The Ketogenic Diet: Common Questions Answered
Authors: Sarah M. Rice, Douglas B. Reynolds
The Ketogenic Diet: Concerns
The ketogenic diet first emerged as a treatment for epilepsy around 100 years ago. Clinicians noticed that fasting improved the condition, usually after 2–3 days, and determined a specific diet could mimic the biochemistry of fasting (nutritional ketosis) and therefore offer a sustainable approach to seizure management. This began the use of the ketogenic diet for the treatment of epilepsy.17 Carbohydrate restricted diets were also being investigated for the treatment of diabetes and obesity and are noted in the literature at a similar time including work by Osler, Joslin, and Rollo.18–20
Over time, different variations of the ketogenic diet have been studied in order to evaluate clinical effect (now for a variety of conditions) against user tolerance and ease of adherence. It is perhaps this aspect that has led to confusion around its use and application. It is important to recognize managing a severe condition like epilepsy (which may exist with other medical conditions), and the very precise therapeutic application of the ketogenic diet in this setting, may look different from its use for other conditions,3,21 or just as a preferred way of eating. In this section, we look at some of the concerns often raised by those interested in the ketogenic diet.
Is ketone production caused by starvation?
Ketones are not necessarily a marker of starvation.1,22 A state of starvation is usually involuntary calorie deprivation leading to nutrient deficiencies, loss of muscle mass, and organ damage. Nutritional ketosis, produced by a well-formulated ketogenic diet, can provide a steady energy supply, nutritional sufficiency, preservation of muscle mass, and support organ health.5
The ketogenic diet does not normally advocate a reduction of calories but rather adjusts the source of those calories to predominantly come from fat and protein, minimizing carbohydrate.23
In the absence of carbohydrates, which are metabolized to glucose, the liver oxidizes fatty acids to produce ketones, which are readily used as an energy source. The body can store around 2,000 calories worth of sugar (called glycogen), which could easily get depleted within one day of fasting or extensive exercise.24 In contrast, an average non-overweight adult stores around 130,000 calories in the form of body fat.25 The brain is happily able to utilize glucose produced by the liver (gluconeogenesis) or ketone bodies for fuel.4 The ability to tap into this energy source is a sign of metabolic flexibility and metabolic health. Our bodies are designed to be able to switch between fuel sources to maintain a constant energy supply—essential for our survival.
Does the ketogenic diet cause ketoacidosis?
While both ketoacidosis and nutritional ketosis involve ketones, they are two very different metabolic states.
Ketoacidosis is a rare and potentially life-threatening condition that typically occurs in type 1 diabetes when insufficient insulin is taken but may also occur in type 2 diabetes under stressful conditions such as trauma, surgery, or infections. This is usually hyperglycemic ketoacidosis.4
Certain medications (e.g., SGLT2 inhibitors) can, in rare instances, cause insulin to be ineffective through a disruption of counter-regulatory systems, resulting in ketoacidosis. This results in dangerously high ketone levels, variable glucose levels (which may be normal) and a decrease in the blood’s pH levels. This disrupts normal metabolic and cellular functions. In these cases, blood ketones levels may occur in the range 10–25 mmol/L (58–145 mg/dL).26,3
Nutritional ketosis is a controlled metabolic state achieved by carbohydrate reduction in the context of a well-formulated diet. It maintains normal ketone concentrations, and blood pH levels remain in a healthy range. Blood ketone levels typically range between 0.5 and 3 mmol/L (3–17 mg/dL). In certain therapeutic applications the target ketone level may be set above 3 mmol/L (17 mg/dL), but it is unusual for ketone levels to go above 5 mmol/L (29 mg/dL).3
Does a ketogenic diet increase the risk of type 2 diabetes?
The ketogenic diet is one of the most effective interventions used to prevent, manage, and even reverse type 2 diabetes.1,22,27
Chronic, excessive carbohydrate consumption results in chronically high blood glucose levels (hyperglycemia) that results in chronically high insulin levels (hyperinsulinemia) which eventually results in insulin resistance. This manifests itself in many chronic conditions, the most common of which is type 2 diabetes.
