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more on ketogenic diets


“All these molecular changes suggest that a ketogenic diet is protective against brain injury.  Remarkably, a long-term ketogenic diet does not seem to be associated with significant side effects…”From Shelly Fan’s October 1, 2013 article published in our nation’s oldest science-related publication, Scientific American (The Fat-Fueled Brain: Unnatural or Advantageous?)

“I am concerned that the federal government, the media, the processed food manufacturers and billion dollar drug and biotech companies have commandeered our food supply and health care systems. Routinely, information and evidence about what truly constitutes healthy eating is altered or hidden from the public in order to advance financial or face saving agendas. And worse, people who aren’t aware of the deceptions are being injured and dying because they follow this agenda driven advice.  Since the privately owned Academy of Nutrition and Dietetics (formerly the American Dietetics Association) receives great sums of money from processed food manufacturers, they can’t just suddenly start saying that a high fat, low grain diet is healthiest – they would lose all their funding from companies like Kraft Foods, Hershey’s and Coca-Cola.”  From Ellen Davis’ (Master’s in Applied Clinical Nutrition) website, Ketogenic Diet Resource.

“I remember exactly where I was sitting in a clinic at Johns Hopkins in 2002 explaining to (admonishing, really) a patient who was on the Atkins diet how harmful it was because of DKA.  I am so embarrassed by my complete stupidity and utter failure to pick up a single scientific article to fact check this dogma I was spewing to this poor patient. If you’re reading this, sir, please forgive me. You deserved a smarter doctor.”  From a blog post (Ketosis – Advantaged or Misunderstood State?) off of Ketogenic Diet proponent, Dr. Peter Attia’s (MD) website — The Eating Academy dot com.  If you want to see the metabolic pathways that show how safe and effective this diet is, this is the site to visit.

“Ketones are the ideal fuel for our bodies unlike glucose – which is damaging, less stable, more excitatory and in fact shortens your life span.   The energy producing factories of our cells – the mitochondria – work much better on a ketogenic diet as they are able to increase energy levels on a stable, long-burning, efficient, and steady way. Not only that, a ketogenic diet induces epigenetic changes which increases the energetic output of our mitochondria, reduces the production of damaging free radicals. Furthermore, recent data suggests that ketosis alleviates pain other than having an overall anti-inflammatory effect.  The ketogenic diet acts on multiple levels at once, something that no drug has been able to mimic. This is because mitochondria is specifically designed to use fat for energy. When our mitochondria uses fat as an energetic source, its toxic load is decreased, expression of energy producing genes are increased, its energetic output is increased, and the load of inflammatory energetic-end-products is decreased.  In short, let fat be thy medicine and medicine be thy fat!”  From an article by Cardio-thoracic Surgeon, Gabriela Segura (The Ketogenic Diet — An Overview)

YESTERDAY I showed you that the Ketogenic Diet is beneficial for a wide variety of chronic illnesses —- especially those that are most related to SUGAR DYSREGULATION — including most neurological problems (ALZHEIMER’S is a super common example).  Today we are going to take a bit different approach and talk about some of the ins and outs of what a Ketogenic Diet looks like, as well as practical ways to pursue this approach.  But the very first thing I want to do is to talk about dangers or side effects of eating in this manner.

Because there are people who stay in Ketosis virtually all the time, the question arises — are there any side effects of eating a ketogenic diet; particularly over the long haul?  When I started researching Ketogenic Diets for these two posts, the first thing I did was go to PubMed and start scrolling through some of the 1,750 studies on the topic.  The peer-reviewed scientific literature is all but unanimous in pronouncing the Ketogenic Diet safe — far safer than the DRUGS / MEDICATIONS people would otherwise be taking for diabetes (HERE) or high cholesterol (HERE).  Although most problems that arise from the Ketogenic Diet are quite benign, THERE ARE some potential side effects and contraindications to eating this way.

