Net carbs is simply total carbs minus fiber and non-digestible sugar alcohols, like erythritol. (This doesn’t apply to high glycemic sugar alcohols, like maltitol.) We don’t have to count fiber and certain sugar alcohols in net carbs, because they either don’t get broken down by our bodies, are not absorbed, or are absorbed but not metabolized. (Read more about sugar alcohols here.)
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.
In the study, Barbara A. Gower, Ph.D., and her colleagues analyzed data from 45 women diagnosed with ovarian and endometrial cancers. The women were randomly assigned to either a ketogenic or a standard, healthy diet group. The ketogenic group was asked to consume 70 percent of calories from fat, 25 percent from protein and 5 percent from carbohydrates. The comparison diet was one recommended by the American Cancer Society, high in whole grains and fruit and low in added sugar.
The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.
For many years, LDL-C tests have been used as the primary method of measuring LDL in the blood. It is cheaper and easier to measure. Recent research has called into questioning how effective LDL-C is compared to LDL-P in precisely assessing cardiovascular risk. After reviewing cross-sectional data, a recent peer-reviewed paper from the world-renowned Framingham Heart Study stated that
Use fat as a lever. We’ve been taught to fear fat, but don’t! Both keto and low carb are high fat diets. Fat is our source of energy as well as satiety. The key to understand, though, is that fat is a lever on a low carb or keto diet. Carbs and protein stay constant, and fat is the one you increase or decrease (push the lever up or down) to gain or lose weight, respectively. So if your goal is weight loss, eat enough fat to be satisfied, but there’s no need to “get your fats in” once you’re satisfied.
There is not one “standard” ketogenic diet with a specific ratio of macronutrients (carbohydrates, protein, fat). The ketogenic diet typically reduces total carbohydrate intake to less than 50 grams a day—less than the amount found in a medium plain bagel—and can be as low as 20 grams a day. Generally, popular ketogenic resources suggest an average of 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. For a 2000-calorie diet, this translates to about 165 grams fat, 40 grams carbohydrate, and 75 grams protein. The protein amount on the ketogenic diet is kept moderate in comparison with other low-carb high-protein diets, because eating too much protein can prevent ketosis. The amino acids in protein can be converted to glucose, so a ketogenic diet specifies enough protein to preserve lean body mass including muscle, but that will still cause ketosis.
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
In one hypoxia-ischemia model, rats fed a ketogenic diet for 25 days before cardiac arrest had fewer postarrest seizures and myoclonic jerks and less neurodegeneration (determined by Fluoro-Jade staining) than those fed a normal diet [28,29]. The ketogenic diet also appears to have cardioprotective properties in an isolated heart perfusion model designed to mimic global ischemia. These changes were concomitant with increased numbers of mitochondria in cardiac muscle, suggesting that improved capacity to generate energy conferred a protective effect in the face of an ischemic insult .
Recent studies show that low-carb diets such as keto are more effective at raising good (HDL) cholesterol than low-fat diets [1, 2]. However, there are also studies showing that keto can increase total cholesterol (HDL and LDL) . On the other hand, low-carb, high-fat diets also decrease LDL particle concentration (LDL-P), increase the size of LDL cholesterol and decrease the amount of harmful VLDL cholesterol in the blood , all of which have a positive effect on cardiovascular fitness.
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.
Though most of our cells can utilize fatty acids of all stripes via beta oxidation to create ATP energy, our central nervous system is at somewhat of a disadvantage. In fact, long chain fatty acids with 14 or more carbons, which can yield the most ATP from beta oxidation, do not cross the blood-brain barrier. However, in a state of prolonged dietary carbohydrate depletion, the liver begins converting acetyl coenzyme A into various ketone bodies, such as acetoacetate and beta hydroxy butyric acid, which easily penetrate into the brain and which can, like acetyl coenzyme A, be shunted into the citric acid cycle and then the electron transport chain, providing the brain with ATP.