Restricting carbohydrates sufficiently prevents hyperglycemia and eliminates hyperinsulinemia as a result. This may prevent the onset of type 2 diabetes or reverse an existing diagnosis of type 2 diabetes where the adjustment of diabetes medications is essential (commonly other medications are reduced as well).
Does the ketogenic diet increase the risk of cardiovascular disease?
The concern that the ketogenic diet may be linked to an increased risk of cardiovascular disease is primarily based on two issues. The first is the flawed research by Ancel Keys that linked saturated fat to heart disease. This research has since been refuted many times over.28
The second issue is the use of cholesterol as an isolated metric of risk. The latest science no longer supports the blanket statement that high cholesterol causes heart disease but considers a range of metabolic parameters to be important.29 It has been demonstrated that total cholesterol or LDL levels are not good predictors of heart disease, especially in the absence of carbohydrates in the diet.30 The triglyceride / HDL ratio and the count of small dense LDL particles are much more useful predictors of potential cardiac risk.31 In fact studies show the ketogenic diet can decrease the triglyceride / HDL ratio32 (1:1 is good, a ratio >3 where measurements are in mg/dL indicates significant risk of heart attack and stroke) and reduce the number of small dense (oxidized) LDL particles.33
A small subset of individuals, who are usually lean and metabolically healthy, may experience significant increases in LDL on transitioning to a reduced carbohydrate diet. These individuals are described as lean mass hyper-responders (LMHR) and researchers have begun to investigate whether high LDL-c in this context constitutes an increased risk for CVD.34 We already know that LDL-c is not a good predictor of CVD risk when viewed as an isolated metric, and in metabolically healthy individuals (with low triglycerides and high HDL-c), the large buoyant LDL particles that predominate in this group, have no predictive value for cardiovascular disease.35 Conversely, the small dense LDL particles that are associated with metabolic syndrome (high triglycerides and low HDL-c) are associated with increased risk,35 and readily improve on a low carbohydrate diet.33 While early data are promising,36,37 cardiac imaging (e.g. a coronary artery calcium score) may be used to help determine risk in those with an LDL-c ≥190 mg/dL (4.9 mmol/L), with a score of zero being associated with low risk.37,38 Due to the wide range of factors that can contribute to CVD risk, a context dependent and individualized approach, considering a range of biomarkers, should be undertaken. An option to reduce LDL cholesterol by adding back a small amount of carbohydrates (50–100 g/day) from starchy vegetables is available.34 Personal preferences and competing conditions may also be a factor.39 Cardiovascular disease (CVD) is discussed further in Section 4.6.
Risk factors that are consistently associated with CVD are diabetes, metabolic syndrome, hypertension (high blood pressure), obesity, and hyperinsulinemia (high fasting insulin),39–41 with hyperinsulinemia and hyperglycemia (high blood glucose) being particularly important.39,42 Carbohydrate reduction has been shown to reliably reduce these risk factors32,33,43 which are considered in more detail in Section 4.
Is consuming saturated fat on a ketogenic diet dangerous?
Historically, saturated fats have been vilified, and unsaturated vegetable (seed) oils have been promoted as heart-healthy. Recent evidence shows that the relationship between saturated fats and heart health is much more complex than previously thought, with some studies showing no association between saturated fat and type 2 diabetes, a leading risk factor for heart disease.44
The bias against foods rich in saturated fats is unfounded when evidence reflects that whole foods such as full-fat dairy, unprocessed meat, and dark chocolate are not associated with an increased risk of cardiovascular disease. These whole foods have a complex matrix and high nutrient density that are likely to be beneficial and should not be compared with processed foods that are higher in fat.45 Foods like dairy and meat have a saturated fatty acid profile (containing C15, pentadecanoic acid) that researchers have found to be beneficial, and may even be essential.46 A meta-analysis of prospective studies demonstrated no significant evidence for an association of dietary saturated fat with an increased risk of cardiovascular disease.47
If the ketogenic diet is high in cholesterol, is it bad for cardiovascular health?
