The ketogenic diet has many health benefits that may be ignored due to misinformation or old ideas from outdated teaching methods. I give Alessandro Ferretti and Dr. Stephen Phinney credit for the amazing research they do in this area.
HIGH CHOLESTEROL CONCERNS
This is a common concern and unfounded fear for those who want to embark on the ketogenic diet but still believe that fat makes you fat, or how fat increases your risk for heart disease, or how cholesterol is bad for you. If you read my post on Fatty Liver, Insulin and Glucose Metabolism you will see how the liver can manufacture two very harmful fatty acids called palmitic and palmitoleic acid (saturated fats) from glucose and carbohydrates. Yes, not from fat, but from carbohydrates. Studies have shown that by increasing carbohydrates and decreasing fats in the diet whilst maintaining the same amount of protein, more of these fatty acids are produced whereas the opposite is true when dietary fats (including saturated fats) are increased and carbohydrates are decreased.
If cholesterol readings are abnormally high it is more likely due to a high carbohydrate/sugar dietary intake, excess inflammation, and just eating too much or all of the time. And to focus on cholesterol as the number to predict cardiovascular risk is a false economy with a study published in 1996 showing that over 50% of heart attack victims and 80% of CAD (Coronary Artery Disease) patients have normal cholesterol levels.
In fact, this is data extracted from a study done over 12 weeks using individuals who have been diagnosed with Metabolic Syndrome. Half of them were put on a Low Fat Diet and the other half on a Very Low Carbohydrate Ketogenic Diet. Notice in particular the difference between good cholesterol (HDL), triglycerides, inflammation and LDL particle size. The LDL particle size is extremely significant as smaller LDL particle sizes are more atherogenic than larger LDL sizes. So even though LDL levels have not reduced with the ketogenic diet, the harmful effects the LDL may have on the blood vessel walls significantly reduced. Interestingly enough, the saturated fat levels went down more in the ketogenic group despite the fact that they were eating a lot more saturated fats than the Low Fat Diet group. The reason for this is that by eating more fats and less carbohydrates you are literally retraining your body to burn fats for energy, so even though you may be consuming more, you are certainly burning more as well.
KETOGENIC DIETS REDUCE BLOOD LIPIDS
The lower carbohydrate intake will suppress free fatty acid production in the liver. However it will eventually start to mobilize stored triglycerides from the adipocytes (fat cells) and increase free fatty acid release into the blood stream, using up stored energy in the body. The latest research that David Wollick is doing from Ohio State indicates that saturated fats found in eggs, coconut oil and other animal fats actually raise good cholesterol (HDL).
KETOGENIC DIETS PROTECT THE BRAIN
The ketogenic diet seems to increase kynurenic acid in the striatum and hippocampus in the brain. This has a protective effect on the brain cells and possibly one of the mechanisms associated with its beneficial effects on epilepsy and seizures. Some children have a glucose receptor abnormality which makes it difficult to transport glucose across into the brain, so they end up with seizures. Ketones can bypass these receptors which is why the ketogenic diet was developed with the seizure population in mind. A lot of research already exists around the use of ketosis in prevention and treatment of Alzheimer’s and dementia. Through its inflammatory effect it will also reduce cytokines and other inflammatory markers in the brain often found in chronic infections affecting the nervous system (such as Lyme) or depression. Providing ketones as a fuel source for the brain may help lift brain fog, improve memory and concentration.
KETOGENIC DIETS PROTECT THE HEART
The lowered blood glucose experienced with this diet prevents glycation and AGEs formation (Glucose Metabolism: Glycation and Methylation) where glucose in the presence of inflammation damages proteins on cell walls and blood vessel walls and causes thickening which can accelerate atherosclerosis.
Improved ATP/energy production would improve the performance of heart function and ketones themselves also increases the hydrolic force of the heart.