For instance, the Ketogenic Diet has the potential to cause both stunted bone growth and fractures in pre-pubescent epileptic children (Part I revealed why).  But remember that both Antidepressants and Anticonvulsants (widely prescribed for those with seizures) are notorious for themselves causing bone loss (HERE).  You’ll likewise hear the argument that losing weight too rapidly is bad for you. RUBBISH!   Research shows that once you get into Ketosis, your body would actually rather burn Ketone Bodies than burn Glucose.  Furthermore, as long as you are getting enough protein, you will not burn your own muscle mass for energy — something that happens during Ketoacidosis, which we’ll cover momentarily.

You’ll also run into the argument (this always occurs in a grudging manner) that while consuming all this fat might cause you lose weight, it will cause blood lipid issues (HIGH CHOLESTEROL, HIGH TRIGLYCERIDES, etc, etc).  While this might be true initially, the results of virtually every study that I’ve seen shows that Ketogenic Diets actually normalize blood lipid profiles — something I dealt with yesterday as well. 

Doctors who are not up on the MOST CURRENT RESEARCH CONCERNING SATURATED FATS; if they are even willing to ‘OK’ a Ketogenic Diet at all (again, grudgingly), will tell you that most of your dietary fat should come from unsaturated sources like Vegetable Oils (yes, even MARGARINE), Flax Oil and FISH OIL.  This is simply not true.  Vegetable Oil is garbage (HERE — particularly SOY); and while there are undeniable benefits to the other two oils, moderation with any and all DIETARY SUPPLEMENTS is key.  Bottom line; do your own research (HERE is my post on everything you ever wanted to know about fats and inflammation). 

And while I absolutely advocate talking to your physician before putting yourself on a Ketogenic Diet (for those keeping score, this is another disclaimer), please realize that it’s quite likely that when it comes to almost anything and everything that has to do with nutrition, he / she knows less than you — possibly way less (HERE). This is why you can expect to run into the argument over the difference between “Ketosis” and “Keto-acidosis” (often called DKA or Diabetic Keto-Acidosis). 

Hans Krebs, the German-born British MD / Biochemist, won the 1953 Nobel Prize for Medicine for figuring out the Citric Acid / TCA Cycle.  If you learned your biology back in the day, you probably had to memorize “The Krebs Cycle”.  A few months ago, the December issue of Multiple Sclerosis International carried a study (The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis) that clarified this all-too-common objection to Ketogenic Diets (Ketoacidosis).

“Hans Krebs first made the distinction between the normal, ‘physiological’ ketosis that is induced when following a carbohydrate-restricted diet, and diabetic ketoacidosis, a complication of [Type I] diabetes.”

In Type I Diabetics, Blood Sugar can skyrocket because Insulin is not available to move it from the blood and into the cells.  Because the body is essentially starving for glucose, it switches over to burn Ketones.  Unfortunately, the protein and fat source in Ketoacidosis is usually yourself.  In other words, the body will consume itself as a source of Ketone-based, non-glucose fuel.  As you can see, this is a pathological state — a far cry from strictly regulating your dietary ratios of fats, proteins, and carbs in order to induce a state of Ketosis.  It’s the difference between the highly controlled nuclear reactions that occur in power plants, and a NUCLEAR BOMB, whose reactions are completely uncontrolled. 

Although I hit you with a veritable barrage of peer-reviewed research yesterday, hang with me as I give you just a little bit more.  A 12 year old study from the Fall 2004 issue of the medical journal Experimental & Clinical Cardiology (Long-Term Effects of a Ketogenic Diet in Obese Patients) came to essentially the same conclusions as a Brazilian study published a decade later in PubMed Health (Very-Low-Carbohydrate Ketogenic Diet -vs- Low-Fat Diet for Long-Term Weight Loss:  A Meta-Analysis of Randomised Controlled Trials).  The cherry-picked conclusions of the studies are respectively as follows.

“The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients.  Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.”

“Individuals assigned to a very-low-carbohydrate ketogenic diet achieved greater long-term reductions in body weight, triacylglycerol and diastolic blood pressure and greater increases in HDL cholesterol levels than those assigned to a low fat diet.”