Cholesterol plays a crucial role in cell membrane integrity, vitamin D synthesis, bile acid production, and hormone synthesis.48 The liver produces cholesterol in accordance with the body’s needs and dietary cholesterol intake is not correlated with blood cholesterol concentrations.49,50 There is no consistent association between plasma cholesterol and atherosclerosis,51 and the limit on dietary cholesterol consumption has been removed from the US dietary guidelines due to a lack of evidence, where they refer to dietary cholesterol as “not a nutrient of concern for overconsumption.”52
Does a ketogenic diet cause nutrient deficiencies?
A well formulated ketogenic diet has been studied across a wide range of population ages and has been shown to be nutritionally complete.53,54 More vigilance may be required in a younger population that requires more strict macronutrient ratio control to achieve a therapeutic level of ketosis (for the management of epilepsy or other neurodevelopmental conditions); however, it may be successfully applied with no adverse events.55 This is discussed further in Section 4:18. In older populations ketogenic diets have been successfully implemented,56 and a higher protein diet applied to elderly care residents has been found to be protective for maintaining nutritional status in this population.57 Animal products also provide the highest quality bioavailable nutrients like iron, retinol (active form of vitamin A), B12, selenium, zinc, and more.58
Nutrient deficiencies result from not consuming enough nutrient-dense whole foods and a properly formulated ketogenic diet provides all the nutritional requirements without supplementation for most people. Where an underlying condition exists some adjustments may be required. A high-carb diet, full of highly processed foods, confectionery, and soft drinks, is low in nutrients and carries a risk of nutrient deficiencies where more nutritious whole foods are displaced.59
A common claim is that avoiding grains will cause nutrient deficiencies. However, this position does not consider the presence of antinutrients like phytic acid, which block trace minerals.60 Grains also contain gluten, which may promote increased gut permeability and inflammation leading to gut disorders in some people.61
Sufficient protein is important for body composition and for satiety (feeling full). A target of around 1.2 to 2.0 g/kg of body weight (or ideal weight) of protein is suggested.2
Are grains, beans, legumes, and fruits essential for health?
The ketogenic diet is often criticized for excluding whole grains, beans, legumes, and fruits, which are believed to be essential for health according to general dietary guidelines.
However, before agricultural crop farming, humans had little to no access to grains, beans, and legumes, refuting the claim that these foods play a critical role in maintaining a healthy body.58 Because humans have evolved mainly without grains and legumes, our digestive systems are not fully adapted to break down and digest various components of grains and pulses, including certain complex carbohydrates, lectins, and phytates.60 This may give rise to common side effects such as bloating, gas, abdominal pain, intestinal inflammation, increased gut permeability, allergies and sensitivities, unexplained fatigue, joint pain, and nutritional deficiencies.61
Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by unexplained digestive issues that appears to be increasing on a population level.62 While there may be several contributing factors, an emphasis on grains and beans as heart-healthy and nutritious staples, may be a contributing factor.63
Another frequent attack on the ketogenic diet involves the avoidance of most fruits. While the ketogenic diet permits moderate amounts of berries, which are among the most nutritious fruits, high-sugar options such as grapes, bananas, mangos, and pineapples should be avoided if your goal is to maintain nutritional ketosis. This may have created a narrative that the ketogenic diet excludes nutrient-rich foods, thereby increasing the risk of nutritional deficiencies. Although fruits do contain various nutrients and dietary fiber, most vegetables offer comparable nutrition without the carbs and sugars that can interfere with ketosis. A common concern is that the ketogenic diet lacks adequate vitamin C due to restricting fruits. However, comparable amounts of vitamin C can be obtained from vegetables such as bell peppers, raw sauerkraut, kale, Brussels sprouts, and cauliflower. In addition, diets containing animal sourced foods are high in nutrient density, which is a common feature of well formulated ketogenic diets.14,58
What about the microbiome?
