Is the Ketogenic Diet Safe for Everyone?

foods_meatsIs a low-carb, moderate-protein, high-fat diet right for you?

Before you try this at home…

First and foremost, if you pick up a copy of Jimmy Moore and Dr. Eric Westman’s excellent new book, Keto Clarity (which I highly recommend–see my review here) and feel (understandably) inspired to immediately embark on a ketogenic diet, I would caution anyone with a serious chronic health problem, especially anyone who is taking prescription medications, not to attempt a ketogenic diet on his/her own without medical supervision.

Medications and Early Ketosis

Even though I personally believe in the power of ketogenic diets to improve and even reverse many chronic illnesses, from diabetes to chronic fatigue to mood disorders, the diet does this by causing very real shifts in body chemistry that can have a major impact on medication dosages and side effects, especially during the first few weeks.

Examples of problematic situations include sudden drops in blood pressure for those on blood pressure medications (such as Lasix, Lisinopril, and Atenolol), and sudden drops in blood sugar for those on diabetes medications (especially insulin). These changes in blood pressure and blood sugar are very positive and healthy, but the presence of medications can artificially intensify these effects and cause extreme and sometimes dangerous reactions unless your dosage is carefully monitored by you and your clinician in the first month or so.

Another important example of a medicine that would require careful monitoring is Lithium, an antidepressant and mood stabilizing medicine.  The ketogenic diet causes the body to let go of excess water during the first few days, which can cause Lithium to become more concentrated in the blood, potentially rising to uncomfortable or even toxic levels.

These are just a few important examples, so regardless of what medication you take, please consult with your clinician before getting started.

Special Medical and Psychiatric Conditions

Some health situations which call for careful medical supervision include (please note this is not a complete list):

  • People with gallbladder disease or without a gallbladder, because fat is more difficult to digest
  • People who have had bariatric surgery (weight loss/gastric bypass) because fats are harder to absorb
  • People with rare metabolic disorders that interfere with normal fat metabolism
  • Women who are pregnant or breastfeeding, because protein requirements are higher
  • Children, because protein requirements vary by age
  • People with pancreatic insufficiency, because fats are more difficult to digest
  • People prone to kidney stones (perhaps due to salt and fluid balance changes)
  • People who are naturally very thin (BMI of 20 or less) because weight loss may occur for some (additional fat calories may be required)
  • People with anorexia* (read on below)

*Anorexia and the Ketogenic Diet

Anorexia bears special mention.  As a psychiatrist, I feel compelled to go into some detail about this particular condition.  Men and women with anorexia have an irrationally intense fear of weight gain that distorts their perception of body image and is typically associated with an extreme fear of eating fat.  Most people with anorexia try to minimize their weight through starvation-level calorie restriction and complete avoidance of dietary fat, which is very dangerous.  Keep in mind that the body can function perfectly well without carbohydrates but it cannot function without fat. The brain cannot function without dietary fat (approximately 2/3 of the brain is made of fat) and the body cannot digest and absorb vital nutrients without dietary fat as part of every meal. While it is slowly becoming more common knowledge that carbohydrates are far more fattening than dietary fat, it is rare in my practice to meet a person with anorexia who does not eat carbohydrates regularly (even if it is only secretly during the night and with tremendous guilt…) this is because anorexia causes starvation, and people who are starving get very hungry. When this happens, they tend to choose low-fat or non-fat carbohydrate-rich snacks.  They are less afraid of eating sweets and starches than fatty foods, because sweets are lower in calories.

If a person with anorexia decides to embark on a ketogenic diet, it may be tempting to try to do so without eating the proper amount of fat.  This can be deadly, because the ketogenic diet already limits protein and severely restricts carbohydrates.  If fat is also limited, starvation will rapidly occur, especially if you do not have plenty of body fat to burn for energy.

However, with careful medical and psychiatric supervision, a ketogenic diet rich in healthy fats can be potentially very healing for people with anorexia, as it can restore proper body and brain composition, naturally regulate appetite and weight, and eliminate carbohydrate cravings.  Since it is a nutritionally adequate diet high in fat, it is excellent for brain health and can therefore potentially correct the emotional imbalance and cognitive impairment that are typical of this serious illness. There are compelling arguments for the use of ketogenic diets in bipolar mood disorders, as well.

Ready, set, go!

All that having been said, please don’t let these cautionary statements stand in your way—talk to your health care professional about your particular situation, and if he/she does not feel comfortable or knowledgeable enough about the diet, recommend Jimmy Moore’s new book, and/or find someone else who is!  Jimmy Moore keeps a list of keto-friendly doctors at http://lowcarbdoctors.blogspot.com.

Even if you do not take medication or have a serious health problem, you may want to consult with a knowledgeable clinician, especially during the first month or two, to help you troubleshoot any issues that may arise, but ultimately the ketogenic diet is a safe and healthy diet for the vast majority of human beings—certainly much safer and healthier than the standard American diet, which should come in a package with a skull and crossbones on it 🙂  A properly-formulated ketogenic diet contains everything the brain and body require to function well.  Not everyone benefits or feels well on it, but most can and do. For those of you who do not feel well on it, please read Freshness Counts:  Histamine Intolerance, which explains how “biogenic amines”, which are compounds in aged and fermented foods like salami and cheese (very popular in ketogenic circles), can cause miserable food sensitivity symptoms in some people.

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  • Michael

    Yay, you’re back. Looking forward to more posts. Thanks!

