Jimmy Moore: The good news is even the dietary guidelines committee is acknowledging “oops, we got it wrong when it came to dietary cholesterol.” A lot of people haven’t heard this yet, because they haven’t released the full report but they now have backed away from limiting the amount of cholesterol that you consume in your diet. You know how eggs have always been vilified because of there cholesterol content? They’re now saying, “Okay it’s not dietary cholesterol that’s the enemy. Please start eating cholesterol again.” You still go into stores and “Cholesterol free food.” It’s a natural cholesterol. I’m going “Okay, so something is going to have to happen.” It is happening Leanne.
I’m discouraged to see that nowhere in the article nor in the comments is there a mention of a diet’s best fit to genetics. Consider if someone is an APOE E2 carrier and/or has certain polymorphisms of the APO5 gene. These are quite rare in Okinawa but much more prevalent in the USA (12% of the population). According to a number of well-designed studies, these genetic characteristics point to a higher fat, lower carbohydrate diet as beneficial and even a “moderate” carb diet as problematic.
Apoptosis Induction. Studies show that dietary energy restriction enhances phosphorylation of adenosine monophosphate kinase (AMPK), which has been found to induce apoptosis in glycolytic-dependent brain cells and protect normal brain cells from death. One way to naturally restrict energy consumption is with a keto diet because most keto dieters spontaneously eat fewer calories than they do when they are on a higher carb diet. Altogether, this may explain why most of the research on keto and cancer has shown the keto diet to be effective in the treatment of brain tumors (glioblastomas and gliomas).
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.
It is vital that anyone using this diet for a seizure disorder do it under the supervision of an experienced physician and dietitian. There are many nuances and individual variations that will influence the exact diet for each person, and coordinating this with medications can be tricky. This is not something that should ever be attempted on your own.
Dr. Gorski's full information can be found here, along with information for patients. David H. Gorski, MD, PhD, FACS is a surgical oncologist at the Barbara Ann Karmanos Cancer Institute specializing in breast cancer surgery, where he also serves as the American College of Surgeons Committee on Cancer Liaison Physician as well as an Associate Professor of Surgery and member of the faculty of the Graduate Program in Cancer Biology at Wayne State University. If you are a potential patient and found this page through a Google search, please check out Dr. Gorski's biographical information, disclaimers regarding his writings, and notice to patients here.
However, this doesn't happen in every case or even most cases. In fact, many people see little to no increase in their LDL cholesterol while experiencing beneficial changes in other markers, such as an increase in HDL cholesterol and a decrease in triglycerides, blood sugar, and insulin levels – all of which are associated with reduced risk of CVD.

I knew Bob quite well, and considered him a friend. We first met when I interviewed him for a nutrition story during my journalism days, and later on while I was a medical student, we kept in close contact. During my freshman year at Cornell Medical School – from which Bob had received his own medical degree – I arranged for him to speak as part of a lecture series I had set up on alternative approaches to disease.
If a person with familial hypercholesterolemia is then put on a high-fat diet,  they will become even more vulnerable to heart disease as the increased saturated fat and cholesterol content of the diet provokes higher cholesterol levels. And it gets even worse — since this person lacks the ability to clear LDL cholesterol out of their blood normally — their cholesterol levels will stay elevated for an even longer period of time. This will make it much more likely that the LDL particles will become damaged and stimulate plaque build up in the blood vessels.
More specifically, subjects in the lowest third of carbohydrate consumption had an HDL concentration of 1.21 mmol/L while subjects in the highest third had HDL concentration of 1.08 mmol/L. [13] According to the authors, “every 100-g/d increment of carbohydrate (approximately the difference between the top and bottom tertiles) was associated with 0.15-mmol/L less of HDL.” [13]
Keto is not hard to follow at all. See, this is why I took my diet and nutrition into my own hands. I have PCOS and the ketogenic diet has worked wonders for me. I’m finally pregnant at the age of 32 and after 11 years of marriage because the ketogenic diet made me lose over 100 lbs and brought my insulin resistance under control. I feel better than I’ve ever felt. Sometimes doctors don’t seem to know as much as they should, or as much as they assume they do, and that’s pretty disturbing. Just like they’re still using the old school and very inaccurate BMI charts that are just pure bs. I’ll just take care of myself outside of certain situations involving illness or injury. I’m doing great on my own.
Interventions with keto diet have proven their effects on plasma lipoproteins both in short-time and long-term studies and among adults with various characteristics, such as age, body mass, gender, type of disease. Moreover, ketogenic diets result in weight loss and fight obesity, one of the main risks of high cholesterol. Therefore, keto diet could eventually decrease the risk of cardiovascular diseases.

