In the 1960s, it was discovered that medium-chain triglycerides (MCTs) produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides). MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system. The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on twelve children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.
The gut-brain link is important not only for the hormones produced by the gut, but also for the long-term body weight regulation. Studies in mice indicate that the gut microbiome influences both sides of the energy balance by contributing to nutrient absorption and regulating host genes that affect adiposity [however there are conflicting reports (Parks et al., 2013; Schele et al., 2013)]. However, it remains uncertain just how important gut microbiota are for nutrient absorption in humans. A cohort study has demonstrated that the nutrient load is a key variable that can influence the gut/fecal bacterial content over short time frames. Furthermore, the observed associations between gut microbes and nutrient absorption indicates a possible role of the human gut microbiota in the regulation of the nutrient intake and utilization (Jumpertz et al., 2011).
We now know the ketogenic diet has many other therapeutic benefits. One of them being that it trains the body to burn fat (in place of sugar) for fuel making the ketogenic diet an excellent choice for weight loss and improvement in body composition. The ketogenic diet is also excellent at treating and preventing insulin resistance like as found in type 2 diabetes and can even lower diabetic medication dosage or even prevent one’s need for blood sugar lowering medication. Weight loss through a ketogenic diet can also help lower cholesterol and triglycerides and improve overall cardiovascular function as well.
I just discovered your site and have been thoroughly enjoying many of the articles and appreciate that you get so in depth in your explanations. I’m in my late 40’s and, while not an extreme endurance athlete, I am moderately active with 18-20 mile rides 3x a week as well as some boxing and body weight resistance (push up, pull up, etc) mixed in. I’ve generally been paleo and stick to quality macros for the most part (grass fed meats/dairy, organic veg and oils) and zero supplements. I recently started following keto (after reading this article) about 10 days ago and things seem good thus far. I do, however, want to avoid any of the negative side effects you mention and also not lose any lean muscle. I’m currently about 174 lbs, 5’8″ and about 19% bodyfat – I’m taking in about 95g protein, 130g fat and <20g net carbs. I'm eating all quality – wild salmon, grass fed beef, pastured eggs, coconut oil, Brain Octane and Grass fed butter in coffee, sardines, etc. With a smattering of organic veg, but it seems real easy to bust through the carb barrier. *I'M ALSO TAKING KETOCANA PRE-WORKOUT* and I notice this is keeping me going throughout a ride or the gym.
Check the nutrition labels on all your products to see if they’re high in carbs. There are hidden carbs in the unlikeliest of places (like ketchup and canned soups). Try to avoid buying products with dozens of incomprehensible ingredients. Less is usually healthier.Always check the serving sizes against the carb counts. Manufacturers can sometimes recommend inconceivably small serving sizes to seemingly reduce calorie and carb numbers.
IBS and even though I go for periods of time feeling well, it does flare up and drives me crazy. My husband, 66 years old has been doing the Keto diet for 5 months and have lost 25 lbs. (he has12 more to go to be on a healthier weight). I am his main support with Keto as I cook in a very creative and I vary his weekly menu a lot to make it Keto friendly and healthy. He is doing about 35-38 grams of carbs per day that allows more vegetables and berries. He has become extremely sensitive to sodium and gets bloated, therefore now also doing low sodium diet.
Yancy WS Jr, Westman EC, McDuffie JR, Grambow SC, Jeffreys AS, Bolton J, Chalecki A, Oddone EZ, “A randomized trial of a low-carbohydrate diet vs orlistat plus a lowfat diet for weight loss,” Arch Intern Med. 2010 Jan 25;170(2):136-45. http://www.ncbi.nlm.nih.gov/pubmed/20101008?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2.
Ketosis is an option for many people with type 2 diabetes because they still produce insulin, which helps their body maintain a safe level of ketones in the blood. If you’re considering trying ketosis or the ketogenic diet with type 2 diabetes, be sure to consult your healthcare provider first to ensure it’s safe for you. This eating approach may interfere with some types of diabetes medication or be inappropriate for you if you have certain diabetes complications, such as kidney damage.
And it all culminated with me stepping into Dr. Jeff Volek’s world famous laboratory at University of Connecitut to subject myself to extensive blood testing, chunks of muscle removed from my legs, fat sucked out of my butt-cheeks, urine, stool and gut microbiome testing, oxygen and carbon dioxide testing and countless hours of treadmill running to discover what a full twelve months of eating a ketotic diet had actually done to my body.
Ketosis is an energy state that your body uses to provide an alternative fuel when glucose availability is low. It happens to all humans when fasting or when carbohydrate intake is lowered. The process of creating ketones is a normal metabolic alternative designed to keep us alive if we go without food for long periods of time. Eating a diet low in carb and higher in fat enhances this process without the gnawing hunger of fasting.
Schele E., Grahnemo L., Anesten F., Hallen A., Backhed F., Jansson J. O. (2013). The gut microbiota reduces leptin sensitivity and the expression of the obesity-suppressing neuropeptides proglucagon (Gcg) and brain-derived neurotrophic factor (Bdnf) in the central nervous system. Endocrinology 154, 3643–3651. 10.1210/en.2012-2151 [PubMed] [Cross Ref]
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research. A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.
