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Merry Christmas.  Happy Hannukkah.  Happy New Year.  Tis the season to celebrate.  Tis the season to give.  Tis the season to receive.  Unfortunately, when it comes to the waist line, the season tends to gives back more than it receives.

The average American will gain up to 7 pounds over the extended Holiday season.  As a result of the Holiday bulge, many will engage in the annual pilgrimage.   Each New Year, Americans pay homage to tradition and bring a resolution of a new diet to start the new pilgrimage to trim the waistline.  Each year, Americans start down the road to weight-loss nowhere.

I would love to say that there is one diet that will fix all waistlines, but there is no perfect diet to fit all metabolic needs.  The key in weight loss is to differentiate fad from science to promote healthy, long-term fat loss and muscle growth.  Many weight loss fads promote water loss, muscle loss and short term weight loss only.  These types of weight loss programs actually set the body up for long term weight loss failure.   I want to take this opportunity to review a well recognized, well researched, but often misunderstood dietary strategy: the ketogenic diet–the diet with benefits beyond weight-loss.



Thanks to Dr. Atkins, the ketogenic diet has become a household name.  But, what is a ketogenic diet?   At its core, the ketogenic diet is a low carbohydrate diet.  There are 3 macronutrients: carbohydrates, proteins, and fats.  According to the CDC, the typical American diet is very high in carbohydrates (approximately 50% of daily calorie intake).  The word ketogenic comes from the increased production of ketones as a result of the bodies shift from a glucose fueled (carbohydrates) energy system to an alternative fuel system as a result of carbohydrate reduction.  If you have ever talked to someone on a ketogenic diet and noticed their bad breathe, you were introduced to ketones.

A ketogenic diet actually can mean many different things.  The reduction of carbohydrates is just one component of the ketogenic diet.   An increase in protein and/or fat must accompany the carb reduction or energy production will suffer.  A high protein shift is the more common American ketogenic diet; however, the classical and more researched ketogenic diet is the high fat shift.  The high fat shift is with healthy fats of course.  This shift to protein or fat drives an increase in ketone production as an alternative energy source.  The classical ketogenic diet consists of 3% carbs, 7% protein, and 90% fat.  This compares to the higher protein Atkins diet of 5% carbs, 25% protein, and 70% fat.  A low-glycemic index diet consists of 27% carbs, 28% protein, and 45% fat.  In contrast, according to the CDC, a typical American diet consists of 50% carbs, 16% protein, and 33% fat.  The classical ketogenic diet is the reference source for the health benefits highlighted below.

Most are aware of the weight loss associated with the ketogenic diet.  The observation and the research is strong in support for both the higher protein and higher fat ketogenic diets in weight-loss.  Weight-loss is where the 2 ketogenic similarities end.

The high fat ketogenic diet has been shown to be a valuable aid in the treatment of type II Diabetes.  As a result of the high fat ketogenic diet, the alternative ketone pathway for energy production improves glucose control, lowers insulin, lowers oxidative stress, and reduces inflammation through avoiding the dysfunctional glucose pathway.

The benefit of the high-fat ketogenic diet in the treatment of cancer is significant.  The knowledge that the ketone pathway benefits cancer is not new: it goes back to the Warburg effect, described by Dr Warburg in 1931 for which he won the Nobel Prize for Medicine.  Dr Seyfried is the current champion of the research on the ketogenic diet and cancer authoring over 150 publications on the effect including the journal article and book entitled Cancer as a Metabolic Disease.  I had the true honor of speaking after Dr Seyfried at the 2016 AFMA in Atlanta, GA.

In a nutshell, what is this concept of cancer as a metabolic disease?   In this concept, cancer has backed itself into a corner, metabolically speaking.  All things growing require resources to make energy i.e. carbohydrates, protein, and/or fat.  Cancer is growing rapidly and this has massive energy requirements to maintain this growth.  This is where cancer has backed itself into a corner.  Cancer relies almost exclusively on glucose (sugar) and glutamine (amino acid) as the sources for energy production.  In contrast, healthy cells can adapt to other resources, such as fat.   Cancer has very limited capacity to utilize fat as a resource for energy production.  It is very important to remember that I am talking about healthy fats here (polyunsaturated fats, monsaturated fats, and even some saturated fats), not the trans-fats found in twinkies.  Elimination of the glucose primarily and the glutamine secondarily will starve the cancer cells of the capacity to make energy, while normal healthy cells adapt to fat resources to continue to energy production.  The high-fat ketogenic diet is selecting out cancer, metabolically speaking.

According to research, other disease states that would benefit from the classical ketogenic diet include:

seizures/epilepsy (gold standard)

Traumatic Brain Injury

Alzheimer’s disease

Parkinson’s disease

Lou Gehrig’s disease (ALS)

Angelman’s syndrome



Multiple sclerosis

Migraine headaches

improved athletic performance

One caveat on the ketogenic diet.  Historically, the ketogenic diet has been a mainstay of the annual diet. However, it was a seasonal ketogenic diet that was the mainstay, not an annual ketogenic diet.  During times of plenty (spring, summer, and early fall), the non-ketogenic diet was dominant, yet during the winter months, the ketogenic diet (and calorie restriction) was more dominant.  Take this to mind when you start your New Years diet resolution.  The ketogenic diet might be a good choice to start (3 months), but not the choice for a long term, well-balanced nutrition plan.

The ketogenic diet is not the answer for all expanding waist lines.  But, in the high carbohydrate American diet, why not consider a turn to an evidence-based approach in the annual New Year pilgrimage?  To your Health!