Wondering what fits into a keto diet — and what doesn’t? “It’s so important to know what foods you’ll be eating before you start, and how to incorporate more fats into your diet,” says Kristen Mancinelli, RD, author of The Ketogenic Diet: A Scientifically Proven Approach to Fast, Healthy Weight Loss, who is based in New York City. We asked her for some guidelines.
Scientists published the first pilot study on the relationship between the ketogenic diet and cancer in 2011. For their study, they recruited 16 patients (12 women and 4 men) with various cancers in advanced stages. They had an average age of 50.4 years (30-65 years). All of them had metastatic tumors, which means that they grew and spread throughout the body.
Given that the consumption of a high carbohydrate diet promotes inflammation and in turn causes CVD, is it any wonder then that our bodies would produce LDL particles which work to repair vascular damage, as they are needed to patch up the damage? Unfortunately LDL can only do so much under the constant onslaught of inflammation but had it not been there in the first place the person would not have survived as long as they did.
Multiple mechanisms of action may explain why the modification of the KD can be effective even without ketosis. Importantly, the KD systemic action can have a broad spectrum of effects that may be beneficial in the treatment of different types of epilepsy and associated comorbidities such as cognition impairment, psychiatric disturbance, and sudden unexplained death.
The good news, however, is that following a well-formulated ketogenic diet should help increase HDL while lowering triglyceride levels. LDL will likely remain the same or potentially increase in order to efficiently transport triglycerides to cells to metabolize for energy. Again, LDL will likely become more of the pattern A type which is a highly beneficial shift.
With this rationale, VanItallie et al. [39, Class III] performed a feasibility study with PD patients and the ketogenic diet. They explored whether PD patients would be able to prepare the ketogenic diet in their homes and remain on it for at least 1 month. Of seven patients enrolled, five completed the study. They were monitored for ketone levels and weekly Unified Parkinson Disease Rating Scale (UPDRS) scores. All the patients lost weight. Interestingly, the mean decrease in UPDRS scores was 43.4%. A placebo effect is not ruled out, but this result at least suggests that the ketogenic diet was not harmful and certainly invites further study into its role in preserving neuron function in PD and other neurodegenerative diseases. The possibility that the diet may have altered levodopa absorption (and that this factor, rather than an effect of the diet on neuronal function, was responsible for the change) has not been studied rigorously .
Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed. Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula. Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet. KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding. Other formula products include KetoVolve and Ketonia. Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.
In 2006, Strahlman [53, Class III] reported the case of his own wife, whose intractable migraine headaches resolved after a medically supervised low-calorie diet. Husain and colleagues [54, Class III] studied an Atkins diet–like plan in patients with narcolepsy and reported an 18% decrease in daytime sleepiness as measured by a standard questionnaire. The Atkins diet is less restrictive than the ketogenic diet and does not contain as much fat as “classic” ketogenic diets.
After the intervention, researchers noted that the ketogenic diet group had decreased their VLDL by 78%, their medium VLDL by 60%, and their small VLDL by 57%.  Additionally, their large LDL had increased by 54%, medium LDL decreased by 42%, and small LDL decreased by 78%.  Overall, the average particle size increased by 2% and the LDL particle concentration decreased by 11%. 
In 2005, he would eventually die with his dream of academic acceptance unrealized. But my colleague Dr. Linda Isaacs and I have worked diligently over the past 26 years, keeping the Kelley idea alive, that different people may require completely different diets. In the next installment, I will address my own experience treating patients diagnosed with advanced cancer with a Kelley based approach. Our therapy involves, oftentimes, diets high in carbohydrates, which proponents of the ketogenic diet would predict should fuel, not stop, cancer.
Historically, elevated blood cholesterol levels have been linked to atherosclerosis, a condition involving deposits of plaque that cause the arterial lining to thicken and potentially impair blood flow to the heart. The process of plaque deposition is complex but involves white blood cells, calcium, cholesterol, and other substances converging at the site of inflamed or damaged arteries.
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.
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.
The precise mechanisms behind the physiological effects of the ketogenic diet and ketones are not fully understood. It is believed that the ketogenic diet is anti-inflammatory, that it decreases free radical production while enhancing production of the body’s own natural anti-oxidants, and it improves metabolic efficiency.8 9 10 11 12 Specific conditions a ketogenic diet may benefit include:
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.
