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.
Many factors can negatively affect cholesterol levels — such as genetics, inactivity, diabetes, stress and hypothyroidism — but an unhealthy diet that includes lots of processed foods and is low in nutrients is the biggest contributor. The “standard American diet” is highly inflammatory, which elevates LDL (bad cholesterol) and lowers HDL (good cholesterol), while a “clean keto diet” tends to have the opposite effect.
“This is an important area of research that has the potential to significantly improve treatment responses,” said AICR’s Director of Research Nigel Brockton, Ph.D. “There are plausible mechanisms by which the ketogenic diet could help make treatment more effective, but, as we see many times, plausibility alone is not enough; it has to be tested. That’s why we are supporting research in this area.”
By doing this, HDL prevents cholesterol from accumulating and clogging arteries. Thus, elevated levels of cholesterol are integral in maintaining optimal cardiovascular health.  HDL is typically measured through an HDL-C test, which shows the concentration of cholesterol bound to HDL. Clinically acceptable levels of HDL cholesterol are 40-60 mg/dl and 50-60 mg/dl for women.  HDL levels above 60 mg/dl are ideal as they lower the risk of cardiovascular illnesses. 
One way to find out if the keto diet is helping quell your chronic inflammation is by seeing how your C-reactive protein (CRP) levels change over time on your routine blood test.  If CRP levels decrease after you’ve made your lifestyle and dietary changes, then you are on the right track. The ideal result is if your cholesterol levels are optimized along with that.
This diet is not without its side effects, so it is very important to become well informed when considering ketogenic diet therapy. Do not attempt the ketogenic diet without medical supervision from a properly trained ketogenic diet team, especially if you are taking anti-seizure medications. This ketogenic diet team includes a neurologist, a registered dietitian and nurse and sometimes a nurse practitioner, pharmacist, social worker and other specialists.
Can your body handle higher amounts of dietary fat? (To make this process easier, I recommend my patients gradually increase their fat intake. Your digestive enzymes need time to ramp up to be able to handle the higher fat content in your digestive tract, or it can cause unpleasant gas, bloating, and diarrhea.) Remember: If the thought of eating higher-fat foods like steak or avocado doesn’t appeal to you, keto probably isn't for you.
When a person first starts onto a low-carbohydrate ketogenic diet, it takes the body several days to a few weeks to shift from relying on glucose to instead rely on fat. During this transition, people may experience what is sometimes referred to as the “keto-flu”—muscle cramps, headaches, fatigue, dizziness, nausea, and sugar and carbohydrate cravings.49 There may also be increased urination which can result in a loss of minerals, such as sodium and potassium. To counter these effects one should strive to get more minerals and in particular, more sodium and potassium, drink plenty of water, get some exercise and ensure adequate caloric intake. Once the body becomes keto-adapted, these symptoms largely resolve, and many people report increased energy, decreased cravings and weight loss.
Increasing numbers of people around the world are suffering from chronic diseases such as diabetes and obesity, and the main culprit is usually the food they eat. The standard American diet, for example, consists of excessive amounts of protein, processed grains and carbohydrates — particularly in the form of refined, added sugars — none of which is good for your health.
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.
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.
In retrospect, it makes sense that in the Arctic the Eskimos, in order to survive, would have adjusted to their high fat, moderate protein, no carb diet. With its brief summer and lacking soils suitable for crops, the region provides insufficient plant foods suitable for human consumption but does offer an abundance of fatty animal food both on land and in the sea. If the Eskimos hadn’t adapted to such food, living as they did in such a difficult, extreme part of the world, they simply would have died off.
A randomised, controlled clinical trial among 120 overweight adults with high levels of cholesterol compared the effects of a ketogenic diet against a low-fat diet. After 24 weeks, the group following the keto diet reported greater weight loss and declines in the triglyceride levels and higher increases in the HDL cholesterol levels compared to the low-fat group (11).
