Of the 1,580 survey participants, more than half reported staying on a low-carb diet for at least one year, and 34% reported more than two years. Further, those on the diet for two years or more said that they had largely maintained their weight loss. This is a self-selected sample, with an obvious bias for people who are experiencing success (dieters are less inclined to report on their failures). However, this data does show that long-term adherence is possible.
For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer (two weeks), but the long-term seizure reduction rates are unaffected.[44] Parents are encouraged to persist with the diet for at least three months before any final consideration is made regarding efficacy.[9]
First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[48]
The ketogenic diet may seem like the latest weight-loss craze, but it’s actually been around for nearly a century. Developed in the 1920s, this ultra-low-carb, high-fat eating plan was originally used to treat seizures in people with epilepsy. Today, it’s getting some serious attention for an entirely different reason. “There’s growing research showing that the ketogenic diet is effective for managing blood sugar in people with diabetes,” says William Yancy, MD, program director at the Duke Diet and Fitness Center in Durham, North Carolina. “However, because we don’t have studies [lasting] longer than two or three years, we don’t know what can happen with regard to complications over longer periods of time.”
Nina, this is a brilliant article, thank you. I have shared it with my Low Carb & Keto Facebook US & UK groups, many of whom are new to this way of eating for weight loss, reversing Diabetes, preventing Diabetes and improving their health. My members receive regular low carb recipes and support but articles like this, really do reinforce their reasons for staying low carb and helps them justify their lifestyle to family, friends and some Medics!
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.
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.

For both keto and Bulletproof diets, opt for full-fat, grass-fed, raw, and organic dairy to reap the anti-inflammatory benefits of omega-3s and CLA. Dairy is a great source of fat on a ketogenic diet, but be mindful not over-do the protein. Although milk (yep, even raw, full-fat, or goat milk) is too high in lactose sugars, you can stay in ketosis with foods like butter, ghee, and colostrum. Avoid sweetened or low-fat dairy, evaporated or condensed milk, and buttermilk to keep your fat intake high.


There are three instances where there’s research to back up a ketogenic diet, including to help control type 2 diabetes, as part of epilepsy treatment, or for weight loss, says Mattinson. “In terms of diabetes, there is some promising research showing that the ketogenic diet may improve glycemic control. It may cause a reduction in A1C — a key test for diabetes that measures a person’s average blood sugar control over two to three months — something that may help you reduce medication use,” she says.


Meanwhile, more than 70 trials have examined the health effects of a low-carb diet. They attest to the benefits64 associated with ketosis and low-carb diets, including a reduction in body weight and body mass index, improved cardiovascular risk factors including blood pressure, and the reversal of Type 2 diabetes. It is virtually impossible to imagine that a diet with so many health improvements in the ‘near term’ (2 years) could ultimately shorten life—and the study authors offer no possible mechanism to explain how this might happen.

