The classic ketogenic diet used as far back as the 1920s is a four to one ratio (in grams) of fat to carbohydrates plus protein. That’s about 90 percent of calories coming from fat. We typically teach our patients a modified Atkins diet, which limits the net carbohydrate intake to 20 grams per day without any limitations on the amount of protein and fat they eat. Typically, about 60 to 70 percent of their daily calorie intake comes from fat. (That’s more than double what the USDA Dietary Guidelines recommend.)
Type 2 diabetes. One study found that being on the keto diet for one year reversed diabetes for up to 60 percent of participants. With an average weight loss of 30 pounds, they dramatically reduced or eliminated their need for insulin and no longer needed oral hypoglycemic drugs. The keto diet is also easier to sustain than the calorie-restricted diet or the protein-sparing modified fast.
Researchers also observed that the size of VLDL particle size did not change in either of the groups. However, they noted that the total number of VLDL particles decreased by 19% from 76.2 nmol/L to 61.7 nmol/L. [22] More specifically, large VLDL particles reduced by 40.2% from 3.33 nmol/L to 1.74 nmol/L, medium VLDL particles decreased by 4.8% from 46.2 nmol/L to 44 nmol/L. [22]
Weight Loss – Part of the resurgence in interest in the ketogenic diet is due to the work of Dr. Atkins and his low-carb diet for weight loss. There is strong evidence to support the use of a ketogenic diet as a weight loss therapy.18 19 People following a low-carb diet tend to lose more weight in the first 3-6 months than those following a more traditional diet.20 Part of the benefit likely comes from the fact that ketogenic diets tend to suppress appetite and lead to a natural decrease in calorie intake.21 But even in studies where participants on a low carb diet ate the same number of calories per day as those on a lowfat diet, significant differences in weight loss were observed.22 This is likely due to the fact that ketosis relies on fat from the diet and body fat to produce ketones for energy.
Cyclical ketosis means you’re sometimes in ketosis and sometimes aren’t. A few days each week—the night before workout days to build glycogen stores in your muscles—try increasing your intake of berries, higher complex carb veggies (like sweet potatoes), and non-gluten grains. It might knock you out of ketosis temporarily, but it also provides a wealth of nutrients to keep you lean, healthy, and happy. This is also called flexible ketosis, which creates metabolic flexibility—the holy grail of metabolism management. I’ve also talked about cycling ketosis with intermittent fasting, which provides a win-win strategy to reach your health goals.
In another parallel experiment the mice used did not have cancer at the start, but were bred to have a genetic predisposition toward breast cancer. Almost half of these mice, when fed on the Western diet, showed cancer within the first year (the average life span of these mice is two years). Only one of the mice in this group reached its normal life expectancy, and 70% ultimately died of cancer. Of the group on the ketogenic diet, only 30% ever developed cancer, and over half reached their normal life expectancy or exceeded it.