KETOGENIC DIETS PROTECT AGAINST CELLULAR DAMAGE
Glucose goes through more processes (11 steps) and produces more NADH to be converted to energy. Fats only use 3 steps and produce less NADH. Every step and every NADH molecule that is formed produces more ROS (free radicals) in the process. Free radicals can include super oxide, hydrogen peroxide, formaldehyde and many other highly toxic substances that are very damaging to the cells, mitochondria and organs. A ketogenic diet as opposed to high carbohydrate diet is more conducive to healthy ageing. For that matter, this is why the mediteranean diet is also responsible for its anti-ageing effects as it restricts glucose and processed/refined carbohydrates but includes healthy fats.
This holds great promise as a dietary application in CDR or Cell Danger Response when cells are overwhelmed with too many free radicals to cope with and cellular activity slows down, often seen in chronic disease. Hypoxia or pseudohypoxia often accompanies this, but since the ketogenic diet does not use oxidative phosphorylation which requires oxygen, it makes it ideal in conditions such as this.
KETOGENIC DIETS REDUCE INFLAMMATION
Excess inflammation and glucose (sugar) promotes insulin release and cholesterol synthesis. Ketogenic diets typically eliminate simple sugars and thus a big source of inflammation. The high fat/cholesterol intake supports the production of steroid hormones such as glucocorticoids which is the body’s natural anti-inflammatories. The reduction in inflammation and insulin is part of the ketogenic benefits in anti-ageing therapies.
Another key player, Inflammasome NLRP3, is a signalling protein complex that regulates inflammation in the body. The ketone bodies beta-hydroxybutyrate (β-HBA) and acetoacetate (AcAc) produced with ketogenic diets or fasting, block Inflammasome NLRP3 and down-regulates inflammation through the reduction of cytokines. High levels of cytokines occur with chronic infections, so a ketogenic approach to Borrelia (Lyme disease) and other hard to treat infections can be very beneficial. In the same way it can also help to treat gut infections and you can read more on How Digestion Affects Ketogenesis.
The blood ketone β-hydroxybutyrate (BOHB) also reduces inflammation via genetic expression which is explained further down.
KETOGENIC DIETS SPARE INSULIN
Carbohydrates and sugar trigger insulin release as blood sugars rise. Protein will do this as well as part of gluconeogenesis but to a much lesser degree. Fats, however, have absolutely zero impact on insulin. It does not raise insulin levels even a little bit. So wouldn’t it make sense to use a higher fat diet in someone who is insulin resistant or diabetic? Insulin is the fat-storage hormone. We need it but in just the right amounts. Most people (as is evident when you just look around you) produce way too much insulin, so we need to shift the diet to foods that do not push this further.
But apart from the fat, ketones produced from ketogenic diets can enter directly into the mitochondria for energy production and does not need to go through GLUT transporters or require insulin activation. The lower glucose diet also triggers less insulin release and less need for GLUT translocation which takes a lot of pressure off the pancreas. This reduces cravings and improves blood sugar control.
Exercise also spares insulin but more so because of its effect on GLUT up-regulation. Combining physical activity with a ketogenic diet will have far more superior effects than doing either alone.
As a side-note, insulin sensitivity is at its highest first thing in the morning and decreases as the day goes on. So it doesn’t make sense to eat your biggest meal in the evening when you are insulin insensitive, more so if it’s high carbohydrate (as fat doesn’t influence insulin levels). This is probably one of the reasons why people lose more weight when they have their biggest meal for breakfast and only a small meal for dinner.
KETOGENIC DIETS REDUCE APPETITE
People are often concerned about what they can snack on when following ketogenic diets. Whilst there may be an adjustment period in the beginning, overall you shouldn’t be hungry in between meals when in ketosis. Ketones have an appetite suppressing effect and blood sugar is also better regulated. If you do experience cravings and hunger then you may have to look at your meals and see what you’re doing wrong – Common Mistakes Made on the Ketogenic Diet.