1. West, R., Beeri, M. S., Schmeidler, J., Hannigan, C. M., Angelo, G., Grossman, H. T., … Silverman, J. M. (2008). Better memory functioning associated with higher total and low-density lipoprotein cholesterol levels in very elderly subjects without the apolipoprotein e4 allele. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 16(9), 781–5. PMID: 18757771
32••. Qin W, Ho L, Zhao Z, et al. Neuronal SIRT1 activation as a novel mechanism underlying the prevention of Alzheimer disease amyloid neuropathology by calorie restriction. J Biol Chem. 2006;281:21745–21754. This study demonstrates that sirtuins link calorie restriction with disease-modifying effects in a neurodegenerative disorder. [PubMed] [Google Scholar]
Adverse effects of the dietary interventions were experienced in all studies. The most commonly reported adverse effects were gastrointestinal syndromes. It was common that adverse effects were the reason for participants dropping out of trials (GRADE rating low). Other reasons for dropout included lack of efficacy and non‐acceptance of the diet (GRADE rating low).
On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through fatty-acid oxidation in the cell's mitochondria (the energy-producing parts of the cell). Humans can convert some amino acids into glucose by a process called gluconeogenesis, but cannot do this by using fatty acids.[57] Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and most fatty acids do not cross the blood–brain barrier. However, the liver can use long-chain fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone. These ketone bodies enter the brain and partially substitute for blood glucose as a source of energy.[56]
I think it was still hard for him to accept that many cancer patients, and many humans without cancer, did best on a plant-based, high carb diet, so foreign to his way of thinking. Though he had heard me expound on the Kelley approach many times over the years, it was to him implausible that humans as a species had adopted to a variety of diets, some high fat, some high carb, some more balanced, and that in medical practice, we as physicians had to be aware that different patients might require completely different diets for optimal health.
Unfortunately, thanks to the widespread prevalence of the standard American diet (SAD) – characterized by high consumption of red meat, processed meat, pre-packaged foods, butter, fried foods, high-fat dairy products, refined grains, potatoes, corn, high-fructose corn syrup (HFCS), and high-sugar drinks – the incidence of obesity, insulin resistance, diabetes, cardiovascular disease, and many forms of cancer are skyrocketing in the U.S.
In relation to overall caloric intake, carbohydrates comprise around 55% of the typical American diet, ranging from 200 to 350 g/day. The vast potential of refined carbohydrates to cause harmful effects were relatively neglected until recently. A greater intake of sugar-laden food is associated with a 44% increased prevalence of metabolic syndrome and obesity and a 26% increase in the risk of developing diabetes mellitus. In a 2012 study of all cardiometabolic deaths (heart disease, stroke, and type 2 diabetes) in the United States, an estimated 45.4% were associated with suboptimal intakes of 10 dietary factors. The largest estimated mortality was associated with high sodium intake (9.5%), followed by low intake of nuts and seeds (8.5%), high intake of processed meats (8.2%), low intake of omega-3 fats (7.8%), low intake of vegetables 7.6%), low intake of fruits (7.5%), and high intake of artificially sweetened beverages (7.4%). The lowest estimated mortality was associated with low polyunsaturated fats (2.3%) and unprocessed red meats (0.4%). In addition to this direct harm, excess consumption of low-quality carbohydrates may displace and leave no room in the diet for healthier foods like nuts, unprocessed grains,  fruits, and vegetables.
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.
Leanne: Perfect tip. To go to the medical issues, I’ve had a lot of people say “If my LDL is higher, and my HDL is lower, is eating this way okay for me?” I would say just based on our conversation so far, “Heck yeah because this is going to increase your HDL and lower your LDL more than the grains and whole foods, whole grain things will do and any of those heart healthy packages.” I just tell people … if your food is coming from a package, especially if it has one of those heart healthy things on it, probably avoid it. Just go to the oats group of the store, grab what you need.
^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.
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.
Importantly, cholesterol doesn’t travel around your bloodstream on its own. As a hydrophobic (water-repelling) substance, it must be packaged within lipoproteins to move around the bloodstream. So that means when we talk about blood cholesterol levels, we’re referring to the amount of cholesterol contained in different lipoprotein particles. In addition to cholesterol, these lipoprotein particles also contain special proteins called apolipoproteins, triglycerides and other compounds.
The patient’s wife, a former college professor with an interest in nutritional medicine, learned about our approach from an article she read in an alternative health journal, and in the fall of 1991 he began treatment with me. Some fifteen months later, repeat CT scans showed stabilization of disease. Since he felt fine at the time, following his program religiously, he decided against any further conventional testing until 1998, seven years after he had started with me, when a series of CT scans confirmed total resolution of his once extensive cancer.
The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet.[58] This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.[56]
Leanne: Yeah, that believed in coconut from the very beginning and they didn’t go on this campaign of ridding it from the earth. I’m totally pro coconut oil and saturated fat. It’s been so great chatting with you about this cholesterol piece. I hope that a lot of our listeners, watchers, readers are going to benefit from the information that you’ve shared. If they want to know more about you Cholesterol Clarity is awesome. Keto Clarity is great. Your podcast, just download every single podcast Jimmy’s ever made. It will keep you busy for the next two years.
Type 2 Diabetes:  Although the current mainstream diabetes treatment advice to eat 45-65% of calories from carbohydrate is starting to change, many practitioners are still giving out the old advice. Since carbohydrate is the prime driver of higher blood sugar, this advice is detrimental to diabetic health because it results in blood sugar spikes and crashes, which in turn causes a greater need for medication and insulin. Those high blood sugars also result in the complications of diabetes.  In contrast, a ketogenic diet reduces and in many cases, eliminates the need for diabetic medications and lowers the number of insulin units needed to manage blood sugar.  For people with Type 2 diabetes, ketogenic diets remove the trigger (carbohydrate intake) and reverse the underlying insulin resistance which causes the disease. As a result, long term complications are reversed or avoided.  Learn more in our Conquer Type 2 Diabetes e-Book  or click on the book cover.
These preliminary findings spurred Dr. Good to encourage a more thorough investigation of Kelley’s methods and results. As the project grew in scope, I continued my “Kelley Study” in my spare time during the last two years of medical school, and ultimately brought it to completion while pursuing my immunology fellowship training under Dr. Good at All Childrens’ Hospital in St. Petersburg.
Now, there’s even evidence that a low-carb, high-fat regimen (as the keto diet is) helps you live longer, compared to a low-fat diet. In a study by the medical journal The Lancet that studied more than 135,000 adults from 18 countries, high carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction or cardiovascular disease mortality.