Given that so many factors (such as diet, exercise, stress, geography, and medications) can affect the microbiome, it is challenging to define what a healthy microbiome looks like.64,65 We know that the ratio (or balance) of bacteria types and species diversity appears to be important.66
Processed foods are known to be detrimental to the microbiome,67 and differences in metabolism when consuming a higher carbohydrate versus a lower carbohydrate (nutritional ketosis) diet may drive differences in the microbiome that are still healthy.65
A well formulated ketogenic diet with a focus on whole foods has been shown to positively influence the microbiome68 and is suggested to contribute to the success of the ketogenic diet in neurological conditions.69
Does the ketogenic diet cause cravings or disordered eating?
People who have achieved their health and weight loss goals with the ketogenic diet report that the ketogenic diet is sustainable and helps reduce cravings.70
Starting a ketogenic diet can involve some significant changes to an existing meal plan and often restricts pleasure and comfort foods such as chips, confectionery, chocolate, ice cream, fast foods, and soda, which can cause temporary cravings as the body adjusts and hormone signaling normalizes. Food cravings reduce as your body adapts to a high-fat diet and significant glucose and subsequent insulin spikes are eliminated. Studies show fats are more satiating than carbs and provide a steady energy source. Dietary fat intake triggers the release of leptin and other similar hormones that induce satiety and reduce cravings.71,72
There are some people who struggle more with their relationship with food, especially ultra-processed foods, and demonstrate addictive behaviors towards these types of foods. As many as 20% of adults may meet the criteria for this condition.73 This additional challenge may be rooted in childhood trauma or other neurobiological vulnerabilities that make adherence to healthy eating patterns more challenging. While there is debate around terminology and diagnosis, the fact that highly processed foods can be considered addictive strengthens the case that addictive behaviors towards certain foods may be a consideration for some individuals.74 Clinicians have begun to recognize that this population needs more support to be successful and some have developed special programs to assist these individuals73 (see Section 6: Resources, for more information). While it may be more challenging, studies show that low-carbohydrate or ketogenic dietary approaches improve the symptoms of ultra-processed food addiction and reduce cravings.73,75
Carbohydrate reduction helps stabilize blood sugar levels, preventing rapid blood sugar spikes and crashes, which are among the most common causes of food cravings, especially for high-sugar and carb-heavy foods.72,76 A ketogenic diet allows for various nutritious and satisfying foods, including meats, fish, eggs, nuts, seeds, full-fat dairy, non-starchy vegetables, and healthy fats like avocados and olive oil. With some planning, you can enjoy delicious meals while maintaining ketosis. Many find this higher, healthy fat approach less restrictive than diets based on meal replacements, calorie counting, low fat, or point-based food value systems. This explains why a ketogenic lifestyle can be successful over the long-term.
While some critics of the ketogenic diet express concerns around disordered eating patterns possibly being triggered by using this approach, emerging evidence is showing that a ketogenic diet can be successful in treating eating disorders like anorexia nervosa.11,77 Key mechanisms include normalizing the neurological and metabolic pathways involved in the associated mental health symptoms of this condition. This can lead to improved brain function and reduction of symptoms, allowing for an improved relationship with food. This approach utilizes nutritionally replete ketosis, where ketone bodies are generated without the need for starvation measures. Ketone bodies are able to provide an efficient fuel source for the brain and seeking the state of ketosis for better brain energy supply may be one of the features that drives patients with anorexia nervosa towards restriction.77 Maintaining higher ketone levels can be addressed by a ketogenic diet in a safe manner.
The possibility of reduced carbohydrate tolerance due to gut sensitivities in anorexia nervosa could also be considered a reason to implement a high-nutrient, low-carbohydrate approach.78 It is important to remember that a ketogenic diet may be nutritionally sufficient and energy-replete.53 In fact, higher energy density may be presented in relatively small amounts of food if volume is challenging. Taken together, the evidence suggests that a ketogenic diet is likely to benefit a range of disordered eating types, although this should be evaluated on an individual basis and the input of an experienced practitioner should be considered (see Section 6.4, Mental health resources)
A ketogenic diet is a metabolic therapy that can be utilized to meet health goals, which may include gaining weight or losing weight while improving body composition. Personalizing the approach according to goals may also include maintaining a healthy weight while using nutritional ketosis for other therapeutic effects.
