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{{SkeletonDISPLAYTITLE:An Introduction to the Ketogenic Diet}}IntroductionThe ketogenic diet restricts carbohydrate and protein intake to the point where the body converts fat into ketones. These ketones are an alternative fuel source for most cells in the body, supplementing or replacing glucose as a critical fuel source. The [[Ketogenic Diet as a Treatment| ketogenic diet has the potential to help with a number of health conditions]], but also has [[Health Risks of the Ketogenic Diet| some significant potential health risks]].=Who Should Consider the Ketogenic Diet?=The table below reflects my personal thoughts on who would be good candidates for the Ketogenic Diet. {| class="wikitable"! Situation! Recommendation! Alternatives! Rationale|-| Epilepsy| A – aggressively pursue with your neurologist/find a specialist who uses the Ketogenic Diet| [[MCT Diet]], [[Modified Atkins Diet]] or [[Low Glycemic Index Treatment]]| There is overwhelming evidence that the Ketogenic Diet can help a significant portion of epilepsy suffers, and the condition is serious enough to outweigh the health risks.|-| Cancer| A – aggressively pursue with your oncologist/find a specialist who uses the Ketogenic Diet| The Ketogenic Diet may need to be combined with calorie restriction and combined with other treatments| While the research is still only at an emerging state, the condition is so serious that is vastly outweighs the health risks.|-| Alzheimer's disease | B – pursue with your neurologist/try alternatives first| [[MCT Diet]] or [[MCT]] supplementation | While the research is still only at an emerging state, the condition has few alternative treatments so the benefits probably outweigh the health risks. Trying MCT supplementation or the MCT Diet is probably appropriate before trying the full Ketogenic Diet.|-| Parkinson's disease| B – pursue with your neurologist/try alternatives first| [[MCT Diet]] or [[MCT]] supplementation | There is very little research, but the condition has few alternative treatments so the benefits probably outweigh the health risks. Trying MCT supplementation or the MCT Diet is probably appropriate before trying the full Ketogenic Diet.|-| Schizophrenia| B – pursue with your specialist/Summarytry alternatives first| Gluten Free Diet| While we only have a few case studies, the potential benefit of this horrible condition probably justifies the health risks. Trying the gluten free diet first is probably appropriate. |-| Amyotropic Lateral Sclerosis| C – talk to your neurologist| High fat, non-ketogenic diet| The evidence is too limited to make clear recommendations, but there could be some benefit.|-| Depression and bipolar disorder| C – talk to your specialist| | The evidence is limited, but there could be some benefit.|-| Severe obesity| C – talk to your nutritionist| | The Ketogenic Diet can clearly help with weight loss, the benefits and risks must be carefully weighed.|-| Type 1 diabetes| D – consider | | |-| Autism| D – consider | | |}

* Greatly reduced The word "ketogenic" literally means that it creates [[Ketones]]. Our bodies produce ketones from fat when carbohydrates become scarce. To trigger ketosis (the production of ketones) we normally have to restrict carbohydrate intake to a very low level. The exact amount of carbohydrate varies by individual, but often it has to be restricted to less than 20g/day. (Normally the amount [[Fiber]] is ignored in the diet, and [[Net CarbohydrateCarbohydrates]] are used.) Because the body will convert protein to glucose, it is also necessary to tightly control the intakeof protein.* Tightly optimized Protein intakeToo much protein will prevent ketosis, but to a little will cause malnutrition. Some authors recommend the RDA for protein, while others suggest 0.6 to 1.0 grams per pound of lean body mass. * High fat intake or burn When carbohydrate availability is restricted, the body does not immediately swap over to using fat. * and ketones, but rather there is a period of adaptation often referred to as [[Ketoadaptation]]* Supplementation.* Medical This made last a few weeks, and some people report feeling sluggish during this time. The ketogenic diet entails some potentially serious health risks, so medical supervisionis required, along with regular tests and diet supplements.* Monitoring. * Mention Atkins* Reference The ketogenic diet is one of the more stringent [[Low Carbohydrate Diets]] =What ketone levels for how long?=Unknown. Suggest Min 0.5 for 2 weeks, better 1.5 for 4 weeks, both measuring fasting BOHBand should not be taken lightly.  

Yes There are various answers to this, both 'yes' and 'no'. While many cells can burn Ketones instead of Glucose, cells with few or nomitochondria must have glucose. Talk about fiberHowever, need for protein can be converted to glucose, option of getting so while carbohydrate is necessary, it from does not have to be consumed in the diet. If no proteinis consumed, then the body will cannibalize muscle tissue to provide the required glucose. The only type of carbohydrate intake that could be considered critical for health would be [[Fiber]], which is converted by the digestive bacteria into Short Chain Fatty Acids which are the primary fuel source for some cells such as the lining of the colon.  