Increased enterohepatic circulation on high fat means that cholesterol is kept "in play" - bounced back into the bloodstream in ApoB particles - while low enterohepatic circulation, in people with with higher synthesis rates, during weight loss - when cholesterol is being dumped by shrinking cells - means that cholesterol can pile up in the gall bladder faster than it can be conjugated to bile salts and bile acids and faster than it can be extracted by the weak stimulus of low fat food.
In subsequent months, reports of enormous toxicity, even patient deaths began to filter through the research community, serving to temper the initial hysteria. And it wasn’t cheap, as miracles go – the very toxic drug was so potentially dangerous it had to be administered in a hospital setting under very close supervision, with costs running in excess of $100,000 for a several-week course of treatment.
The nutritional world then, as it is today, was surely confusing, with various scientists, physicians, and lay authors promoting one diet or another, often – as in the case of Atkins and Pritikin – offering completely contradictory dietary recommendations. Fortunately, when in 1987 Dr. Atkins offered me a job, I had already found what I thought represented a solution to the dilemma of dueling dietary dogma.
A ketogenic diet is a very high-fat low-carbohydrate diet that is designed to induce fat metabolism. When the body is depleted of glucose stores, it shifts to metabolizing fat and fatty acids, which produces compounds called ketones. Ketones cross through the blood-brain barrier and enter the brain, where they’re used as an alternative energy source.
Adhering to a keto diet can be challenging and may be particularly so for cancer patients, many of whom may be enduring side effects from treatment. Entering a state of ketosis requires following a strict diet-plan, comprised of high fat foods such as bacon, heavy cream, and butter, while simultaneously restricting other categories of food, such as starchy vegetables like sweet potatoes, whole grains, and certain fruits. This dramatic change in eating habits can lead to nausea and digestive upset in addition to unintentional weight loss and increased risk of malnutrition.
However, in most cases, avoiding all foods that contain cholesterol (like eggs or cheese) isn’t necessary to support heart health, especially since some sources of cholesterol can be nutrient-dense foods. What’s important is practicing moderation and finding balance in your diet, as well as eating a combination of natural foods that fight inflammation.
Jimmy Moore: I wouldn’t fret so much about the blood sugar, I would definitely keep an eye on insulin. Unfortunately there’s just not an easy way to prick your finger and check insulin at home. It doesn’t exist yet. It’s coming real soon. It’s not available yet. I think the big take home is relax, chill out, you’re doing good for your body, especially like we talked about with the cholesterol numbers. If that HDL is going up, if the triglycerides are going down, the small LDL particles are going down, your HSCRP is under 1, why are you worried?
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There’s less research, as I mentioned before, in humans, but the little that does exist, I think, is promising and should lead us to doing more. One study monitored tumor growth in response to a high-carb versus a ketogenic diet in 27 patients with cancer of the digestive tract. Tumor growth increased by 32.2 percent in patients who received the high-carb diet, but actually decreased by 24.3 in the patients on ketogenic diet. However, in this study, the difference was not statistically significant. That’s a whole other discussion about statistical significance that I won’t go into here, but that’s one potential reason to take that study with a grain of salt.
Your child may start the diet in the hospital, so nurses and doctors can observe the first few days. Your child will probably need to go without any food for 36 to 48 hours before beginning the diet. After that, food is gradually increased over a few days. This diet does not provide all the vitamins a body needs, so your child will probably have to take sugar-free vitamin supplements.
• Pancreatic insufficiency — Pancreatic insufficiency is a condition where your pancreas does not produce enough enzymes to help break down and absorb nutrients in your digestive tract. If you have an enzyme deficiency, I suggest having it treated first before embarking on a ketogenic diet, because your digestive system will have a hard time absorbing dietary fats.
“Because cancer cells prefer to use glucose, diets that limit glucose may be beneficial,” Barbara Gower, PhD, senior author and professor in the Department of Nutrition Sciences, said in a statement. “Because they limit glucose and several growth factors, ketogenic diets will limit the ability of cancer to grow, which gives the patient’s immune system time to respond.”
