This content is strictly the opinion of Dr. Josh Axe and is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of medical advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Dr. Axe nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.
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In the first month of the study, participants were put on a baseline diet, which was designed to be similar to what they reported they were eating outside the hospital, including lots of sugary carbohydrates. For the second month, the participants got the same amount of calories and protein as they did in the first month of the study, but ramped up the amount of fat in their food and ate far fewer carbs.
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.
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Another common effect of the ketogenic diet is “keto flu”: fatigue, lightheadedness, and dizziness people feel when they greatly reduce their carb intake. This effect should go away after the body adjusts to the diet, but staying on keto for a long time could lead to kidney stones, high cholesterol, constipation, slowed growth (in young people), and bone fractures. We actually don’t know whether keto is safe in the long term.
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The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted. It involves a consultation with the patient and their caregivers and, later, a short hospital admission. Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.
Another way to get into ketosis is by eating less than 20 grams of carbs — or a slice of bread — per day. So people on a ketogenic diet get about 5 percent of their calories from carbohydrates, 15 percent from protein, and 80 percent from fat. Note that that’s a much lower ratio of protein and a lot more fat than you’d get on other low-carb diets, but it’s this ratio that will force the body to derive much of its energy from ketones. If you eat too much protein, or too many carbs, your body will be thrown out of ketosis.
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With Type 2 diabetes, the body either doesn’t produce enough insulin or becomes insulin-resistant, so it can’t move glucose from the blood into the cells for energy. Eating carbs results in an increase in blood glucose — so if you vastly cut down your carbs, your blood glucose levels won’t go up as much, and you won’t need as much insulin to manage blood sugars. It’s not surprising that researchers have been finding that people who follow a ketogenic diet can better manage their blood sugar by cutting down their carbs.
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If you select Gain Muscle as your goal, then you can select the Gain (surplus). The macro calculator will then recommend that you eat this percentage more calories than you need. Eating more calories than you need will result in weight gain, which will be in the form of muscle if you do weight training. For example, if you select 10% as the gain, the calculator will output 10% more calories than your body needs for maintenance.
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%. The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy, and tuberous sclerosis complex.
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.
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While the evidence behind ketogenic diets for diabetes is still preliminary and the evidence for weight loss isn’t all that convincing (more on that next), the evidence of using the diet to treat epilepsy is extremely robust. The idea for treating people with epilepsy with the keto diet came about in the 1920s, when researchers observed that people who fasted experienced fewer seizures. (Researchers still aren’t sure why the diet can work for epilepsy, but a few mechanisms have been proposed, including making neurons more resilient during seizures.)
Skinfold Calipers: Skin calipers are affordable and easy to get on Amazon. Your local gym most likely has them too. A skinfold caliper works by pinching one area of your skin that folds easily (like your belly and back), in three to ten different areas of your body to measure your subcutaneous fat. That measurement is then used in a formula to calculate your body fat percentage. If you’ve never done this before, let a physician or coach do it first and teach you how to read the measurements accurately so you can do it at home next times.
You didn’t convert grams to calories. You must convert the grams of fat and protein to calories and then calculate your macronutrient percentages. Calorie percentages, not gram percentages, are what the recommended keto percentages are based on. Usually, once you account for the fact that one gram of fat has five more calories than one gram of protein the calorie percentages will end up being what you expect from a typical keto diet.
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A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice. One major factor may be the lack of adequately trained dietitians who are needed to administer a ketogenic diet programme.
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