Her agent, according to reports at the time, began circulating a book proposal the day after the Times story ran, asking for a $2 million dollar advance! The whole episode raised some eyebrows over a reporter seeking to benefit personally from a subject she was promoting in the news section of the Times. After a fair amount of criticism, Kolata withdrew her book proposal.

They also noted that some patients were more responsive to the ketogenic diet than other patients were. The best response was in a 3-year-old girl who had complete remission five years of treatment with a ketogenic diet. Two other patients also experienced complete remission after the diet, and the other two patients had disease progression after stopping keto. (Keep in mind, however, that all of these patients used conventional treatments along with the keto diet.)
As individuals in general, we never hesitate to gorge on pounds of sugar with, before, and after every meal. Sugars and carbohydrates should rarely be included in our diets. One century ago, the average US citizen consumed 5 pounds of sugar per year; today, we consume an inconceivable average of 150 pounds per year. This becomes even more horrifying when we realize it only takes 100 grams of sugar to restrain our white blood cell’s ability to kill the bad cells in our body by 90% for several hours; this happens within 15 minutes of digestion. Founder of the American Anti-Cancer Institute (AACI), Bob Wright, adds, “One can of [soda] has enough sugar to shut down 50% of our immune system for a minimum of 4 hours.” When we consume sugar, we are simultaneously shutting off our defenses while pouring gasoline on the fire that is cancer. When we take into account that “50 to 70% of our total immune system cells cannot see cancer … even on our best day,” the notion of adding it to our diet seems even more blasphemous.
So rather than giving one-size-fits-all dietary advice or weaponizing the word “balanced” it might be better if the medical community suggested that there are Individual differences that need to be considered. This might also help those lay folk who have had success with one dietary lifestyle or another also realize that what’s valid for them may not be good advice for others.