    • Yay, I’m delighted to be back, and thanks for your enthusiasm, Michael!

  • PC

    I have a low BMI but I do feel much better on a ketogenic diet. Is there any way I could reap the benefits of keto without losing too much weight?

    • John

      I don’t think it is correct to assume that you necessarily lose weight on a ketogenic diet. As long as you eat as much as your body needs you should be pretty weight stable and may even gain some lean body mass as happened in my case. Wolfgang Lutz (author of the book “Life Without Bread”) used low-carb diets (<= 70 g of carbohydrates per day) to treat patients that were underweight. He reported that they initially would lose some additional weight, but would finally be able to gain weight when they kept at it. He couldn't offer an explanation at the time of writing, but simply observed that overweight patients lost and underweight patients gained weight on a low-carb diet. I would suspect that it has to do with fat cells being insulin resistant in the underweight patients for whatever reason. The low-carb diet restores insulin sensitivity in the fat tissue, which leads to the ability to efficiently store and release fat again. Before I started a ketogenic diet I couldn't go without food for as little as 2 hours. I would feel hypoglycemic resulting in an immediate urge to eat. I suspect that I had an disproportionate release of insulin in response to a high carb meal. Now I can easily fast up to 36 hours without any problems. I never had a problem with being overweight, rather I was on the low end of normal weight and constantly hungry. Maybe this is somewhat similar to your experience.

      • Philip Clax

        Thankyou both! Luckily I seem to be doing ok on keto now…I eat a lot of fat, one of my favourites is coconut butter which I eat to satiety. I also drizzle MCT oil on salads.

    • Dear PC

      I completely agree with John, below (thanks, John!)–the ketogenic diet does not necessarily cause weight loss if you are at a normal weight or underweight–it should normalize weight, so long as you are eating enough fat and protein for your body. Everyone is different, of course, so if you are not able to maintain or gain weight if necessary, please consult with a knowledgeable local clinician about your situation. Jimmy Moore keeps a list of keto-friendly doctors at http://www.lowcarbdoctors.blogspot.com

      Best of luck!

  • me

    ketogenic diet has not be hypocaloric!

    • That is correct–most people do not need to worry about calories on a ketogenic diet (although some of us do). The great thing about a KD is that calories usually take care of themselves–the diet naturally regulates your calorie intake for your body’s needs.

  • Jessica B

    A big warm welcome back from the Netherlands. We so missed your profound insights
    on ketosis and the rest

    • Thanks for the warm welcome, Jessica, it’s great to be back!

  • Petra

    Glad you’re back from the Netherlands too! I was almost worried and I even searched for information on the Internet. So good you’re o.k.

    • Hello, Petra–thank you for your concern; I have been fine, just incredibly busy, and I’m very happy to be back after a year of many transitions!

  • Judy Suzanne Reis Tsafrir

    I am so happy to see that you are blogging again! I am looking forward to reading the articles you have planned. They all look so interesting.

    • Thanks, Dr T! I am glad to hear from you, and hope the articles will not disappoint!

  • John

    Dear Dr Ede, I would be very much interested in your thoughts on the notion mentioned by Gary Taubes’ in his book Good Calories, Bad Calories about a relationship between Anorexia nervosa and a potential “physiological defect of fat metabolism and insulin”. Would you think it is plausible that at least in a subset of patients the psychological symptoms develop as an outgrowth of the inability to properly store fat? Has this hypothesis ever been explored further or are there compelling signs in patient histories that make it implausible?

    p. 440 in the Anchor Books Edition:

    “One of the most radical implications of this hypothesis is that even such an intractable condition as anorexia nervosa—which, like obesity, is now universally considered a behavioral and psychological disorder—may be caused fundamentally by a physiological defect of fat metabolism and insulin. The behavior of undereating may be a compensatory response to a physiological condition, just as the behavior of overeating can. Any hormonal abnormality that makes it difficult to store calories as fat —the fat cells, for example, becoming prematurely or abnormally resistant to insulin— could conceivably induce a compensatory inhibition of eating behavior and/or an increase in energy expended. What appears to be purely a behavioral phenomenon, the anorexia itself (and perhaps even bulimia nervosa), would be the compensatory response to a physiological problem, the inability to store calories after a meal in the energy buffer of the fat tissue. Correctly identifying cause and effect in these conditions would be difficult, if not impossible, without the understanding that there is an alternative hypothesis to explain the observations.”

    • Dear John

      Thank you for this very interesting question. I am a big fan of Taubes’ book myself! I have not yet personally read the metabolic literature about anorexia, although there is quite a bit of it out there to read. I would be interested in looking into this further in the future, time permitting, but what I can say for now, is that I have worked with many people who have anorexia who were overweight as children or teens, and that the anorexia began in many cases (although certainly not all) as a way to try to control what started to feel like an unhappy and uncontrollable situation at a young age. Anorexia is a very complicated condition and there are numerous factors involved in its origins, including family dynamics, cultural pressures, individual personality traits (such as perfectionism, obsessive-compulsive tendencies, and emotional disconnection), as well as metabolic predispositions. I think it is even possible that the origins may vary from one person to the next and that there may be a subset of people who are metabolically predisposed to it. I hope to be able to learn more about this going forward. Thanks again for the excellent question!

  • Jan in KW

    So glad you’re back!

    • Thanks, Jan, I’m happy to be back!

  • Becky W.

