The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[10] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[17] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.[1]
Tea and coffee, including Bulletproof Coffee, are completely ketogenic, with bonus points for jump-starting weight loss and focusing your mental clarity. Watch out for sweeteners, fillers, or artificial flavors. While you can drink unsweetened, plant-based milk alternatives in moderation without going out of ketosis, they are not Bulletproof, and are usually loaded with toxic molds — the exception being full-fat coconut milk.[4] If you plan to include them in your diet, beware of carrageenan and BPA-lined containers.
Even hibernating bears do not go into ketosis[2]. And predatory animals who undergo extended periods of food deprivation, such as elephant seals[3], are metabolically resistant to ketosis; instead, they have upregulated gluconeogenesis pathways through which they can steadily produce glucose. This makes perfect sense, since predators’ survival depends on their ability to catch their prey, which usually requires intense bursts of activity. And sprinting capacity is dependent on glucose, as humans who adopt a ketogenic diet quickly discover.
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
Cyclical keto diet: The Bulletproof Diet falls into this category. You eat high fat, low carb (less than 50 grams of net carbs a day) five to six days of the week. On day seven, you up your carb intake to roughly 150 grams, during what’s called a carb refeed day. Carb cycling this way helps you avoid the negative effects some people experience when they restrict carbs long term, like thyroid issues, fatigue and dry eyes.[9][10]  Learn more here about how carb cycling works.
While many health care providers aren’t comfortable recommending the keto diet for people with diabetes, there’s a substantial body of research indicating that it can help with weight loss, reduce the need for medication, and even lower A1C into the non-diabetes range. It’s so effective that when researchers assigned 349 volunteers with type 2 diabetes to follow either a keto diet or a traditional diabetes eating plan (the makeup of that plan wasn’t defined in the study) for one year, they observed some powerful results. While the people on the “diabetes diet” didn’t experience any positive movement in their A1C, body weight, or medication requirements, those on the keto plan reduced their A1C from 7.6 to 6.3 percent, shed 12 percent of their body weight, eliminated their need for sulfonylurea medication, and lowered or reduced their need for insulin by 94 percent. The results were published in 2018 in the journal Diabetes Therapy.
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]
Metagenics offers a wide range of educational opportunities including webinars, group meetings, and seminars as part of our commitment to continuing functional medicine education. Our goal is to give our practitioners further insight to help address their patients’ unique health needs for a higher level of personalized, lifetime wellness care. We have been sharing this ever-growing body of nutritional and lifestyle research for over 25 years.

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 reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[18] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[48] 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.[18]
Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of acidosis, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.[9]
A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.[24]
There are numerous benefits that come with being on keto: from weight loss and increased energy levels to therapeutic medical applications. Most anyone can safely benefit from eating a low-carb, high-fat diet. Below, you’ll find a short list of the benefits you can receive from a ketogenic diet. For a more comprehensive list, you can also read our in-depth article here >
There is nothing inherently difficult about following a ketogenic diet. We have many patients who do this very easily over many years. The metabolic benefits significantly outway any perceived challenges from limiting particular food types. Uptake would be far more widespread if nutrition professionals left their predujical opinions of SFA’s behind. Finally, given the expertise in Ketogenic Diets at Harvard, Dr David Ludwig, for one springs to mind, I am surprised the author did not avail themselves of the local expertise.

The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.[7]

OMG! I have a household of 9. 3 of us are Keto. EVERYONE in the house asks for this recipe on the regular! I add a little heavy cream into the ground beef with the cream cheese and make the recipe for 16 servings (have dad, hubby and 18 yo son in the house.) I like to carmalize the onion and garlic in bacon grease as well. This recipe is an easy “go to” that pleases anyone in the house as well as a great idea when we have extra company. This is probably our favorite keto recipe to date!
I actually went on a ketogenic diet last year to see if it would help my migraines. I have a history of chronic migraines which would usually last 3 days, sometimes longer. Triptans help a lot but I don’t like having to take them. I stayed in ketosis for about 8 months and experienced a significant reduction in migraines, from feeling some type of headache (mild o r severe) almost everyday to 1 or 2x per month while in ketosis. Although I’m very healthy otherwise, I do think my migraines may have something to do with blood sugar fluctuations (despite previously eating a whole foods diet and no refined carbs), and keto totally stabilized this. I eventually came off of Keto because I’m not really a meat lover. When I came off, but remained low carb, my migraines stayed under control for the most part. When I increase carbs, they do return.