7. Raygan, F., Bahmani, F., Kouchaki, E., Aghadavod, E., Sharifi, S., Akbari, E., . . . Asemi, Z. (2016). Comparative effects of carbohydrate versus fat restriction on metabolic profiles, biomarkers of inflammation and oxidative stress in overweight patients with Type 2 diabetic and coronary heart disease: A randomized clinical trial. PMID: 28607566
People claiming huge benefits of these supplements – despite the lack of solid scientific support – may sometimes have a financial reason to believe in the supplements. Some of these products are sold under a multi-level marketing arrangement, where sales people are paid based on commission. For example, the company Prüvit sells drinkable ketones, called KETO//OS with a multi-level marketing structure.
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.
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.
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.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
The ketogenic diet may seem like the Jekyll to the Hyde-like low-fat craze of the 1990s. The bulk of current research finds that the middle ground between the two extremes is more beneficial for overall health. Make it easy for yourself: Eat at least two servings a week of fatty fish (salmon, sardines, mackerel) and cook with a variety of quality fats (olive oil, canola oil, avocado oil) throughout the week.
It is very interesting to read about the keto/low card diet.I love to change my lifestyle as I an TYPE 2 Diabetic.I subscribed for a free printable low carb meal .The initial email stated that that I will receive an email for instructions to access the members area .Your free download will be there.However it is very deceiving ,I never got the 2nd email with instructions which is frustrating and not good .Hopefully this is not a way to get us to pay to get the printable version.

Although the high-fat, calorie-restricted ketogenic diet (KD) has long been used to prevent childhood epileptic seizures that are unresponsive to drugs, physicians have not really understood exactly why the diet works. New studies by a research team at Emory University School of Medicine show that the diet alters genes involved in energy metabolism in the brain, which in turn helps stabilize the function of neurons exposed to the challenges of epileptic seizures. This knowledge could help scientists identify specific molecular or genetic targets and lead to more effective drug treatments for epilepsy and brain damage.
In terms of weight loss, you may be interested in trying the ketogenic diet because you’ve heard that it can make a big impact right away. And that’s true. “Ketogenic diets will cause you to lose weight within the first week,” says Mattinson. She explains that your body will first use up all of its glycogen stores (the storage form of carbohydrate). With depleted glycogen, you’ll drop water weight. While it can be motivating to see the number on the scale go down (often dramatically), do keep in mind that most of this is water loss initially.
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.