    It’s a comfort to see you’re back! Your encouragement keeps me on course. Thank you, too, for touching on the delicate issue of anorexia. “A ketogenic diet rich in healthy fats can be potentially very healing for those with anorexia.” Thank you for the nuanced perspective on ED’s.

    • Thank you, Becky, it’s great to be back after such a busy year of transitions, and very nice to hear from you!

  • Didi

    I sure am looking forward to more from you, as I am a woman in low ketosis who has chronic constipation and can hardly lose a pound. I also eat loads of fat and barely any carbohydrate. And I have been low carb since 2008 after my diabetic diagnosis. I enjoy your posts.

    • Hi Didi
      THank you, I’m glad you are finding the posts enjoyable and hope that you will find the coming articles useful!

  • HelenM

    Hi – glad you’re back …… I’ve been LCHF since November ’13 – and have had a wonderful time of it … no more osteoarthritis pain, no more reflux, no more asthma, no headaches, an abundance of energy and a clear head! YAY! BTW – 20 kg (45 pounds) have vanished from my body!!! I’ve also had gallstone attacks sporadically over the last 5 years or so …. and now have had a CT scan that has revealed a single, solitary 13 mm diameter stone. I enjoy my Ketogenic diet enormously, and have a wonderful time developing different recipes along the way. I am concerned regarding the disparity of information regarding the diet I will supposedly need to adopt after Wednesday this week, when my gallbladder and its inhabitant will hit the bottom of a kidney dish, albeit pulverised in a laprascopic procedure! Do I avoid fat for a week or three, and then slowly re-introduce it to my diet? Or do I rationalise the amount of fat from here on in (shudder!) and go without all that wonderful flavour and satiated sensations?

    • kevin

      have you ever gotten a response from this? what have you done after your gallbladder removal? what has happened while continuing keto diet?

      • HelenM

        Hello again ….. just found this in my emails ….
        My system was a bit sluggish after the removal of my gallbladder – and interestingly, I grew another!!
        Well, that’s what the specialist said – what he actually meant (and explained in diagrams) was that the redirected duct to my now-gone gallbladder had decided to grow a bulb-like extension to collect bile, rather than drop it straight into my small intestine. How clever!!
        He explained that it would most likely shrink in time – and it would take me a while to get accustomed to the new regime! It did – believe me – it did!
        Fatty foods took quite a while to reestablish in my diet – so other than a multitude of bowel movements for several weeks, eventually if all sorted itself out and settled down.
        I’m not sure just how much fat as a percentage of my intake I’ve ever eaten – I’ve never counted anything – just winged it. I have however recently had a prolonged dose of something gastric that was so nasty I was hospitalised for over a week, over New Year just gone – 15/16. It was nasty and so debilitating. Up to 18 movements a day!!!!
        Obviously my system has adapted well to scavenging nutrition on the speedy trip through – even with that degree of output, I lost only 2 kg. I drank loads of water to stave off dehydration, and of course, avoided the sugary gunk they tried to make me drink. I just added salt to everything I ate – within reason.
        The gastroenterologist was surprised, to say the least! They tested me for everything under the sun – and in the dark! You name a test – I had it, and numerous repetitions of some like faecal tests, blood tests. Of course they included both gastroscopy and colonoscopy. Some 37 biopsies taken – nothing to report, just one 10 mm long polyp that was harmless, was removed and examined, and given the all clear.
        Like many, I have had evidence of diverticula disease – but this was not an attack of diverticulitis, as confirmed by the colonoscopy – all clear.
        What is was, however, we still don’t know.
        I’m betting it was a really tricky parasite that avoided detection ….. don’t really know for sure though – and never will.
        It ran (pardon the pun) from mid-November till just after Easter …… So whether a fully functioning gallbladder would have made any difference…. again, we don’t know, and either does my gastroenterologist, who just happens to be Dean of Medicine at Melbourne University. So he’s no push over when it comes to research! He didn’t think there was any link between my gallbladder ‘hitting the dish’ and this last adventure.
        It’s a mystery!
        Having lost a total of 28 kg, on his orders to consume some rice to put some bulk into my gut, I’ve regained three kilograms …. but not for long. Now that things have finally settle down, I’m back onto my fully-fledged LCHF diet …. and loving it!

    • Hello, Helen

      I apologize for not having responded to you back then and notice your question today as Kevin has called attention to it. Unanticipated increases in responsibility in my psychiatrist position occurred shortly after I wrote this post and took me away from nutrition work again for another year. This past year I was finally able to reduce my hours in order to devote time regularly to my nutrition work and have been back for real since last summer. Anyway, we would all love to hear what has happened to you since your gallbladder and its inhabitant hit the dish (nicely phrased!) if you have a moment to share with us. I hope your’e doing well and that you’ve found a way to stay happily on your LCHF diet!

  • Andrew Findlay

    I can’t Keto. Get crazy heart palps if I don’t get carbs. I’m between 18-22 BMI, 14% BF and do HITT 5 times/week. Tried increasing fats, but more carbs work better.

    • Shelly

      Many people get heart palpitations when switching to Keto, and they are usually caused by a lack of electrolytes. Since the diet has a diuretic effect, you have to be careful to drink enough water and also increase salt and potassium intake. Then again, not every diet is for everyone.

  • Why was my comment not approved? Was it because I provided robust evidence of the danger of nutritional ketosis in terms of CHD risk & Sudden Coronary Death risk?

    Removing this blog from my blog list.

