ketogenic diet may improve glycemic control. It may cause a reduction in A1C — a key test for diabetes that measures a person’s average blood sugar control over two to three months — something that may help you reduce medication use,” she says.
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.
Clearly, ketogenic diets are not ready for prime time as a treatment for cancer, either alone or in combination with conventional therapy. Unfortunately, that hasn’t stopped it from being touted by all manner of alternative cancer practitioners (i.e., quacks) and others as a cancer cure that “they” don’t want you to know about or saying things like, “…it’s nothing short of medical malpractice and negligence to fail to integrate this type of dietary strategy into a patient’s cancer treatment plan,” as Joe Mercola did. Dr. Seyfried himself has contributed to the hyperbole quite a bit as well. For example:
Fanatic? Someone with T2D, a disease usually claimed to be progressive and a never ending stream of problems and medications, was REVERSED. That’s something to shout from the rooftops. The drop in medication use alone, but the big pharma companies would prefer that people’s stories of reversing (well, putting it into remission) T2D get called fanatical instead of insightful.

I also want to be clear that I’m not making any specific recommendation here for treatment of cancer using ketogenic diet or anything else. As I’ve argued earlier in the podcast, I think cancer is a complex multifactorial disease and varies from individual. The ideology and pathology vary from individual to individual, and treatment decisions should be made with the support of an oncologist and other doctors on the care team. Please don’t take anything that I’ve said in this podcast as a recommendation for your particular situation or somebody in your life that’s struggling with cancer.
For most people, a ketogenic diet leads to improvements in cholesterol, but there are sometimes transient rises in cholesterol levels during weight loss. During rapid weight loss, cholesterol that you had stored in your adipose tissue (ie, body fat) is mobilized, which will artificially raise serum LDL as long as the weight loss continues. To avoid being misled by this, the best time to check blood lipids is a couple of months after weight loss ceases. Total cholesterol includes HDL (the so called ‘good cholesterol’), which usually goes up 10-15% on a ketogenic diet. That said, some people have high calculated LDL cholesterol values even after weight loss stops. If this occurs, you should discuss further diagnostic tests with your doctor. Current research is looking at LDL cholesterol as a mix of different particle sizes, where the small ones are dangerous and the larger ones are not. With a well-formulated ketogenic diet, we see a shift away from the small dangerous LDL even when the total LDL goes up.
In general, cholesterol is traditionally misunderstood. I am going to show why high cholesterol is not inherently bad, and how to lookout for some real warning signs that you are in an inflammatory state. Knowing how cholesterol works in the body and how to interpret your cholesterol numbers will empower you to move forward on your ketogenic journey with confidence.
I recall so well, this time sitting in my mid-Manhattan office, reading that famous May 3, 1998 front page lead New York Times article (in the upper left of the page reserved for wars, revolutions, and, yes, miracles) by reporter Gina Kolata, announcing Folkman’s preliminary findings to the world, extolling anti-angiogenesis in a tone that one more skeptical writer, Jack Breibart, described as “breathless.”
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.
It is an oversimplification that cancer cells use anaerobic fermentation all the time. Tumors have hypoxic zones and normoxic (aerobic) zones, with a symbiotic relationship between the two. Hypoxic cancer cells derive energy from fermentation of glucose, and secrete lactate. Normoxic cancer cells prefer and attract lactate as fuel for the TCA cycle, sparing glucose for the hypoxic cells. Cancer cells can switch fairly quickly between hypoxic and normoxic states, and may oscillate between the two. [NCBI, “Tumor cell metabolism: an integral view”]