So on the surface, Dr. Seyfried’s argument that cancer is primarily a metabolic disease (an argument I’ll look at in more depth shortly) is well within the bounds of current oncologic science. Indeed, a few years ago it was all the rage, and I remember attending several sessions and lectures on the Warburg effect and cancer at the AACR meetings three or four years ago, although, oddly enough, I don’t recall as many the last couple of years. In any event, if that’s all I looked at, I probably would have shrugged my shoulders and moved on, as in, “Nothing to see here.” But there are quite a few red flags. The first red flag is a claim that a ketogenic diet can treat cancer better than chemotherapy. The second, even bigger, red flag is on Dr. Seyfried’s Boston College web page:
Leanne: Totally, awesome, perfect. Today we’ve really come together to talk about cholesterol. It is a huge topic. Yeah, Cholesterol Clarity right there. A lot of my readers who are adopting this high fat, keto eating style are getting really nervous about cholesterol and you know if I eat too many eggs is my cholesterol going to go up and so a lot of people that are watching this show today, I bet you about 80% of them have their blood work in front of them.
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.
[46:12] – Why smoking is linked to a high risk of cardiovascular disease even when cholesterol might be low. The key is to find out what it is that makes the vascular system weak or strong. Dave explains why he believes the weak association between cholesterol and atherosclerosis may be due to the body’s response to stress bringing higher levels of cholesterol.
He followed her advice, refused radiation, came to see me, and over the years he has proven to be a very vigilant, determined and compliant patient. Within a year on his nutritional program, which includes a high carb diet, his pain had resolved, his energy, stamina, and concentration had improved, and scans confirmed total resolution of all his original extensive disease – in complete contradiction to what Dr. Seyfried would predict or claim possible.
It can be challenging to maintain ketosis while providing enjoyable meals with enough calories for normal growth. Our long-running Ketogenic Diet Clinic is anchored by nutritionists who specialize in the diet and can provide detailed counseling. Families using the classic ketogenic diet will receive a selection of recipes individualized for their child. A gram scale will be needed to precisely weigh food ingredients (thanks to support from the Tyler Foundation, we have been able to help with obtaining a gram scale when necessary). Our nurses and social workers experienced in diet treatment can provide additional support.
Conversely, when beginning a diet, motivation is high, and the tendency is to push oneself to the physical and dietary limit. You might decide to cook every meal at home when you typically eat out, or you may sign up for the gym and commit to working out 3 hours a day for 5 days a week. But pushing oneself too hard, especially in the beginning, most often leads to burnout and diet failure.
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. 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. For this group, and for children in particular, the diet has once again found a role in epilepsy management.
Of course, there are plenty of cancer therapies that are effective and non-toxic, but they are not covered by insurance companies in the U.S., and most of them are not approved by the FDA, so one must go south of the border into Mexico or travel to another country to receive the best non-toxic cancer therapies. (See: Cancer – The Forbidden Cures and Why Medicine Won’t Allow Cancer to Be Cured)
Leanne: Yeah, that’s amazing that you took your health into your own hands. I think that’s so empowering for so many people. When we just say “enough is enough and we need to change.” For me I came at this from the hormone piece, but also we have a strong line of dementia in our family. Very, very strong. For me, it was how can I be as good to my brain as possible? Not only is this good for your heart and everything else, but also looking at the health of your brain, which we talked about with having enough cholesterol is important for our brain function, too.
"The message is not that children with [uncontrollable] seizures should not be on this diet, because it can be remarkably effective and most children only stay on it for a few years," Kwiterovich tells WebMD. "But our findings suggest the distinct possibility that anyone who eats a very high-fat diet may be setting themselves up for later [blood vessel] disease."
Acid Reflux/GERD (heartburn): people who suffer from acid reflux or chronic heartburn will find great relief after adopting a keto diet, especially if all grain and fermentable carb sources (FODMAPS) are eliminated from the diet. In fact, I believe that some of the beneficial effects of a ketogenic diet are rooted in the elimination of toxins in foods that the keto diet limits.
The benefits above are the most common ones. But there are others that are potentially even more surprising and – at least for some people – life changing. Did you know that a keto diet can help treat high blood pressure, may result in less acne, may help control migraine, might help with certain mental health issues and could have a few other potential benefits?
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures. Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet. Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective. Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.
The traditional Atkins’ Diet was certainly high fat, in the range of 70% or more, nearly all from animal sources, and with minimal dietary carbs, less than 10%. Dr. Atkins, famed for his all-encompassing emphasis on ketosis during his early years as a diet doctor, insisted his patients routinely check the levels of ketone bodies in their urine several times a day, using special “ketone strips.”