* [['''Ketogenic Diet as a Treatment]]'''. The greatest advantage of the ketogenic diet is probably [[Ketogenic Diet as a Treatment| its use for the treatment or management of disease]].** '''Strong evidence and serious disease: *** Epilepsy'''. The use There is a preponderance of evidence that the ketogenic diet to treat is an effective treatment for epilepsy. I believe that anybody with epilepsy or is well-established.*** Type 1 diabetes. At one time, type 1 diabetes (previously called childhood diabetes) was expected to be fatal within a year. The first approach was a starvation diet of 450 calories per day, which lead Fredrick M Allen to use a 70% fat, 8% carbohydrate diet that was the standard treatment before the discovery of insulincaregiver for someone with epilepsy should discuss this with their doctor. ** '''Limited evidence, but serious disease'''. Cancer, Alzheimer's disease, Parkinson's disease, Amyotropic Lateral Sclerosis (ALS), Schizophrenia, Depression, Bipolar disorder (therefore possibly [[Overtraining Syndrome]]), Type 1 diabetes. While the evidence is somewhat limited, there is a growing body of supporting literature, and these diseases have such a catastrophic impact on life that the ketogenic diet is almost certainly worthwhile tryingworth investigating.** UnclearI would encourage anyone with one of these conditions to discuss the ketogenic diet with their doctor. *** '''Evidence is unclear''': Head trauma , stroke and hypoxia, Stroke.*** Heart heart disease, autism, inflammatory disease, severe hyperactivity. *** AutismWhile of these conditions can be serious, the evidence for the use of the ketogenic diet is limited. *** Inflammatory disease.*** '''Little or no evidence''': Migraine. *** Severe hyperactivityWhile there was hope that the ketogenic diet would help with migraines, what little evidence we have suggests this may not be the case. * Weight lossHowever there is so little evidence, that this conclusion may change in future.* '''Hunger'''. Initial hunger can be greater due to reduced food volume. However, ketones suppress appetite so hunger tends to be less on a ketogenic diet.

* '''Weight loss'''. The Ketogenic Diet can be effective in weight loss, possibly aided by the reduction in hunger.* '''Muscle Building'''. The ketogenic diet tends to have a protein sparing effect. There are anecdotal reports (myself included) that it is much easier to build muscle on the ketogenic diet.

** The [[Ketogenic Mechanism of Action]] is probably the ketones levels, so increased protein intake (or [[Net Carbohydrates| Net Carbohydrate]] intake) can impair muscle growth.* '''Altitude'''. There is evidence that the ketogenic diet provides protection against hypoxia, and in this may convey a survival advantage at extreme altitude<ref name="Myles-1976"/>. In addition, it is possible that the ketogenic diet may improve the ability to function at high altitude. My personal experience is that during my [[Altitude Training]], I am able to remain unimpaired while breathing much lower percentages of oxygen.

