Dr. Campos, it is unfortunate that you retain the medical community’s negative stance on the ketogenic diet, probably picked up in medical school when you studied ketoacidosis, in the midst of an obesity and type II diabetes epidemic that is growing every year, especially among populations who will never see the Harvard Health Letter. The medical community has failed in reversing this trend, especially among children, and the public is picking up the tab, in the form of higher health insurance premiums to treat chronic metabolic diseases which doctors cannot cure. The ketogenic diet does not bid its adherents to eat unhealthy processed meats, and the green leafy vegetables that it emphasizes are important in a number of nutritional deficiencies. People lose weight on the ketogenic diet, they lose their craving for sugar, they feel more satiety, they may become less depressed, their insulin receptors sensitivity is improved, and these are all the good outcomes you fail to mention. There is a growing body of research which demonstrates the neuroprotective effects of the ketogenic diet to slow cancer progression, as well as diseases like Parkinson’s and Alzheimer’s, for which there are no effective medical treatments. Please respect your patients by providing them with evidence-based medical outcomes, not opinions.
Practitioners from hospitals both in the U.S. and abroad who wish to start a ketogenic diet center at their institutions can participate in one of our 1- or 2-week training sessions for a fee. The training covers both the ketogenic and modified Atkins diets. Professionals affiliated with centers already using ketogenic diet programs are welcome to attend our monthly ketogenic diet follow-up clinics.
Energy Deprivation. By its nature, the ketogenic diet is very low in carbohydrates (typically 20 to 50 grams/day) and naturally restricts calorie consumption. This restricts the amount of fuel that cancer cells receive, even for the cancer cells that are able to thrive off of multiple substrates. Furthermore, almost all cancer cells seem to lack the ability to use the ketones produced when carbs consumption is restricted. Thus, cancer patients who are keto-adapted will probably be the most effective at starving cancer cells.
In the 1920s, German scientist Otto Warburg found that cancer cells fuel their growth through metabolizing a large amount of glucose. Unlike the average healthy cell, he saw that cancer cells were converting glucose into energy without using oxygen, even when oxygen was readily available. Now called the Warburg effect, this phenomenon is seen in about 80 percent of cancers.
A more recent clinical trial comparing a ketogenic diet (33.5% protein, 56% fat, 9.6% carbohydrate) to a low-fat diet (22% protein, 25% fat,55.7% carbohydrate) among 55 obese adults, showed that the ketogenic diet resulted in improved cholesterol levels compared to the low-fat diet. More specifically, the group following the ketogenic diet reported higher increases in HDL cholesterol and higher decreases in triglyceride levels compared to the control group (15). 

Let’s go back to the research assessing how the low-carb, high-fat diets such as the ketogenic diet affect your LDL levels. In the meta-analysis by Bueno et al., low-carb diets were shown to increase HDL twice as much as low-fat diets after randomized controlled interventions. It also showed that there was a small increase in LDL-C in low-carb subjects compared to low-fat diet subjects who experienced no increase.

People use a ketogenic diet most often to lose weight, but it can help manage certain medical conditions, like epilepsy, too. It also may help people with heart disease, certain brain diseases, and even acne, but there needs to be more research in those areas. Talk with your doctor first to find out if it’s safe for you to try a ketogenic diet, especially if you have type 1 diabetes.
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. Some evidence of synergistic benefits is seen when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[18]
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).