    • Hello, Nigel

      Which comment was not approved? I welcome all comments unless they are clearly spam or are vulgar/inappropriate. Please send your comment again and I will look for it. Unfortunately I have not had time to monitor comments on older articles lately but do hope to catch up on those comments this fall, so if you posted your comment on an older article about ketogenic diets, I apologize for not having come across it yet.

      • There would have been at least 2 links to supportive evidence in my comment. That may have resulted on my comment being flagged as SPAM. Is there a SPAM folder that you can check, as I can’t remember exactly what I wrote a month ago!

        I have this problem on other comment sections, as I usually back up what I say with links to evidence (as opinion is worthless).

        • Jeanie

          Nigel-

          On my site, I auto-spam comments with more than 1 link. This may be the case with Dr. Ede as well.

  • Nargis

    Really looking forward to the post on ‘Ketosis and Constipation’ . Thank you very much for all the information! 🙂

  • silver

    Hi there Dr Ede , I would like to share my experience and if u will get your feedback.. , I have a chronic disease called spondylithe ankylosant , I take a biological medicine for that called remicade , so I think this disease is related to the gut . From 4 years till now I developes depression , I was first medicated with anafranil , then valdoxan , then mutabom m ( if I recall its called evalil there in us – a tryciclic antidepressant) anyway in about 5 months ago I was only having half of the pill I was felling nice as I was making lots of sports and having CBT sessions since the beginning . All after all I few (2) months ago just taking 1/4 of the mutabon m pill felling nice and getting stronger at the gym I started looking at the ketogenic diet as a mean to feel better and to improve my gut which could cure my rheumatic disease as there is literature for that regarding the link of inflammation of the gut linked to starch and carbs . So over I month ago I started the diet , I started to become HIGHLY energetic but very irritable and couldn’t sleep for days , I thought I was beginning to go nuts as I had so much energy but at the same time rage and insomnia . I went to my psychiatry and told him all about my anxiety and what that I couldn’t sleep . so I am now on zyprexa (olanzapine( 5mg) and 0.5mg of klonopin , all at night and besides all that I cant have a natural nice sleep , though now I sleep. I talked him about the diet but he doesn’t have knowledge of it , so I was wondering if you could give me some advise.. I am now eating some carbs and og cetones in my urine , do u think I could get back to the diet with no problem regardless of my medication now prescribed ? I am on it – zyprexa – since 2 weeks now and I am hoping to not having to take it for too long . please give me your advice , thank you

    • Hello, Silver

      I’m sorry to hear about your experience. I cannot provide individual medical advice on line, so I can only comment generally on your question. The ketogenic diet can increase energy and lift mood, therefore some people taking antidepressants may need to reduce the dosage or stop taking them. If there is no history of bipolar disorder or mood swings in the family, a medicine like Zyprexa is unlikely to be necessary, and the risks of taking Zyprexa probably outweigh the potential benefits of the ketogenic diet, as Zyprexa can cause high blood sugar, dyslipidemia (cholesterol problems), appetite increase, and weight gain in some people.

      • silver

        Hello Dr Ede ,

        Thank you soo much for replying , and giving me a nice straight answer .

        Still i would like to make some points if you will answer I would be gratefully. I don´t have history of bipolar as it doesn’t in my family (sorry if I make mistakes writing but I am Portuguese , and I would really like to attend your services , unfortunately I am here in Portugal…

        has said before I was in severe inmsonia , I didn´t sleep for days regarding the keto diet and maybe to cause I was taking just a small amount of the pill 1/4 of mutabom m in us its called (Etrafon 10 mg amitriptyline + 2 mg perphenazine) , I felt fine with the med , but after taking the ketogenic diet I couldn´t sleep anymore , I was so nervous agitated , and at the same time getting a to very kick mind as I was having a kind of cyclic beahviour between euphoria and depression , depression I think because I couldn’t sleep … Even If I was bipolar or having a mania crisis , wouldn´t that mean that the keto diet would calm me down ?
        I am now reducing the dose of zyprexa to 2,5mg , do you think that at this level making a keto diet wouldn’t outweight the bad effects of taking the zyprexa pill ?? I mean even at 5mg I don´t have any cravings or appetite increase , I still maintain a low weight , I am now 87 kg and height 1,88cm.. I didn´t increase 1 kg of weight since starting the zyprexa 1 month ago…
        I think I cannot let go yet the zyprexa cause I need to get sleep , and not sleeping I have no energy to go to the gym has I used to..
        Right now I am not doing keto anymore cause I want to get stable , I don´t even drink any coffee or caffeine anymore . you said that bipolar persons who get to the diet may cure their issue but given that they too take medications wouldn´t these outweigh to the benefits of the keto diet ?
        One last question , don´t you recommend resistant starch to the keto diet ? I can´t figure out why simple starch is bad for the gut , but accordingly to some publications resistant starch is good for the good gut bacteria..
        I want to get back soon to the keto diet , would you recommend something to deal with the imnsonia or does that mean that in my chaise I am somehow addicted to sugar from the carbs ? I have been searching a lot of keto forums and it seems that this issue is very common ..
        Thank you for your attention Dr Eve

        • Philip Clax

          Hi Silver, I suffered similar problems on keto, so I use the supplements GABA and 5htp to aid my sleep. Keto diets can be low in serotonin due to the lack of carbs, so supplementing with 5htp or tryptohan can aid sleep. However if you decide to try this I would recommend a little research first, you don’t want to overdo 5htp or tryptopahn. Personally I only need a small amount to help me drift off to sleep and calm down.