Patients diagnosed with the immune based “blood cancers” like leukemia, lymphoma, and myeloma, as well as the sarcomas, a type of connective tissue malignancy, required a lower carb, high animal fat, moderate animal protein diet. Other patients, usually with problems other than cancer, thrived on a more “balanced” diet, incorporating a variety of plant and animal foods.
The reason you’re hungry is that was not a high fat diet. That was a high protein meal that you had. While yes adding a little bit of fat is good, maybe a little more might be helpful in order to stay down those hunger things and what the hunger is, is your blood sugar being so high you can’t get it down because there’s this big long G word we talked about in my book Keto Clarity, called gluconeogenesis. When you eat more protein than your body can use, it actually can’t store protein. What it does is it sends that excess protein to the liver. The liver squirts out glucose, which is sugar. If you’re trying to be ketogenic, if you’re trying to control your blood sugar levels, you absolutely need to keep carbs low. That’s duh. You also need to moderate down on the protein. Especially if you’re insulin-resistant.
The problem with this is that it’s the B particles that cause the biggest problems. Remember, since particle B molecules are very small, they are the ones that get stuck in nooks and crannies of the arterial and vascular walls. Having more B particles will be bad. But, having more A particles won’t necessarily be bad. But if all you get is the TOTAL LDL (which is typical), you have no idea of your actual particle composition. So it’s possible that a high LDL number, without any context or further testing is not a problem at all.
Though I would see Bob occasionally at conferences, I never mentioned any of this to him. Some years later we met for lunch in Washington, DC, at a conference where we were both scheduled to speak. To my astonishment, he told me he was closing down his cancer unit completely, to concentrate on his traditional area of expertise – obesity, diabetes, heart disease, hypoglycemia, the metabolic syndrome – problems for which he knew his nutritional approach with the ketogenic diet worked quite effectively.
“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.”
Patients diagnosed with the immune based “blood cancers” like leukemia, lymphoma, and myeloma, as well as the sarcomas, a type of connective tissue malignancy, required a lower carb, high animal fat, moderate animal protein diet. Other patients, usually with problems other than cancer, thrived on a more “balanced” diet, incorporating a variety of plant and animal foods.
Ketogenic diet is one of the oldest forms of medical treatment for epilepsy. Most ketogenic diet centres have traditionally specialized in treating children ages 0 to 18 years of age. However, there is growing evidence that shows its usefulness in controlling seizures in adults. In the content below, you will find answers to frequently asked questions about the benefits and challenges of this diet therapy. Please note, the ketogenic diet should never be attempted on your own. It should only be attempted with the support of a trained medical team.
Yes you can lose fat on a low carb because it’s just another low calorie diet. How do I know this? I’ve done low carb, (Atkins, etc) high carb, (Slimming Word) moderate carb etc and log my food and was shocked each time to see they were all low calorie. After the initial week or so the rate of fat loss is same as any other diet. It’s calories in calories out. Simple. It’s what some call indirect deficit diet placing silly restriction, rules can eat must eat etc. and of course you lose weight but nothing to do with low carb. It works because it’s a low calorie diet.
Because epilepsy is a metabolic disease (Clanton et al., 2017), interest in studies of alterations of metabolism by anticonvulsants such as the KD has increased, as has their importance for the treatment of drug-resistant epilepsy. This contribution reviews the use and effects of the KD and its variants for the treatment of adults and children with intractable epilepsy.
Thank you, Dr. Jockers. I really appreciate your reply. I was wondering if insulin resistance would make my cholesterol go up on the ketogenic diet from a total of 220 before I went on it to 378 after being on it for six months. I have always been in a healthy weight range for my height, but I have always been extremely hungry most of the time. I really got on the ketogenic diet hoping that this would be regulated after being on it for some time, but it hasn’t helped that much. Would this signify that insulin resistance may be the culprit for my sudden rise in cholesterol even though I am following the ketogenic diet perfectly?
While I would like to offer a magic bullet for all cancers, a ketogenic diet is not that. The diet does not “cure” cancer. It should not be used to replace traditional treatment. But the diet has shown promise for some cancers especially GBM. So why would a diet help? On a simplistic level, cancer “eats” glucose and needs 20 times more glucose compared to normal cells. Cancer cells cannot make the transition to using ketones, especially in the brain, making them more vulnerable to chemo and radiation.
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A: The most common ways to track your carbs is through MyFitnessPal and their mobile app. You cannot track net carbs on the app, although you can track your total carb intake and your total fiber intake. To get your net carbs, just subtract your total fiber intake from your total carb intake. I have written an article on How to Track Carbs on MyFitnessPal.
Hi Stacey, I can’t give medical advice and definitely recommend following your doctor’s recommendations. You can ask him/her if low carb would be better suited for you. Also, you may want to double check with him/her if the kidney concern was related to high protein, because that is a common misconception about keto – it is not a high protein diet/lifestyle.
The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.
Leftovers will be another thing we will take into consideration. Not only is it easier on you, but why put yourself through the hassle to cook the same food more than once? Breakfast is something I normally do leftover style, where I don’t have to worry about it in the morning and I certainly don’t have to stress about it. Grab some food out the fridge, pre-made for me, and head out the door. It doesn’t get much easier than that, does it?
In adults, the type of ketogenic diet typically used is the modified Atkins diet. Carbohydrates are limited to 20 grams per day and the intake of foods containing fat is required to get into the state of ketosis. For example, foods such as heavy cream, oils, avocado, eggs, butter and meats are encouraged; whereas conventional breads, pastas, cereals and cakes are restricted.

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 🙂


Jimmy Moore: Let’s look at all of those things. Let’s look at the triglycerides, let’s look at the HDL, let’s look at the HSCRP, let’s see how your blood sugar is doing, your fasting insulin levels are doing. All of it matters and I think anybody that tries to do treatment of their high cholesterol, which is not a disease by the way, they might even call it hypercholesterolemia, to make it sound like it’s just this dastardly thing. It’s just a medical term that says you have high cholesterol.
Unknown to most, even within the alternative world, my friend Bob Atkins tried the ketogenic diet for some 12 years on many of his cancer patients, with no significant success as he reported to me. As a telling point, under the name “Dr. Robert Atkins” on Amazon, one will find dozens of books he authored including his original diet book, its many incarnations and editions, along with books on vitamins, minerals – but glaringly absent, no book on cancer. Yes, the ketogenic diet has been tried before, with cancer patients, and without success.
There is a lot I could respond to here, I’m a little surprised that you would include a study that feeds pregnant and lactating mice a diet (Teklad diet no. TD.96355) consisting of almost entirely hydrogenated vegetable shortening (Crisco), and also casein and corn oil, and calls it a “ketogenic diet.” On top of the fact that it’s a mice study. There is no evidence to show that there is any danger in pregnant and lactating women eating a (real) ketogenic diet. The only issue is that if a lactating woman switches from SAD to keto, “keto flu” may reduce her milk supply.
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.
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.