When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]

These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.
The digestion of carbohydrates (sugar and starch) releases sugar (glucose) into the bloodstream. Greater carb intake results in rising blood sugar and insulin, a pancreatic hormone that manages blood sugar.  Going keto replaces dietary carb with fat and protein. Over time, your cells switch metabolic pathways, and burn stored and dietary fat as a primary energy source instead of sugar. As more fat is burned, some of it is converted into ketone bodies. As blood glucose and insulin levels fall, and ketone levels rise, your muscles (skeletal and heart), use the fats in the bloodstream as fuel, while your brain uses the ketones. The result is more energy, clearer thinking and better health. Ketones are beneficial in many different ways, and being in this metabolic state of "nutritional ketosis" (where blood sugar is low and ketone levels are moderate) has some powerful effects on your metabolism. There is strong research evidence that these metabolic-affecting diets can be used to treat the following medical conditions:
{Correction to my earlier comment above: The brain is able to use ketones as fuel, but when glucose is in short supply, the glucose permeability of the blood brain barrier increases by 1/3 to 1/2. And despite what the textbooks say, there is a pathway for converting fatty acids to glucose; it’s a fruitless pathway, because there is no net gain of glucose.}
A study evaluating the effects of a ketogenic diet among 66 obese adults, from which 35 had high cholesterol levels and 31 had normal levels of cholesterol demonstrated that both groups resulted in statistically significant decreased levels of LDL cholesterol, total cholesterol, and triglycerides, whereas the HDL cholesterol levels were increased. These results show that keto diet can improve cholesterol levels and ratios of cholesterol levels among obese people regardless of their cholesterol levels before the dietary intervention. Furthermore, this study also demonstrates that low-carb diet is safe to use for a longer period of time in overweight people with a high total cholesterol level and those with normocholesterolemia (18).
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 Ketogenic Diet (KD) is a modality of treatment used since the 1920s as a treatment for intractable epilepsy. It has been proposed as a dietary treatment that would produce similar benefits to fasting, which is already recorded in the Hippocratic collection. The KD has a high fat content (90%) and low protein and carbohydrate. Evidence shows that KD and its variants are a good alternative for non-surgical pharmacoresistant patients with epilepsy of any age, taking into account that the type of diet should be designed individually and that less-restrictive and more-palatable diets are usually better options for adults and adolescents. This review discusses the KD, including the possible mechanisms of action, applicability, side effects, and evidence for its efficacy, and for the more-palatable diets such as the Modified Atkins Diet (MAD) and the Low Glycemic Index Diet (LGID) in children and adults.
Fortunately, patients have an alternative—a ketogenic diet. Research indicates that a ketogenic diet improves multiple aspects of metabolic syndrome, inducing significant reductions in body fat percentage, BMI, hemoglobin A1c levels, blood lipids, and blood pressure. (10, 11, 12) The ketogenic diet produces these beneficial effects by reversing the pathological processes underlying metabolic syndrome, including insulin resistance and chronic inflammation.
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.
This is so important. I think people need to know just because you lower your LDL doesn’t mean you’ve necessarily made yourself healthier. What it does when you have the vegetable oils and you lower your LDLC, you could see your total cholesterol go to 150 for example. Okay, you think you’ve done something good, what you’ve done though is you totally eliminated all of those healthy pattern A, the large fluffy kind, you’ve totally eliminated those drinking these vegetable oils because you’ve oxidized the LDL, making them into more of those small LDL and you’re at great risk for heart disease.
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.
I actually went on a ketogenic diet last year to see if it would help my migraines. I have a history of chronic migraines which would usually last 3 days, sometimes longer. Triptans help a lot but I don’t like having to take them. I stayed in ketosis for about 8 months and experienced a significant reduction in migraines, from feeling some type of headache (mild o r severe) almost everyday to 1 or 2x per month while in ketosis. Although I’m very healthy otherwise, I do think my migraines may have something to do with blood sugar fluctuations (despite previously eating a whole foods diet and no refined carbs), and keto totally stabilized this. I eventually came off of Keto because I’m not really a meat lover. When I came off, but remained low carb, my migraines stayed under control for the most part. When I increase carbs, they do return.
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Weight loss was also irresistible. I actually tried not to lose weight. Based on advanced bro science, I was supposed to maintain my weight if I ate at least 2,000 calories a day. Yet my efforts to stuff myself with gloriously fatty food were futile. I lost 10 kilos and got abs — “blurry” ones though. You still need a bit of imagination to count six.