          • silver

            hi Philip , thanks for replying , I would be glad to try it out bur now I am on a mixture of pills so that I can have some sleep.. I am now eating more cabs and eating honey and milk at night , still what´s impressive is that I am still losing weight .. I am taking again the anti depressive , I hope I can be back to some good sleeping , so that then I may come back to ketosis and train hard again… The Keto diet and the exercise just made me get so much high that I can´t describe … even although I was as I am still now drinking a lot of magnesium… This all thing just led me to depression and anxiety , but who knows , maybe I just won´t be able to pass some carbs… Its a pity that investigation doesn´t go further , as if you research you will see a lot of people that try keto and they too get severe insomnia that may lead to depression or mania.. I would like to see more info by Dr Ede , as like what could avoid insomnia in keto , and which carbs are good for the gut , cause from what I know the gut as bacterias that produce serotonin that must be fed.. Thank you

  • Zoe McMurtrie

    What if you have low thyroid function before doing keto (the non auto-immune kind)? I keep reading low carb reduces thyroid hormone production

  • Julie

    Dr. Ede,
    I very much want to give the ketogenic diet a trial. I am bipolar and have been poorly controlled on trials of many medications/combinations for > 25 years. Anticonvulsants have been the class of meds that have worked better than the rest (currently on Lamictal & Trileptal) but my mood stability leaves a lot to be desired, especially since perimenopause started. In addition to med interactions and side effects, I’m 60 pounds overweight for the 2nd time due to atypicals.
    How do I find a doctor willing to supervise my trying this?

    I feel it would foolish to try without supervision as there are electrolyte issues with both keto adaptation and the meds I’m on. I’m willing to put the hard work into making the lifestyle changes necessary to do this but I’m daunted by trying to find someone who is both willing to monitor me doing this and has the knowledge to recognize trouble if they saw it.

    • Dear Julie

      Dr. Dominic D’Agostino has a very helpful website about ketogenic diets that includes a list of physicians in the lower right corner: http://ketonutrition.org/#

  • Sheila

    @GeorgiaEde:disqus I know it is a while since you wrote this, but I really hope that you can answer my question, since I am very interested in following a keto-diet, and maybe it could finally change my life.

    I struggle with anorexia & bulimia for six years, and I am a little underweight. When I heard about LCHF, I was scared! Too scared to even consider following a diet with so much fat, because it’s exactly how you wrote: I am absolutely terrified of fat. But now, I actually consider it to follow a keto diet, so I can lose weight in a healthy way and not the way I am doing now. My question is, would LCHF make me gain weight? Since I am also bulimic, I don’t eat food without purging. I am afraid that doing LCHF will make me gain instead of lose weight safely. A part of me wants to do keto without the fat, but I know that can cause huge problems for my muscles, and I don’t want to lose any more of them. Would a keto diet make me gain?

    • Dear Sheila

      If you are underweight, it would be healthy for you to gain some weight. It’s not about body appearance or pounds on the scale, but about the health of your brain, heart, and whole body. If you are not getting enough food you will not feel your best, will be hungry, and can have problems with energy, concentration, sleep, and mood.

      I would also like to point out that there is a difference between “LCHF” (low carb high fat) diets and ketogenic diets. A ketogenic diet limits carbohydrates AND protein whereas an LCHF diet only limits carbs. Both diets are relatively high in fat.

      A ketogenic diet forces your body to burn fat (instead of carbohydrates) for energy. Therefore it is very important, especially if you are underweight and don’t have enough body fat to begin with, to eat plenty of fat on a ketogenic diet or you will be extremely hungry and tired. You will essentially be starving. Please do not try a ketogenic diet without the fat. It is very dangerous.

      An LCHF diet does not limit protein or fat, so it can lead to weight gain in some people, depending on how much they are eating, but many people lose weight safely on an LCHF diet. .

      People with anorexia and bulimia are often afraid to eat fat because they think it will make them fat, but it is carbohydrates that are the main problem in overweight and obesity. It is carbohydrates that cause us to feel out of control of our appetite and weight. I hope you are working with a psychiatrist and/or counselor as well as consulting with your primary care provider about your struggles and that you will not try any new diet without some support and guidance.

      A ketogenic diet is a very special diet and hard to follow, whereas LCHF is easy to follow and is a much healthier diet than a high carbohydrate diet. Many people find that they do very well with LCHF and do not need to resort to a ketogenic diet after all.

  • Cynthia Ortiz

    Hello @Dr. Ede I’d like to try keto diet. Will it help me? I have lateral wall schemia, high blood pressure, high cholesterol, addicted to carbs & coffee.

    • Hi Cynthia

      I believe that eating a low-carbohydrate diet could be very beneficial for you! If you’re looking for a doctor that can work with you, Jimmy Moore keeps a list on his website: http://lowcarbdoctors.blogspot.com/

  • Aurelia2

    Dear Dr. Ede,
    Thank you very much for your post!
    I’ve been searching online for information on the effects of a ketogenic or mildly ketogenic diet on kidney transplant recipients and found very little information. What is your general opinion on the matter? Are you aware of any studies or case reports on transplanted patients?

    The reason I am asking is that I am looking for ways of optimising the health of my husband, who has had a transplanted kidney since 2003. He lost his kidneys due to PKD at a relatively young age (36).