Leanne: For those of you guys who don’t know Jimmy Moore, first of all you’ve probably been living under a rock because this guy’s huge. Excited to have you here on the show today. Jimmy busted on health scene in 2004 after a phenomenal 180 pound weight loss that enabled him to come off of his prescription drugs for high cholesterol, high blood pressure, and respiratory problems. He is the co-author of Cholesterol Clarity, Keto Clarity, and the energetic personality behind the blog Living La Vida Low Carb at www.livinlavidalowcarb.com, and the voice of the top ranked podcast The Livin’ La Vida Low Carb show. He’s interviewed over 900 of the world’s top health experts, I’m pretty sure I’ve listed to at least 400 of those.
Just this week as I write this, one of my newer patients, a wonderful, creative inventor and computer whiz from the Washington, DC area, came into my office for his regularly scheduled six month re-evaluation appointment. When he started with me in January 2010, three and a half years ago, he had been diagnosed with stage IV metastatic squamous cell carcinoma of the lung, with multiple tumors in both lungs and with evidence of metastases in his ribs. His local doctors in DC had explained he had terminal disease, for which chemotherapy would be useless.
Whatever the source of protein you consume, make sure they are organic grass fed and antibiotic-free, as they are generally healthier and safer for your body. In one study, researchers indicated that grass fed beef (regardless of cuts) contains more omega-3 acid and conjugated linoleic acid compared to grain-fed beef.21 As for non-meat sources of protein, try to look for organic and pesticide-free varieties.
Insulin Resistance, Metabolic Syndrome and Pre Diabetes: these conditions are directly related to the effects of chronically high blood sugar and insulin resulting in insulin resistance (IR).  In addition, related conditions such as fatty liver disease and PCOS are also caused by IR.  Low carb, high fat diets have been used in studies to treat and reverse all of these IR conditions.
I’m discouraged to see that nowhere in the article nor in the comments is there a mention of a diet’s best fit to genetics. Consider if someone is an APOE E2 carrier and/or has certain polymorphisms of the APO5 gene. These are quite rare in Okinawa but much more prevalent in the USA (12% of the population). According to a number of well-designed studies, these genetic characteristics point to a higher fat, lower carbohydrate diet as beneficial and even a “moderate” carb diet as problematic.

Research here is conflicting. While you might think reducing insulin-triggering carbohydrate foods would improve insulin sensitivity, that isn’t always the case. Rodent studies found at least in the short-term, ketogenic diets increased glucose intolerance and insulin resistance. Researchers speculate part of this insulin resistance occurs because of keto-adaptation, and once your body adjusts to ketosis, you become more insulin sensitive. Your mileage will vary, of course, and I believe going too low-carb could create these and other potential dangers.
Well, I am going to give this another try. I have great difficulty in eating greens , or drinking them, also I am not fond of fats, years and years of low fat diets have totally screwed my metabolism,and taste buds. I will read this page every day to keep my mind focused. Start tomorrow when I get up …… I work nights which can cause me problems as well. When I tried this diet before, I got terrible cramp, now I realise I wasn’t drinking enough water. Anyway.here goes.
Fortunately, the keto diet has been found to decrease inflammation (which is part of the reason why it can help people who have autoimmune thyroid conditions). [29] However, if you still have high levels of inflammation after following the keto diet, then you may have to address other important variables like your stress levels, sleep quality, and food allergies/sensitivities before your cholesterol levels can rest at healthier levels. (By addressing these variables, you will also decrease your stress levels which may help improve your cholesterol levels even more.)
Gary D. Foster, Ph.D., Holly R. Wyatt, M.D., James O. Hill, Ph.D., Brian G. McGuckin, Ed.M., Carrie Brill, B.S., B. Selma Mohammed, M.D., Ph.D., Philippe O. Szapary, M.D., Daniel J. Rader, M.D., Joel S. Edman, D.Sc., and Samuel Klein, M.D., “A Randomized Trial of a Low-Carbohydrate Diet for Obesity — NEJM,” N Engl J Med 2003; 348:2082- 2090. http://www.nejm.org/doi/full/10.1056/NEJMoa022207.
Thanks for this article. I just started a Keto diet so found it appropriate to my current lifestyle. Though I don’t believe your bottom line is strong enough since you simply stating that the diet is “hard to follow” and food is “notoriously unhealthy” without evidence going deeper into why those “notoriously unhealthy” foods are worse than keeping carbohydrate-heavy food that are addictive and give the body a quick sugar high for energy. I believe “hard to follow” is your opinion only, since acceptable Keto foods are found at all restaurants easily and also all grocery stores. All the foods you mention: “rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water” are all Keto-friendly. Many people have been on a Keto-diet for years. A healthy lifestyle is a healthy mindset change and making right choices – it’s not going to be easy.

