Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change. Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.
In this same chapter, there are also two case reports, neither very impressive. The first, written by the mother, tells the story of a four-year old child diagnosed in 2004 with a low-grade (less aggressive) but quite large and inoperable brain tumor. The parents, as the mother writes, entrusted their child into the hands of the experts, who prescribed the usual “gold standard” treatments, which are not clearly described initially but presumably mean chemotherapy and perhaps radiation.
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.
While KD and MAD have demonstrated efficacy in reducing the extent and degree of seizures in epileptic patients, the dietary approaches have been tied to risk of adverse events in both adults and children, although most are treatable and are nearly all preventable. Adverse effects include constipation, low blood sugar, and gastrointestinal reflux.5,6 Other side effects, such as kidney stones and high cholesterol, can often be improved with supplements or dietary changes.1 These also tend to improve over the long term. Kossoff and colleagues found that both total cholesterol and LDL cholesterol normalized within a year of treatment after initial increases during the first three months of MAD.5
The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted. It involves a consultation with the patient and their caregivers and, later, a short hospital admission. Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.
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. 
Ketosis was a beneficial process the human body developed as an adaptation to times when food was unavailable (such as for these hunter-gatherers). However, you can effectively produce ketones too by limiting the carbohydrates in your diet to less than 80 grams daily and protein to no more than 1.2 grams of protein/per kg lean body mass. As the body adapts to the use of ketone metabolism over time, the hormone in the liver that is essential to ketone metabolism (known as FGF21) becomes more efficient.
There aren’t any studies on control groups living healthy lifestyles, eating a low carb/whole food/meat diet, that shows an increase in cancer. There are 1000’s of examples of blood work showing improvements in LDL ratios (risk of heart disease) and low/steady blood sugar levels (diabetes prevention/treatment). That is actual science. as far as anecdotal evidence, there are many accounts of vegans/vegetarians that have became extremely ill over time due to lack of complete nutrition. It is also more difficult (takes more planning) to ensure you are getting sufficient amounts of calories since plant based is not calorie dense and it takes larger quantities. Additionally, Fats and animal fats especially play a vital role hormone production as well. Look up Dr. Shawn Baker.
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. 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. Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug. Some evidence indicates that adolescents and adults may also benefit from the diet.
Not surprisingly, he immediately and strongly advised that I abandon the keto lifestyle in favor of the Mediterranean diet. I was incredibly disappointed, given the ease with which I had lost weight, though I understood his position and followed his counsel. In the past several weeks, I have gained some weight back, though certainly not all, and generally feel unhappy about the direction I seem to be headed. I have not had cholesterol levels checked again. I very much want to return to the keto lifestyle I was following, but I respect my provider and don’t want to make decisions that might lead me to poorer health down the road.
Here’s what happens when you eat low carb, high fat, keto. The small LDLP number goes way down. Along with the triglycerides dropping, along with the HDL going up, along with all those other great markers that improve that nobody’s paying attention to in the medical profession, your small LDL goes down. The question that comes into play here is “What about the number of total particles?” That’s the debate that nobody’s going to answer until we do some studies on it.
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
Of the many benefits of a keto diet, weight loss is often considered No. 1., as it can often be substantial and happen quickly (especially for those who start out very overweight or obese). The 2013 study published in the British Journal of Nutrition found that those following a keto diet “achieved better long-term body weight and cardiovascular risk factor management when compared with individuals assigned to a conventional low-fat diet (i.e. a restricted-energy diet with less than 30 percent of energy from fat).” (2)
For patients interested in the keto diet, a more moderate approach may be advised. There is evidence that cutting down on the amount of refined carbohydrates in typical diets and increasing the amount of healthy fats consumed can be beneficial to one’s overall health. Before altering your diet in any way, you should always consult with your doctor and registered dietitian.
Keep eating low carb to continue losing weight, feeling good and becoming healthier!Try making any of our hundreds of recipes available on the site. We make sure each and every recipe is delicious, nutritious and will keep you under your daily carb limit, even if you go for seconds. In addition, we provide step-by-step instructions to make the process as easy as possible. If you ever run into any issues or have any questions, be sure to leave a comment or contact us directly! We’re always happy to help.