    I understand that on the one hand, a ketogenic diet may help lower triglycerides and/or the risks of cancer and diabetes. On the other hand, it may raise uric acid levels and the risk of gout. I am also concerned about kidney stones.

    We would, of course, discuss this with his doctors, but we would like to be as informed as we can beforehand.

    Thanks again!

    p.s. Btw, I have considerably lowered my own intake of carbs to address acid
    reflux, and have seen incidental improvements on many aspects of my
    health.

    • Dear Aurelia

      I am not aware of any studies of ketogenic diets in kidney transplant patients, however, there is a study in mice demonstrating reversal of diabetic kidney damage using a ketogenic diet: https://www.mountsinai.org/about-us/newsroom/press-releases/diabetic-kidney-failure-may-be-reversed-with-low-carbohydrate-diet.

      A transplanted kidney is a healthy kidney, not a kidney damaged by diabetes or other diseases. However, that healthy kidney has been transplanted into a new environment, and that new environment, as you know, presents challenges to the immune system, leading to inflammation. A ketogenic diet should, theoretically, reduce inflammation significantly, because diets high in carbohydrate worsen inflammation.

      This article explains that gout in transplant patients can be treated using low-carbohydrate diets: http://www.ncbi.nlm.nih.gov/pubmed/16392875 This is because the risk factors for gout are the same as for most chronic diseases: insulin resistance. For more information about this please see my article: http://www.diagnosisdiet.com/is-fructose-bad-for-you-a-summary-of-the-research/

      Bottom line: THEORETICALLY a ketogenic diet should not only be safe for kidney transplant patients but may be beneficial in protecting patients from inflammation (and therefore risk of rejection) and gout. However, each case is unique and I’m glad to know that you would be consulting with his physician before considering any dietary changes.

      I hope this is helpful!

  • kevin

    so if i plan on getting my gallbladder removed i shouldn’t be on a keto diet?

    • Hi Kevin–I wouldn’t go so far as to say that, only that you may have trouble digesting high amounts of fat and therefore may need some special guidance if you run into that problem. It’s worth a try, but it may not be as easy for you as it otherwise might be or may require some tweaking or careful timing of fat intake or digestive enzyme supplements.

  • Alison Roberts

    been doing keytogenic diet for a month no weightloss at all – I have no thyroid so I take thyroxine does this make a difference?

    • Hi Alison

      I doubt that taking thyroxine is the culprit. It could be that your body has not had enough time to fully adapt to fat burning yet (this can take longer than a month in some people), but if that turns out not to be the issue, the most common obstacles to weight loss on adapted ketogenic diets are:

      *eating too much protein for your metabolism (can raise insulin)
      *dairy products (which can raise insulin and other hormone levels)
      *low-calorie and no-calorie sweeteners (can raise insulin)
      *caffeine (can raise cortisol levels and keep blood sugars elevated)

      Hope this helps!

      • Alison Roberts

        Net Calories 1400. Work-outs 90 minutes Bikram’s yoga 4/5 times a week.
        Protein is 20-25% but I do eat dairy (cheese and small amounts tablespoons of buffalo yogurt) – I never eat sweeteners, and I have tea in the morning & coffee I drink weak and watery with high fat milk. I do indulge in a few drinks in the evening a couple glasses or dry white or red wine – have switched to vodka and soda with slice of lemon. Over the past 5 weeks I have been in ketosis state except for one day a week (knocked out for a day) Does this reset the whole process? I have read that folks with hypothyroidism need more carbs to get thyroid hormones right.

        So I am guessing you’d say.

        – give up dairy
        – give up all caffeine
        – no alcohol

        • Hi Alison

          Thanks for sharing additional details–very helpful. Not sure which factor(s) may be interfering with your goal of losing weight, but the possibilities include dairy, not being in ketosis every day for at least a month, alcohol (which has complicated effects on metabolism), and caffeine. The other possibility is that you may not be eating enough fat calories for your activity level, in which case your metabolism will slow down to resist weight loss. You’d have to experiment with one or more of these (probably one at a time if you want to isolate the culprit) to see what’s going on.

          • just curious to know more about the details of alcohol’s effects while on ketogenic diet. Since alcohol has 7 calories/gram (close to what fat has), it seems that having a few drinks would take up a good bit of the total daily calories and likely be bumping out some good fat calories. But does the body “see” the alcohol calories as part of the total in terms of not slowing down metabolism, or would more fat and less alcohol do a better job of keeping metabolism revved up?

  • Decbaby71

    Hi Dr. Ede,
    I had a question regarding the Kept diet and gallbladder. I am nearing my 2yr post op this July. I lost weight right after surgery but regained that loss plus more since. I consider myself healthy other than no gallbladder and obesity, however I do feel that the obesity has led to hormone imbalance, insulin resistance, bloating, gas, joint pain and swelling. For the last 2 weeks I reduced my carb intake to 30-50grms /day. I track all my food. Eat more fresh, “real” food– with these changes I have experienced weight loss, return of monthly cycle, reduced hair growth on chin, better mood and energy, and less gas or bloat. I suppement Krill oil, B Compkex, 2bil probiotic, D3 and L-carine. I feel with these positive results I could benefit greatly with the KD. I am 44 @ 5’10 and my current weight is 240 and my goal is 180-190.
    Do you have any suggestions or plans that would assist my journey to lose 60 pounds, live longer and increase activity?