A computer program such as KetoCalculator may be used to help generate recipes.[47] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[37]
Before starting, ask yourself what is really realistic for you, Mattinson suggests. Then get your doctor’s okay. You may also work with a local registered dietitian nutritionist to limit potential nutrient deficiencies and talk about vitamin supplementation, as you won’t be eating whole grains, dairy, or fruit, and will eliminate many veggies. “A diet that eliminates entire food groups is a red flag to me. This isn’t something to take lightly or dive into headfirst with no medical supervision,” she says.
Fat is the primary source of fuel on a ketogenic diet, and supplementing with specific types of fat, particularly coconut oil and medium-chain triglyceride (MCT) oil, can help you get into ketosis faster. MCT oil is unique in that it increases ketone levels in a linear, dose-dependent manner and allows for the induction of ketosis with lower amounts of total fat in the diet. (44)
The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and '30s, it was largely abandoned in favour of new anticonvulsant drugs.[1] Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs.[9] For this group, and for children in particular, the diet has once again found a role in epilepsy management.[1][10]
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.
Several studies have shown that the MAD, besides being more palatable, is as effective as the KD in the treatment of drug-resistant epilepsy in children (Miranda et al., 2011; Martin et al., 2016). A study performed using 20 children receiving 10 g of carbohydrates daily showed that 65% of the children had a >50% seizure reduction, 35% of the children had >90% improvement, and four children were seizure-free at 6 months (Kossoff et al., 2006). In a study in South Korea, 36% of 14 children treated with the MAD showed improvement of >50% in seizures and 12% were seizure-free (Kang et al., 2007). A recent meta-analysis performed using 70 studies concluded that the MAD and classical KD do not differ in reduction of seizure frequency at month 3 and month 6, with ≥50% and ≥90% reductions, respectively (Rezaei et al., 2017). A retrospective study showed >50% of seizure reduction in 65% of the 10 children who remained on the diet for up to 6 months, and 20% of them were seizure-free (Park et al., 2018).
Gluconeogenesis is the endogenous production of glucose in the body, especially in the liver primarily from lactic acid, glycerol, and the amino acids alanine and glutamine. When glucose availability drops further, the endogenous production of glucose is not able to keep up with the needs of the body and ketogenesis begins in order to provide an alternate source of energy in the form of ketone bodies. Ketone bodies replace glucose as a primary source of energy. During ketogenesis due to low blood glucose feedback, stimulus for insulin secretion is also low, which sharply reduces the stimulus for fat and glucose storage. Other hormonal changes may contribute to the increased breakdown of fats that result in fatty acids. Fatty acids are metabolized to acetoacetate which is later converted to beta-hydroxybutyrate and acetone. These are the basic ketone bodies that accumulate in the body as a ketogenic diet is sustained. This metabolic state is referred to as "nutritional ketosis." As long as the body is deprived of carbohydrates, metabolism remains in the ketotic state. The nutritional ketosis state is considered quite safe, as ketone bodies are produced in small concentrations without any alterations in blood pH. It greatly differs from ketoacidosis, a life-threatening condition where ketone bodies are produced in extremely larger concentrations, altering blood ph to acidotic a state.
The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients.[18] Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective.[9] Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug.[1] Some evidence indicates that adolescents and adults may also benefit from the diet.[9]
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[54]

An overwhelming majority (90%) of parents said that they would. Even though the keto diet is extremely restrictive, time consuming, and requires rigid maintenance, most parents found the potential benefits outweighed its drawbacks. Many parents in the study were more concerned about the side effects of the medications―and were grateful for the opportunity to explore an alternative option. Further, 55% would consider trying the diet again.


Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[56]
Additionally, research suggests that during menopause, women may experience an increased thickening of the carotid intima and media layers of the arteries, a marker of subclinical atherosclerosis. In a study of 249 middle-aged women, those who were postmenopausal or in the late stages of perimenopause were much more likely to show progression of carotid intima-media thickness (CIMT) than those in early perimenopause (11).
They included participants who were 35-75 years of age and who were not born in Canada but had lived there for at least 5 years. Subjects who suffered from moderate to severe medical conditions such as diabetes, heart diseases, and active cancer were not included. Subjects of all different weights and BMIs were included as long as they were considered healthy.
The Keto diet emphasizes weight loss through fat-burning. The goal is to quickly lose weight and ultimately feel fuller with fewer cravings, while boosting your mood, mental focus and energy. According to Keto proponents, by slashing the carbs you consume and instead filling up on fats, you safely enter a state of ketosis. That’s when the body breaks down both dietary and stored body fat into substances called ketones. Your fat-burning system now relies mainly on fat – instead of sugar – for energy. While similar in some ways to familiar low-carb diets, the Keto diet’s extreme carb restrictions – about 20 net carbs a day or less, depending on the version – and the deliberate shift into ketosis are what set this increasingly popular diet apart.
All trials applied an intention‐to‐treat analysis with varied randomisation methods. The 11 studies recruited 778 patients; 712 children and adolescents and 66 adults. We assessed all 11 studies to be at low to unclear risk of bias for the following domains: random sequence generation, allocation concealment and selective reporting. For the other domains (blinding, incomplete outcome data, other bias) assessments were varied (low, unclear and high risk of bias). We could not conduct a meta‐analysis due to the heterogeneity of the studies and the quality of the evidence was low to very low (GRADE ratings).
2. I agree, progression of the score is now all that matters. Any concern with the NMR/other biomarker results, or am I a classic Lean Mass Hyperresponder, hyperabsorber? The literature is FILLED with studies showing raised TC/LDL on a fasting/ketogenic protocol. So is this simply physiological "view" and not an underlying fundamentally artherogenic profile?
You’re very welcome, Judy! I’m glad it’s helpful. If you are keto (as opposed to low carb), unfortunately peaches would not allow you to stay in ketosis. You can check my keto food list to help determine what is keto friendly. Of course, there are worse things than fresh fruit 🙂 but in the end our bodies still see the sugar. That being said, it doesn’t mean you sabotaged the whole day. Just pick up again – you got this!! (And for next time, try some fresh berries in moderation when you’re craving fruit.)
While I can appreciate Mr. Feldman's efforts and I am also a hyper responder, I have no doubt that cholesterol levels are merely an artifact / symptom of the real cause of CVD which is hyperinsulinemia which for type 2 diebetics or pre-diabetics (which are simply undiagnosed diabetics) is due to high carbohydrate diets causing high blood glucose levels as well as other known causes of infllammation such as trans fat and high omega 6 to omega 3 ratios. In other words, there is no need to try and cure the symptom which is controlling lipoprotein levels directly.  
My latest blood work showed great HDL, VLDL, my LDL is just a bit high and my doc is saying we should do something about it. I don’t want to go on cholesterol meds they gave me leg cramps and other side effects I didn’t like. I think if he lets me give it more time that number could come down as well. I’ve lost 23lbs since January when I started Keto, my sugars are back to normal all other blood work is great! I’m going to try to add more of the avocado, coconut and olive oil and see what happens.
To get the most benefit from the Keto diet, you should stay physically active. You might need to take it easier during the early ketosis period, especially if you feel fatigued or lightheaded. Walking, running, doing aerobics, weightlifting, training with kettlebells or whatever workout you prefer will boost your energy further. You can find books and online resources on how to adapt Keto meals or snacks for athletic training.
For most people, a ketogenic diet leads to improvements in cholesterol, but there are sometimes transient rises in cholesterol levels during weight loss. During rapid weight loss, cholesterol that you had stored in your adipose tissue (ie, body fat) is mobilized, which will artificially raise serum LDL as long as the weight loss continues. To avoid being misled by this, the best time to check blood lipids is a couple of months after weight loss ceases. Total cholesterol includes HDL (the so called ‘good cholesterol’), which usually goes up 10-15% on a ketogenic diet. That said, some people have high calculated LDL cholesterol values even after weight loss stops. If this occurs, you should discuss further diagnostic tests with your doctor. Current research is looking at LDL cholesterol as a mix of different particle sizes, where the small ones are dangerous and the larger ones are not. With a well-formulated ketogenic diet, we see a shift away from the small dangerous LDL even when the total LDL goes up.
We’re going full on fats with breakfast, just like we did last week. This time we’ll double the amount of ketoproof coffee (or tea) we drink, meaning we double the amount of coconut oil, butter, and heavy cream. It should come to quite a lot of calories, and should definitely keep us full all the way to dinner. Remember to continue drinking water like a fiend to make sure you’re staying hydrated.
In practice, a ketogenic diet is one that keeps net carbohydrates below 50 grams per day, although the absolute number necessary to achieve ketosis will vary from individual to individual and may be as high as 100 grams/day for some. 46 (Because fiber is indigestible when eaten, it is usually not included in the carbohydrate count on a ketogenic diet, therefore net carbohydrates equals the total amount of carbohydrate minus the fiber.) Including some protein and carbohydrate on a ketogenic diet is important too since it supplies the needed substrate for the body to produce ketones, but too much can interfere with ketosis.47 48 A ketogenic diet usually includes low-moderate amounts of meat, fish, poultry, and eggs, moderate amounts of low-carb vegetables such as leafy greens and broccoli, and lots of healthy fats like avocados, nuts, and seeds, coconut oil, olive oil, etc. For those intent on ensuring they are in ketosis, home devices for testing ketone levels are available.