Is the ketogenic diet only used for treating epilepsy?
We have over one hundred years of research on the use of the ketogenic diet in the treatment of epilepsy and this has expanded to include other conditions. Recently, the number of publications reflecting this interest has risen dramatically.23,79 Being in a state of ketosis can profoundly benefit metabolic health, hormone balance, energy production, and cognitive functions. An appreciation of the potential applications of the ketogenic diet for human health is growing in the clinical and academic space, driving research forward.12,80,81
Common topics under investigation in relation to the ketogenic diet include:
Weight loss Neurological disorders Cancer Diabetes (Type1 and Type 2) Cardiovascular health Body composition Gut health and the microbiome Mental health (includes disordered eating) Metabolic syndrome Inflammation Autoimmune diseases Aging Endocrine disorders Polycystic ovary syndrome Fertility Maternal and fetal health Liver health Bone health Sleep disorders Genetics and epigenetics Athletic performance82
Does the ketogenic diet cause cancer?
The incorrect assumption that ketosis results in ketoacidosis, which is characterized by increased body acidity and thought to be (incorrectly) associated with the development of cancer, may be the source of the concern that the ketogenic diet causes cancer. Nutritional ketosis does not lead to a change in plasma pH; however, the tumor microenvironment can become acidic as a metabolic byproduct of the tumor itself.83,84 Nutritional ketosis and the tumor microenvironment are two very different metabolic states. There is no evidence that the pH of dietary components is associated with cancer.84
It has long been established that cancer cells rely on glucose to proliferate and grow and that their ability to utilize ketones as a fuel source is limited. A ketogenic diet improves many metabolic processes that contribute to cancer growth such as reducing insulin, downregulating insulin growth factor (IGF-1), and reducing inflammation. As such, utilizing a ketogenic diet to improve metabolic health may be protective.There is more and more evidence that a ketogenic diet may support cancer treatment (as an addition to standard of care protocols) and improve the well-being of cancer patients undergoing chemotherapy.85–87
Does the ketogenic diet affect bone health?
Studies involving children with severe epilepsy may be driving concerns that the ketogenic diet harms bone health. A mechanism suggested involves acidity changes in the blood with calcium released to act as a buffer creating more brittle bones, prone to osteoporosis. Children with epilepsy are a specific population that may be significantly affected by other conditions. It is misleading to apply findings from this group to the general population, especially as epilepsy medications and reduced mobilization can also negatively affect bone metabolism.88,89 Overall, long term results (up to 5 years) show the ketogenic diet to be safe in the treatment of epilepsy.55,90,91 In children and adolescents, appropriate surveillance, ensuring correct ratios and nutritional sufficiency are important to ensure growth trajectories, and studies indicate these targets can be achieved.55
As stated previously, while ketones are classified as acids, the state of nutritional ketosis does not alter plasma pH and no negative effects have been demonstrated when using the ketogenic diet to treat metabolic disease,92,93 in fact, protection of bone health has been demonstrated.94
While long-term adherence to the ketogenic diet does not appear to be linked to poor bone health, metabolic conditions like type 2 diabetes and insulin resistance are risk factors for the development of osteoporosis,95,96 so foods to be avoided are those that contribute to the development of these conditions97:
- Soft drinks
- Fried foods
- Processed foods
- Sugary foods
- Refined grains
These same foods displace nutrient dense foods which can lead to nutritional deficiencies, another cause of poor bone health, yet concerns about bone health are generally directed at the ketogenic diet.
Will the ketogenic diet damage your kidneys?