The failure of Big Pharma to develop an Alzheimer's drug has been well-documented in the corporate-sponsored "mainstream" media. As Alzheimer's diagnoses continue to increase, drug companies are scrambling to develop the next big drug to market to seniors. In modern times, the most successful drugs in sales, so far, have been cholesterol-lowering statin drugs, as one out of every five people over the age of 50 are now taking drugs to lower one's cholesterol, raking in billions of dollars for pharmaceutical companies. The sick irony to this is that lowering one's cholesterol artificially is directly linked to declining cognitive health and diseases such as Alzheimer's, since 25% of one's total cholesterol is located in the brain. The failed scientific hypothesis behind these drugs is that cholesterol is a cause of heart disease, and that diets high in saturated fats contribute to high cholesterol. However, the actual science shows almost the opposite, and when one looks at death rates, for example, lower cholesterol rates do not equate to longer life - in fact the converse is true: higher cholesterol levels lead to longer life spans. The pharmaceutical industry and the U.S. government cannot afford to reverse their warnings against saturated fats and cholesterol, however, as it would be the same as confessing that the entire statin drug industry has been a scam, and that statin drugs actually cause more harm than good. This is the main reason why the USDA must continue supporting a low-fat diet and condemning saturated fats, even though the science does not support their positions. It is no surprise, therefore, to learn that peer-reviewed scientific studies continue to show that the high-fat ketogenic diet supports cognitive health and can help prevent or reduce cognitive diseases such as Alzheimer's. Here are four new studies just published on the high-fat ketogenic diet related to cognitive health, and preventing Alzheimer's Disease.
Ketogenic diets (some using calorie restriction) have been associated with decreased tumor growth in animal models of gliomas [10], prostate cancer [25], and gastric cancer [11]. In the context of cancer, ketone bodies may provide an alternative substrate for ATP production in malignant cells, as outlined above. However, other work suggests that glucose is used to produce components critical to proliferative cell growth [26], and it is conceivable that the ketogenic diet may restrict that aspect of malignant cell transformation.
The ketogenic diet now has nearly 100 years of history supporting its use. Most major medical textbooks and reviews no longer question its efficacy. About 50% of the children appear to have had an excellent response to the diet as defined by marked reduction (at least a 50% reduction) in seizure activity. About 15% of children become seizure-free after initiation of the ketogenic diet, usually within 3-6 months, and typically stop the diet after 2 years. Of those children who become seizure-free, a minority (15-20%) have recurrence after the diet is stopped. Risk factors that increase the likelihood of recurrence of seizures are:
The ketogenic diet initially was developed in the 1920s in response to the observation that fasting had antiseizure properties [1]. During fasting, the body metabolizes fat stores via lipolysis and then the fatty acids undergo beta-oxidation into acetoacetate, β-hydroxybutyrate, and acetone—ketone bodies the cell can then use as precursors to generate adenosine triphosphate (ATP). The ketogenic diet, which is very high in fat and low in carbohydrates, is thought to simulate the metabolic effects of starvation by forcing the body to use primarily fat as a fuel source. The ketogenic diet fell out of favor with the development of new anticonvulsant agents, starting with phenytoin in 1938, but it has experienced a resurgence in use over the past 20 years, particularly in the treatment of refractory epilepsy.
Mitochondria generate reactive oxygen species (ROS) during their metabolic activities. In normal cells, the production of ROS and their elimination by antioxidants are kept in balance.10 Intriguingly, a higher incidence of errors, or mutations, in mitochondrial DNA have been observed in many human cancers, likely as a result of uncontrolled ROS production and oxidative stress.11
Available research on the ketogenic diet for weight loss is still limited. Most of the studies so far have had a small number of participants, were short-term (12 weeks or less), and did not include control groups. A ketogenic diet has been shown to provide short-term benefits in some people including weight loss and improvements in total cholesterol, blood sugar, and blood pressure. However, these effects after one year when compared with the effects of conventional weight loss diets are not significantly different. [10]
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.
Ketone bodies, especially β-hydroxybutyrate, can be measured easily, so much work has centered on determining how these molecules may have anticonvulsant effects. Inconsistencies in studies attempting to correlate seizure protection with levels of ketone bodies suggest that another mechanism may be involved in the diet’s beneficial effects on seizures [2–5, Class III]. Several mechanisms have been proposed, including changes in ATP production making neurons more resilient in the face of metabolic demands during seizures; altered brain pH affecting neuronal excitability; direct inhibitory effects of ketone bodies or fatty acids on ion channels; and shifts in amino acid metabolism to favor the synthesis of the inhibitory neurotransmitter GABA [6,7].
Of course, we know that genes alone are not responsible for cancer because we share many of the same genes as our hunter–gatherer ancestors and even just the same genes as our ancestors several generations ago, and yet the rate of cancer keeps going up. It’s expected to overtake cardiovascular disease as the number one cause of death in the U.S. fairly soon, and so that can’t be explained by genes alone.
Following a very high-fat diet may be challenging to maintain. Possible symptoms of extreme carbohydrate restriction that may last days to weeks include hunger, fatigue, low mood, irritability, constipation, headaches, and brain “fog.” Though these uncomfortable feelings may subside, staying satisfied with the limited variety of foods available and being restricted from otherwise enjoyable foods like a crunchy apple or creamy sweet potato may present new challenges.

