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You probably have heard of the so-called "ketogenic diet," or the "keto diet" in short. But you may not be that very familiar with it, and what it’s supposed to be. Would you like to understand more what the "keto diet" really is? Well, you've come to the right place, AND it's good to find you here because in this article, that's what we are precisely going to do! Let's dissect what really is the "ketogenic diet," and what good can it do for you!




Many have considered the "keto diet" as just another "fad" diet - particularly one that was supposed to promise quick weight loss and lesser body inflammation. Well, I would tend to agree that indeed, it could be just a “fad” diet for you - especially if you really don’t know what it is, and what’s the real deal of the science behind it - most probably because you are doing it just for the kicks, perhaps to “go with the trend” or to “follow what your friends are doing” from what they’re posting in Facebook and YouTube. However, I’m here to tell you that there’s a whole world of science behind it, and you should know what that science is all about, so that you can properly decide if the “ketogenic diet” is good enough for you!


First things first. The "ketogenic diet" is actually part of the spectrum of diets that fall under the "low carbohydrate diet" category. Compared to other low carbohydrate diet regimens, a low carbohydrate ketogenic diet (LCKD) is considered among the ones containing the lowest consumption of net carbohydrates at less than 50g per day. A much lower daily carbohydrate allocation of less than 30g is expected for the very low carbohydrate ketogenic diet (VLCKD).



With its low to very low carbohydrate content, the ketogenic diet was named as such because of its tendency of making the body go into a state called "nutritional ketosis." Different macronutrients elicit different levels of insulin response from the pancreas. Of course, carbohydrates elicit the highest levels of insulin in the blood. Fats have the least insulin response, with proteins somewhere in the middle. So with very low carbohydrate food intake, the insulin level in the body doesn't rise as much, and with low levels of insulin, the metabolic process of "lipolysis" is activated, thus leading to the release of fatty acids from the body's fat stores. Excess fatty acids are brought to the liver where they are catabolized to ketone bodies, specifically acetoacetate, acetone and 3-beta-hydroxybutyrate.




So how did we first come to know about the “ketogenic diet”? Physicians first used the so-called "ketogenic diet" for the treatment of epileptic patients in the 1920s. So, we neurologists are quite familiar with this. However, prior to this, for over two thousand years since at least 500 BC, fasting has already been known as a way of treating different ailments, including epilepsy as noted in the Hippocratic Corpus. The ketogenic diet was originally meant to imitate the benefits of fasting, particularly the production of ketones, in the liver. This was especially embodied in the works of Drs. Geyelin, Woodyatt and Wilder in 1921. It was Dr. Russell Wilder who first designated the term "ketogenic diet" to such dietary intervention, and by 1925, Dr. M. G. Peterman of the Mayo Clinic reported in the Journal of the American Medical Association (JAMA) a "ketogenic diet" formulation that is much similar to what is being used today, and which was meant for epileptic children, consisting of daily allocations of about 10-15g carbohydrates, 1g per kg body weight of protein, and the remainder as fat calories.

However, in 1938, when the anti-seizure properties of the drug diphenylhydantoin (more commonly known as phenytoin) was discovered by the neurologists Dr. H. Houston Merritt and Dr. Tracy Putnam, the use of the ketogenic diet among epileptic patients gradually waned and fell by the wayside.

Dr. Russell Wilder was the first to designate the term "ketogenic diet"




Let's talk just a little bit of science here. As a very low-carbohydrate form of low-carbohydrate diets (LCDs), the "ketogenic diet" mimics a lot of the biochemical scenarios of fasting. Hence, with the very minimal levels of carbohydrates and the relative abundance of healthy fats, the secretion of the hormone insulin by the beta cells of the pancreas is kept at low levels.


One of the basic functions of insulin is the inhibition of hormone-sensitive lipase (HSL) - which is an enzyme in fat cells that breaks down fats through hydrolysis (otherwise known as "lipolysis"). This results in the release of free fatty acids. Low levels of insulin encourage the body to enter what is called a “fat-burning mode.” This is further enhanced by elevated levels of the hormone glucagon.


Fatty acids may be used as a source of energy by certain body tissues including your skeletal and heart muscles, as well as the liver. However, the brain does not utilize fatty acids for its energy needs, thus it would need ketones. When there is high level of free fatty acids in the blood, and in the background of low levels of insulin, these fatty acids are then brought to the mitochondria of the liver, where they are catabolized or broken down into ketones.


Ketones are then used as fuel by the neurons of the brain, as well as the cells of the skeletal muscles and the heart. The low levels of glucose are then primarily allocated for the cells which do not consume ketones – such as your red blood cells (RBCs).




Perhaps you may have heard of "ketoacidosis," and you might wonder how is "nutritional ketosis" different from "ketoacidosis"? Ketones are continually produced in the liver, though at different rates depending on the level of dietary carbohydrates and proteins. Among individuals following diets high in carbohydrates, insulin levels are high enough to inhibit the breakdown of fat, and blood ketone concentrations are usually below 0.3 mmol/L. For those maintaining a well-formulated "ketogenic diet," the usual ketone concentration is somewhere between 0.5 to 2 mmol/L. And such well-formulated ketogenic diets usually limit daily carbs to within 30-50 grams, and proteins between 1.2 to 2 grams per kilogram body weight.