The concern that the ketogenic diet may cause kidney damage originates from several misconceptions and misunderstandings about how the ketogenic diet works and how it affects the body. Many people think the ketogenic diet is a high-protein diet, which may have the potential to cause kidney damage due to an increased need to filter and eliminate by-products of protein metabolism. The standard ketogenic diet is generally moderate in protein, commonly around 20% of daily calories.81 Studies show the ketogenic diet does not have a negative effect on kidney function98 —in fact, it can improve kidney function in people with diabetes-related kidney disease,99 obesity,100 and polycystic kidney disease.101
Considering that obesity, insulin resistance, and diabetes are the primary contributors to kidney dysfunction, it is not surprising that the ketogenic diet has demonstrated promise as an effective therapeutic option for individuals affected by certain forms of kidney disease.
Kidney stones For most individuals on a ketogenic diet, the risk of kidney stones is low. People with epilepsy, who are also on antiseizure medication, tend to be more at risk.12,16 Other risk factors for the development of kidney stones are obesity and CKD, no matter what dietary pattern is followed. There may also be a genetic component to risk.16 The benefits of reducing risk factors that may drive the development of kidney stones (like obesity and type 2 diabetes) need to be weighed against any risks where generally kidney disease improves with a ketogenic diet. Seeking the support of an experienced practitioner who may recommend increasing fluid intake or other measures is recommended.
Does a ketogenic diet increase the risk of gallbladder disease?
Metabolic disease appears strongly associated with gallbladder disease, with abnormalities in lipid metabolism appearing to contribute to disease risk.102,103 These abnormalities (low HDL-c, high triglycerides) promote the development of cholesterol crystals, which precede gallstone formation. Using a reduced carbohydrate approach improves metabolic health and increases HDL-c, which supports bile acid flow, reducing the risk of gallstone disease. While rapid weight loss has been associated with an increased risk for gallstones, a higher-fat diet during weight-loss has been found to help prevent their development.103 Seeking support from an experienced practitioner may be helpful if you have risk factors for gallstone disease and a slow transition to a ketogenic diet, allowing time for adaptation, may be appropriate. In the same way, if you have had your gallbladder removed, a slow transition to a low-carbohydrate or ketogenic approach is recommended.104
Can a ketogenic diet trigger a gout attack?
Metabolic dysfunction, accompanied by high levels of inflammation, is associated with gout flares, a condition that has increased significantly in the last 20 years. Increased consumption of sugar-sweetened beverages may be a factor increasing the amount of fructose in the diet which drives elevations in uric acid as a product of fructose metabolism.12 Lowering carbohydrates in the diet lowers uric acid production by removing the need to metabolize fructose and other sugars. It also addresses features of insulin resistance and inflammation, key drivers of gout flares. Entering into nutritional ketosis can offer further benefits by causing inhibition of the NLRP3 inflammasome, reducing inflammation in a similar way to the one of the drugs used to treat gout.12
One caution is that ketone body metabolism uses a similar pathway to that which is used for uric acid excretion. Competition for this pathway can result in a temporary increase in uric acid concentrations as the body adapts to nutritional ketosis.16 At the same time, rising levels of beta-hydroxybutyrate (a ketone body) counter these metabolic effects via anti-inflammatory mechanisms, providing a therapeutic benefit.105 An experienced practitioner can advise on individual risk and may recommend a temporary treatment plan for transition. Reducing carbohydrate intake more slowly allows for the body to adapt, and it may be more beneficial to be consistent in following a ketogenic approach to avoid re-adaptation challenges.
Does the ketogenic diet increase your risk of chronic diseases?