KETOGENIC DIETS IMPROVE ATHLETIC PERFORMANCE
‘Sugar-burners’ have about 2,000 calories to burn for energy in the form of glycogen. However, ‘fat-burners’ have access to 30,000 – 50,000 calories for energy even in those with low body fat. This is a massive source of energy that’s not being accessed in those dependent on carbohydrates for their energy. As a ‘sugar-burner’ you will run out of energy much quicker during your event forcing you to use glucose gels and syrups along the way to keep you going, whereas ‘fat-burners’ will be able to continue for much longer without having to turn to other fuel sources. In this aspect I can speak from experience as I ran the best times of my life in long-distance and half-marathon events after I had been following a ketogenic diet for some time. Running close to 3:45/km half-marathons and 35 minute 10km races were comfortable without ever needing extra glucose or electrolytes. A lot of marathon runners are now turning to ketogenic diets away from traditional carbo-loading diets and experiencing improvements in their performance.
Body builders may also use this form of dieting closer to competitions to reduce their body fat percentage as much as possible.
A study was done for 1 month on elite cyclists who didn’t really have any body fat to burn where they were put on a ketogenic diet. VO2max and Endurance didn’t really change that much, but RQ showed a significant change. RQ is the CO2:O2 ratio and tells you how much energy you are burning from carbohydrate and fat. At baseline these athletes were burning fats and carbs at a 50:50 ratio. At level 0.7 it would indicate that all energy is coming from fat sources. Considering that these athletes have only followed this diet for 4 weeks, the 0.72 RQ reading is very significant as they have pretty much adapted to fat burning almost exclusively. Muscle biopsies indicated a marked reduction in glycogen use which has always been thought of as the major source of fuel especially for endurance athletes and the reason why carb loading was popular for many years amongst athletes.
KETOGENIC DIETS REGULATE GENE EXPRESSION
Ketones can act as signalling molecules that may affect epigenetic control. The primary circulating ketone (β-hydroxybutyrate or BOHB) is a potent regulator of genes whose function it is to protect cells from oxidative stress. The way it does this is by down-regulating Histone Deacetylase enzymes, thus increasing histone acetylation and gene expression of the genes that reduces oxidative stress. Essentially what this means is that when you eat carbohydrates, the defence against oxidative stress is turned off, so you need more antioxidants to compensate. And what does oxidative stress cause? That’s right, inflammation, and all the diseases associated with chronic inflammation.
BOHB also has implications for longevity where one study showed that it extended the live span of nematodes (worms) by about 26%, and another mouse study showed improvements in metabolic defects associated with accelerated ageing.
KETOGENIC DIETS IMPROVE CELL MEMBRANE STABILITY
Saturated fatty acids are shorter while MUFA (Mono-Unsaturated Fatty Acids) and PUFA (Poly-Unsaturated Fatty Acids) are longer chain fatty acids. These longer chain fatty acids are more bendable and create more fluidity in the cell membranes. Together with adequate methylation and phospholipid production, the cell membranes become healthier and more fluid, with better responsiveness to environmental and dietary changes.
KETOGENIC DIETS AND THE MITOCHONDRIA
Ketogenic diets in combination with intermittent fasting stimulates a process called autophagia which is destruction of dead or dying cells, so a bit like in-house cleaning. This concept is very important in those with chronic disease, autoimmune disease or heavy toxin loads. It also stimulates mitogenesis which is the production of new mitochondria.
As a continuation on athletic performance, if we look at the energy (ATP) production aspect of mitochondria, a ketogenic diet has the potential to produce a lot more energy than a standard high carb diet. Dr. Kurt Woeller has a really good analogy where he describes glucose as the kindling to the fire. It can get the fire going pretty quickly, but also burns out very quickly. Eventually you’ll need the bigger logs (fats and proteins) to keep the fire going. This is because glucose is burned via the glycolysis cycle producing only 2 ATP or energy molecules, whereas proteins and fats enter the mitochondrial krebs cycle that works a bit slower than glycolysis but spits out 30+ ATP or energy molecules. It is clear that proteins and fats especially provides a much higher yield and more sustained production in energy, whereas glucose or refined carbohydrates provide short bursts and fluctuations in energy.