In 1921, Dr. R.M. Wilder at the Mayo Clinic proposed a diet for the treatment of epilepsy – which he referred to as a ketogenic diet – in which most of the calories were derived from fat, mimicking the biochemical changes of fasting.2 Today, children resistant to anti-epileptic drugs are still advised to follow keto diets to prevent seizures, always under the management of well-trained dietitians, of course. Indeed, according to the Epilepsy Society, the keto diet is considered to be a medical treatment.3
The second is called LDL-P which measures the number of LDL particles in the blood. Sometimes, there is a correlation – more LDL particles means that you can have higher levels of LDL-C. However, larger LDL molecules can grow and carry more cholesterol – leading to a discordance in which LDL-C and LDL-P are not necessarily proportional. When this happens, LDL-C and LDL-P are said to be “discordant.”
Chronic ketosis may play a role in the KD anticonvulsant properties, since it has been shown that chronic ketosis elevates the brain energy reserve via stabilization and reduction of excitability of synapses (Devivo et al., 1978). The energy reserve is directly associated with mitochondria, which is an important element to consider in the antiepileptic effect of KD. Bough et al. (2006) demonstrated an increase in mitochondria biogenesis in an experimental model of rats fed with KD, indicating an increase in the energy stores (Bough et al., 2006). The increase in mitochondrial metabolism leads to an increase in ATP production, which activates KATP, in turn attenuating neuronal excitability. This activation may be associated with adenosine A1 receptors (Li et al., 2010) and GABAB receptors (Mironov and Richter, 2000).
One of the difficult things about science-based medicine is determining what is and isn’t quackery. While it is quite obvious that modalities such as homeopathy, acupuncture, reflexology, craniosacral therapy, Hulda Clark’s “zapper,” the Gerson therapy and Gonzalez protocol for cancer, and reiki (not to mention every other “energy healing” therapy) are the rankest quackery, there are lots of treatments that are harder to classify. Much of the time, these treatments that seemingly fall into a “gray area” are treatments that have shown promise in animals but have never been tested rigorously in humans or are based on scientific principles that sound reasonable but, again, have never been tested rigorously in humans. (Are you sensing a pattern here yet?) Often these therapies are promoted by true believers whose enthusiasm greatly outstrips the evidence base for their preferred treatment. Lately, I’ve been seeing just such a therapy being promoted around the usual social media sources, such as Facebook, Twitter, and the like. I’ve been meaning to write about it for a bit, but, as is so often the case with my Dug the Dog nature—squirrel!—other topics caught my attention.
The diet seems to work for more than one kind of seizure, and for children who have a lot of seizures or few seizures. But most doctors say it shouldn’t be used instead of medications if the drugs are working and the child is not having bad side effects. Parents generally decide to try the diet because they hope it will give their child a better chance for a normal life.
As the authors write, “the protocol was not designed to reverse tumor growth or treat specific types of cancer.” The researchers also acknowledge the patient numbers were too small to allow for meaningful statistical evaluation, even for the avowed purposes. Overall, the discussion centers on the practicalities of implementing the diet and the results of the PET scans.
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:
The KDE is usually begun in a hospital setting, and often begins with a one- to two-day fasting period (though there may be a trend away from both of these requirements). After determining the proper amount of protein (depending on age, etc.), the diet is structured as a ratio of fat grams to protein grams plus carb grams. It usually begins with a 4 to 1 ratio, and then can be fine-tuned from there. The diet is often calorie-limited and fluid-limited as well. Additionally, no packaged "low-carb foods" (shakes, bars, etc.) are allowed for at least the first month.
Proponents of the super-high-fat, low-protein approach argue that protein kicks the body out of ketosis by supplying amino acids for gluconeogenesis (simply put, turning non-carbs into fuel); however, research indicates that the impact of dietary protein on gluconeogenesis and glucose flux is nearly negligible, making this argument irrelevant. (42) In my practice, we have found that usual protein intakes (15 to 20 percent of calories) do not have appreciable effects on blood ketone levels. Besides, a super-high-fat, low-protein diet typically has more drawbacks than benefits—it may cause weight gain, muscle loss, fatigue, and chronic hunger. Don’t be afraid of including plenty of protein in your ketogenic diet; protein is a powerful tool that will satiate your appetite while facilitating fat loss and preventing muscle loss.