A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >

Another hypothesis regarding the function of the KD is related to changes in neuronal metabolism, mitochondrial function and energy reserve, and the environment. In normal conditions, the usual substrate for the neurons is glucose. To facilitate its diffusion through the brain-blood barrier, glucose transports are present in the brain capillary endothelial layer (Greene et al., 2003). The glucose metabolism produces the rapidly available energy that is necessary for seizure activity. Therefore, in patients on the KD, the blood glucose energy levels are low, and the brain begins to use KB for energy. This anaerobic metabolism slows the energy availability, which reduces seizures. The anticonvulsant propriety of a decrease in glucose metabolism has been shown in experimental models in which the administration of 2-Deoxy-D-glucose elevates the seizure threshold (Garriga-Canut et al., 2006). The anticonvulsant effect of the KD can be quickly reversed after glucose infusion (Huttenlocher, 1976). Based on these data, we can postulate the influences not only of the KB, as discussed above, but also the reduction in glucose levels as a mechanism of action of the KD.
I have great respect for Harvard Medical School. I notice that they support their readers posting comments and I am most appreciative of the article and all the many thoughtful comments by the readers. The readers seem to have the most expertise here and I hope that the doctor who wrote the article will think long and hard about the comments by readers. After 35 years of clinical practice in mental health, I notice that all issues of emotion involve medical issues, nutrition, and the gut bacteria. I would say that these issues and all of the executive brain functions seem to improve with ketogenic principles. For those that apply it in a flexible and smart manner, it appears to improve every area of their lives. I strongly encourage the author of the article to take one class via The Institute for Functional Medicine. If he is open to more learning he can take more classes and get certified. I’m sure a fine doctor, he will be an even better doctor and personally healthier, if he gets more training. Are we all open to new learning(especially us healthcare providers)?
In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet.[10] Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[10] 