There have been a few studies of the modified Atkins Diet in adults with seizure disorders, and the results are similar to studies with children. Interestingly, it was remarked in one of the reports that it was more difficult to keep adults on the diet since they obviously have more control over what they eat. Research is still limited in this area and more trials are needed.
Most of the DNA errors that lead to cancer appear to modify cellular metabolism in cancer cells, by targeting a dozen or so signaling pathways. Metabolism is a term used to describe chemical reactions that help to keep our cells and, by extension, our body, alive. Many of these metabolic changes are absolutely essential for cancer cell formation and survival.
Eating a 5,000-calorie diet high in fat will certainly put you in ketosis, but you probably won’t lose weight because those excessive calories have to go somewhere. You needn’t be as adamant about calories doing a ketogenic diet, but they do still matter. Drizzling 500 calories of MCT oil or butter onto your steak will probably get you into ketosis, but the scales aren’t going to provide you much love. However, having the right amount of extra fat in the diet while keeping starchy carbohydrates low will make you into a fat-burning machine.
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).
A ketogenic diet also has been shown to improve blood sugar control for patients with type 2 diabetes, at least in the short term. There is even more controversy when we consider the effect on cholesterol levels. A few studies show some patients have increase in cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing its effects over time on diabetes and high cholesterol.
The body needs bile to break down and digest dietary fat, and the gallbladder is responsible for storing bile before its release into the small intestine. Removal of the gallbladder and gallbladder disease cause fat malabsorption and may make it difficult to follow a ketogenic diet. If you have had your gallbladder removed or have existing gallbladder disease, consult with your doctor before trying a ketogenic diet.
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Some of the most exciting research on the ketogenic diet pertains to its applications in the treatment of cancer. A rapidly growing collection of animal studies indicates that the ketogenic diet has anticancer effects in malignant glioma, neuroblastoma, prostate cancer, and colon cancer. (34) In humans, a ketogenic diet has been found to work synergistically with antineoplastic agents in the treatment of malignant glioma, a common primary brain tumor that is notoriously difficult to treat. (35) Several small studies indicate that the ketogenic diet improves body weight and blood profiles while reducing a marker for tumor progression, TKTL1, in patients with breast, prostate, colon, melanoma, and lung cancers. (36, 37)
Leanne: I went to my naturopath, and she’s like this is awesome, this is exactly what we want to see. My issue was hormones, so I want cholesterol so that my body can build hormones, because without that cholesterol good luck. When I went to my regular GP, he was like “Statins, put you on statins. Oh my gosh it’s way too high.” What do you say to people, you’re saying 200 is always thrown out there with cholesterol. What you’re saying is that cholesterol is not really all that important in the grand scheme of things if you’re looking at your number. It’s more important to look at triglycerides in that ratio?
The Modified Atkins Diet (MAD) is one of these alternative diets. It is a less restrictive form of the ketogenic diet. Adults and adolescent patients are restricted to 20 grams of carbohydrates per day and children to 15 grams per day. This diet can be easier to tolerate especially in older children and adults who eat a normal diet. In the MAD, there are no restrictions on protein and calories (and the biggest difference is probably the protein compared to the ketogenic diet). Increased fat intake is encouraged to increase ketosis.
The cancer industry is probably the most prosperous business in the United States. In 2014, there will be an estimated 1,665,540 new cancer cases diagnosed and 585,720 cancer deaths in the US. $6 billion of tax-payer funds are cycled through various federal agencies for cancer research, such as the National Cancer Institute (NCI). The NCI states that the medical costs of cancer care are $125 billion, with a projected 39 percent increase to $173 billion by 2020.
The understanding of the mechanisms of action of KD is incomplete; however, some theories have been advanced about how it modifies the neuronal metabolism and excitability in order to reduce the seizure frequency. Possibly, the real mechanism of reduction of cortical hyperexcitability involves multiple factors. Some of the systems involved in seizure reduction are related to metabolic changes in the blood and cerebrospinal fluid (CSF), including a decrease in glucose levels and an increase in KB. The mitochondria function and energy reserve may also play a role in the KD mechanisms, resulting in synapse stabilization and excitatory decrease.
