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The Ketogenic Diet:
Research-Proven Help for Weight Loss, Dementia, MS, Diabetes, and More

By Joanne Pizzino, MD, MPH
Medical Editor of Health&Healing

Dr. Pizzino

There is a lot of buzz these days about “ketogenic” diets, and for good reason. They are already showing research-proven success for serious conditions, such as epilepsy, Alzheimer’s disease, multiple sclerosis, and brain cancer. The diet is also widely touted for weight loss and management of metabolic conditions such as high blood pressure and diabetes. Still, many people give up without achieving their health goals. This may be because this is a technically challenging diet—more than simply eat more of this and less of that. Specifically, this is a diet in which you must use a specific laboratory test to determine if you are actually achieving the metabolic changes that can heal your condition, called ketosis. Let’s take a look at some tips which can yield better results, particularly if you are using this for a specific health condition.

What is a Ketogenic Diet?

Every cell has two ways to get energy: the usual way and a back-up system. The most common pathway is to turn carbohydrates such as starches and sugars into ATP (also known as the “energy currency” of the cell.) The back-up pathways use a type of fat called ketone bodies, or just ketones. The three main ones found in humans are acetoacetate, ?-hydroxy butyrate, and acetone. The main goal of a ketogenic diet is to produce more ketones, which can be made from burning our own fat stores, or taken in from certain foods. When ketosis is triggered by strictly following the specifics of this diet, your body will be required to burn fat to keep up with its energy needs, as carbohydrates are very limited.

This is very much like changing the carburetor in your car from burning gasoline to burning diesel. Once you flip this switch, metabolic changes can trigger rapid weight loss and resolution of metabolic diseases such as diabetes and hypertension. Cancer cells also start to die, because these genetically mutated cells lack the ketone back-up system and must rely on carbs, so ketosis causes them to starve.

How Does Ketosis Help the Nervous System?

Brain cells, unlike muscles, cannot burn fat but can burn ketones. Many neurological diseases share one major problem: deficient energy production. This is one reason that Alzheimer’s disease has been called “Type 3 diabetes.” During metabolic stress, ketones serve as an alternative energy source to maintain normal brain cell metabolism. Stroke and many neurodegenerative diseases, including multiple sclerosis and Parkinson’s disease result from oxidative stress, which is similar to rust on iron. Ketosis acts as an antioxidant, similar to vitamins A, C and E.

What Tools Can Help Me Start the Ketogenic Diet?

A ketogenic diet starts with principles similar to other ancestral nutrition programs: What we have eaten over 250,000 years of evolution is probably a safe bet to promote survival. These are the hunter-gatherer foods now commonly called the paleolithic or paleo diet for our caveman ancestors. They ate lean meat on the hoof (grass-fed, not grain-fed), fish, poultry, some eggs & a wide variety of plant-sourced foods. They did not have grains or dairy products from cows or other animals.

Despite many “keto” recipes that have a lot of cream or cheese, most of my patients do better without dairy, which is very inflammatory. (Humans are the only animals that drink another animal’s milk, and the only animals that drink milk after weaning. Probably not intended for human consumption!) If you are currently eating the Standard American Diet (SAD), the many books and websites on paleo recipes are a good way to ease into a ketogenic lifestyle.

Succeeding with the Ketogenic Diet

It is a good idea to set realistic expectations for how long it may take to get into ketosis. I have seen people do it in two days or two months. Two to four weeks is probably reasonable. I tell patients not to even check for ketosis (discuss urine, blood, or breath meter options with your doctor.)
This is not a simple diet; so let’s look at some of the reasons people don’t get the results they aim for with a ketogenic diet.

Reason #1: Too Much Protein. The big difference between ketogenic and paleo is the amount of protein eaten. Many people fear they will be hungry if they don’t eat large portions of animal protein. Perhaps because of years of mistaken health advice advising us to avoid all fats, many people load up on carbs and proteins. Unfortunately, this “fats are bad” advice was based upon poorly-done science. (To learn more about why that science is erroneous and how to do a healthy version of ketogenic diet, read Dr. Mark Hyman’s excellent book: Eat Fat, Get Thin.)

The problem with too much protein is that the body can convert protein into carbohydrates, but fat is only processed as fat. When we are trying to make the metabolic shift to ketosis, we must strictly limit carbs of all sorts in order to get the body to burn fat. Therefore, to get into ketosis, we must limit both carbs and protein. Aim for 20 percent of calories from protein, 10 percent carbs, and 70 percent of calories from fat.

Reason #2: Too Many Carbs. It is important to understand that achieving ketosis is more about the quality of your calories than the amount. Ketogenic diets have gotten a mistaken reputation for allowing unlimited amounts of eating. However, when done properly, it is true that you won’t be hungry as eating enough fat quickly becomes very satisfying. To get results with ketogenic diets, it really is necessary to actually do the calculations rather than guessing. While this seems time consuming, you can quickly learn how much and what to eat by simply entering your data for about two weeks. There are several great apps that make this easy. I prefer Cronometer (phone or computer based as recommended by Dr. Joe Mercola’s excellent book on ketogenic diets Fat for Fuel. It wasn’t until I did this that I realized my old ideas about eating “unlimited veggies,” such as lettuce, kale, broccoli, cucumbers, etc. actually needed to be measured so that I achieved ketosis. Like my favorite teacher’s book, The Wahl’s Protocol Diet Cooking for Life, I recommend eating about 6 servings of non-starchy veggies daily. Add up to 3 servings of lean protein about 3 oz each.

If you plan to be in ketosis for more than two weeks, consult a physician knowledgeable in safely maintaining ketosis to reverse dementia, diabetes, and autoimmune conditions..