Ketosis is a physiological state that is considered normal. Although ketone bodies are acidic, in low levels of nutritional ketosis, the body's strict buffering mechanism can effectively deter the development of metabolic or anion gap acidosis. As Dr. Ben Bikman has said, the body defends its blood acid or alkaline levels so well, it takes a very significant amount of insult for it to go haywire. So you need not worry about developing ketoacidosis when you are just keeping yourself well within levels of "nutritional ketosis."


On the other hand, "ketoacidosis" occurs when there is very high pathological levels of ketone bodies in the blood. And when does this happen? This may usually be encountered in patients with Type 1 Diabetes, where there is pathological absence of insulin production by the pancreas (called diabetic ketoacidosis or DKA), especially in those not strictly compliant to insulin treatment, and which leads to very high levels of free fatty acids that are shunted over to the liver for ketogenesis or the production of ketones. Ketoacidosis may also occur in excessive alcohol binge consumption (which is called alcoholic ketoacidosis). After ethanol is metabolized to acetic acid, this is then shunted to ketogenesis especially when insulin level is low and glucagon level is high. This may occur when excessive intake of ethanol is coupled with decreased food consumption due to vomiting, thus leading to episodes of low blood glucose or hypoglycemia.



As you probably have known by now, I advocate a very low carbohydrate ketogenic diet (VLCKD) for the reversal of the so-called metabolic syndrome, or insulin resistance. The so-called "ketogenic diet," which as previously noted, maintains daily carbs of around 30-50 grams and 1.2-2 grams protein per kg body weight, effectively limits the rise of the level of insulin in the bloodstream. Since insulin resistance is characterized by chronic elevations of serum insulin, or what is called hyperinsulinemia, the sustained decrease in blood insulin levels brought about by the "ketogenic diet" somehow gradually reverses the effects of the so-called "insulin resistance syndrome" or the "metabolic syndrome."


How does this happen? Hyperinsulinemia, when it becomes chronic, eventually promotes the development of insulin resistance, thereby leading further to the manifestations of the Metabolic Syndrome. Various studies have shown that the pathology of chronic hyperinsulinemia is vascular in nature, thus hyperinsulinemia is itself at the core of the development of atherosclerosis, lipogenesis and its subsequent state of obesity, and the evolution of Type 2 Diabetes. I will be discussing these in more detail in another video.


And since it looks like chronic hyperinsulinemia indeed seems to be at the bottom of it all, finding a means to effectively curtail the levels of insulin would then effectively work towards the reversal of Metabolic Syndrome itself. And that's where the role of low carbohydrate diet regimens come into play.




However, if you have any of the following medical conditions listed here, do be extra careful when trying to go on the ketogenic diet. And discuss your options properly with a well-informed physician or medical professional. What are they?

  • Those with psychological eating disorders like anorexia or bulimia nervosa;
  • Pregnant and breastfeeding women;
  • Children and adolescents who are still in their growing up years - though I advocate having them eat whole non-refined unprocessed foods, and to make them avoid refined sugars and carbs, and not to just let them have high-carb snacks every so often even if they’re not really hungry;
  • Those with severe diabetes - both Types 1 and 2 – more so in those with severe complications such as irreversible end-organ damage in the kidneys; and
  • Those taking certain medications that may conflict with the state of nutritional ketosis - like certain antipsychotics such as quetiapine, risperidone, and aripiprazole (which may increase insulin levels in some people), as well as certain anti-diabetic medications which could result to severe episodes of hypoglycemia when taken together with a glucose-lowering ketogenic diet.


In patients with Type 2 diabetes, this is where you need to partner with a well-informed medical professional to help you out with a medically-guided therapeutic ketogenic dietary intervention, wherein your anti-hyperglycemic medications may gradually be decreased, and perhaps even stopped or de-prescribed if deemed appropriate depending on your compliance.




When we know that obesity and Type 2 Diabetes are now established at epidemic proportions worldwide, and this is by all intents and purposes much related to the development of insulin resistance and its corresponding Metabolic Syndrome, I suppose at this point, we REALLY need to redefine what is supposed to be a “healthy” diet. Is it what government health “authorities” define as “healthy” based on guidelines they make and promote? Or is it that kind of diet that will TRULY optimize our body’s metabolism and longevity?

Lastly, some patients have asked me: what about intermittent fasting or IF? What is it? Can I combine it with my LCHF or keto diet? In a nutshell, intermittent fasting has its own good points with or without keto. But I guess that would take us much time here, and that would be worth a topic for another video - so watch out for it soon!


I hope I got you the answers to all those questions brewing in your head about the ketogenic diet. Like the YouTube video above and share it with your friends! Subscribe to the Low Carb Health Doctor | LCHD channel!

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