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Diets come and diets go with amazing predictability. The standard American diet has shortcomings, so people are frequently eager for an approach to nutrition that will be healthful. A ketogenic diet has been an option for at least a hundred years.

History of the Ketogenic Diet:

In the early 20th century, when there were few effective drugs to treat epilepsy, doctors prescribed starvation or a very low-carbohydrate high-fat diet (Wheless, Epilepsia, Nov. 4, 2008). Such a regimen forced the body to burn fat rather than carbohydrates for energy and resulted in the formation of ketones (explaining the term ketogenic diet).

This dietary approach frequently reduced the number of seizures epileptic children suffered. Parents learned how to manage the diet, which was considered the standard treatment for seizures for several decades.

When phenytoin (Dilantin) was introduced in 1938, doctors lost interest in the ketogenic diet to treat epilepsy. Patients found taking pills much easier than following such a restrictive eating pattern. Medications worked well enough for many individuals with epilepsy.

After decades of neglect, however, the ketogenic diet is returning to popularity. Some individuals don’t respond well to anti-seizure drugs. As a consequence, neurologists have once again begun to treat youngsters with refractory epilepsy by prescribing a low-carb high-fat ketogenic diet (Elia et al, Current Pharmaceutical Design, online Aug. 9, 2017).

Other Possible Uses for a Ketogenic Diet:

We recently received this question from a reader who made no reference to epilepsy: “Can you enlighten us about the ketogenic diet, which I suspect I need?” In recent years, physicians have adopted a carbohydrate-restricted diet to treat metabolic syndrome, type 2 diabetes and cardiovascular disease.


Researchers have found that cutting carbohydrate intake dramatically reliably lowers blood sugar in people with type 2 diabetes (Feinman et al, Nutrition, Jan. 2015). A year-long study of 115 overweight people with diabetes compared the effects of low-carb and high-carb diets (Tay et al, American Journal of Clinical Nutrition, Oct. 2015). The patients following a low-carb diet high in unsaturated fat were able to reduce their medications for blood glucose control. Their blood sugar was less variable, and their lipid profiles, especially HDL and triglycerides, were more favorable. Both groups lost weight and reduced their HbA1c (a measure of blood sugar control over time).

Weight Loss:

Studies in humans and experimental animals show that a very low-carb high-fat diet can help with weight loss (Kosinski & Jornayvaz, Nutrients, May 2017).  In one study, the weight loss drug orlistat (Xenical or Alli) combined with a low-fat diet was compared to a low-carbohydrate ketogenic diet (Yancy et al, Archives of Internal Medicine, Jan. 25, 2010).  Over the course of almost a year, both groups lost weight. Those following the ketogenic diet conscientiously improved their blood pressure, blood glucose and insulin levels more effectively.

Athletic Recovery:

Could a very low-carbohydrate diet improve athletic performance? That hypothesis was tested in a case study of five New Zealand endurance athletes (Zinn et al, Journal of the International Society of Sports Nutrition, July 12, 2017). After ten weeks on the diet, their performance actually dropped somewhat. However, they reported feeling better, with improvements in recovery time, skin conditions and other inflammatory complaints.

In summary, a low-carbohydrate high-fat diet with adequate protein appears to be a reasonable approach for people who are attempting to lose weight, control their blood sugar and improve their fat metabolism. You’ll find information on how to follow such a diet in the book KetoClarity by Jimmy Moore and Dr. Eric Westman. Be sure to ask your doctor if this regimen is safe for you.

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  1. katie

    Any thoughts about a ketogenic diet if one has no gallbladder? My understanding is that it is high in fats and that might be a problem? Anyone done it?

    • Terry Graedon

      A ketogenic diet is high in fat. People without gallbladders may vary in their ability to tolerate such a diet.

  2. alan

    Back in my mid-20s after returning from vietnam as a contractor i was a “trim” 230# (5’8″!). Following a colleague’s advice my diet changed to meat, fish, eggs, poultry, cheese & what passed for a multivitamin in those days. i also had illusions of athleticism & a taste for beer. Less than a year later 1 was 180# or so & able to at least keep up on the rugby field.

  3. Marilee

    I’m 73 and a lifetime of yoyo dieting has affected my metabolism and made it nearly impossible to lose weight just by reducing calories.

    A couple of years ago, I followed a very low carb diet and lost 30 lbs rather easily. I kept that weight off as long as I was careful not to eat too much starchy food, but gradually, I’d let the bread, potatoes, pasta etc begin to overwhelm my diet and the weight came back.

    This summer, following a 3 week vacation with many many carbs at meals and as snacks, I gained almost 7 pounds more than I ever weighed, seemingly without overeating, except for all the ever present french fries, chips, breakfast breads, etc that one encounters in restaurant meals in vacation areas. Shocked and disheartened at this, I tried to cut back to a “normal” lower calorie diet, but had only shed 2 of the pounds after several very hungry weeks.

