^ Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–63. doi:10.1542/peds.102.6.1358. PMID 9832569. https://web.archive.org/web/20040629224858/http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM Lay summary]—JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.
The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy.[26][27] It is approved by national clinical guidelines in Scotland,[27] England, and Wales[26] and reimbursed by nearly all US insurance companies.[28] Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet.[9][29] About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.[9] A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.[5][30]
In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[55]
“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

To minimize the risk of hypoglycemia, Yancy and his team decrease medication as soon as a patient starts the diet. While drugs like metformin and liraglutide (Victoza) are less of a concern, there are others that pose a substantial hypoglycemia threat. In addition to insulin, the sulfonylurea drugs glipizide and glyburide require a watchful eye, as they work by stimulating the pancreas to make more insulin, increasing the risk of dangerous lows in the face of insufficient carbohydrate intake. “People on this diet need to be prepared to check their blood glucose any time they feel like it could be getting too low,” says Urbanski. “I would say a minimum of twice a day, but ideally three to four times a day, at least in the beginning in order to see the effect of the diet on their blood glucose readings.”
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.  
As discussed in the first article of this series, ketosis is a metabolic state in which the brain switches to using ketone bodies – derived from the breakdown of fat – as its primary energy source, instead of glucose. This way body protein, which would otherwise be broken down and converted into glucose through the process of gluconeogenesis, are spared.

Epilepsy is one of the most common neurological disorders after stroke,[7] and affects around 50 million people worldwide.[8] It is diagnosed in a person having recurrent, unprovoked seizures. These occur when cortical neurons fire excessively, hypersynchronously, or both, leading to temporary disruption of normal brain function. This might affect, for example, the muscles, the senses, consciousness, or a combination. A seizure can be focal (confined to one part of the brain) or generalised (spread widely throughout the brain and leading to a loss of consciousness). Epilepsy can occur for a variety of reasons; some forms have been classified into epileptic syndromes, most of which begin in childhood. Epilepsy is considered refractory (not yielding to treatment) when two or three anticonvulsant drugs have failed to control it. About 60% of patients achieve control of their epilepsy with the first drug they use, whereas around 30% do not achieve control with drugs. When drugs fail, other options include epilepsy surgery, vagus nerve stimulation, and the ketogenic diet.[7]


Moreover, the ketogenic diet also reliably raise the “good” HDL-cholesterol, while also improving most other cardiovascular markers, including blood pressure, as this study shows.24 Thus, the overall effect on cholesterol and other markers for heart disease is positive. In some lean hyper-responders, a keto diet will increase LDL particle number, and this effect needs further investigation.

Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
Missing Nutrients. One of the biggest concerns for dietitians is the keto diet’s lack of key foods. Many question the eating plan’s impact on the development of certain chronic diseases. Without milk, for example, getting enough calcium and vitamin D for sturdy bones becomes a challenge. Take away whole grains, fruit, beans, and potatoes, and it’s nearly impossible to consume enough potassium for healthy blood pressure or enough fiber to stay regular. And unless you’re eating lots of low-carb, leafy green vegetables, you miss out on vitamins A, C, K, and folate, too. 
I tried the keto diet a couple years ago and about 6 weeks in of following it closely I started having significant episodes of lightheadedness and anxiety like symptoms. The coach I was working with said it was keto flu so I continued on the diet for a couple more weeks but it was making life difficult so I stopped. Now every time I try to go low carb the symptoms come back. Sometimes I wonder if it’s just anxiety response or all in my head. I would love to eat low carb but haven’t ever been able to figure out why this happens. I read somewhere that keto can be harder for women’s bodies and affect their adrenal glands. Would this increase anxiety symptoms.
All of our diets are developed with each individual child in mind. We focus on what the child likes to eat and try as much as possible to incorporate their favorite foods into their diets, and many children actually enjoy their keto food. Even if your child is already on a special diet due to allergies or food intolerances, our team can still incorporate these special needs into your child's ketogenic diet.

A computer program such as KetoCalculator may be used to help generate recipes.[47] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[37]


No human population has ever lived in a permanent state of ketosis. Ketogenic diets are dangerous for pregnant women and developing fetuses, and the only human population that has ever subsisted on this dietary pattern advocated by keto diet proponents could only do so because of a genetic mutation that prevents them from going into ketosis. Unfortunately, it has the unintended but unavoidable consequence of reducing the survival prospects of their infants.
The ketone bodies are possibly anticonvulsant; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.[56]

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]
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[10][14]
Weight loss is the primary reason my patients use the ketogenic diet. Previous research shows good evidence of a faster weight loss when patients go on a ketogenic or very low carbohydrate diet compared to participants on a more traditional low-fat diet, or even a Mediterranean diet. However, that difference in weight loss seems to disappear over time.
Our human ancestors did not consume high-fat, low-carbohydrate diets and therefore would not have been in diet-induced ketosis. Even the most successful early hunters could not possibly have consumed enough fat to enter ketosis since african wildlife such as wildebeests, warthogs and impalas all have low body fat – well under 10%, and as low as 0.3%[6] in the dry season.
In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[55]

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]
A ketogenic diet helps control blood sugar levels. It is excellent for managing type 2 diabetes, sometimes even leading to complete reversal of the disease. This has been proven in studies. It makes perfect sense since keto lowers blood-sugar levels, reduces the need of medications and reduces the potentially negative impact of high insulin levels.
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