Frequently Asked Questions About the Ketogenic Diet

by Josh Turknett, MD

Our next 30-Day Ketoblast Challenge starts soon! We know some of you are well versed in the ketogenic diet, and are already raring to go.

We also know that others of you may have questions, or may not know what this whole “keto” thing is about at all! So here’s an overview of what exactly the ketogenic diet is, why it’s of interest to those with migraines, and the most common questions folks have about it.

And to learn more about the “Keto Blast” challenge, or to sign up to take part, just click the relevant button below:

Q: Um, what’s the ketogenic diet?

A: The ketogenic diet is a diet designed to promote the production of ketones in the liver. Those ketones can then be used for energy by the brain in place of glucose, which is our primary goal with the ketogenic diet.

Q: Why would anyone want to do that?

A: Because some pretty fantastic things start to happen when the brain starts using ketones for energy.

One thing we’ve known (for a long time) happens is that ketones in the brain prevent seizures. They’ve been proven to do a much better job of preventing seizures than even the strongest and best drugs ever invented (prediction: we’ll be saying the same thing about the ketogenic diet and migraines in the not too distant future).

And though we’re in the early stages of understanding its full potential for other conditions, a ketogenic diet is already showing great promise in other areas like cancer treatment and prevention (brain cancers in particular, but other forms as well, due to the unique way in which cancer cells use energy), neurodegenerative disorders (things like Alzheimer’s and Parkinsons), inflammatory conditions, obesity, and migraine.

Given the many parallels between seizure and migraine, these benefits aren’t so surprising.

I’ve used a ketogenic diet with great success in the treatment of my own migraines, as have many others now. Many people with longstanding chronic migraines have found a ketogenic diet succeeding where all other treatments had failed.

In addition to those therapeutic benefits, people also commonly experience a significant boost in energy and mental clarity on a ketogenic diet.

It’s also a powerful tool for weight loss (it beats calorie restricted, low fat diets head to head for weight loss).

Q: So how do you stimulate the liver to produce ketones?

A: There are several ways to stimulate the liver to produce ketones, including reducing dietary carbohydrates under a certain level, fasting (most people are in mild ketosis in the morning, after sleep), and consuming medium chain triglycerides (found in abundant amounts in coconut, and the oils derived from them).

Q: My doctor / nurse / nutritionist / pharmacist / mother-in-law / hairdresser / mailman, etc. said that ketosis was very dangerous. Is that true?

A: This is a common response, particularly amongst those in health care.

Most health care providers, when they hear the word “keto,” immediately jump in their minds to a condition known as ketoacidosis (for most, it’s the only “keto” anything they’ve heard of, so this is natural).

But “ketoacidosis” and “ketosis” are two ENTIRELY DIFFERENT THINGS (sort of like telling someone your doctor said you had a “heart beat”, and they interpreted it as you saying you had a “heart attack”).

Ketoacidosis is a condition that most commonly arises in people with type 1 diabetes who cannot produce insulin, and in certain situations this can cause the unregulated production of ketones, a process that can acidify the blood.

Nutritional ketosis, which results from a ketogenic diet, is when the liver produces ketones in response to certain triggers (including reduction in dietary carbohydrate, consumption of medium chain triglycerides, and fasting). Under normal conditions, the level of ketones in nutritional ketosis is nowhere near as high as it is in ketoacidosis.

Q: This sounds amazing. What’s the catch?

A: For most folks, the main hurdle is getting the body into ketosis in the first place.

Once you start eating a ketogenic diet, multiple changes must occur inside the body to fully transition into ketosis. This transition typically takes about 5-7 days to occur fully, and the transitional “symptoms,” which are most commonly feelings of fatigue and fogginess (before the body has fully optimized its fat burning machinery) are typically most prominent around days 2-4.

Some folks have virtually no symptoms, but some do. Whether or not you experience any of these symptoms has to do with your dietary habits before adopting a ketogenic diet.

Most folks will know when this transition to fat-burning mode is complete, as the fatigue is replaced by a dramatic surge in energy and mental clarity (oftentimes to levels never previously experienced).

Q: Can you do anything to make that transition period easier?

A: Absolutely. One of the reasons we created the Keto Challenge was to help provide support through this initial phase.

Q: Hold on a sec. This means I’ll be eating more fat, right? Won’t that be bad for my “cholesterol”?

A: Multiple studies have been done on the effects of both low carb and ketogenic diets on blood lipids. Here’s a summary of those effects, and their impact on the risk of vascular disease (heart disease, stroke, peripheral vascular disease).

An increase in serum HDL ———————> protects against vascular disease
A reduction in LDL particles ——————> protects against vascular disease
An increase in the size of LDL particles ——> protects against vascular disease
A reduction in serum triglycerides ———–>  protects against vascular disease
A reduction in the cholesterol : HDL ratio —> protects against vascular disease
A reduction in oxidized LDL ——————-> protects against vascular disease

(see specific references below)

A ketogenic diet has also been shown to reduce blood pressure and body weight, two additional factors that are known to protect against vascular disease.

Q: But I thought dietary fat clogged your arteries?

A: Looks like we can thank the sugar industry for spreading that nasty rumor (by literally paying off top nutrition research to promote that connection, all the way back to the 1960s), as recently reported in the Journal of the American Medical Association. More on that story in this recent NY Times piece: “How the Sugar Industry Shifted Blame to Fat.”

Q: Are there more studies on the therapeutic benefits of a ketogenic diet?

A: Absolutely. As I said earlier, we’re still in the early stages of learning all about what it can do (thanks to that the half century of fat-phobia that’s slowly coming to an end), but there’s a tremendous amount of interest in it now, and more studies coming out all the time.

Q: So should I do it?

A: Since I don’t know you personally, or your health history, I can’t make that decision for you. What I can do is try to help give you the best chance of success if you do choose to give it a go. Of course, if you have questions related to any specific health conditions, it’s best to check with your doctor about it (you can even show them this FAQ so they’ll know what you’re talking about 🙂 )

More Articles about the Ketogenic Diet:

• The Ketogenic Diet VS. Raging House Fire
• Experiments in Ketosis: Maximizing the Migraine Preventative Effects

Other references on the effects of a ketogenic diet on blood lipids:

1. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. Journal of Nutrition, 2002.
2. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 2013.
3. Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. International Journal of Cardiology, 2006.