"It's called ketogenic metabolic therapy," and he says in this context, "the ketogenic diet shouldn't be considered a diet like green salads or other such stuff. It's essentially medicine, and the process primarily tries to remove one of the driving fuels for the disease, which is glucose, and transition the whole body over to ketones, which the tumor cells can't use as a fuel."
The story behind LDL, or low-density lipoprotein, is more complicated. LDL transports cholesterol produced by your liver and cells throughout your body. Unlike HDL, LDL molecules move slowly through the bloodstream and are vulnerable to oxidizing agents known as “free radicals.” Once oxidized, LDL can easily burrow itself into the walls of your arteries (called endothelium) and impede cardiovascular function. This triggers an inflammatory response in which white blood cells called macrophages rush to eat up the LDL.

First, I want to thank you for all of your dedication and work in providing this site. The difficulty of maintaining a healthy weight is a big problem for so many people. My personal question & issue in staying on Keto is my craving for fresh fruit. This a.m I had a large fresh peach along with my “Bullet Proof” coffee. Have I now sabotaged today’s Keto eating?
After the 12 weeks intervention, researchers noted that the concentration of LDL particles decreased by 9.6% from 1180 nmol/L 1180 to 1066 nmol/L. [22] As previously mentioned, lower levels of LDL particles are beneficial to cardiovascular fitness. Additionally, the particle size of LDL increased by an average of 5.2% from 20.75 mm to 21.27 mm. [22]
Another group at increased CVD risk are those with one or two copies of the apoE4 allele (gene). These individuals tend to have higher VLDL cholesterol but lower HDL cholesterol. In addition to heart disease, they have greater risk for Alzheimer's disease, cancer and other diseases (9). The Apo-E4 forums provide helpful information, guidance and support for those with the apoE4 allele.
A: It's generally recommended that only 5 percent of your daily diet is allocated to carbohydrates because if you consume more than that, your body gets thrown off ketosis. However, this is only for SKD, or the standard ketogenic diet. If you're an athlete or a bodybuilder, you can consume more carbs without affecting ketosis by following a targeted ketogenic diet (TKD) or a cyclic ketogenic diet (CKD).
Intermittent fasting, an eating style in which you eat within a specific period each day and fast the rest of the time, is a great way to reduce the amount of time your body needs to enter nutritional ketosis. (48) Intermittent fasting accelerates the time to ketosis by keeping insulin levels low and raising ketone levels. If you’re new to intermittent fasting, start by limiting your eating to an eight- to 10-hour window each day and fasting for the remaining 14 to 16 hours of the day (and night).
To obtain the optimum engagement of the family and the patients, providing information and training is essential because the diet is difficult to maintain. Counselors should talk with the family about their expectations and make clear the efficacy rate and adverse events (AE), to reduce the abandonment of the diet. Websites, videos and publications, especially from support groups, can be very helpful and should be encouraged. It is also important to review the medications and change from oral solutions (carbohydrate content) to tablets (Armeno et al., 2014). The KD counseling, evaluation and follow-up should be done by a multidisciplinary team. A pediatric neurologist or neurologist and a nutritionist are the minimum team requirements.