When epileptics or those who are extremely OBESE (‘grossly’ or ‘morbidly’ Obese —- BMI’s of 40 or higher) start a Ketogenic Diet, not only is it typically done in a clinic or hospital setting by people with experience in inducing Ketosis (especially true for epileptic children), but most medical plans actually cover it as well.  However, what do you do if you are one of the “others” (those without Epilepsy) that I dealt so much with yesterday?  How does the average person go about starting a Ketogenic Diet and inducing Ketosis?  After speaking with your physician of course………


Take a look at the pie charts above (these show what are known as Ketogenic “Macros”).  As per the key at the bottom, the yellow represents dietary carbs, the burgandy represents dietary protein, and the blue represents dietary fat (we’ll cover the MCT Ketogenic Diet later).   The first thing people notice is how much fat is being consumed in a Ketogenic Diet (you can see why the Atkins Induction Phase of the Atkins Diet is considered “moderate”).  For the standard 4:1 Ketogenic Diet, your “Macros” are approximately 70% fat, 25% protein, and 5% carbs).  The questions usually arise, how do I consume that much fat and where does it come from; and how can I live on so few carbs?

A QUICK NOTE ON FAT CONSUMPTION:  Because you are consuming a lot of fat on a Ketogenic Diet, and because bad things are stored in the fat (ANTIBIOTIC RESIDUES, XENOHORMONES, ENDOCRINE DISRUPTORS, ectc), you need to treat this as a “PALEO KETOGENIC DIET“.  In other words, keep it clean (see link!).  This becomes even more critical for those of you who are really sick or really heavy.

To get yourself into Ketosis, some doctors will recommend you start with a fast, while others recommend jumping in wholehog (fairly easy if you have been doing LOW CARB or PALEO).  The ‘whole hog’ approach can be much tougher if you have been eating STANDARD AMERICAN FARE as per the pie chart at the top.  Still others suggest slowly decreasing carbs to the 5% target over the course of a couple of weeks.  While this approach might work well for a few; for THE HARDCORE CARB ADDICT — a huge segment of the American population — I am not a big fan of this approach, as it will likely feed the cravings longer than necessary.

The fat’s the easy part.  It’s the carbohydrates you are going to have to count.  On this diet, you are not going to eat GRAINS, FRUITS, BEANS, etc (you can probably do some cheese, due to its high fat content).  You are going to live on meat, eggs, and green leafy vegetables (spinach, kale, greens, broccoli, cabbage, etc, etc, etc — natural BIOTRANSFORMERS).  You are going to have to eat lots of good fat (HERE).  I have a patient who brings me lard he has rendered from naturally raised beef or pork (incredible stuff).   EVOO will be a staple, but do not cook with it.  Cook with Coconut Oil, butter, or lard — and don’t be stingy with it as 70% of your diet must come from good fats (less will not allow you to switch over to Ketosis).  Good snacks include foods like cheese, seeds, nuts (peanuts are not nuts — they are legumes), and nut butters. 

To calculate the grams of carbs in the vegetables you are going to consume, you’ll need a chart that automatically subtracts the FIBER from the total grams of carbohydrates.  HERE is one of many.  You will also need a “Keto Calculator” to help you calculate your “Macros” according to both your body weight and your level of activity (they are widely available online at no cost). 

Be aware that particularly if you are not used to a low carb approach to eating, you will likely have varying degrees of what is commonly referred to as “The Keto Flu”.  Because your body is converting over from burning carbs for energy (Glucose), to burning Ketone Bodies (a byproduct of fat metabolism), you may feel like crap for a week or two.  What does this entail?  Some people actually have FLU-LIKE SYMPTOMS, but most will report headaches, foggy thinking, dizziness / wooziness, and similar.  No big deal as it will soon resolve itself.

In order to keep yourself in Ketosis, you are going to monitor your urine with “Keto Strips”.   These help you check to see if you are in Ketosis and burning Ketone Bodies for fuel.  Be aware that the strips will not turn color as much once you have actually converted over to burning Ketones.  also be aware that if you have a “CHEAT DAY” and binge out on carbs, it will take some time to get back into Ketosis again. And for those who are interested, you can purchase inexpensive blood Ketosis measuring instruments that are analogous to the home monitors for Blood Sugar.