There is never a one-size-fits-all approach with diets. They all have their pro’s and con’s which very much depends on the individual person. What’s their digestion like, liver function, gut microbiome, any food intolerances, mitochondrial health, existing diseases or metabolic dysfunction and what genes/enzymes are up-regulated or down-regulated? There are many variables that can influence what effect certain diets will have on your health. You have to find what works for you and better yet find a health practitioner that can look at your biochemistry and guide you through dietary recommendations that would benefit your health at that time. I use many different eating plans in my practice based on individual needs.
There’s bound to be many more benefits that has not been listed here or that we may not even be aware of yet. Certainly enough evidence to consider this diet in:
- Autoimmune disease
- Chronic disease and inflammation
- Fatigue syndromes and mitochondrial dysfunction
- Conditions affecting the heart and brain
- Diabetes and Metabolic Syndrome
- Improving athletic performance
- Weight loss
Read more on How To Do The Ketogenic Diet if you want to embark on this journey.
Another really good source of information is Jimmy Moore’s website Livin’ La Vida Low Carb.
Keto Clarity by Jimmy Moore and Dr. Westman
If you need guidance in the treatment of this or any other condition, please make an appointment with one of our practitioners.
This article is for information purposes only. Please refer to our Medical Disclaimer policy for more information. The opinions expressed here represents the author’s and not necessarily those of Realize Health. In addition, thoughts and opinions change from time to time due to updates in research and as a necessary consequence of having an open mind. Views expressed in out-of-date posts may not be the same to those we hold today.
Castelli.Atherosclerosis 1996:124 suppl SI-9
Gillies at al ‘Causes and consequences of increased glucose metabolism of cancers’ (2008) Journal of nuclear medicine : Society of Nuclear Medicine vol. 49 Suppl 2 p. 24S-42S
Hussain, et al. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes.(2012) Nutrition (Burbank, Los Angeles County, Calif.) vol. 28 (10) p. 1016-21
Quillin, 2005; Calvo et al, 2010; Klement & Kammerer, 2011.
Shimazu et al.(2013) Science (New York, N.Y.) vol. 339 (6116) p.
Masino, Susan A.; Rho, Jong M. Mechanisms of Ketogenic Diet Action (2012) National Center for Biotechnology Information (US)
Haces ML,et al Exp Neurol. 2008;211(1):85-96. doi:10.1016/j.expneurol.2007.12.029.
Julio-Amilpas A,et al J Cereb Blood Flow Metab. 2015;35(5):851-860. doi:10.1038/jcbfm.2015.1.
Douglas C. Wallace, Weiwei Fan, and Vincent Procaccio. Mitochondrial Energetics and Therapeutics Annu Rev Pathol. 2010; 5: 297–348.
Santos et al.(2012) International Association for the Study of Obesity vol. 13 (11) p. 1048-66.
Dashti et al. Beneficial effects of ketogenic diet in obese diabetic subjects.(2007) Molecular and cellular biochemistry vol. 302 (1-2) p. 249-56
Kashiwaya Y et al Substrate signaling by insulin: a ketone bodies ratio mimics insulin action in heart. Am J Cardiol. 1997;80(3A):50A – 64A.
Pr Jeff Volek IHMC
Jones RG, Thompson CB.Genes Dev. 2009;23(5):537-548. doi:10.1101/gad.1756509.
Henderson & Poirier BMC Med Genet 2011;12:137
Henderson in: Emerging Drugs and Targets for Alzheimer’s Disease: Volume 1. Martinez, editor. 2010.
Studzinski et al Brain research. 2008;1226:209–217.
Taha et al Neurochemical research. 2009;34(9):1619–1625
Murphy, P., Likhodii, S., Nylen, K., & Burnham, W. M. (2004). Biological Psychiatry, 56(12), 981–983.
Phinney et al Metabolism 32 (8): 769-776, 1983