The ketogenic diet may also worsen some mitochondrial diseases, pyruvate carboxylase deficiency, or organic acidurias. In general a metabolic screen, including urine amino and organic acids, serum amino acids, lactate, pyruvate, and carnitine profile, should be performed before starting the ketogenic diet to make sure children do not have a contraindication to using it.
Dr. Jockers, thank you so much for this clear and detailed article! I began a keto-style diet around August 2019. By late November, I had fallen from 197 lbs. to under 175 lbs., dropped from 28% to 18% body fat, and anecdotally felt much better in all aspects of my health. All of this occurred exclusively due to diet, I believe– I had almost no exercise routine to speak of, and my desk-based job is pretty sedentary. My family practice doc was surprised and happy with the results as well when I met with him in January… until my blood work came back showing total cholesterol at 257, triglycerides at 236, LDL-C at 162, and HDL at 50.
When I was six years old, I was diagnosed with temporal lobe, partial-complex epilepsy. Over the years, I have seen multiple doctors and neurologists and I have been on every medication created to treat epilepsy, but I still continued to have seizures about every 6-8 weeks. For the most part, I have been able to lead a normal life achieving my college degree, getting married and having two happy, healthy kids but every time I had a seizure it was a cruel reminder that I was not everything I needed to be for my family. Many times after a seizure, I would be unable to work and care for them for days at a time.
You’re transitioning. Your body is equipped to process a high intake of carbs and a lower intake of fat. Your body needs to create enzymes to be able to do this. In the transitional period, the brain may run low on energy which can lead to grogginess, nausea, and headaches. If you’re having a large problem with this, you can choose to reduce carb intake gradually.
I had some eggs and some meat and all this stuff. Then they tested me literally every 30-60 minutes for five hours. I got to see literally what was happening real time after a low carb meal. I think that’s where having the right nutrition really is the basis for knowing where you stand. The other thing for people that are worried about this morning reading, check your A1C. That’s the average of the last 3 months worth of all of your blood sugars, not just the ones in the morning that you’re testing and freaking out about. By the way, when you freak out that also raises your blood sugar.
These preliminary findings spurred Dr. Good to encourage a more thorough investigation of Kelley’s methods and results. As the project grew in scope, I continued my “Kelley Study” in my spare time during the last two years of medical school, and ultimately brought it to completion while pursuing my immunology fellowship training under Dr. Good at All Childrens’ Hospital in St. Petersburg.
This essential, fully referenced book is a practical guide for physicians, patients and caregivers, and provides step-by-step instructions for customizing the diet and clear explanations of the cutting-edge research on ketogenic therapies being done by Dr. Dominic D’Agostino’s team at the University of South Florida and Dr. Thomas Seyfried’s team at Boston College. The ketogenic diet for cancer is based on the consumption of whole, fresh foods and it can be used in addition to standard care or as a stand-alone treatment in wait-and-see situations.
What is the ketogenic diet exactly? The classic ketogenic diet is a very low-carb diet plan that was originally designed in the 1920s for patients with epilepsy by researchers working at Johns Hopkins Medical Center. Researchers found that fasting — avoiding consumption of all foods for a brief period of time (such as with intermittent fasting), including those that provide carbohydrates — helped reduce the amount of seizures patients suffered, in addition to having other positive effects on body fat, blood sugar, cholesterol and hunger levels. (1)
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.
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.