Ketogenic diet could improve body composition: For some sports (such as gymnastics, cycling and some fighting sports), power to weight ratio is a key determinant of performance. Because the ketogenic diet has been associated with fat loss accompanied by lean muscle maintenance (or gain), it could thereby improve the power to weight ratio 21 ,22 and performance.
However, the researchers noted that it was still substantial and noted that “Evidence from this systematic review demonstrates that low-carbohydrate/high-protein diets are more effective at 6 months and are as effective, if not more, as low-fat diets in reducing weight and cardiovascular disease risk up to 1 year.”  They emphasized, however, that more research needs to be done to evaluate the long-term effects of the ketogenic diet on weight-loss.
A few variables were tested in conjunction with weight loss. One was initial insulin secretion, specifically to see if it had any affect on loss in each diet group. It did not. They had also checked a few genetic markers that were suspected to give dieters pre-dispositions to success either on low fat diets or low carb diets based on previous studies. However, genetics were shown to have no effect.
Fasting is another way to achieve ketosis. This doesn’t suggest going days without food, but rather intermittent fasting. You can eat for eight hours and then fast for 16 hours, or eat a low-calorie diet for a few days (about 1,200 daily calories if you’re a woman and 1,500 daily calories if you’re a man). As you take in less food, your body uses more of its fat stores for fuel.
Still, I enjoy cooking and I plan my meals on the regular anyway. With a keto food list in hand and advice from Dr. Axe in my mind, I filled my grocery cart with family-size versions of what I regularly buy (apples, berries, nut butter, kale), and a lot more meat than I ever have in my cart at one time (ground lamb, chicken, REAL bacon). What was missing? Some of my usual high-carb items, like whole-grain English muffins, orange juice, butternut squash, and tortilla chips.
The gastrointestinal tract (GIT) plays a central role in the control of energy balance. Many molecules produced by the GIT exert hunger or satiety effects on the brain. Ghrelin is a peptide produced mainly by the stomach's oxyntic cells that stimulates ghrelin secretion in the hypophysis and has some neuroendocrine activities. However, its orexigenic properties are the most relevant to us and ghrelin is the only known peripheral orexigenic hormone (Date, 2012). Cholecystokinin (CCK) is a peptide produced mainly in the duodenum and jejunum that acts on the vagus nerve and directly on the hypothalamic nuclei. CCK is an anorexigenic factor and it reduces food intake, meal size and duration (Murphy et al., 2006). Three other related hormones are pancreatic polypeptide (PP), amylin, and peptide YY (PYY). PP is a peptide produced by the endocrine pancreas in relation to the caloric content of meals, and it reduces food intake both in rodents and humans. Amylin is a peptide co-secreted with insulin; its main effect on food control is a reduction of meal sizes and food intake (Murphy et al., 2006). Peptide YY (PYY) is produced in the gut and is similar to PP. PYY is stored in intestinal cells and released into the circulation as PYY3−36, a truncated form of PYY. The release of PYY3−36 is dependent on a meal's caloric and fat content (Veldhorst et al., 2008). The glucagon-like peptide 1 (GLP-1) is produced by the cleavage of pro-glucagon gene in the intestine. It acts as incretin at a pancreatic level, promoting insulin secretion and as neuro hormone on hypothalamic nuclei, inducing satiety (Valassi et al., 2008).
Carbohydrates are necessary for the conversion of inactive thyroid hormone to active thyroid hormone, and if you’re on an extremely strict low carbohydrate diet, then you may actually be limiting this conversion. Your TSH is what tells your thyroid gland to “release more hormone,” so your TSH rises when your thyroid gland is underactive, or conversion of inactive to active thyroid hormone is inadequate. A high TSH means that the pituitary gland is releasing its hormone to try to get the thyroid to respond and produce more thyroid hormone. Because of inadequate carbohydrates, TSH will often elevate in a high-fat, low-carber – indicating potential for long-term thyroid and metabolic damage.
I am so glad that I never went full board on the keto diet. I work from home. Because of this, I have the option to eat my bigger meal at lunch time rather than dinner/supper. What I noticed for me personally is that when I go to bed on a fully carbed meal, I am less likely to want to eat breakfast in the morning. So, I have moved my carbs to lunchtime and then a dinner that is lighter and less carbed out. I also go to the gym in the evening and just don’t care for a heavy meal sitting on my stomach because I feel like I have to work out just to burn that meal off.
Many people may look at my side-by-side before and after pics and think, "She was fit before and she looks the same now." (Isn't it strange how differently other people see you versus how you see yourself?) But eating and exercise should always be about more than the aesthetics. How do your diet and fitness habits make you feel? Food is fuel (and recovery) for the activities you like to do most. If eating well means you gain some perspective, then ending up with a better butt is just icing on the cake. BTW, I can have cake now.
Hey Alex, thanks for commenting and great to have you as a new listener! For this kind of thing, because it requires so going into detail, I'd suggest you book a consult with me by going to ×