Ketogenic Diets: How to Avoid Pitfalls and Maximize Benefits

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Nutritional ketosis means that our mitochondria are burning fat instead of glucose (carbohydrates) or amino acids (protein) to generate energy (ATP). We do this when access to food is limited, as would occur during famine, drought, winter, or war. Diabetic ketoacidosis is a metabolic problem that occurs when the person has too little insulin and very high blood sugar.  That is a critical health problem. Nutritional ketosis is a normal response to limited access to food when the body relies on its own fat stores.

Scientists have figured out that a high-fat diet can create nutritional ketosis without causing starvation. These diets are called ketogenic diets and have become popular for weight loss. Most ketogenic diets stress butter, cream, and eggs to achieve a diet in which 90% of calories come from fat, while the remaining calories come from protein and low carbohydrate vegetables. This is very effective for lowering blood sugar, which can help reduce the amount of medication needed to control blood sugar if you are diabetic.

Because dietary fat also controls appetite, ketogenic diets are very satiating. That makes it easier to achieve long-term weight loss without chronic hunger. For dairy-based ketogenic diets, carbohydrates are limited to 25 grams. That is the equivalent of 3 cups of greens or other non-starchy vegetables like broccoli. Ketogenic diets based on medium chain triglycerides (MCTs) generate more ketones and allow for 50 grams of carbs, the equivalent of 6 cups of non-starchy vegetables.

Ketogenic diets are being studied in the setting of seizures, diabetes, obesity, cancer, polycystic ovarian disease, dementia, Parkinson’s, and multiple sclerosis. The research is promising.  However, seasonal ketosis may be more feasible physiologically than ongoing ketosis for the remainder of one’s life.


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The hazards of ketogenic diets include excessive weight loss, low sex hormone levels and infertility, increased infection risk, microbiome disruption, excessive electrolyte loss, and nutritional inadequacy. Reduce the risk of nutritional inadequacy by following Wahls Paleo Plus™, an MCT ketogenic diet that is highly structured. Reduce the risk of microbiome disruption by using an MCT ketogenic diet, eating 50 grams of carbs, and consuming additional fiber such as inulin.  More details about ketogenic eating can be found in my book, The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions.

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