This brings me back to the question of whether cancer is a metabolic disease or a genetic disease, the answer to which I promised early on. The likely answer? It’s both! Indeed, a “chicken or the egg” argument continues about whether it is the metabolic abnormalities that cause the mutations observed in cancer cells or whether it is the mutations that produce the metabolic abnormalities. Most likely, it’s a little of both, the exact proportion of which depending upon the tumor cell, that combine in an unholy synergistic circle to drive cancer cells to be more and more abnormal and aggressive. Moreover, cancer is about far more than just the genomics or the metabolism of cancer cells. It’s also the immune system and the tumor microenvironment (the cells and connective tissue in which tumors arise and grow). As I’ve said time and time and time again, cancer is complicated, real complicated. The relative contributions of genetic mutations, metabolic derangements, immune cell dysfunction, and influences of the microenvironment are likely to vary depending upon the type of tumor and, as a consequence, require different treatments. In the end, as with many hyped cancer cures, the ketogenic diet might be helpful for some tumors and almost certainly won’t be helpful for others. Dr. Seyfried might be on to something, but he’s gone a bit off the deep end in apparently thinking that he’s found out something about cancer that no one else takes seriously—or has even thought of before.
• Your body is still growing — In one study, epileptic children experienced a reduction in symptoms and improved cognitive performance when a ketogenic diet was introduced.49 However, this may have a negative effect on the growth of their bodies in the long run, according to a study published in the journal Developmental Medicine & Child Neurology.50
This uncoupling of glycolysis from the citric acid cycle and electron transport, and the supposed fundamental dependency of cancer cells on anaerobic metabolism, has been studied extensively since Warburg’s day, with many scientists around the world claiming to confirm, then adding to, Warburg’s hypothesis. As Dr. Seyfried correctly points out, in more recent times, cancer researchers have begun drifting away from the study of disordered cellular physiology, enamored as they are of genetic abnormality as the primary and only driving force in cancer formation and growth.
Notice he used the word “effective” twice. The word “effective” does not mean cure. It typically only means temporarily slowed growth or temporary tumor shrinkage. To put it in perspective, over 580,000 “effectively treated” cancer patients die in the U.S. each year. The sobering truth is the cancer industry has only improved the overall cancer death rate by 5% in the last 60+ years. “Ineffectively treated” is a more accurate and appropriate way to describe the current state of affairs, but I digress.
It is very interesting to read about the keto/low card diet.I love to change my lifestyle as I an TYPE 2 Diabetic.I subscribed for a free printable low carb meal .The initial email stated that that I will receive an email for instructions to access the members area .Your free download will be there.However it is very deceiving ,I never got the 2nd email with instructions which is frustrating and not good .Hopefully this is not a way to get us to pay to get the printable version.
I just got to know too that my Cholesterol raised a lot, I've been on keto for a little more than 3 months and before that always had a low carb diet. I don't know if the 3 day fast I did before taking the blood test only " aggravated" the situation. The total is 302, LDL is 214! But since the triglycerides are 94 and HDL 57, it seems to be OK. I read that a low rate of TG/HDL may indicate that the LDL particles are of the bigger, fluffier type less dangerous.
‘”Absolutely not… A number of situations where the ketogenic diet may not be the preferred therapy for most cancers, I would say, leukemia, lymphomas, Hodgkin’s lymphoma, thyroid cancer, testicular cancer, if caught early prostate cancer, melanoma, breast cancer. All these cancers can be effectively treated with chemotherapy or radiation in some cases, and also brain tumors if it’s grade 1 or 2 tumor that’s not very metastsatic and is more localized then surgery, radiation, and chemo can be very effective.”
In the 1960s, medium-chain triglycerides (MCTs) were found to produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides). MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system. The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.
A recent 2017 study of over 2,500 adults looked at fasting insulin and high-sensitivity C-reactive protein (hs-CRP), an inflammatory marker considered a strong predictor of heart attack risk. In this study, people with the highest insulin levels were more than four times as likely to have an elevated hs-CRP value compared to those with the lowest insulin levels. By contrast, elevated LDL cholesterol levels showed no association with hs-CRP (4).
You may find it easy to eat less when all you can eat is protein and fat. But after a while, you may grow tired of bringing your own whole salmon to parties, and wonder what the other 95% of the grocery store is up to. You may start to have fantasies about a threesome: you, Oreos, and chocolate sauce. Not only that, you may be getting some serious scurvy and other nutrient deficiencies.
Early studies reported high success rates; in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).
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?