By Dr. Mercola
A ketogenic diet calls for minimizing carbohydrates and replacing them with healthy fats and moderate amounts of high-quality protein.
This kind of diet is now being investigated for its potential to prevent and treat cancer, but it has long been established as an excellent treatment for epileptic seizures.
A high-fat, low-carb diet will also help optimize your weight and virtually all chronic degenerative disease, as eating this way will help you convert from burning carbs to burning fat as its primary fuel.
In the US, epilepsy affects an estimated 2.3 million adults and nearly 468,000 children below the age of 17. It's a chronic neurological condition characterized by recurring seizures, which can have a significant impact on a person's quality of life, given the heightened risk of accidents and injuries.1
Ketogenic Diet—An Accepted First Line Approach for Epilepsy in Children
Standard treatment for epilepsy includes anti-epileptic drugs, which tends to work for 60-65 percent of patients.2 For the remainder, the drugs don't work—but oftentimes a ketogenic diet will.
Clinical medicine began recognizing the ketogenic diet as a valuable option in the treatment of epilepsy in the late 90s, and there's even a Ketogenic Diet Special Interest Group at the American Epilepsy Society.
The special interest group was organized by Dr. Thomas Seyfried, who today is one of the leading academic researchers looking at using the ketogenic diet as a cancer treatment.
Jim Abrahams was another key player. Abrahams created the Charlie Foundation for his son Charlie, who went through a near-death experience from seizures and was healed using a ketogenic diet.
Today, the ketogenic diet is frequently used as a first line approach in seizure disorders where medications fail, and according to Dr. Seyfried, it's recognized as an important component for the management of refractory (drug resistant) seizures in children specifically.
Interestingly, the mechanism by which the ketogenic diet manages seizures is not nearly as clear as the way the ketogenic diet manages cancer. This is ironic considering that it's barely known, let alone applied, within oncology circles, while it's already an established treatment for epilepsy.
New Study Investigates Ketogenic Diet for Adult Epileptics
While the ketogenic diet has a successful track record in treating epileptic children, adult studies have been scarce. To investigate the potential effectiveness of dietary intervention in adult epileptics, researchers recently reviewed3, 4, 5, 6 the limited body of published studies.
Two types of diets were included:
- Ketogenic diet, consisting of a 3:1:1 or 4:1:1 fat to carbohydrate and protein ratio, with 87-90 percent of calories from fat
- Modified Atkins diet: 1:1:1 fat to carb and protein ratio with approximately 50 percent of calories from fat
In all, the results were very similar between the two diets; 32 percent of those on a ketogenic diet and 29 percent of those on a modified Atkins diet reduced their seizures by about half.
A small subset of patients—nine percent of those following a ketogenic diet, and five percent of those using a modified Atkins diet—reduced the frequency of their seizures by more than 90 percent.
The effects were persistent over the long term, but low rates of diet acceptance and high rates of treatment discontinuation were found to be significant barriers to success.
More than half of all patients doing a ketogenic diet discontinued it before the end of the study period, as did 42 percent of those on a modified Atkins diet. That said, for those who kept the course, the results were typically rapid and beneficial. According to the authors:
"The anticonvulsant effect occurs quickly with both diets, within days to weeks. Side effects of both diets are benign and similar. The most serious, hyperlipidemia, reverses with treatment discontinuation. The most common, weight loss, may be advantageous in patients with obesity...
In summary, ketogenic and modified Atkins diet treatment show modest efficacy, although in some patients the effect is remarkable. The diets are well-tolerated, but often discontinued because of their restrictiveness. In patients willing to try dietary treatment, the effect is seen quickly, giving patients the option whether to continue the treatment."
Another finding was that while children sometimes remain seizure free after discontinuing the diet, such was not the case in adults. This means that adult epileptics would likely have to maintain the diet indefinitely, or suffer a relapse...
The Importance of Intermittent Fasting
In my experience, the vast majority of people are adapted to burning carbs as their primary fuel opposed to burning fat. This is the result of eating a diet too high in sugar/carbs and generally lacking in healthy fats.
One of the most common side effects of being a sugar-burner is that you end up with insulin and leptin resistance, which it at the root of most chronic disease. Intermittent fasting is one of the most effective strategies I know of to shift your body from burning sugar to burning fat as its primary fuel.
While there are many different strategies, my favorite (and the one I personally used to become fat adapted) is to simply restrict your daily eating to within a six- to eight-hour window, which means you're fasting for about 16-18 hours each day. This upregulates the enzymes that are designed to burn fat as a fuel, and downregulates the glucose enzymes. This approach really only needs to be used until insulin resistance resolves.
This kind of intermittent fasting can also be a useful modality to help you make a more gradual transition to a ketogenic diet, as it helps break your body's addiction to glucose. In fact, eliminating sugar cravings is one of the most welcomed side effects of intermittent fasting. Unless you have a very serious disease, I believe it is best for most people to implement intermittent fasting slowly over six to eight weeks rather than a three day complete fast. You begin by not eating for three hours before you go to bed and then gradually extend the time you eat breakfast until you have skipped breakfast completely.
For Optimal Health, Pay Attention to What and When You Eat
For optimal health, there are two key factors to keep in mind: what you eat, and when you eat. Some intermittent fasting advocates permit you to eat just about any kind of junk you want as long as you restrict calories on certain days, but in my view this can be really counterproductive because when you're fasting, optimal nutrition becomes more important, not less so...
As you will see below, the ketogenic diet is very similar to what could be considered ideal for most people, and I believe it can be very beneficial for the vast majority of people, either alone or in combination with intermittent fasting. The primary difference between someone struggling with a chronic disease such as epilepsy or cancer and people who have not yet been diagnosed with a chronic disease is how long you have to maintain this type of regimen.
