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.
Some practitioners have raised the concern that long-term adherence to a ketogenic diet may shift the composition of the microbiota (the beneficial microbes that live in our bodies) in an undesirable direction and may even encourage the overgrowth of ‘bad’ bacteria. These beneficial bacteria feed on prebiotics (such as fiber and resistant starch), both of which are likely to be low in a low-carbohydrate ketogenic diet. Without prebiotics, beneficial bacteria are not able to produce substances like butyrate and other short chain fatty acids that keep the intestinal cells healthy, and long-term disruption of the microbiota can lead to a host of health problems throughout the body. 57 58
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking.
In some ways, it’s similar to the Atkins diet, which similarly boosts the body’s fat-burning abilities through eating only low-carb foods, along with getting rid of foods high in carbs and sugar. Removing glucose from carbohydrate foods will cause the body to burn fat for energy instead. The major differences between the classic keto and the Atkins diet is the former emphasizes healthier keto fats, less overall protein and no processed meat (such as bacon) while having more research to back up its efficacy.
Recent animal studies suggest a role for the ketogenic diet as a potential therapy for amyotrophic lateral sclerosis (ALS). ALS results from the death of motor neurons in the brain and spinal cord. A small number of cases are caused by an inherited mutation in the gene encoding the Cu/Zn superoxide dismutase I (SOD1). Mice expressing the mutated gene recapitulate the progressive muscle weakness and death due to respiratory failure seen in humans with ALS. Various lines of evidence suggest that mitochondrial dysfunction may play a role in the pathogenesis of ALS. A recent study suggests that ketosis induced by the ketogenic diet might affect progression of the disease . Transgenic SOD1 mice fed a high-fat diet (60% of calories from fat, compared with < 10% fat in standard rodent chow and > 90% of calories from fat in a typical rodent ketogenic diet) preserved their performance on a standard rotorod test longer than those fed a regular diet. Mice were fed ad lib, and mice fed the high-fat diet gained more weight than those on the standard diet, so overall caloric restriction was unlikely to be a factor in this study. When spinal cords were examined, significantly more motor neurons were preserved in the mice fed the ketogenic diet than in those fed a regular diet. However, the ketogenic diet did not significantly prolong survival.
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.”  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.” 
Regular readers of SBM should know the problem with this sort of approach. No IRB worth its salt would approve such a trial because it would be ethically dubious, but, even worse, it would be ethically dubious and it wouldn’t really tell us anything unless those few patients either had near-miraculous responses or died very quickly. Anything else would simply tell us that the diet is probably doing no harm. More numbers would be needed, particularly if the comparison is to historical controls, to get even an inkling of whether there might be benefit. In that case, you might as well do a proper phase I/II clinical trial, which is what is happening. For instance:
So, what evidence does Dr. Seyfried himself provide to prove his point that the best diet for all cancer patients, whatever the type, is the ketogenic, high fat, no carb diet? Well, very little. Certainly the 400 plus pages of elaborate biochemistry and theory are impressive and informative. But in terms of practicalities, that is, results with actual human patients diagnosed with cancer, there is next to no evidence.
If you're new to keto, watch out for hidden carbs. Generally, dairy products and nuts are a good way to meet your daily fat intake, but know that some of those items may contain more carbohydrates than you think. For example, yogurt topped with nuts may seem like a great keto-friendly snack, but a 5.3 ounce serving of plain yogurt has 12 grams of carbohydrates. Vanilla flavored yogurt has 24 grams of carbohydrates. Add an ounce of cashews, weighing in at nearly nine grams of carbs, and you’re up to 21 to 33 grams of carbs for that snack, which could knock you out of ketosis. Be sure to read nutrition labels carefully and pay careful attention to serving sizes. Track foods using a keto-specific app like Senza or KetoDiet can help you stay within your recommended daily carb intake.
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.
The ketogenic diet has been shown in many studies to be particularly helpful for some epilepsy conditions. These include infantile spasms, Rett syndrome, tuberous sclerosis complex, Dravet syndrome, Doose syndrome, and GLUT-1 deficiency. Using a formula-only ketogenic diet for infants and gastrostomy-tube fed children may lead to better compliance and possibly even improved efficacy.
Ive been strict keto for over 3 months and have lost 20lbs. I got my test results back yesterday and was shocked to see how my levels had changed: total cholesterol went from 230 to 308!! All the bad went up and all the good went down. But I’ve also heard that it can take a bit longer for cholesterol levels to even out and start going down. Is this true? I don’t want to quit keto because I have another 20lbs to lose, but I don’t want to have a stroke either.