A ketogenic diet derives approximately 90% of dietary calories from fat, 8% from protein, and just 2% from carbohydrates.1 In comparison, the standard American diet derives 35%, 15%, and 50% of calories from fat, protein, and carbohydrates, respectively. Although it is rising in popularity, the ketogenic diet is not a new dietary intervention. It is an established nutritional treatment approach — first developed in the 1920s — for patients who have epilepsy that is not well controlled with antiepileptic agents. The keto diet later remerged as an acceptable intervention in the 1990s.

I have great respect for Harvard Medical School. I notice that they support their readers posting comments and I am most appreciative of the article and all the many thoughtful comments by the readers. The readers seem to have the most expertise here and I hope that the doctor who wrote the article will think long and hard about the comments by readers. After 35 years of clinical practice in mental health, I notice that all issues of emotion involve medical issues, nutrition, and the gut bacteria. I would say that these issues and all of the executive brain functions seem to improve with ketogenic principles. For those that apply it in a flexible and smart manner, it appears to improve every area of their lives. I strongly encourage the author of the article to take one class via The Institute for Functional Medicine. If he is open to more learning he can take more classes and get certified. I’m sure a fine doctor, he will be an even better doctor and personally healthier, if he gets more training. Are we all open to new learning(especially us healthcare providers)?
32••. Qin W, Ho L, Zhao Z, et al. Neuronal SIRT1 activation as a novel mechanism underlying the prevention of Alzheimer disease amyloid neuropathology by calorie restriction. J Biol Chem. 2006;281:21745–21754. This study demonstrates that sirtuins link calorie restriction with disease-modifying effects in a neurodegenerative disorder. [PubMed] [Google Scholar]
The ketogenic diet has many potential effects and is likely to have different mechanisms in different diseases [8]. In metabolic conditions, cancer, trauma, and ischemia, the ketogenic diet may confer a protective effect by providing an additional energy substrate to tissue at risk of cell death. However, ketosis may have more complicated effects. In one model, rats fed the ketogenic diet show marked upregulation of both the ketone transporter and the glucose transporter type 1 (GLUT-1), promoting the influx of nutrients into the brain [9]. These authors provided evidence that the ketogenic diet increases capillary density without increasing overall blood flow, providing a way that the diet may help nourish tissue at risk. This finding is particularly interesting in light of findings in animals with tumors, in which the diet is associated with an anti-angiogenic effect [10,11]. These discordant results eventually will need to be reconciled; they may be due to differences in angiogenic stimuli in normal cells versus malignant cells.
We are brazilian, living in Brazil. My daughter, Isabel, 21y. o., born in 1996, has syndrome of deficiency of Glut1. She was diagnosed around her first year of life. At that time her baby bottle, her begining diet meal, was 50ml water plus 50ml oil plus vitamin. Since then, which means, for 20 years, she is under this diet. For almost 18 years under 4:1 proportion. At this right moment 3:1. The only problem she had since started the diet were kidney stones in 2002. Nothing else. Grateful to the diet she doesn’t take any kind of medicine to avoid seizures. Her health is perfect, no colesterol at all. We are at your will for any issues related to her health.
Before embarking on the ketogenic diet, we assess the child’s nutritional status, diet preferences and calorie needs. If the diet seems like it will be feasible for the family, we customize it to each child to achieve optimal seizure control while meeting daily energy and nutrient needs. Sometimes, if extra attention is needed, we start the diet in the hospital. Special ketogenic formulas are available for infants or children who need to be fed though a tube.
Determining who will respond well to KD is a topic still ripe for research. Researchers have previously explored the use of electroencephalogram, but results from a recent study were not statistically signifigant.3 Other studies have explored a patient’s preference for certain foods, but neither have been very effective strategies to determine the success of KD.
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.

