The Ketogenic (Keto) Diet

The ketogenic diet, also known as the keto diet. A diet starting from the 1920s, mainly used for epilepsy, but also can be used for weight loss, managing type 2 diabetes, some neurological conditions like Alzheimer’s or Parkinson’s (however is still experimental), hormonal conditions like PCOS, and certain cancers (as a complementary therapy, it is very carefully supervised). It is usually used in children, generally for epilepsy, but can be seen for some adults, especially for weight loss (which is not recommended to use for children in that state).

The diet consists of high-fat, low-carbohydrate, and adequate-proteins, carefully supervised by dieticians and other medical professionals. The ketogenic diet forces the body into a state of ketosis when the diet is being used.

Your body usually burns carbohydrates from food into glucose for energy. Ketosis, however, is when your body burns fat instead, breaking it down into ketones to use for energy instead of glucose. Ketones are the molecules your body makes, and ketosis is the state your body is in when it’s producing and using those ketones as its main fuel. This shift in the energy source changes the brain's metabolism and can reduce seizure frequency in some individuals, though the exact mechanism is still not fully understood.

Carbohydrates we eat consist of things like grains (ex. bread, rice, pasta, cereal), certain fruits (ex. apples, bananas, other fruits with natural sugars), certain vegetables (ex. potatoes, corn, peas), some dairy products (ex. milk, yogurt), and all sweets (ex. cookies, candy, cake). These foods are highly limited on a ketogenic diet, as it is a diet we eat more fats in.

The foods high in fat that we eat and are given in a ketogenic diet include nuts and seeds (ex. almonds, walnuts, chia seeds, flaxseeds, etc), fatty fishes (ex. salmon, mackerel, tuna), meats and poultry (ex. beef, chicken, eggs, pork), full-fat dairy only (ex. butter, whipping cream, cheese, plain greek yogurt), plant-based fats (ex. avocados, olives, coconut), and cooking oils (ex. coconut oil, olive oil, avocado oil). It is important to eat in moderation, as some are higher in carbohydrates, as well as to avoid sweetened versions of the foods.

With the ketogenic diet and foods that we eat, we won't get all the nutrients that our bodies need, due to the lack of specific foods we need to avoid. These nutrients typically are vitamins B and C, vitamin D, calcium, magnesium, selenium, iron, and fiber, which are very important for our bodies. These nutrients help support our brain and nerves with mood, memory, sleep and stress, give us energy and strength, keep our muscles, including the heart, working properly, keep our bones and teeth strong, boost our immune system, protect our organs and prevent diseases, and keep our digestion healthy. With all of that not being given to us while on the diet, these functions will be lowered, so it is crucial that we take specific vitamin supplements or pills to keep our bodies healthy.

There are different types of the ketogenic diet. The standard one is most common, usually for for epilepsy, weight loss, and overall health, and it is quite strict because the carbohydrates must stay very low. The targeted one is designed for those who exercise regularly, and can give you a bit more energy for workouts, but is not usually used for medical conditions like epilepsy. Similar to that is the cyclical diet, mostly used by bodybuilders or athletes, however again not recommended for epilepsy, as it is risky to come in and out of ketosis. There is also the high-protein one, helping for more protein for muscle, and again, not the best for epilepsy for it has too much protein that can interfere with ketosis. Finally, the medical/clinical diet, used specifically for epilepsy or medical conditions, and most effective for epilepsy. It is usually guided by a neurologist or dietitian.

The ketogenic diet is typically started with the guidance of a medical team, including a dietitian. Before beginning, they’ll assess your overall health, history, and run some blood tests to make sure it’s safe for you. This ensures the diet is tailored specifically to your needs. Once approved, a dietitian will design a strict meal plan that carefully balances fat, protein, and carbohydrate intake, often using a 4:1 ratio of fats to carbohydrates and protein combined. This ratio is important for helping the body enter and stay in ketosis. Most people begin the diet gradually, slowly reducing carbohydrates over a few days to allow the body to adapt. In some cases, especially with younger children, the diet may be started in a hospital to monitor how the body responds and to adjust the plan as needed.

So who exactly is possible to be on a ketogenic diet? Well, for epilepsy exactly, it is most common as a non-drug therapy for it, or is often considered when 2 or more seizure medications have failed. It can be used alongside medication, however is not a replacement unless advised. In this case, it is especially effective in children, but also helps teens and adults. Around 50% of children on the ketogenic diet have at least a 50% reduction in seizures, and about 10–15% become seizure free. Benefits can sometimes last even after the diet is stopped, though this varies. The diet can also help those with glucose transporter type 1 deficiency syndrome and pyruvate dehydrogenase deficiency, and is sometimes used under guidance for type 2 diabetes, metabolic syndrome, polycystic ovary syndrome, and certain brain tumours, as part of therapy. People looking to lose weight may also use it with guidance, as the diet is often used for obesity or rapid fat loss and also helps control appetite and insulin levels.

What about who shouldn’t use the diet? Some people shouldn't follow the ketogenic diet unless a doctor says it’s safe. This includes those with liver or kidney disease, since the diet puts extra stress on those organs. People with pancreatic problems may struggle to digest all the fat, which can worsen their condition. Those with rare fat metabolism disorders can't properly break down fat into energy, making the diet unsafe. It's also not recommended for people with a history of eating disorders because the strict rules can lead to unhealthy habits or relapse. Pregnant or breastfeeding women need more balanced nutrients, and the diet might not provide enough for the baby’s development without close supervision, so it should be avoided for them as well.

Now, lets talk side effects, because of course, theres got to be some. As I mentioned before, we won't be getting specific vitamins our bodies need while on the diet. If we don't supplement them, our bodies will weaken, causing problems and many systems will start to suffer. You might feel more tired, weak, or mentally foggy. Your immune system can become weaker, making it easier to get sick. Bones and muscles may weaken, healing can slow down, and your digestion may become irregular. Over time, nutrient deficiencies can affect your heart, brain, blood, and bones, sometimes leading to serious health problems if not corrected. With starting the ketogenic diet, there are also many side effects. At first, many people experience what's known as the "keto flu"- a group of symptoms like fatigue, headache, nausea, dizziness, irritability, and difficulty focusing. This happens because your body is adjusting from burning carbohydrates to burning fat for energy. It can also be very hard at first to avoid the certain foods that need to be avoided on the diet. Some people also notice digestive issues, like constipation, due to the lower intake of fiber. Others may have bad breath from the ketones being released, or feel dehydrated since the body flushes out more water on this diet, so it is important to drink lots of water. In rare cases, people may develop high cholesterol, kidney stones, abnormal liver functions, and some feel socially limited because the diet restricts many common foods. These side effects don’t happen to everyone and often improve with time or proper management. That’s why medical supervision is recommended when using the diet for medical reasons like epilepsy.

Overall, the ketogenic diet is a powerful tool primarily used to manage epilepsy, especially when medications alone aren’t enough. While it offers promising benefits for other health conditions and weight management, it requires careful medical supervision due to its strict nature and potential side effects. With the right support and planning, the diet can improve quality of life for many, but it’s important to balance its benefits with proper nutrition and ongoing monitoring to stay healthy and safe.