Because people with type 2 diabetes are at an increased risk for cardiovascular disease, there’s a specific concern that the saturated fat in the diet may drive up LDL, or “bad,” cholesterol levels, and further increase the odds of heart problems. If you have type 2 diabetes, talk to your doctor before attempting a ketogenic diet. They may recommend a different weight-loss diet for you, like a reduced-calorie diet, to manage diabetes. Those with epilepsy should also consult their doctor before using this as part of their treatment plan.
The keto diet changes the way your body converts food into energy. Eating a lot of fat and very few carbs puts you in ketosis, a metabolic state where your body burns fat instead of carbs for fuel. When your body is unable to get glucose from carbs, your liver converts fatty acids from your diet into ketones, an alternative source of energy. Burning ketones in place of glucose reduces inflammation and spurs weight loss.[1]
Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[19] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[31] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[18] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[51] Other formula products include KetoVolve[52] and Ketonia.[53] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[53]
If you’re wondering about the difference between ketosis and diabetic ketoacidosis, you’re not alone. “The word ketone is scary for most people with type 1 diabetes because they relate ketones to diabetic ketoacidosis,” says Patti Urbanski, MEd, RD, CDE, a certified diabetes educator with St. Luke’s Hospital in Duluth, Minnesota. “But with the ketogenic diet, we’re talking about a much lower level of ketones.”
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Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.
Upon starting the diet, some patients report symptoms like fatigue, headaches, and muscle aches. However, these short-lived symptoms are, in fact, a sign that the diet is working, and the body is switching over from burning glucose as fuel to burning fat. This transition involves upregulating certain enzymes and down-regulating others; it is a profound shift for the human body that can have uncomfortable symptoms. However, these side effect usually last only 3-4 weeks. They can be ameliorated in most cases, by drinking several cups of bouillion broth during the day until the transition is completed.15
We realize that the ketogenic diet can be very demanding of children and families, so we make sure that we stay with families throughout the entire treatment. Our multidisciplinary team includes a social worker that can help your child and their siblings cope with the stresses that come with the diet. Your child will also have regular, relationship-building contact with the same team of nurses. Additionally, we have an education specialist on staff who specializes in meeting with teachers and administrators to help prepare schools for children with epilepsy.
The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture, and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more food energy than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein, and carbohydrate is then evenly divided across the meals.[37]

In fact, patients with gastroesophageal reflux disease (GERD) have been shown to improve after eating very low carbohydrate diets.31, 32 Another study found increased carb-intake worsened GERD, while a high-fat, low-carbohydrate diet reduced symptoms.33 And two studies have linked esophageal diseases, including Barrett’s esophagus (BE)34 and GERD,35 to sugar and carbohydrate intake.

During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative bromides (discovered 1857) and phenobarbital (1912), the ketogenic diet was widely used and studied. This changed in 1938 when H. Houston Merritt, Jr. and Tracy Putnam discovered phenytoin (Dilantin), and the focus of research shifted to discovering new drugs. With the introduction of sodium valproate in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time restricted to difficult cases such as Lennox–Gastaut syndrome, declined further.[10]
In fact, patients with gastroesophageal reflux disease (GERD) have been shown to improve after eating very low carbohydrate diets.31, 32 Another study found increased carb-intake worsened GERD, while a high-fat, low-carbohydrate diet reduced symptoms.33 And two studies have linked esophageal diseases, including Barrett’s esophagus (BE)34 and GERD,35 to sugar and carbohydrate intake.
Our Clinical Services Team - staffed by clinicians and other nutritional experts - answer technical questions about our nutritional formulas and the most effective ways to recommend them in a variety of protocols. And our product representatives help practitioners grow their business in many more ways than suggesting practice-appropriate nutritional products.
^ Jump up to: a b c d e f g h i j k l m n o p q r s Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325

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.


It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]
The keto diet is one of the most effective that I’ve come across and one of the more straightforward (as opposed to easy!) to follow. In a nutshell, when you’re on a keto diet, you eat a very low-carb, high-fat diet. That means goodbye pasta and bread, hello cheese and oils. It’s pretty much the opposite of what we’ve been taught our entire lives. But it works if you follow the keto diet food list. Plus, you can make many favorite recipes keto-friendly.
The “Dirty Keto” version of high-fat, low-carb dieting promises the same fat-burning results as mainstream keto. The only difference? You can get fat, protein and other macronutrients from any source — including foods like fast-food burgers and sugar-free candy. Dirty keto recipes have gained popularity because they taste great while promoting weight loss. But does dirty keto really work?
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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).[19]
Most people have probably heard of the Atkins diet, which is a pretty general take on ketogenic eating. Wildly popular in the 70s and again in the 90s, Atkins and the low-carb diet are one of the best ways to lose weight. In fact, one of the biggest benefits to low carb eating is that it is a very efficient way to lose weight without much effort. The combination of filling meals that reduce overeating and the fact that, when you’re in ketosis your body burns stored fat for energy makes this an ideal diet for people whose primary goal is fat loss.
This was delicious! It will be my new go to easy dinner from now on. I did make a couple of changes though. I swapped the pickles out for jalapenos, doubled the bacon, and added a dollop of Primal Kitchens chipotle lime mayo on top of my serving along with some hot sauce and it was perfect! It reminded me a lot of In-n-Outs animal style cheeseburger.
Even low carb chips can contain inflammatory yeast or protein powders from grain-fed cows. This keto recipe gives you the same crunch and zesty flavor of cheesy store-bought chips without the harmful ingredients. Simply fry thin slices of zucchini then toss with spices for the perfect crunchy snack. Fry in heat-safe grass-fed ghee or beef tallow to make this recipe more Bulletproof.
First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[48]
This was a great read. I aim to restrict carbs always because I believe most are why the American population is obese. I would very much like to hear more about carb restriction excluding the discussion on processed meats and processed high salt content foods because I consume neither. I also don’t consume dairy or eggs. So can you provide some substance.