  • Gerardo Cantu

    Hi. I started a ketogenic diet almost two weeks ago and I can’t seem to stay in ketosis consistently. I take supplements and probiotics. I also take lisinopril for blood pressure. I notice that I’m in ketosis later in the day and evening (get’s progressively darker until it is the darkest at night)…but in the mornings, my test strips are very light and I have not lost any weight. I am at 210 and have stayed there for these past two weeks. I’m becoming discouraged and I feel like I’m doing more harm than good by eating so much fat, and not staying in ketosis. Can someone please help? Thank you so much!!!

    • Hello, Gerardo

      It would help to know how many grams of carbohydrate and protein you are eating per day first, if you wouldn’t mind sharing that information. The most common reasons for not losing weight on a ketogenic diet are:

      too many carbs for your metabolism (less than 10 per meal of non-refined carb is best for most)

      too much protein for your metabolism (somewhere between 0.8 and 1.5 grams per kilogram lean body weight works for most)

      dairy (raises insulin levels)

      caffeine (keeps blood sugar and stress hormones elevated for some)

      sweeteners (even zero calorie sweeteners)

      Too many grams of fat/calories per day

      A very helpful free tool for calculating your requirements is at:
      http://keto-calculator.ankerl.com/

      Hope that helps!

  • Kimberly

    Hello, I have a question. I started the Keto diet 2 weeks ago. I have been staying in Ketosis and I am losing weight. My only problem is I still get nausea. I hate it. Could it be the fact that I don’ t have a gallbladder and that is causing the stomach issue? What can I do to help stop the nausea. I can’t have crackers. 🙁

    • Hi Kimberly

      Assuming you were not having issues with nausea prior to starting a ketogenic diet, it could be due either to a food sensitivity to something you’re eating regularly on a ketogenic diet that you weren’t eating before, or due to lack of gallbladder (more likely, in my opinion).

      People with gallbladder problems and other gastrointestinal compromise may need to be very careful with the amount and timing of fat intake on a ketogenic diet and/or may need to take digestive enzymes to support their ability to process fat. In some cases, a ketogenic diet may simply not be the right approach for people with gallbladder problems.

      I would recommend consulting with a gastroenterologist or primary care practitioner with experience and expertise in treating people with gallbladder problems with low-carb high-fat diets. Jimmy Moore maintains a list of low-carbohydrate doctors on his website: lowcarbdoctors.blogspot.com, and Marika Srobos has created a new Low-carb Map of the World that lists doctors, nutritionists, and other professional resources: foodmed.net/gd-home.

    • Jo

      Digestive bitters or digestive enzymes. I no longer have my gallbladder and have started taking these to digest the fat and decrease nausea. Be sure you are not drinking fluids with your food as well. I believe we are to wait at least a half hour to keep stomach acid as concentrated as possibe to initiate digestion processes.

  • bigmyc

    Hello there, Dr. Ede. I will frequently go on keto binges and at this stage, I’m fairly efficient at transitioning into a fat adapted state…since I’ve done it so many times before. Even when I’m not producing and burning ketones, my carb intake is well under 150 grams daily and many times, probably less than 100grams. I normally function well here and when I go keto, there isn’t much of a noticeable difference in my metabolism but I will reliably lose weight. This is to be expected however, lately, I have been having problems maintaining the keto-metabolism without experiencing some sort of crash a few days later. My first thought is that maybe I’m not eating enough food and that I am unwittingly engaging my adrenals. My sleep suffers along with my daily energy levels. I suppose that my leptin gets too low but isn’t that the point of being fat adapted; that you can remain satiated primarily upon fat and moderate protein?

    Of course, perhaps it is that I’m not eating enough and that might account for the pronounced weight loss and lack of energy but while in ketogenisis, I’m fairly diligent in eating meals with a high nutrient content, if not loaded with calories. I should also mention that I will also consistently employ intermittent fasting, during normal eating patterns as well as through the ketogenic stretches. What do you think might be my obstacle and the source of poor sleep?

    • Hello, bigmyc,

      I wish I knew exactly what the problem is, but I don’t have any experience with intermittent ketosis. i personally find it very difficult to go in and out of ketosis, so I try to stay in ketosis all the time or I don’t feel right. Have you ever tried staying in ketosis for a long time? Or is there some reason why long-term ketosis hasn’t worked out for you?

      • bigmyc

        Basically, I haven’t committed to going full keto for long periods. I am low-carb, however and I have been for much of the summer. This is how I was able to lose 7 lbs. where I previously had been stalled at my latest “set point.”

        I should say that I wasn’t trying to lose weight so much as I was trying to stay ketogenic and in doing that, the lbs. finally came off. Of course, this weight loss was probably the reason for the sluggishness and not being accustomed to that “playing weight.” Even a couple of weeks later, I feel that I have stabilized and my energy levels are more consistent yet I have only regained 3 lbs. This still keeps me at a weight that I haven’t remembered being since high school!

        I suppose that it’s also helpful to tell you that the previous low for my daily weight was around 170 lbs. I am 5′ 10″ so that is hardly over weight. In fact, to most people, it was significantly trim. Now in the mid- 160’s, those same people think that I have a psychological issue with my diet! I just tell them that I appreciate not having to remain a slave to an eating schedule and that I enjoy walking around with as little extra baggage as possible. As J.J. Cale once crooned, “Travellin’ light…it’s the only way to fly.”

        The important thing that I tell them is that I am not losing much muscle mass, if any at all. This is what lets me know that my dieting isn’t ultimately harmful. Let’s face it, the tribulations that one goes through, whether it be out of detox or weight loss or athletic conditioning, can be daunting and at times, cause one to second guess whether or not these are good things for the body…However, in all these cases, I have come to realize that a little bit of turbulence is to be expected before the ultimate results are experienced.