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.
That plan didn’t allow much variety or leeway. Eggs, two small green salads a day, gelatin for dessert, cheese (up to 4 ounces daily), bone broth, no-calorie liquids, and lots of meat: That was pretty much it for the first week. After level one, you added vegetables like broccoli. Yes, you would be in ketosis doing the original Atkins diet, but for most people, that spartan plan would get boring quickly.
Its hard to find any information about hyper responders, even harder for me as my total cholestorl levels increased extremely after I went on the keto diet, from an already high 5mmol/dL to extremely high (14mmol/dL or 538mg) which is unheard of, even in the many hyper responder cases I've studied. But my HDL increased to 2.7mmol and my trigicerides stayed the same at good 0.9. Nobody 've seen has such a high total cholestrol. Even as i research how cholestrol doesn't have much link to heart disease mortality, there's no research on anything as high as my case.
To counteract these genetic vulnerabilities, it is may be best to eat a low to moderate fat diet that is whole food based with plenty of fiber, monounsaturated fats, polyunsaturated fats (especially omega 3s), and limited saturated fats. This, as well as a lifestyle filled with physical activity, stress relief practices, and plenty of sleep, should keep their cholesterol levels under control.
When your body burns its stores of fat, it can be hard on your kidneys. And starting a ketogenic diet -- or going back to a normal diet afterward -- can be tricky if you’re obese because of other health issues you’re likely to have, like diabetes, a heart condition, or high blood pressure. If you have any of these conditions, make diet changes slowly and only with the guidance of your doctor.
After my original lengthy conversation with Dr. Kelley, my research mentor Dr. Good suggested that during my summer break I begin an informal review of Kelley’s patient charts located in his Dallas office. From my first day in Dallas, I found among Kelley’s records patient after patient with appropriately diagnosed poor prognosis or what would be considered terminal disease such as metastatic pancreatic and metastatic breast cancer, who had done well under his care for many years, often with documented regression of his disease.
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.
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.
Dr. Gonzalez and his colleague Dr. Linda Isaacs MD have had remarkable success treating cancer patients with a non-toxic nutritional protocol that incorporates some of the principles of the late Dr. Max Gerson MD along with the late Dr. William Donald Kelley’s protocol which includes high doses of pancreatic enzymes and individualized diets depending on body type and cancer type. I have huge respect for them, not because of their theories, but because they are getting RESULTS, including reversing “incurable” stage four cancers. Two volumes documenting 112 of their successful case studies can be found here.
As I wrote in my book, “Nevertheless on the therapy [Kelley’s] he slowly began to improve, to the point his mental status normalized and over a period of a year, he progressed from a wheelchair to a walker to a cane.” When I completed my study in 1987, he had survived 5 years and was in excellent health, with no evidence of cancer in his brain or spinal canal.
The keto diet also appears to help induce autophagy, which helps clear damaged cells from the body, including senescent cells that serve no functional purpose but still linger inside tissues and organs. In animal studies when rats are put on the ketogenic diet, autophagic pathways are created that reduce brain injury during and after seizures. (21)
How can a ketogenic diet help with IBS and GERD? By significantly reducing dietary carbohydrate load, a ketogenic diet provides less fermentable substrate for gut bacteria, reducing the amount of gas produced in the small intestine. Several small studies indicate that a ketogenic diet improves abdominal pain, stool frequency, and reflux in patients with IBS-D and GERD, respectively. (30, 31) However, it is important to note that the long-term effects of a low-fermentable-carbohydrate diets, including the ketogenic diet, on gut bacteria remain to be seen. Our beneficial gut bacteria also require fermentable carbohydrates to survive, so it’s possible that the ketogenic diet could reduce their numbers. This is why I highly recommend following a cyclic ketogenic diet rather than a long-term, strict ketogenic diet. I’ll provide more information on that topic shortly.
