The Ketogenic Diet – April 2025 Newsletter
The Ketogenic Diet
Hello, this is Dr. Ellen. In this month’s newsletter, I want to briefly talk about a diet that has been very popular for more than two decades, the keto (i.e., ketogenic) diet. Many were looking for an alternative way of losing weight that did not emphasize caloric restriction… a diet that would not only allow but encourage an increased intake of dietary fat, particularly of animal products. The first such diet to become popularized was the Atkins diet in the 1970’s. It required that initially the amount of dietary carbohydrates should be extremely low compared to fat content. Later, only a very gradual increase in carbohydrate intake was permitted, making certain not to cause weight gain.(1) The keto diet has increasingly gained in popularity since then as a weight loss diet. It also led to weight loss and, similar to the Atkin’s diet, claimed additional health benefits. However, the health benefits of a keto diet have been brought into question. I will address this below.
By the way, if you haven’t had a chance to see my previous newsletters, you can find them on my website, www.drellencutler.com under ‘Free Resources’.
The first fast-mimicking diet
Before the advent of anticonvulsant medications, one of the measures used to treat epilepsy was fasting. Fasting is in fact the only therapeutic method for epilepsy recorded in the Hippocratic records. Over one hundred years ago, it was found that a diet high in fat and low in carbohydrates caused the formation of molecules called ketones. This is the same reaction the body has when fasting. The ketone-forming diet (i.e., the ketogenic diet) was subsequently used for children with epilepsy with a good deal of success. It remained popular for this application until the discovery of diphenylhydantoin (Dilantin), which then became the first choice for the treatment of epilepsy for both children and adults.(2)
Why increase ketone levels in the blood?
As I mentioned above, the very low carbohydrate diet for weight loss first became popularized in the 1970’s by Atkins. This diet, at least initially, causes an increase in the production of ketones. Ketones are created in the body by the breakdown of fats in the liver. When the body’s carbohydrate stores are significantly decreased or fat (i.e., fatty acid) concentrations are increased, there is an increased production of ketones. Most organs and tissues (other than the liver) can use ketones as an alternative source of energy. Because ketones can also cross from the bloodstream into the central nervous system, the brain can also use them as a major source of energy when an adequate amount of glucose is unavailable.(3)
There are several different types of ketogenic diets, but all restrict carbohydrates, usually to as little as 5 to 10% of the calories in the diet. Conversely, fat intake is usually up to 75% (or more) of calories, and protein is typically between 20 and 35%.(4) In addition to ketogenic diets reducing the frequency of seizures in some with drug-resistant epilepsy, they can also result in decreased body weight. However, the resulting weight loss is no more effective than it is with other dietary approaches when matched for energy intake and is difficult to maintain. Ketogenic diets can also lower blood glucose, but this effect often decreases after the first few months on the diet.(5)
The case against going on a ketogenic diet
When beginning a ketogenic diet, there can be some relatively mild short-term adverse effects, which have collectively become known as the “keto flu.” The symptoms can include nausea, vomiting, diarrhea, constipation, headache, fatigue, and weakness. These symptoms typically resolve in a week or so. Adequate hydration with appropriate electrolyte intake can help mitigate at least some of the symptoms.(4)
Possible long-term effects of a ketogenic diet include decreased bone mineral density, kidney stones, and anemia. Ketogenic diets are difficult to sustain, and many individuals go off the diet even without experiencing negative effects. Very low carbohydrate diets in general can be associated with increased LDL cholesterol levels, although they may initially become decreased. Foods and other dietary components of animal origin are typically increased in ketogenic diets; these have been linked to an increased risk of cardiovascular disease, kidney disease, cancer, diabetes, and Alzheimer’s disease. Conversely, intake of health-protective plant-derived foods are typically decreased in a ketogenic diet.(5) Additionally, ketogenic diets have been found to undermine exercise efforts and, although creating fat loss, lead to muscle shrinkage as well as bone loss.(6)
Because of the lack of sufficient plant-based foods, ketogenic diets can be nutrient deficient in as many as 17 vitamins, minerals, and micronutrients. The many types of fiber and resistant starches (prebiotics) found in beans and whole grains are typically lacking in keto diets. As a result, constipation is very common and there has been found to be a reduction of the diversity of the intestinal microbiota and of the ‘good gut bacteria’ overall. Also, some of the saturated fat in the keto diet likely reaches the colon, possibly with detrimental changes to the gut microbiome, leading to weight gain, increased ‘leaky gut’, and pro-inflammatory changes.(7)
A recent study (published August 2024) of healthy adults compared three diets for up to 12 weeks: a low carbohydrate ketogenic diet, a low free sugar (e.g., table sugar) diet which allowed complex carbohydrates, or a diet with moderate sugar and carbohydrates (the control group). Both the low free sugar diet and the ketogenic diet led to fat loss. However, the ketogenic diet was found to increase cholesterol, reduce good gut bacteria (particularly Bifidobacterium), and reduce the body’s ability to tolerate sugars. Conversely, free sugar restriction which otherwise allowed complex carbohydrates led to fat loss without the apparent negative health impacts of the ketogenic diet as well as reducing their total cholesterol by the end of the study.(8,9)
Ellen Cutler Method (ECM)
Over my years of practice, I have not seen evidence in my ECM energetic testing that a ketogenic diet was the best dietary choice for a patient to lose weight. And I have seen those who have chosen to be on a ketogenic diet have negative health consequences from that choice. Almost every time, testing has shown that the best choice for each patient, whether for weight loss or for optimal health, was a whole food plant-based diet!
Please be well, be healthy, but remember…
“I get very frustrated when I see claims on the internet that the keto diet is good for your gut health. There’s not one single study to support that. In fact, the studies that exist suggest that keto decimates the gut.”
― Will Bulsiewicz, M.D., board-certified in both internal medicine and gastroenterology, from https://www.eatingwell.com/article/291999/why-you-should-never-try-the-keto-diet-according-to-a-gut-health-expert/
Dr. Ellen
References:
“Atkins Diet: What’s behind the claims?” at https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/atkins-diet/art-20048485
“History of the ketogenic diet” at https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2008.01821.x
“Biochemistry, Ketogenesis” at https://www.ncbi.nlm.nih.gov/books/NBK493179/
“The Keto Diet Explained: What the Science Really Says” at https://foodrevolution.org/blog/keto-diet-benefits/
“Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks” at https://pmc.ncbi.nlm.nih.gov/articles/PMC8322232/
“Muscle Shrinkage and Bone Loss on Keto Diets?” at https://nutritionfacts.org/blog/muscle-shrinkage-and-bone-loss-on-keto-diets/
“The Safety of Keto Diets” at https://nutritionfacts.org/blog/the-safety-of-keto-diets/
“Ketogenic diet but not free-sugar restriction alters glucose tolerance, lipid metabolism, peripheral tissue phenotype, and gut microbiome: RCT” at https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(24)00381-1?ref=omic.ly
“Is Keto Worth The Risk? A New Study Casts Doubt on Its Safety” at https://www.sciencealert.com/is-keto-worth-the-risk-a-new-study-casts-doubt-on-its-safety
* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, mitigate, or prevent any disease.