The concern that the ketogenic diet may increase your risk of chronic disease is typically linked to concerns about a diet higher in fat and assumptions that this drives poor metabolic health. As addressed in the previous sections, this is unfounded in the context of a diet low in carbohydrates and good metabolic health.106 Much of the confusion is also rooted in studies that label diets as ‘high-fat’ where they are also high in carbohydrates and usually contain processed foods (also called a Western Diet).107 In the same way diets labeled ‘high-fat’ in mice are likewise often high in carbohydrates as well, and translating these studies to human outcomes has problems.108
Scientific evidence consistently confirms that a properly formulated ketogenic diet is safe, may be considered a primary approach for obesity and diabetes, and is beneficial for many other chronic health conditions.12 These include:
- Cardiovascular disease
- Neurodegenerative diseases
- Cognitive decline
- Fatty liver disease
- Chronic inflammatory conditions
- Sleep disorders
- Mental health conditions
Dismissing the ketogenic diet as a fad diet that increases the risk of chronic disease is misleading, especially as its main constituents are ancestral whole foods. Encouraging the public to consume fewer carbohydrates, whether or not they are in nutritional ketosis, could contribute to a significantly lower prevalence of serious health issues, including obesity, heart disease, and type 2 diabetes.
Is a ketogenic diet good for long-term health?
Questions have been raised around the lack of long-term data on the ketogenic diet and it has been suggested that the ketogenic diet should only be used for short-term weight loss. Longer term studies in patients with type 2 diabetes (5 years and ongoing) who are in nutritional ketosis have maintained positive results, and a GP practice in the UK has published 8 year data on the successful use of a reduced carbohydrate approach.109,110
In a recent study of healthy women who reported sustained nutritional ketosis for 3.9 years, no adverse effects were reported, and it was suggested that this metabolic state is protective against the development of insulin resistance while preserving metabolic flexibility.111 We know that historically, metabolic flexibility was a consistent feature of human existence, and certain populations existed in long-term ketosis, meeting nutritional needs and experiencing good health.12,58,112
These findings also address the question of long-term nutritional ketosis for women of reproductive age, where ancestral dietary patterns reflect thriving populations. As mentioned previously, healthy pre-menopausal women in nutritional ketosis experienced no adverse effects and were metabolically flexible. They had no negative findings where biomarkers of aging were examined.111,113 Ketogenic diets have been found to improve menses in overweight women,114 and women with GLUT1 deficiency syndrome (GLUT1-DS), a treatable metabolic brain condition, have normal cycles with long-term ketogenic diet therapy.115 Therapeutic carbohydrate reduction may also be utilised for improving fertility which may be reduced in conditions of insulin resistance (see Section 4.12.).
At a time when 93% of the US population has poor metabolic health and more than 70% of food consumption is from foods that would have been unfamiliar to preagricultural humans, adopting a more ancestral way of eating seems like an excellent choice116,117.
Is a ketogenic diet affordable and sustainable?
The affordability of a low-carbohydrate or ketogenic dietary approach is another question commonly raised when considering sustainability. Studies have shown that a whole-foods, well-formulated ketogenic diet can be nutrient dense and cost-effective, with savings occurring through fewer meals and snacks (improved satiety) and fewer medications and clinic visits.118,119
This approach has been successful in a low-resource setting in South Africa, and in India for children with epilepsy.119,120
In terms of sustainability, many who have achieved their health goals using a ketogenic approach find that the benefits outweigh any perceived downsides to continuing with this lifestyle. Examples where long-term ketogenic diets have been used with success include type 1 diabetes (10 years),121 mental health conditions (5 years),11 healthy females (approx 4 years),111 and a metabolically health mixed population (5 years).36,37 These data suggest that, in individuals who are experiencing the benefits of a ketogenic lifestyle, this way of eating may be sustained in the longer term.
Individuals who experience symptoms of carbohydrate or processed food addiction may need additional support in order to be successful. Having a supportive family or other community support can be essential and there are experienced practitioners who can assist you if this is an area of struggle (see Section 6: Resources, for more information)
Ketogenic Diet Series
Get Certified
Join our Premium Membership and complete the CME-Approved, Online Training to get Certified. Then have this badge displayed on your profile.
After that you will be required to submit a certificate for CME credits from one of our conferences every 2 years to show you are keeping up to date with the science.
Dry Farm Wines
Ketogenic Wines Delivered!
Now you can get access to wines from around the world that are lab tested to ensure they are sugar and additive free. Finally a prefect companion for anyone on a low carb or ketogenic diet.