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]
While dietary saturated fat and cholesterol do not impact blood cholesterol levels in most people, they may raise total and LDL cholesterol in a subset of the population referred to as “hyper-responders.” If you are a hyper-responder (this is something you’ll need to determine with the help of your doctor), I recommend following a Mediterranean Paleo-style diet, an approach that is lower in fat and higher in Paleo-friendly carbohydrates, rather than a ketogenic diet.
I am very encouraged by this recent study, published in January 2014, looking at the ketogenic diet and intermittent fasting as an adjunct nutritional therapy to be administered to cancer patients undergoing standard radiation therapy in cancer treatment. The study provides “dietary interventions” to be used along side “radiotherapy”. Therefore, this is not really a study that lends itself to developing more pharmaceutical drugs. However, will physicians in the allopathic medical field seriously consider rigorous diet therapy?
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.
Notably, there is a relationship between metabolic and epigenetic modifications. Shimazu et al. (2013) observed that βOHB inhibits class I histone deacetylases. During the KD, the elevation of βOHB causes changes in large-scale gene transcription but particularly those linked to oxidative-stress resistance factors. This result emphasizes that the KD has a potential role as a disease-modifying treatment in epilepsy.
Except that it really isn’t, at least not anymore. If you do a Pubmed search on “targeting cancer metabolism,” which is what Dr. Seyfried is talking about, you’ll find over 22,000 articles, with over 3,000 in 2013 alone, with a sharply increasing curve since 2000 that only now appears to be leveling off. A search on “cancer metabolism” brings up 369,000 references, with 28,000 in 2013 alone. Cancer metabolism is an incredibly important topic in cancer research and has been for several years now, and finding means of targeting the common metabolic abnormalities exhibited by cancer cells is currently a hot area of research. From my perspective, Dr. Seyfried is exaggerating how hostile the cancer research community is towards metabolism as an important, possibly critical, driver of cancer, although, to be fair, one prominent cancer researcher, Robert Weinberg, has been very skeptical. To me, Seyfried just appears unhappy that genetics is currently thought—for good reasons, I might add—to be the primary driver of most cancers. Note that I intentionally used such phrasing, because Dr. Seyfried, in my readings, appears all too often to speak of “cancer” as if it were a monolithic single disease. As I’ve pointed out many times before, it’s not. Indeed, only approximately 60-90% of cancers demonstrate the Warburg effect.
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.

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.
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
I have been on a low carb keto diet for more than a year. As T2DM my A1C dropped from 9% to 5.4% & I discontinued meds. All my lipids improved even with ample healthy saturated fat. More than a year now so I wonder why this would be a short term improvement when its obvious that I will not go back to a high A1C and taking 3 diabetes medications including sulphonylureas. It is clear from this article that you lack the necessary experience that would be gained from wholeheartedly trying the diet or monitoring patients doing it properly like me. I would be probably be facing my first amputation if I believed the negativity in your article. So for people with diabetes who may be dissuaded by your article. Ignore it and take back your health by restricting carbs (<25 g a day) or as low as you reasonably can below 130g while being satisfied that you are getting adequate nutrition.

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 study, a variant of the ketogenic diet was applied to children with autism [51, Class III]. This diet was a modified John Radcliffe diet, which substitutes medium-chain triglycerides for some fat, but it was administered for only 4 of every 6 weeks during this 6-month trial (ie, cycles of 4 weeks “on diet” and 2 weeks “off diet” were used for the duration of the study). This group studied children on Crete, an island with a relatively isolated population and a significant number of autistic children. Behavior was rated on the standardized Childhood Autism Rating Scale (CARS) by a blinded child psychiatrist. Of the 18 children who completed the study, 2 demonstrated significant improvement (ie, CARS score reduced by > 12 points), 8 had moderate improvement (CARS score reduced by 8–12 points), and 8 showed minor improvement (CARS score reduced by 2–8 points). Children with lower starting CARS scores (less severe autism) appeared to respond better than those more severely affected. These findings should be interpreted with caution for a number of reasons. Given the geographic isolation of Crete, there may have been a strong genetic contribution to autism in this population. Methodologically, the CARS score was not designed as a longitudinal test, making its meaning in this study unclear. Additionally, intermittent administration of the ketogenic diet has not been examined in other disorders, making it difficult to compare this intervention with other studies of the ketogenic diet. Finally, any structured intervention may be associated with improved performance in patients with autism. Further study with appropriate controls (structured diet plans, vitamin administration) is needed to confirm these findings.
Unknown to most, even within the alternative world, my friend Bob Atkins tried the ketogenic diet for some 12 years on many of his cancer patients, with no significant success as he reported to me. As a telling point, under the name “Dr. Robert Atkins” on Amazon, one will find dozens of books he authored including his original diet book, its many incarnations and editions, along with books on vitamins, minerals – but glaringly absent, no book on cancer. Yes, the ketogenic diet has been tried before, with cancer patients, and without success.

While dietary saturated fat and cholesterol do not impact blood cholesterol levels in most people, they may raise total and LDL cholesterol in a subset of the population referred to as “hyper-responders.” If you are a hyper-responder (this is something you’ll need to determine with the help of your doctor), I recommend following a Mediterranean Paleo-style diet, an approach that is lower in fat and higher in Paleo-friendly carbohydrates, rather than a ketogenic diet.

The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.

Along with slashing carbs, a ketogenic plan also calls for limiting your protein consumption. If you know your macronutrients, you recognize that cutting carbs and restricting protein means seriously upping your fat intake. And that’s exactly what a true ketogenic diet entails. “You’d want healthy fats to account for about 80% of your calories, and protein around 20%,” Westman says. (For comparison’s sake, the average American gets roughly 50% of her calories from carbs, 15% from protein, and 30% from fat, per the CDC.)
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