Ketogenic Diet

Many patients and readers ask about my thoughts on the Ketogenic Diet (KD). My answer is that it is one of the diets I use with patients depending on their genetics and health situation.
The KD has been used by the medical profession for the treatment of seizures (especially for children) for many decades.  In recent years it has also been used for the treatment of Alzheimer’s disease, Parkinson’s disease, Amyotrophic Lateral Sclerosis (Low Gehrig’s Disease), Traumatic brain injury, Hypoxic/ischemic brain injury (stroke), Autism, Depression, Headaches, Narcolepsy, Metabolic Inherited Diseases, various cancers, Type 2 Diabetes, and Cardiac ischemia. It has also been used successfully to reduce body weight for those with obesity.
What Foods Can You Eat with The KD?
The KD focuses on foods that are very low in carbohydrates, rich in natural fats, and contains low to moderate protein. It is called a ketogenic diet since it causes the body to release ketone bodies (often referred to as ketones) by breaking down fat. This process is known as ketosis. The KD removes sugars and all grain products. Also, starchy vegetables such as corn, potatoes, peas, okra, artichokes, and most legumes are avoided. Fruits are high in sugar and are avoided except avocado, lemon, lime, and small amounts of berries such as strawberries, blueberries, and raspberries.
There are many non-starchy vegetables that can be consumed. Any of the leafy green vegetables and lettuces are good options. Other good choices include alfalfa sprouts, asparagus, beet greens, bok choy, broccoli, Brussels sprouts, cabbage, cauliflower, celery, chives, collard greens, cucumbers, fennel, garlic, kale, kohlrabi, leeks, mushrooms, olives, radishes, sauerkraut, scallions, snow peas, spinach, swiss chard, turnips, water chestnuts, and zucchini.
Proteins that contain more fat are best. Wild caught seafood, organic eggs, and grass-fed meat are best. Specific examples would include whole eggs; meat (beef, pork, lamb, veal, goat, duck, venison, buffalo/bison); poultry (chicken turkey); fish (anchovies, cod, halibut, herring, salmon, sardines, trout); shellfish and seafood (clams, crabs, lobster, scallops, shrimp, mussels, oysters); nuts and seeds (macadamias, pecans, almonds, walnuts flax, hemp, chia); and protein powders (low in sugar).
Examples of fats and oils in the KD would include animal fats (ghee, butter); and non-animal fats such as avocado oil, almond oil, avocado oil, cacao butter, olive oil, coconut oil, and coconut butter.
The Mechanism of KD
The body uses carbohydrates broken down into glucose as a main sources of energy (glycolysis).  When carbohydrates are restricted to an amount of approximately 50 grams or less daily the liver is relied up on for glucose. The liver contains glycogen, which is stored glucose. However, after 24 to 48 hours of carbohydrate restriction and the depletion of liver glycogen, the use of ketones is required as a fuel source (ATP). Ketones are derived from fatty acids in the diet or from the breakdown of fat in the body. Most people need to have a net carbohydrate intake of 20 to 50 grams daily to be in ketosis. Net carbohydrates are the total carbohydrates minus fiber per day.
Precautions with the KD
People following the KD may experience digestive discomfort due to the high fat intake.  They may also experience hypoglycemia, hunger and cravings, weakness, dizziness, fatigue, constipation, muscle cramps and dehydration, mild acidosis, ketone breath, weight loss, changes in blood pressure, heart palpitations, and nausea.
It is especially important to consult with a doctor before starting a KD if you have a history of pancreatitis, active gall bladder disease, impaired liver function, impaired fat digestion, poor nutritional status, and gastric bypass surgery. Some studies have reported the KD depletes the body of minerals such as selenium, copper, and zinc. Supplementation of minerals during the KD is recommended.
Modified KD      
At the Stengler Center For Integrative Medicine we have regular KD protocols as well as a modified KD. The modified version is often used as it can be maintained for a longer period. Also, to make the program easier to follow we often recommend a Ketogenic shake to replace one meal a day. Also, for long-term compliance I may rotate patients between the KD and a Modified Mediterranean Diet.
Lose Weight-Feel Better
I have observed several patients lose 25 pounds or more on the KD program. This was quite successful considering that other diets had not worked well for them. Many patients with Type 2 diabetes have had great reduction in glucose levels and were able to reduce or wean off diabetic medications. Of course any type of KD program should be monitored by a knowledgeable doctor or nutritionist.