Research suggests that cancer cells with low levels of particular enzymes (the ketolytic enzymes 3-hydroxybutyrate dehydrogenase and succinyl CoA 3-oxoacid CoA transferase) are more susceptible to the anticancer effects of a ketogenic diet. Screening a patient’s cancer cells for these enzymes may represent a valuable strategy for determining whether a ketogenic diet may be of use. (39)
If I was diagnosed with cancer or one of my relatives or friends were diagnosed, I would certainly put the ketogenic diet and fasting at the top of the list of potential treatments to investigate because I see a high potential for benefit and very little downside. You can’t say that about many cancer therapies. As we talked about earlier, the goal with cancer treatment is to find something that inhibits the growth of cancer cells but doesn’t damage healthy cells. Again, there just aren’t that many therapies out there that do that.
So, what evidence does Dr. Seyfried himself provide to prove his point that the best diet for all cancer patients, whatever the type, is the ketogenic, high fat, no carb diet? Well, very little. Certainly the 400 plus pages of elaborate biochemistry and theory are impressive and informative. But in terms of practicalities, that is, results with actual human patients diagnosed with cancer, there is next to no evidence.
They need to make a lot of ATP, and quickly, to support their high requirements for energy. Adenosine triphosphate, also known as ATP, is a compound that provides energy to drive hundreds of thousands of biochemical processes in living cells. Found in all forms of life, ATP is often referred to as the chemical energy “currency” that powers metabolic activity.
The take-home message here is that patients with epilepsy have options beyond simple pharmaceutical intervention, and these include dietary changes which well-respected science is now validating as having significant efficacy. A fundamental cornerstone of the Grain Brain Program is profound reduction of carbohydrates and sugars while increasing “good” dietary fats. This approach tends to favor a low grade of ketosis which may well be the normal state of human metabolism. I have written extensively both on the site and in Grain Brain how this dietary approach has profound health-related benefits that relates to weight loss, metabolism, energy, reduction of inflammation, and even reduce risk for diabetes and cancer. This new report offers up yet another benefit to a higher fat lower carbohydrate dietary approach, in this case, for a disease that is devastating for so many.
Other genetic disorders caused by mutations limit the availability of energy substrates but do not necessarily cause seizures. One such disease is phosphofructokinase (PFK) deficiency. PFK is the rate-limiting enzyme in glycolysis for the conversion of fructose-6-phosphate to fructose-1,6-bisphosphate. Patients with mutations in the muscle isoform of PFK demonstrate exercise intolerance with myalgias and stiffness. There also are rare infantile forms, such as a case reported by Swoboda et al. [21, Class III], with myopathy and arthrogryposis. This patient displayed marked gains in muscle strength and improvement in his developmental milestones after being placed on the ketogenic diet.
A great deal of exciting research is emerging regarding the application of a ketogenic diet in the treatment of neurodegenerative diseases, including Alzheimer’s and Parkinson’s disease. (17) Neurodegenerative diseases are characterized by brain insulin resistance, a condition that starves neurons of the glucose they normally need to function correctly. Scientists have found that ketones are an excellent alternative fuel for the insulin-resistant brain. In addition, ketones reduce brain oxidative stress and mitochondrial dysfunction, two significant factors in the neurodegenerative disease process.
Thanks for this inputs. 20 years ago I gain 17 pounds a year for 5 years. I was healthy but my dr told me start diet, any diet just come back in a month I want to see you start loosing… I started Atkins and lost 7 pound in a month. She was checking my progress every six months and checking my condition. I lost 64 pounds in 3 years. Now I started eating out of control. I am eating healthy but too much… I gain 40 pound back after 20 years. Now I will start again my Atkins to take off 30 pounds…

A Cochrane systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures.[2] Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types of diets or ways of introducing them to make them more tolerable.[2] In the largest trial of the ketogenic diet with a non-diet control[16], nearly 38% of the children and young people had half or fewer seizures with the diet compared 6% with the group not assigned to the diet. Two large trials of the Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.[2]


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?

Tumors did not progress at all at all in the five patients that successfully completed the ketogenic trial. This is a positive outcome given the advanced stage of their cancer. Additionally, some of these patients experienced favorable changes in glucose, HDL:LDL ratio, triglycerides, and healthy levels of weight-loss. These findings further support the healthy impact a ketogenic diet may have on cancer.
There are several medical studies — such as two conducted by the Department of Radiation Oncology at the Holden Comprehensive Cancer Center for the University of Iowa, and the National Institutes of Health’s National Institute of Neurological Disorders and Stroke, for example — that show the ketogenic diet is an effective treatment for cancer and other serious health problems. (12)
David Book graduated with a PharmD from Drake University. After completing a Drug Information Residency in the greater Atlanta area with Mercer University's College of Pharmacy and InpharmD, he now works full time at an independent pharmacy. Drawn towards innovation and entrepreneurship, his interests include the business of pharmacy, healthcare advocacy, diet & nutrition, and health information technology.
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