* '''Health Risks'''. There are some serious [[Health Risks of the Ketogenic Diet]]. These can largely be mitigated with care, but anyone considering the Ketogenic Diet should be aware of both the risks and the mitigations. Also, * '''need list of contraindicationsMedical Supervision'''.* Medical Supervision. The Ketogenic Diet should only be started under medical supervision. If you're smart, detail oriented and willing to take a few risks with your health then you can be provide your own medical supervision. * '''Difficult to Get Right'''. The Ketogenic Diet requires far more effort is harder to get right than most diets, as even trivial amounts of carbohydrate will prevent ketosis. There is relatively little room for error, and mistakes can have an impact the lasts for longer than you would expect. * '''Easy to get wrong'''.** Examples: Suntan lotion, ToothpasteIt is remarkably easy to make a mistake and drop out of ketosis. Even if you measure and analyze all of your foods, the rounding errors that occurs on nutrition labels can result in you getting far more carbohydrate or protein than you expected. There is also the problem of mistakes on nutrition labelsor the natural variation in nutritional content that occurs in foodstuffs. You also have to be careful with things you would not necessarily expect, such as toothpaste, errors or even skin lotions. There have been examples of people applying sunscreen (suntan lotion) and absorbing the carbohydrate through the skin. This causes them to drop out of ketosis and because they are on labelsthe ketogenic diet for epilepsy, they then have seizures.* '''Attention to detail required'''. The ketogenic diet requires you I've found it necessary to measure and analyze all of my foods for some weeks before I learned what I could and could not eat. * '''Detective work'''. Many people experience problems achieving the expected level of ketones, and have to spend time analyzing all aspects of their diet. This detective work can be time-consuming and frustrating.* '''Supplementation required'''. The ketogenic diet is generally acknowledged as incomplete and requiring various levels of supplementation.* '''Monitoring required'''. To mitigate the health risks of the ketogenic diet, and to ensure adequate levels of ketones, it is necessary to perform regular testing while on the ketogenic diet. See [[Health Checks for the Ketogenic Diet]] for more details. * '''Lack of variety'''. Without hard workIt is much harder to get a variety of foods while on the ketogenic diet as so many foodstuffs are off-limits.* Lack This also leads to a lack of spontaneity, as foods have to be analyzed and there is little room for error.* '''Difficulty when traveling'''. The ketogenic diet is not trivial when you are at home, but it becomes even harder when traveling. In foreign countries it can't be hard to know what is in different foods, and your ability to sample the local foods easilycuisine is greatly impaired.* Reduced speed'''Individuality'''.* IndividualityThere appears to be a lot of individual variation in response to the ketogenic diet. This can make it hard to apply the generalized recommendations to your specific situation.* '''Adaptation time'''. It can take some weeks to adapt to the ketogenic diet, a process known as [[Ketoadaptation]]. * High calorie burnDuring this time many people report feeling sluggish and the benefits may not be readily apparent. Requires more fatIt is unclear how longer you can be out of ketosis without losing your [[Ketoadaptation]], no increase in NCAPsomething that is important if you accidentally eat the wrong foods.* '''Many unknowns'''. While there is a significant body of research on the ketogenic diet and low carbohydrate diets, there are still a large number of unknowns. Our lack of knowledge makes it harder to provide good recommendations, but hopefully this will improve as time progresses.=The Inuit Diet=The Inuit diet consists almost entirely of animal based foods, with virtually no plant food sources due to their artic location. It is therefore sometimes considered a model of the Ketogenic Diet. However, this diet is not what someone on a western diet would think of as a "meat diet", as the Inuit eat most of the animal, with the meat eaten raw (sometimes frozen) or partly boiled (including the broth), and they consume the blood, liver, etc.<ref name=Common pitfalls"Sinclair-1953"/>. The Inuit diet is not ketogenic unless they fast for a couple of days<ref name= "Heinbecker-1928"/>, possibly because of the glycogen in the meat<ref name="Ho-1972"/>. Even though the Inuit eat animal parts that are higher in Vitamin C, such as the liver and skin, Vitamin C deficiency is widespread<ref name=" Geraci-1979"/>.

If you are seriously considering the ketogenic diet, you should read Dr. Kossoff's book as a bare minimum. The other books are worth reading, but I'm not as critical as Kossoff's volume. (The popular book [[Keto Clarity]] is not recommended and should be treated with caution.){| class="wikitable" |- valign=Recommendations"top"|[[File:KetogenicDietsKossoff.jpg|none|thumb|200px|[http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic Diets: Treatments for Epilepsy and Other Disorders, by Eric H. Kossoff] is the best all-around book I've come across on the ketogenic diet. It focuses on the diet as a treatment for epilepsy, but touches on other conditions. It has a positive view of the ketogenic diet, but balances this with the caution that comes with being a medical practitioner that has used the diet for many years.]]|[[File:Art-and-Science-of-Low-Carbohydrate-Living-Book-Cover.jpg|none|thumb|200px|[http://www.amazon.com/The-Art-Science-Carbohydrate-Living/dp/0983490708 The Art and Science of Low Carbohydrate Living] is an easy to read and entertaining look at the ketogenic diet. However, the book is biased in favor of the ketogenic diet, and it does not have a well balanced view that includes a comprehensive review of the risks.]]|- valign="top"|[[File:KetogenicMcdonald.jpg|none|thumb|200px|[http://www.amazon.com/The-Ketogenic-Diet-Complete-Practitioner/dp/0967145600 The Ketogenic Diet: A Complete Guide for the Dieter and Practitioner] is an interesting book, and while I believe it's worth reading, I find myself unconvinced by the evidence it presents. Look to Kossoff's book as a better source of information.]]|[[File:anslowcarbperf.JPG|none|thumb|200px|[http://www.amazon.com/The-Art-Science-Carbohydrate-Performance/dp/0983490716 The Art and Science of Low Carbohydrate Performance] is obviously focused on the ketogenic diet for athletes. While it suffers from the same bias as the "The Art and Science of Low Carbohydrate Living", it is highly recommended for any athlete who is considering the ketogenic diet.]]|}=See Also={{KetoList}}