Early studies reported high success rates; in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).
Jimmy Moore: My mamma would kill me if she know I did that. I had four root canals and then I also had some mercury amalgams that were put in way back, twenty years ago when I was in my early twenties. Anyway, I determined I bet that’s a big reason why my cholesterol has always been high since I’ve been adult. I got that taken care of the year that I wrote Cholesterol Clarity in 2013, and I got it tested my total cholesterol was over 400. Got it tested again in October, total cholesterol had dropped over 100 points.
Dr. Seyfried does include a chapter toward the book’s end entitled “Case Studies and Personal Experiences in using the Ketogenic Diet for Cancer Management.” Here, Dr. Seyfried provides a description of a pilot study, written by the investigators themselves, discussing the use of the ketogenic diet in children with inoperable brain cancer. However, the authors admit the study was intended only to evaluate the diet’s tolerability and effect on glucose metabolism as determined by PET scanning, not treatment benefit or survival.
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In subsequent months, reports of enormous toxicity, even patient deaths began to filter through the research community, serving to temper the initial hysteria. And it wasn’t cheap, as miracles go – the very toxic drug was so potentially dangerous it had to be administered in a hospital setting under very close supervision, with costs running in excess of $100,000 for a several-week course of treatment.
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients. Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term. Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.
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.
The keto diet works for such a high percentage of people because it targets several key, underlying causes of weight gain — including hormonal imbalances, especially insulin resistance coupled with high blood sugar levels, and the cycle of restricting and “binging” on empty calories due to hunger that so many dieters struggle with. In fact, these are some of the direct benefits of the keto diet.
She learned about Kelley’s work, began the program, regained her health, and avoided all conventional doctors for many years. In 1984, nine years after coming under Kelley’s care, she returned to her primary care physician who was quite perplexed she was still alive after all this time. A chest x-ray showed total resolution of her once widespread lung metastases.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder, and it affects women of reproductive age. Symptoms include obesity, hyperinsulinemia and insulin resistance. A pilot study took 11 women through 24 weeks of a low-carbohydrate ketogenic diet (20 grams or less per day). Among the five who completed the study, they lost 12 percent of their weight on average and reduced fasting insulin by 54 percent. Additionally, two women who previously experienced infertility problems became pregnant. (6)
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.
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 appears to enhance mitochondrial function via a number of potential pathways. Given the important role of mitochondrial dysfunction in many neurodegenerative diseases, it is important to outline potential mechanisms of apparent disease-modifying effects of the ketogenic diet. It is unclear whether there is something specific or direct about the ketogenic diet (ie, provision of ketone bodies or fatty acids) or, perhaps more importantly, the metabolic changes it induces.
Jimmy Moore: One year ago my, I guess this about a year and a half ago now, time flies when you’re having fun … my total cholesterol was over 400. A lot of people, and of course I talked to lipidologists and heart people all the time on my podcasts, and I was throwing the numbers out there and one of the lipidologists “Oh you need the highest dose of Staten drug possible because you’ll not be able to get that down without it.” In writing Cholesterol Clarity, I determined that I had some other things that were raising the cholesterol and it’s not that I have a Staten drug deficiency. It’s that I have something underlined inside of me somewhere that the cholesterol was going to try to take care of.
But what surprised me – and what began to concern others I knew in the medical community – was some time later the deafening silence about the trial’s outcome, and what seemed to be a blackout about the actual data. Eventually, the study results were published indicating that 42 subjects had been ultimately recruited for the trial, not the planned 70, and not a single one of these had responded to the drug.
I also quickly understood that for his approach to gain academic acceptance, Kelley must back off completely from involvement with popular controversial books and media hysteria. When I expressed my opinion about such things to him, he accepted the wisdom of my position unconditionally. When he then told my writer friend in a rather difficult phone call that he had no interest in pursuing the book she had suggested, she was, to say the least, livid with me – especially since she had brought Kelley and me together in the first place, seeking my opinion about his authenticity.
Also, consider supplementing with the amino acid leucine, as it can be broken down directly into acetyl-CoA, making it one of the most important ketogenic amino acids in the body. While most other amino acids are converted into glucose, the acetyl-CoA formed from leucine can be used to make ketone bodies. It’s also present in keto friendly foods like eggs and cottage cheese.