As a general rule, if you are insulin resistant, I recommend intermittent fasting along with a ketogenic-type diet for as long as it takes to resolve your insulin resistance. At that point, you can add more meals back in. However, whether you're intermittently fasting or not, I believe the following food guidelines are beneficial for the vast majority of people—especially if you're trying to shed unwanted weight:
- Avoid sugar, processed foods, fructose in excess of 15 grams, and grains. This effectively means you must avoid most processed foods
- Eat plenty of whole foods, ideally organic, and replace the grain carbs with:
- Large amounts of fresh organic locally grown vegetables
- Low-to-moderate amount of high-quality protein (think organically raised, pastured animals). Most Americans eat far more protein than needed for optimal health. I believe it is the rare person who really needs more than one-half gram of protein per pound of lean body mass. Those that are aggressively exercising or competing and pregnant women should have about 25 percent more, but most people rarely need more than 40-70 grams of protein a day.
The rationale behind limiting your protein this: when you consume protein in levels higher than recommended above, you tend to activate the mTOR (mammalian target of rapamycin) pathway, which can help you get large muscles but may also increase your risk of cancer. There is also research suggesting that the "mTOR gene" is a significant regulator of the aging process,7 and suppressing this gene may be linked to longer life.
To determine whether you're getting too much protein, first calculate your lean body mass by subtracting your body fat percentage from 100 (example: if you have 20 percent body fat, you have 80 percent lean body mass). Then write down everything you're eating for a few days, and calculate the amount of daily protein from all sources.
Aim for one-half gram of protein per pound of lean body mass, which would place most people in the range of 40 to 70 grams of protein per day. If you're currently averaging a lot more than that, adjust downward accordingly. You could use the chart below or simply Google the food you want to know and you will quickly find the grams of protein in the food.
Red meat, pork, poultry, and seafood average 6-9 grams of protein per ounce.
An ideal amount for most people would be a 3-ounce serving of meat or seafood (not 9- or 12-ounce steaks!), which will provide about 18-27 grams of protein
Eggs contain about 6-8 grams of protein per egg. So an omelet made from two eggs would give you about 12-16 grams of protein.
If you add cheese, you need to calculate that protein in as well (check the label of your cheese)
Seeds and nuts contain on average 4-8 grams of protein per quarter cup Cooked beans average about 7-8 grams per half cup Cooked grains average 5-7 grams per cup Most vegetables contain about 1-2 grams of protein per ounce
- As much high-quality healthful fat as you want (saturated and monounsaturated from animal and tropical oil sources). Most people need upwards of 50-85 percent fats in their diet for optimal health. Sources of healthful fats to add to your diet include:
Avocados Butter made from raw grass-fed organic milk Raw dairy Organic pastured egg yolks Coconuts and coconut oil Unheated organic nut oils Raw nuts, such as almonds, pecans, and macadamia, and seeds Grass-fed meats
Low-Fat Diets Finally Acknowledged as 'a Bad Idea'
One of the most destructive health recommendations that have pervaded the US food system is the recommendation to avoid dietary fat. As noted above, most people need at least 50 percent or more of their daily calories in the form of healthy fat—a far cry from the 10 percent currently recommended.
When food manufacturers started removing saturated fats from their foods, they added not just one but two ingredients that have wrought tremendous harm: sugar, and trans fats. As recently noted by investigative journalist Nina Teicholz, author of The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet, in an opinion piece for the Wall Street Journal:8
"The top scientist guiding the US government's nutrition recommendations made an admission last month that would surprise most Americans. Low-fat diets, Alice Lichtenstein said, are 'probably not a good idea.' It was a rare public acknowledgment conceding the failure of the basic principle behind 35 years of official American nutrition advice."
I recently interviewed Nina on the topic of fats, and in that interview she revealed that while the food industry reduced the use of trans fats, restaurants ended up reverting back to using regular vegetable oils (such as peanut, corn, and soy oil) for frying, and these oils, it turns out, degrade into highly toxic oxidation products when heated... In fact, they may be even worse for you than the trans fat they're replacing! Basically, while the FDA has recognized the harms of trans fat and is in the process of eliminating them, they have not reviewed the evidence to conclude what the healthiest replacement might be. As explained by Nina:
"There's a whole category called aldehydes, which are particularly worrisome... [A]t fairly low levels of exposure, these aldehydes in animals caused tremendous inflammation, which is related to heart disease. They oxidized LDL cholesterol, which is thought to be the LDL cholesterol that becomes dangerous. There's a link to heart disease. There's also some evidence that links these aldehydes in particular to Alzheimer's. They seem to have a very severe effect on the body."
One researcher has found that cyclic aldehydes cause toxic shock in animals through gastric damage, and this seems consistent with the rise in immune problems and gastrointestinal-related diseases in the human population. So, please, while it's important to avoid trans fat, you also want to avoid food cooked in regular vegetable oils, as the byproducts produced when these oils are heated may be even worse for your health than trans fat... Instead, stick to saturated fats like coconut oil, butter, or lard for cooking.
Ketogenic Diet and Intermittent Fasting Can Be Greatly Beneficial for Most
If you or your child is an epileptic, I would encourage you to try a ketogenic diet. Intermittent fasting may further boost results. I also believe it's crucial for cancer9, 10 patients.
That said, a ketogenic diet, in which you replace carbs with low to moderate amounts of protein and high amounts of healthy fat (such as avocado, coconut oil, butter, olive oil, and macadamia nuts), is really recommended for everyone, whether you have a chronic health problem or not. It's a diet that will help optimize your weight and health overall, as eating this way will help you convert from carb burning mode to fat burning.