If you go back and look at the pie charts above, you’ll see that the bottom one pertains to the “MCT Ketogenic Diet”  MCT stands for Medium Chain Triglycerides, which is a type of fat that produces Ketone Bodies much easier than the Long Chain Triglycerides found in the SAD.  By supplementing with MCT, people are able to stay in Ketosis while eating somewhat more protein and carbohydrates.  Ward Dean (MD), writing for an April 2013 issue of Nutrition Review (Medium Chain Triglycerides (MCT’s):  Beneficial Effects on Energy, Atherosclerosis and Aging) revealed why this is.

“The energy-enhancing properties of MCTs are attributed to the fact that they cross the double mitochondrial membrane very rapidly, and do not require the presence of carnitine, as do LCTs. The result is an excess of acetyl-coA, which then follows various metabolic pathways, both in the mitochondria (Krebs Cycle) and in the cytosol, resulting in the production of ketones. Scientists attribute the increased energy from consumption of MCTs to the rapid formation of ketone bodies. MCTs are thus a good choice for anyone who has increased energy needs, as following major surgery, during normal or stunted growth, to enhance athletic performance, and to counteract the decreased energy production that results from aging.”

Sounds pretty darn good to me.  Which begs the question of the best dietary sources of MCT’s. Although grass-fed dairy / beef and free-range egg yolks contain moderate amounts of MCT’s, nothing touches coconut oil, which is made up of 65% MCT’s.   For those who are wanting to add MCT’s to their diet, they are widely available at health food stores as bottled oils (there are some companies out there making outrageous claims about their products).  However, I’m not sure you can go wrong with organic coconut oil.  My favorite products are those that actually have a coconut taste to them. (Some of you will need to realize that coconut itself is a FODMAP that has the potential to throw those of you dealing with SIBO into a tailspin)


Firstly, if you go back and look at my website, you’ll realize that I have been a proponent of KETOGENIC DIETS since my first experience with Low Carb just after getting married two decades ago next month.  Many physicians, including the brilliant Cardiologist Dr. Robert Atkins, were talking about Ketosis to treat things other than epilepsy decades before it became fashionable (HERE). Secondly, if you are chronically sick or morbidly obese, Ketogenic Diets flat out work (see PART I of this post).   The Ketogenic Diet is nothing more than the logical progression of the Low Carb thought process. 

Listen to what Dr. Dr. J Pérez-Guisado of the Department of Medicine of Spain’s University de Córdoba said in the abstract of his decade-old paper that was published in the Internet Journal of Nutrition and Wellness (Arguments In Favor Of Ketogenic Diets).  By the way, the bibliography for this paper contains nearly 200 peer-reviewed studies. 

“Many negative comments have been made about the use of ketogenic diets and experts today believe that the best way to lose weight is by cutting back on calories, chiefly in the form of fat. The international consensus is that carbohydrates are the basis of the food pyramid for a healthy diet. However, this review will clarify that low-carbohydrate diets are, from a practical and physiological point of view, a much more effective way of losing weight. It is also argued that such diets provide metabolic advantages, for example: they help to preserve muscle mass, reduce appetite, diminish metabolic efficiency, induce metabolic activation of thermogenesis and favor increased fat loss and even a greater reduction in calories. These diets are also healthier because they promote a non-atherogenic lipid profile, lower blood pressure and decrease resistance to insulin with an improvement in blood levels of glucose and insulin. Low-carbohydrate diets should therefore be used to prevent and treat type II diabetes and cardiovascular problems. Such diets also have neurological and antineoplastic [anti-Cancer] benefits and diet-induced ketosis is not associated with metabolic acidosis, nor do such diets alter kidney, liver or heart functions.”   

Again, if you are considering a Ketogenic Diet, consult your doctor.  If he / she pats your shoulder while patronizingly telling you that a LOW FAT approach is better; start looking for another doctor.  If a Ketogenic Diet is something you are truly interested in doing, search the web as there are scores of excellent sites with much more information than mine, including recipes.  For those of you who struggle despite a Ketogenic Diet, there could be any number of underlying reasons.  HERE are a few of them.


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