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.


A ketogenic diet is comprised of approximately 10% of daily calories coming from healthy carbohydrates such as leafy greens, nonstarchy vegetables, and limited amounts of legumes and berries; 20% of daily calories coming from proteins such as omega-3-rich fish and grass-fed animal protein; and ~70% of daily calories coming from high-quality fats such as avocado, unsaturated and medium-chain triglyceride oils, nuts and seeds, and coconut.
The low glycaemic index treatment (LGIT)[49] is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[5] Although it is also a high-fat diet (with approximately 60% calories from fat),[5] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[18] However, the types of carbohydrates consumed are restricted to those that have a glycaemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]
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.

The past 4 years I was suffering from mild to severe pain all over my body and unrelenting fatigue, sleep disturbances, brain fog, etc. Diagnosed with Sjogren’s Syndrome and Fibromyalgia. Medication included Vicodin, Morphine and a muscle relaxer. I would not take Plaquenall (spelling?), Lyrica or other “biologics”. I was taking a bunch of supplements but nothing was improving.  


Professional guidance is important in deciding whether or not the ketogenic diet is the right path based on the individual’s health history and goals, and it's also necessary to routinely monitor ketone levels in the body while on the diet. At Metagenics, we offer a number of resources to help support the ketogenic journey along with several convenient ketogenic supplementation options to help bring convenience and variety to ketogenic living.
Even in endurance sports that don’t require sprinting, ketogenic-style diets are disadvantageous according to a ketogenic diet and exercise article published in Sports Medicine[5]: “a high-fat, low-carbohydrate ketogenic diet may impair exercise performance via reducing the capacity to utilize carbohydrates, which forms a key fuel source for skeletal muscle during intense endurance-type exercise.” The article concluded, “At present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.”

You won’t miss dirty keto add-ins like heavy cream or peanut butter with this recipe. Ripe strawberries and coconut milk blend into a sweet pastel shake perfect for dessert (or breakfast). Choose full-fat canned coconut milk for your dairy and get fresh, organic strawberries to make it more Bulletproof. (And enjoy chia seeds in moderation, since they can irritate your stomach.)
Even when exercising at a submaximal level (for example, biking at a moderate speed), heart rate and adrenaline levels rise more when people are eating a high-fat, low-carbohydrate diet[4] vs. a high-carbohydrate, low-fat diet. This results in those on the high fat diet perceiving that they are working harder to achieve the same pace as the high-carbers, and they have much more difficulty speeding up their pace in sprints or climbs.
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.
The backbone of a keto plan is its extraordinarily high fat content, making up 65 to 80 percent of calories daily. Protein—which can raise blood glucose, though not as much as carbohydrate does—makes up 15 to 25 percent of calories on the keto diet. And carbs are even more heavily restricted to just 5 to 15 percent of calories. That’s only about 20 to 50 grams a day (compared with the average 245 grams daily), or the amount in a small apple or a cup of cooked brown rice, respectively.
A ketogenic diet could be an interesting alternative to treat certain conditions, and may accelerate weight loss. But it is hard to follow and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. We also do not know much about its long-term effects, probably because it’s so hard to stick with that people can’t eat this way for a long time. It is also important to remember that “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.
Note the emphasis on ketosis as a temporary adaptive state. Our ancestors could not be in fasting-induced ketosis permanently because they would eventually exhaust their fat reserves (which were presumably far more limited than ours, owing to the simple fact that they ate less and moved more than we do). They would then progress from fasting to starving, and subsequently die.
Short-term results for the LGIT indicate that at one month approximately half of the patients experience a greater than 50% reduction in seizure frequency, with overall figures approaching that of the ketogenic diet. The data (coming from one centre's experience with 76 children up to the year 2009) also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.[18][50]
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]
The first modern study of fasting as a treatment for epilepsy was in France in 1911.[12] Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[13]
Metagenics offers a wide range of educational opportunities including webinars, group meetings, and seminars as part of our commitment to continuing functional medicine education. Our goal is to give our practitioners further insight to help address their patients’ unique health needs for a higher level of personalized, lifetime wellness care. We have been sharing this ever-growing body of nutritional and lifestyle research for over 25 years.

Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.

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