This is because the triglycerides from those fat cells are metabolized for energy while the cholesterol is not. The cholesterol is simply released into the blood where it will remain until removed by the liver, making it appear that our cholesterol has suddenly skyrocketed. Many people are quick to assume that this is due to an increase in dietary fat and cholesterol intake.


A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice.[34] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]
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.
Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D., “A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity,” N Engl J Med 2003; 348:2074-2081. http://www.nejm.org/doi/full/10.1056/NEJMoa022637.
The ketogenic diet’s origin dates back to the 1920s when doctors began using it to control seizures among patients with epilepsy. The history of the ketogetnic diet began with a nutritional plan made of carbohydrates (carbs), fat, and protein forces the body to use fat instead of carbohydrates for energy. Dubbed ketosis, this process creates two acids in the blood, ketones and decanoic acid, that our bodies and brains use for fuel.
Then there are some more experimental drugs that restrict the availability of glucose via inhibition of glycolysis and other processes. One of those drugs is called 2-DG, and that’s shown quite a bit of promise, so there’s not a lot of research on it yet, and then there’s an older drug named DCA, which also limits the availability of glucose. That has shown some promise, although it has known toxicity and side effects. It may not be a good choice for that reason.
In fact, one study stated that “…the group with the highest risk for cardiovascular events had high LDL-P and LDL-C, while the group with the lowest risk had low LDL-P but higher LDL-C.” [17] As a result of prior clinical research and their findings, the researchers stated that: “While the low carb, ketogenic diet did not lower total LDL cholesterol, it did result in a shift from small, dense LDL to large, buoyant LDL, which could lower cardiovascular disease risk.” [23]

In short, a well-formulated ketogenic diet will likely increase your cholesterol. The reason for this is that keto emphasizes a large amount of saturated fat in the diet, and high levels of saturated fat will increase cholesterol. Now, because of Ancel Keys, we’ve be taught that high cholesterol is a problem. However, putting it bluntly, Ancel Keys was wrong. In this meta-analysis of 21 well-formulated studies the conclusion was that there is absolutely no relationship between high levels of cholesterol and heart disease or cardiovascular disease.

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.

It’s not as though Dr. Seyfried doesn’t cite clinical evidence. It’s just that the evidence is so darned thin and unconvincing thus far. For instance, in this talk, the first study he presents is a very small case series (two patients, actually) performed in 1995 in which two girls with inoperable astrocytomas were placed on a ketogenic diet in order to “determine if a ketogenic state would decrease glucose availability to certain tumors, thereby potentially impairing tumor metabolism without adversely affecting the patient’s overall nutritional status.” Interestingly (to me, at least) these case reports came from University Hospitals of Cleveland, where I did my general surgery residency. In fact, I was still there in 1995. Unfortunately, I don’t have access to the journal back to 1995; so I’m stuck with just the abstract. However, the abstract is pretty clear:
As of the moment, there is no industry standard as to how many calories should be consumed in a restricted ketogenic diet, but there are published studies that provide estimates. In one example, a 65-year-old woman who was suffering from glioblastoma multiforme (GBM), an aggressive type of brain cancer, was put into a restricted ketogenic diet that started with water fasting and then proceeded to consuming 600 calories a day only.
For the latest update we searched the Cochrane Epilepsy Group's Specialized Register (11 April 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO, 11 April 2017), MEDLINE (Ovid, 11 April 2017), ClinicalTrials.gov (11 April 2017) and the WHO International Clinical Trials Registry Platform (ICTRP, 11 April 2017). We imposed no language restrictions. We checked the reference lists of retrieved studies for additional reports of relevant studies.
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