While there is no such thing as a one-size-fits-all diet, diets with varying macronutrient compositions can help in supporting different health goals. The ketogenic diet, with its high fat, low carbohydrate, and moderate protein intake, has been solidly researched for a number of health applications since the 1920s and has been growing in popularity in recent years. Additional science and the potential for the ketogenic diet in various applications is emerging.
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.”
“I really believe that the more informed you are about the benefits of a healthy bite versus the chain reaction that you’re going to put into effect in your body when you take that bite — you just suddenly don’t want to make that choice for yourself anymore. It’s beyond willpower at that point; it’s become a desire to do something good for yourself.” — Christie Brinkley
The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal. On admission, only calorie- and caffeine-free fluids are allowed until dinner, which consists of "eggnog"[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.
When your body burns its stores of fat, it can be hard on your kidneys. And starting a ketogenic diet -- or going back to a normal diet afterward -- can be tricky if you’re obese because of other health issues you’re likely to have, like diabetes, a heart condition, or high blood pressure. If you have any of these conditions, make diet changes slowly and only with the guidance of your doctor.
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.
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. Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula. Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet. 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. Other formula products include KetoVolve and Ketonia. Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.
If you’ve decided to move forward in trying the keto diet, you will want to stick to the parameters of the eating plan. Roughly 60 to 80 percent of your calories will come from fats. That means you’ll eat meats, fats, and oils, and a very limited amount of nonstarchy vegetables, she says. (This is different from a traditional low-carb diet, as even fewer carbs are allowed on the keto diet.)
Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose). Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.
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 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.
Insulin is a hormone that lets your body use or store sugar as fuel. Ketogenic diets make you burn through this fuel quickly, so you don’t need to store it. This means your body needs -- and makes -- less insulin. Those lower levels may help protect you against some kinds of cancer or even slow the growth of cancer cells. More research is needed on this, though.
"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.
First appointment: Your first meeting with our team will be a one-hour new patient appointment. You’ll meet our nurse practitioners, social worker and dietitians to discuss the diet’s daily requirements, the initiation process, the length of time your child will be on the diet, how the diet may affect your family and any other questions your family may have. If the ketogenic diet team and your family both agree the diet will be manageable for your family, an initiation is scheduled.
The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and '30s, it was largely abandoned in favour of new anticonvulsant drugs. Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs. For this group, and for children in particular, the diet has once again found a role in epilepsy management.
My principal hope in this article is to provide journalists with a resource to do what basic journalism demands, namely to ensure that stories are scientifically balanced and accurate. At the end of this post I provide contacts for some of the credentialed experts who helped me compile this research. Reporters, please seek out these or other low-carb diet experts so you can provide accurate, up-to-date information for your readers.
^ 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
Full disclosure: I have followed a low-carb diet for nearly a decade and find no problem adhering to it. I’ve lost weight and all my cardiovascular biomarkers have improved. Moreover, I’ve studied the science and history behind low-carbohydrate diets, so beyond my personal experience, I bring an evidence-based perspective. (Previously, for 25+ years, I adhered faithfully to a “mostly plants” regimen of fruits, veggies, and whole grains, including my own homemade 7-grain bread, while exercising religiously. Yet during that time my blood lipids were unhealthy, and I never could shake an extra 10-20 pounds.)
A Cochrane systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures. Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types of diets or ways of introducing them to make them more tolerable. In the largest trial of the ketogenic diet with a non-diet control, nearly 38% of the children and young people had half or fewer seizures with the diet compared 6% with the group not assigned to the diet. Two large trials of the Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.
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.
There are so many tricks, shortcuts, and gimmicks out there on achieving optimal ketosis – I’d suggest you don’t bother with any of that. Optimal ketosis can be accomplished through dietary nutrition alone (aka just eating food). You shouldn’t need a magic pill to do it. Just stay strict, remain vigilant, and be focused on recording what you eat (to make sure your carb and protein intake are correct).
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.