The predominant use of glucose anaerobically by cancer cells (Warburg effect) may be the most important characteristic the majority of these cells have in common and, therefore, a potential metabolic pathway to be targeted during cancer treatment. Because this effect relates to fuel oxidation, dietary manipulation has been hypothesized as an important strategy during cancer treatment. As such, the concept of a ketogenic diet (KD) in cancer emerged as a metabolic therapy (ie, targeting cancer cell metabolism) rather than a dietary approach. The therapeutic mechanisms of action of this high-fat, moderate-to-low protein, and very-low-carbohydrate diet may potentially influence cancer treatment and prognosis. Considering the lack of a dietetics-focused narrative review on this topic, we compiled the evidence related to the use of this diet in humans with diverse cancer types and stages, also focusing on the nutrition and health perspective. The use of KD in cancer shows potentially promising, but inconsistent, results. The limited number of studies and differences in study design and characteristics contribute to overall poor quality evidence, limiting the ability to draw evidence-based conclusions. However, the potential positive influences a KD may have on cancer treatment justify the need for well-designed clinical trials to better elucidate the mechanisms by which this dietary approach affects nutritional status, cancer prognosis, and overall health. The role of registered dietitian nutritionists is demonstrated to be crucial in planning and implementing KD protocols in oncology research settings, while also ensuring patients’ adherence and optimal nutritional status.
Aside from carb flu, be warned that staying in long-term, continuous ketosis may have drawbacks that may actually undermine your health and longevity. To stay on the safe side, I recommend undergoing a cyclic ketogenic diet. The "metabolic magic" that ketosis brings to the mitochondria actually occurs during the refeeding phase, not during the starvation phase.
In terms of seizure recurrence among children, the risk of seizures returning in those who are seizure free and stop the diet is 15 to 20%, according to Kossoff. In children who experience less frequent seizures, but are not seizure free, about one-third will have some worsening of seizures when the diet is stopped, though this is sometimes transient.
The first signs of ketosis are known as the “keto flu” where headaches, brain fogginess, fatigue, and the like can really rile your body up. Make sure that you’re drinking plenty of waterand eating plenty of salt. The ketogenic diet is a natural diuretic and you’ll be peeing more than normal. Take into account that you’re peeing out electrolytes, and you can guess that you’ll be having a thumping headache in no time. Keeping your salt intake and water intake high enough is very important, allowing your body to re-hydrate and re-supply your electrolytes. Doing this will help with the headaches, if not get rid of them completely.
A high carbohydrate intake can exacerbate irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) by feeding opportunistic and pathogenic bacteria in the gut. (29) These microbes ferment dietary carbohydrates, producing gases that increase intraabdominal pressure, a driving force behind acid reflux and GERD. The gas manufactured by these bacteria also contributes to bloating, abdominal pain, and diarrhea in IBS.
Senior moments. They joke about, “Oh you’re just getting older so you’re going to get dementia, you’re going to get Alzheimer’s, that’s just normal of getting older.” No! No it’s not. They’re taking these very drugs that are robbing the body of exactly what it needs to stay mentally sharp. I’m in my early forties now, I’m hoping twenty, thirty years from now … having all that butter I eat, and healthy fats is going to keep this noggin sharp. I think it will and I’ll be danged if I ever take anything that will take away the very key element that’s making my brain sharp.
I believe (as well as the numerous experts I have interviewed) that over 90 percent of cancer cases are either preventable or treatable. The key here is to view cancer as a metabolic dysfunction, allowing you to gain control over this dreadful disease. Simply put, the right foods and strategies may help suppress cancer growth while simultaneously pushing it into remission.
HDL cholesterol transfers the extra cholesterol from the blood to the liver for removal from the body and is also referred to as “good” cholesterol. LDL cholesterol transfers the cholesterol within the bloodstream to the parts of the body where cell repair is needed and also inside the arteries. It is also known as “bad” cholesterol. Total cholesterol is HDL and LDL cholesterol combined (4).
The ketone bodies are possibly anticonvulsant; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.
You can change that genetics. I can’t change the genetic tendency, it’s going to be there. By golly, I’m going to pay attention to everything that I put in my mouth for that sake alone. Anyone with that kind of history, I don’t think it’s reason to freak out. I don’t think it’s a reason to think it’s an inevitability for you. It’s just one of those things that you have to pay attention to all of your numbers, anal retentively. That’s why I pay attention to my HSCRP so closely, that’s why I run my numbers so often. I know I have that tendency. I probably, had I not lost the 180 pounds in 2004, I would be in an early grave just like my brother.