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.

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)?
This was delicious! It will be my new go to easy dinner from now on. I did make a couple of changes though. I swapped the pickles out for jalapenos, doubled the bacon, and added a dollop of Primal Kitchens chipotle lime mayo on top of my serving along with some hot sauce and it was perfect! It reminded me a lot of In-n-Outs animal style cheeseburger.
Thanks for this post, I am always on the look out for new blogs I haven’t discovered yet and you have provided a couple. I am also on the look out for new dinner recipes ( this is not to say I don’t appreciate your dessert recipes cause boy do I ) but my husband cannot eat red meat of any kind so this makes it even harder to make a low carb dinner for us. I have gotten used to subbing ground turkey for beef and have discovered that using broth from dried porcinis gives it a very beefy flavor. Now I have a few more recipes to try, Thanks for that.
There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.[7]

Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[19] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[31] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[18] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[51] Other formula products include KetoVolve[52] and Ketonia.[53] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[53]
In the mid-1990s, Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC's Dateline programme and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.[1]
First, that study, which was reported upon widely, was on mice. Mice are not like humans in the way they fatten or contract metabolic diseases. Journalists/media should stop reporting on mice stories as if they were applicable to humans, especially when there is such a large body of clinical trial data on humans. Let’s be clear: rigorous clinical trial data on humans trumps any data on mice. Every time. And what does the rigorous data on humans say?

Cost. At the grocery store, your shopping cart can take on a whole new look (and price tag) thanks to high-ticket items such as beef, fish, poultry, pork, and cheese, which are replacing budget-friendly pasta, potatoes, rice, and bread. And chronic constipation may require fiber supplements or stool softeners. Before beginning a keto diet, determine whether it’ll fit within your budget.


One of the most-cited worries about the keto diet is the long-term impact it may have on heart health—especially because people with diabetes are at greater risk for heart disease. In the small Diabetic Medicine study that found people with type 1 improved their A1Cs on a keto diet, participants had higher triglycerides and LDL (“bad”) cholesterol. This raises concerns about the diet’s longer-term heart health implications, as do the results of research published last year in The Lancet. That study followed more than 15,000 adults for 25 years and found that people who consumed less than 40 percent of their calories from carbohydrates were significantly more likely to die from heart disease than those whose diets contained 50 to 55 percent of calories from carbs—especially if the foods that replaced those carbs were rich in animal fats and proteins.


To lower your heart risks while following a keto diet, be mindful of the types of fats you’re eating. “Most nutritionists encourage people to get their fat from heart-healthy mono- and polyunsaturated fats,” Urbanski says. So even though going keto may sound like a license to load up on bacon and butter, reach for unsaturated fats from foods such as olives, nuts, seeds, and avocados, and olive, canola, and nut oils.
The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron's cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a "gate" which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.[7]
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)?
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