A recent study found that ketone supplementation extended survival in mice with metastatic cancer. But while it’s true that most cancers have a highly anaerobic metabolism, this in not universal. If proven to be effective, it’s likely that ketone supplementation would be an additional treatment rather than a stand alone treatment for cancer, because of its robust nature.
So what do you do about GBM? Standard treatment begins with surgery. After surgery, you are given radiation and chemo. In the meantime, you take other medications to control the side effects. Tick, tick, tick, GBM makes you acutely aware of clocks ticking. You start searching for medical trials. There are many rules to qualify, most extend life by only a few months. Some have a substantial chance of killing you.
This is where we have to depart! Sorry to say but you’re on your own. You should have plenty of leftovers that are frozen, ready, and waiting! I know a lot of you out there have trouble with timing and are busy people – so making sure that some nights you make extras to freeze is important. All those leftovers you have in the freezer? Use them up! Create your own meal plan, at first using this as a guide, and then completely doing it yourself. Once you get the hang of it, it’ll be a sinch – I promise you 🙂
If seizures are well controlled with antiseizure medications and the medications are well tolerated, many people would not wish to consider trying a ketogenic diet. However, in cases where seizures are not well controlled with antiseizure medications, or where the medications result in difficult side effects, or in cases where surgery is not an option, a ketogenic diet may be recommended.
Jimmy Moore: Just removing the infections that were in the mouth and the mercury amalgam poisoning that was probably happening. Was raising my cholesterol because it was trying to be that fire fighter to put out the fire. Of course it never showed up in my inflammation because the cholesterol was taking care of it, had I been taking a Staten drug Leanne, I would have been at great risk. I would have been in really bad shape. Anyway, I thought okay that was maybe an anomaly, that was in October. Let me have it run again, I had it run again last month … 289 again. Not a fluke, and that’s one of the things we did in Cholesterol Clarity, was you said, “why aren’t doctors asking why the cholesterol is high?” All they know is that it’s high. Therefore you have a Staten deficiency and please take this drug.
A very recent review on nutritional approaches toward preventing and reversing Alzheimer’s disease (AD) was conducted in Christchurch, New Zealand’s Canterbury University. The results were submitted to the journal Nutrition. It’s title: "The ketogenic diet as a potential treatment and prevention strategy for Alzheimer's disease." After analyzing 33 studies researching AD and other neurological disorders handled with a ketogenic diet and supplementing coconut oil, the University of Canterbury review analysis concluded: "In this review, we hypothesize that the ketogenic diet could be an effective treatment and prevention for Alzheimer's disease, but both ketone production and carbohydrate restriction may be needed to achieve this."
Some negative side effects of a long-term ketogenic diet have been suggested, including increased risk of kidney stones and osteoporosis, and increased blood levels of uric acid (a risk factor for gout). Possible nutrient deficiencies may arise if a variety of recommended foods on the ketogenic diet are not included. It is important to not solely focus on eating high-fat foods, but to include a daily variety of the allowed meats, fish, vegetables, fruits, nuts, and seeds to ensure adequate intakes of fiber, B vitamins, and minerals (iron, magnesium, zinc)—nutrients typically found in foods like whole grains that are restricted from the diet. Because whole food groups are excluded, assistance from a registered dietitian may be beneficial in creating a ketogenic diet that minimizes nutrient deficiencies.
Throughout his talks, both here and elsewhere, Dr. Seyfried presents mouse studies that are interesting and suggestive that there might be something to this whole ketogenic diet thing, at least in brain tumors, such as this one. However, this is what we in the oncology biz would call pretty preliminary data, worthy of further investigation but not supporting the grandiose claims that Dr. Seyfried makes.
In children who can be successfully withdrawn from anti-convulsant therapy and are seizure-free for 2 years on the ketogenic diet (about 10 percent of treated children), an EEG is repeated and the ketogenic diet is slowly withdrawn. However, the diet is often stopped earlier if not successful. Similarly, after 2 years in children with continued seizures, most ketogenic diet centers will at least try to have the children come off the diet and see if it is no longer necessary for control.
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.