    So, I dusted off my low carb eating guidelines, cleaned out the cupboard and refrigerator and started in. It’s been two weeks now and 6 additional pounds are gone, poof! I’m not suffering from hunger pangs, I have good energy and feel terrific and hopeful again. I’m eating lots of non-starchy veggies, some dairy, limited low G fruits, protein foods like eggs and fish, moderate fat both healthy (avocado, EVOO, nuts, etc) and small amounts of saturated. My husband has joined me in this and he’s losing weight without hunger too. We’re not counting calories though we’re not overeating either.

    I may be particularly sensitive to carbs, especially “white” ones, like flour, potatoes, white rice, sugars, etc, but getting them out of my diet makes a huge difference to me and how I metabolize food. There’s no way for someone to know if low carb eating will work for them without trying it for a couple of weeks, but for us, it’s a success.

  4. frank

    Can I download your show from another source than ITUNES? I don’t have itunes and don’t want it.

    • Terry Graedon

      Sure. You can listen to the show stream from the webpage or download the free mp3 from the store.

  5. Lynne

    I have had problems with my lower back & legs for years now. I had a successful operation for spinal stenosis about 7 years ago but an MRI doesn’t show any signs of its returning but I cannot stand or walk for more than 20 minutes without pain . I’m 85 years young & people are saying “Just live with it. You’re 85” I don’t believe we should just accept pain. I want to find the cause & deal with it but my doctor doesn’t seem to have any answers for me. Do you believe that we must just “live with it” or resolve the problem.
    Thanks, Lynne

  6. Mary Ellen
    Fayetteville, NC

    I was on the keto (Atkins) diet for about 10 years and my Hashimoto’s thyroiditis was under control and my weight within normal limits. I did find that initially I was tired a lot, but that side effect wore off over time. I’m trying to get back on the diet but it is difficult initially because I have a lot of carbs around the house, even so called “healthy” ones such as gluten free grains. Gluten free products tend to have a high carb content!

  7. Kathy
    Clinton, MS

    There is also the Always Hungry Approach by Dr. David Ludwig, whom you have interviewed before. He recommends carbs as part of a diet but based on glycemic index. For years I have not been able to lose any weight by lowering portions and exercising; I think my metabolism just slowed down. Although my weight loss from Always Hungry has been slow but steady, it does work and I find it sustainable (i.e., you don’t go hungry).

  8. Steve
    Everett, WA.

    As far as the athlete test noted above; You are just getting fat adapted at 8 to 10 weeks so it doesn’t surprise me that their performance went down a bit. They should have held the test over 6 months. I am in ketosis due to my pre-diabetes and it’s working well. The book you mention by Jimmy Moore is excellent but people should also read his Cholesterol Clarity so the “high fat” diet doesn’t freak you out.

  9. Bonnie

    This low carb diet is the only thing that has worked for me. I have struggled with weight gain since being introduced in 2015 to a new depression drug. I gained about 25 lbs. after starting it in about 3 months. Every time that I went to the Dr the weight would increase. I was eating a very healthy Mediterranean diet but it wasn’t working for me. So my daughter suggested looking up a low carb program and then I started going to a professional dietician and she agreed. She has tapered it a bit and made good suggestions for natural diuretics , etc. and I have now lost 17 lbs. it is a first in 2 years. It is slow but it is working and my blood work is great!

  10. DMA

    Anyone suffering from Autoimmune diseases might want to check out Wheat Belly Dr. Davis, it’s very similar to keto, but somewhat different…..there is testimony on how people have put their autoimmune diseases into remission, such as RA, diabetes, fatty liver, etc…..Dr. Davis goes on to his new book UNDOCTORED….which dives into this even further…..just wanted to share!

  11. Margie
    West palm beach, fl

    I can attest to low carb, high protein food plan works. I am 62, am the very picture of metabolic syndrome: type 2 diabetes, lots of extra pounds, high A1C, low LDL, high HDL, high triglycerides. I was ill in January, required steroids, and my blood sugar rose to 550. My endocrinologist put me on insulin and no carbs for a week. I felt great, once my sugar returned to normal. And once you’ve made it through the first week with no carbs, it gets easier.

    Blood work after 3 months: perfect! Everything was completely normal! My blood pressure is normal. I have lost 35 pounds, and I am still losing weight, albeit slowly. And I don’t snore any more. Oh! And no more heartburn!!!

    Sometimes I do have “fun food”, but I don’t crave it any more.

  12. DianeC

    I tried a ketogenic diet for about 6 months. I am 5 foot 5 inches and weighed 148. I lost 20 pounds and although my BP and cholesterol dropped some, it was not enough to drop medication. I lost mostly from around my waist which is where I gained after menopause. It is difficult at first but the key was knowing that I could eat until full as long as it was the right choice of food.

  13. Paul R

    It is said that in a slightly ketotic condition, our cognitive function is improved. I wonder how slightly. I know a person who did a ketotic diet. The Scientific American article I saw said bread carbs negated Resveratrol’s effect. So does it seem like a good idea to forgo the bread and not eat after an early subsistence dinner?

  14. Timothy

    Please try to include articles RE: Diabetic Neuropathy and effective treatments…

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