All that said, it’s really promising, interesting info here, and we know that a ketogenic diet can be therapeutic in many other situations. There’s not really much downside to the ketogenic diet and fasting if they’re done under supervision. Both can have a lot of beneficial effects in terms of upregulating autophagy—cellular repair process, possibly stem cell regeneration in the case of fasting, for both of those. Ketosis has neurological benefits and many other potentially positive effects when it’s done in the right circumstances, so I don’t see any downside at all in continuing to explore these therapies for cancer treatment.
I also might offer a thought as to why, from a more esoteric, more biochemical perspective, for most people diagnosed with cancer the ketogenic diet might not work. For the past 150 years, researchers have approached cancer as a disease in which perfectly happy, normal mature cells sitting in some tissue somewhere suddenly go awry, lose their normal regulatory restraint, develop a primitive, undifferentiated appearance or phenotype, begin proliferating without restraint, begin invading through tissues and organs, begin migrating, spreading, creating new blood vessels along the way to feed the rapacious appetite of cancer. But over the past 15 years, gradually, a new, more productive, and I believe more truthful hypothesis has emerged, spearheaded particularly by Dr. Max Wicha at the University of Michigan. Scientists such as Dr. Wicha have discovered that cancer may be a little more complicated than we have thought these long decades.
Try resistant starch. Resistant starch passes through the small intestine intact and therefore doesn’t count as a dietary carbohydrate. Instead, it travels to your large intestine, where it’s used to feed beneficial gut bacteria. Try adding a teaspoon of resistant starch, such as raw potato starch or green banana flour, to your keto smoothie each day to keep your gut happy.
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.
Research here is conflicting. While you might think reducing insulin-triggering carbohydrate foods would improve insulin sensitivity, that isn’t always the case. Rodent studies found at least in the short-term, ketogenic diets increased glucose intolerance and insulin resistance. Researchers speculate part of this insulin resistance occurs because of keto-adaptation, and once your body adjusts to ketosis, you become more insulin sensitive. Your mileage will vary, of course, and I believe going too low-carb could create these and other potential dangers.
In AD, ingestion of carbohydrates may worsen memory . Patients with cognitive impairment lacking the APO-ε4 allele (one of the risk factors for AD) showed improved scores on the Alzheimer Disease Assessment Scale–Cognitive Subscale after ingesting a medium-chain triglyceride shake, which induces low but measurable levels of ketosis [43, Class I]. Scores on this test for those with the APO-ε4 allele (as well as scores for all patients on some other tests administered in this study) were not improved after ingestion of the medium-chain triglyceride shake, making the generalizability of these findings to other patients with cognitive impairment (including AD) an area for further investigation.
In some ways, it’s similar to the Atkins diet, which similarly boosts the body’s fat-burning abilities through eating only low-carb foods, along with getting rid of foods high in carbs and sugar. Removing glucose from carbohydrate foods will cause the body to burn fat for energy instead. The major differences between the classic keto and the Atkins diet is the former emphasizes healthier keto fats, less overall protein and no processed meat (such as bacon) while having more research to back up its efficacy.
Feel free to practice cyclical ketosis (maybe doing a ketogenic diet five days a week and going higher in healthy carbs the other two days) or whatever works for you. I’ve never heard an expert say you should be in ketosis 24/7, and militantly sticking with this plan can ultimately stall your goals. Once you’re in a state of ketosis, you can transition to a more flexible ketogenic plan. You can rotate complex carbs, like sweet potatoes, pumpkin, and butternut squash, into the diet every three to four days to maintain your glycogen stores if you work out and lift weights regularly.