  • John

    Hi Doctor Ede.
    I have used a keto calculator to compute my dietary metrics. I am finding it difficult to get going and maintain the keto diet because with the increase in good fats, avocado, mct oil and olive oil, I have a hard time meeting my calorie metric which is between 1750 and 2100. This depends on whether I choose the high or moderate restriction metrics. I often fall short of 1700 calories. I don’t want to eat when I am not hungry unless you are supposed to on the keto diet. Any advice you can give would be very helpful, Thank you

    • Hi John

      If you’re not hungry, you don’t need to worry about meeting caloric goals unless you are underweight or losing weight that you can’t afford to lose or don’t want to lose.

  • Debi

    I am wanting to start the keto diet but I had a heart stent 3 months ago.. Is it safe for me to do this diet?

  • Julie Hord

    Hi Dr. Ede,
    My 21 year old daughter has joined me in the ketogenic diet. She is already quite slim BMI 18.5) and has not lost any weight eating lo carb/hi fat. But now, about 4 weeks in, she has developed a pretty bad rash on both sides of her neck and it’s spreading. We’ve been reading everything out there about the keto rash. She does not want to stop ketosis by upping her carbs. Do you have any special knowledge or advice to help with the rash? Thanks!!!

  • Brent

    This is an excellent read, Doc. Thanks so much for putting this out there! Not just ‘Don’t do that!!’ but ‘Do it with caution, include your physician, and here’s the reason why’. Too many don’t understand what it’s all about and simply respond with an emphatic ‘NO!’ out of sheer ignorance.

  • Surinder

    Dr,
    my father has been diagnosed with a rare brain disorder called psp. he is diabetic and has had heart attacks in the past. do you think we should try keto?

    • Diana Lynne

      Dr.’s cannot give medical advice online. You need to ask your father’s doctor.

  • Sophia Contini

    I’m not sure if comments are still being responded to, but here goes. I’m taking Atenolol for high blood pressure. Also, I just started Metformin and Glipizide for Type 2 diabetes. It’s very difficult to find a doctor who is on board with a ketogenic diet at the clinic that I go to. I guess it will be a minor miracle if I find someone in the Minneapolis St Paul area who knows about this way of eating and recommends it. So, I guess I will just have to be aware of any changes in blood pressure, etcetera. Thank you for pointing this out.

    • NC2013

      I started the Keto diet with my wife on 2/4/17. I checked with my physician beforehand (Type II diabetes-Metformin and Glipizide) and HBP. He said it was fine, just to watch my blood sugar for lows. I’ve gone from 228 lbs to 212 and no longer take the diabetes medications. I looking forward to continuing on this journey and getting back to my normal weight. I may even remain on it and just have a carb day once in a while. I definitely recommend speaking with your physician. Do they ever say why they don’t recommend it? A good website I’ve found is ruled.me

  • Janet Garcia

    After 3 months eating keto had to have my gallbladder removed because of a blocked common bile duct that resulted in pancreatitis. Didn’t know I had gallstones. But was on a very low fat raw food diet for over a year. I absolutely Love eating keto and am pretty much addicted to it. But, there are definitely somethings that need more research. Doctors say eating high fat creates gallstones so stay away from fat. Hollistic community say that high carb and low fat creates gallstones not fat. All this information is confusing. Need more studies done and results available for those of us wanting to do this or continue on it. I monitor my blood levels monthly and my triglycerides are the lowest ever! Potassium deficiency, & magnesium deficiency are definitely something people need to be more aware of on this diet. Constipation, so eat lots of fiber, don’t just rely on meats and fat. Flax seeds, chia seeds and tons of greens. So much more needs to be taught about this diet to follow it safely. Jan R.N.

  • Nicole Kriebel

    I also am scheduled to have my gallbladder removed after 3 months of the keto diet.Completely sucks!

  • Lois Allen

    I had a gastric bypass in 1999 and also had my gallbladder out. I have been doing Keto for about a month and a half now and lost 15 pounds but now at a stand-still for a week. I have about 20 more to lose but wondered if there was truth to not being able to absorb the fats in an effective way in order to stay in ketosis. After 2-3 weeks of keto, my keto sticks (urine sticks) were not working anymore even though I was only consuming 20 grams of carbs per day. I think it is because I am keto adaptive, so don’t pay much attention to the sticks, but wondering why my weight loss has stalled for 10 days. Anyone else experience anything similar?

  • Glen Monks

    Does anyone have experience with CFS and ketogenic diet? I have been intermittent fasting until 12 pm each day no problem – then back to medium carbs and quality meats and fats. But when I fast and then take only fats and protein I seem to get anxiety and more heart palpitations – Also sleep issues. So each time I try – I revert back to healthy natural unrefined foods. I still manage imild fatigue and mild Adhd symptoms so would like to find out if ketones could bring more clarity – obviously heart health comes first. Blood pressure is normal to low – not high naturally. Any comments would be gratefully accepted.

  • Parker Hilton

    Hey, I really love this post and it is super helpful. I’m relatively new to the Ketogenic diet but was diagnosed with PKD almost a year ago. I know that the jury is still out on the appropriate amount of protein for a PKD patient with regular kidney function (i.e. Me) but is the ketogenic diet safe for someone in my position? thanks so much!