When ketones are present in the body fluids at elevated concentrations, a person is said to be in ketosis. Dietary ketosis is a normal physiological response to sustained low carbohydrate intake that results in lowered blood glucose and insulin levels and stimulates the production of something known as ketone bodies. During ketosis, fats, either from the diet or from body stores, become the obligatory source of cellular energy for most body tissues while ketone bodies are produced in the liver to supply the rest of the body’s energy needs.4 Dietary ketosis should not be confused with diabetic ketoacidosis, a pathological condition that occurs mainly in type I diabetics due to an acute severe insulin deficiency (usually due to missing insulin injections) and a resulting inability to use glucose, though it is abundant. During diabetic ketoacidosis, blood ketone levels can be as high as 10-15 mM/l (significantly higher than what can be achieved in dietary ketosis). As ketone production exceeds the tissues’ ability to use them, the ketones build up and the blood pH is lowered.5 Immediate medical attention is required to prevent serious complications. This document deals with dietary ketosis only.
Pattern B LDL, on the other hand, has a much smaller particle size and is much more prone to oxidation. Another thing about pattern B LDL is that it is small enough to enter into the endothelial lining of the artery where it can become oxidized and more likely to form plaque. There is a high association between these small dense particles and cardiovascular disease.
Thank you, Thank you, Thank you!!!!! Your article couldn't have been timed any better. I got my blood panel back from my "western" doctor two days ago and the numbers had me very worried. After reading your post yesterday I felt so much better and sent the results off to my naturopath knowing that everything should be fine. I printed it out for my own reference and for any others, doctors included, who may have doubts and questions. Again, a big thanks for all your research and putting it out there for the rest of us trying to live a longer, healthier life!!
It is important to emphasize, however, that the ketogenic diet had a variable response. Some patients were able to comply with it better than other patients were. Additionally, of those that completed the trial, some had changes that are more favorable in certain parameters such as CRP. This suggests that the ketogenic diet is not suitable for everyone.
This study demonstrates not only high feasibility but also that a ketogenic diet can shift the metabolic environment among women with ovarian and endometrial cancers, said Gower, a professor at the University of Alabama at Birmingham (UAB) Nutrition Obesity Research Center. Further study in a clinical setting is needed to determine whether the ketogenic diet may be an effective non-pharmacologic adjuvant therapy for certain types of cancer, the paper concluded.
Unfortunately, that path isn’t so clear-cut and will differ among individuals. The transition to a ketogenic diet might also differently affect hormones than maintaining the plan long-term. Hormones are complicated, and other factors beyond diet—including sleep quality, stress levels, circadian rhythm nutrient status, and your overall health—dramatically affect whether they become balanced or unbalanced.
Similarly, in a 2015 study, mice receiving a combination of hyperbaric oxygen and dietary ketone supplementation showed a clear reduction in tumor growth rate and metastasis.20 Also, these mice lived twice as long as control animals. Based on these results, the study authors state that further investigation into the effectiveness of this combination therapy as a potential treatment for late-stage metastatic cancers is urgently required.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
Although the exact role of the keto diet in mental and brain disorders is unclear, there has been proof of its efficacy in patients with schizophrenia. And, to boot, it works to reverse many conditions that develop as a side effect of conventional medications for brain disorders, like weight gain, type 2 diabetes and cardiovascular risks. More research is needed to understand the role of the ketogenic diet in treating or improving schizophrenia, as the current available studies are either animal studies or case studies, but the benefits of a low carbohydrate, high-fat diet in neurology is promising.
People suffering from diabetes and taking insulin or oral hypoglycemic agents suffer severe hypoglycemia if the medications are not appropriately adjusted before initiating this diet. The ketogenic diet is contraindicated in patients with pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency. People on a ketogenic diet rarely can have a false positive breath alcohol test. Due to ketonemia, acetone in the body can sometimes be reduced to isopropanol by hepatic alcohol dehydrogenase which can give a false positive alcohol breath test result.