There are five variations of the Ketogenic Diet which have been published in medical literature as effective treatments for diseases that have an underlying metabolic dysregulation, such as epilepsy, cancer, and Alzheimer’s. The original Ketogenic Therapy, known as the classic Ketogenic Diet, or classic Keto for short, was designed in 1923 by Dr. Russell Wilder at the Mayo Clinic for the treatment of epilepsy. All Ketogenic Diets are a variation of classic Keto, which is the most strict, seen by it’s ratio of fat to protein and carbs, also called the macronutrient ratio. Classic Keto carries a 4:1 ratio, which means that there are four parts fat for every one part protein and carb. Since fat has a higher caloric content versus protein and carb (fat has 9 calories per gram, while both protein and carb have just 4 calories per gram), 90% of calories come from fat in a classic Ketogenic Diet, while 6% come from protein, and 4% come from carb. The main difference between the five types of Ketogenic Diets is this macronutrient ratio.
All Ketogenic Diets are high in fat, adequate in protein and low in carbohydrates. This combination changes the way energy is used in the body, converting fat into fatty acids and ketones in the liver. When there is an elevated level of ketones in the blood, one is in a state of ketosis, which has a variety of therapeutic benefits for the sick and healthy alike. In addition to the macronutrient ratio, the frequency of eating can influence ketosis. More specifically, a practice called intermittent fasting, which reduces the window of time a person eats throughout the day, can help in obtaining and sustaining ketosis. When the eating window is shortened, the body is forced to access energy from its own fat stores rather than calories directly from the diet.
An individualized and structured diet that provides specific meal plans. Foods are weighed and meals should be consumed in their entirety for best results. Macronutrient Ratio: 4:1
Modifying the restrictiveness of classic keto can be helpful when starting the diet, or when tapering down to a more sustainable, long term diet.
Macronutrient Ratio: 3:1 to 1:1 (range)
An individualized and structured diet containing highly ketogenic Medium Chain Triglycerides (MCT), allowing for more carb and protein than classic keto.
Macronutrient Ratio: 1.9:1
Limits the amount of carbohydrate, encourages fat, and does not limit protein. Carbohydrates are to be accompanied by fat when consumed.
Macronutrient Ratio: 0.8:1
An individualized but less structured diet, it uses exchange lists for planning meal and emphasizes complex carbohydrates. It is not intended to promote ketosis.
Macronutrient Ratio: 2:3
A dietary intervention that shifts the body into ketosis by limiting the window of time one eats during the day, forcing the body to access energy from body fat.
Macronutrient Ratio: N/A
The chart below outlines the macronutrient ratios and their caloric percentage counterpart for different variations of the ketogenic diet.
|Ketogenic Diet Macronutrients; Percent of Total Calories|
|Classic Keto (4:1)||90%||6%||4%|
|Modified Keto (3:1)||87%||10%||3%|
|Modified Keto (2:1)||82%||12%||6%|
|Modified Keto (1:1)||70%||15%||15%|
|MCT Oil (1.9:1)||* 50%/21%||19%||10%|
|* 50% MCT / 21% LCT : MCT stands for medium chain triglycerides, LCT stands for long chain triglycerides|
LIFESTYLE AND OTHER FACTORS
Ketogenic therapy includes more than just diet. Nutritional supplements, electrolytes, hydration and activity levels are also key. Individuals who are suffering from digestive problems generally need additional support. This is where an experienced ketogenic specialist can be extremely helpful. Monitoring ketosis is another important aspect of therapy. Ketosis can be measured by three different methods: Blood, breath and urine. Blood readings is the most accurate and reliable method of testing, though it is also the most expensive. Urine strips provide an affordable option, though readings can vary widely based on hydration. Breath monitors have similarly varying results, and a higher entry price, though technology is improving.
Think the ketogenic diet is right for you? Talk to your doctor before adopting a ketogenic diet, or connect with one of our qualified diet professionals to determine a course of action that is right for you.
Am I a candidate for a Ketogenic Diet?
While the short answer is yes for the majority of people consuming a western diet, we urge you to consult your general practitioner prior to making the switch to keto. The Charlie Foundation will provide you with the information and tools necessary to adopt the diet, and partnering with your doctor during this process will ensure the most therapeutic outcom.
What are the benefits of Ketosis?
Achieving a state of ketosis can have many benefits from treating chronic illnesses to optimizing performance. While the benefits are well documented, the underlying mechanism of action is not entirely known. The diet enhances the ability of mitochondria, the power plants of our cells, to deliver our bodies’ energy needs in a manner that reduces inflammation and oxidative stress. Through optimizing the way our body uses energy, we fortify our bodies’ ability to combat several diseases as well as take no the stressors of our modern way of living.
How long should I be on the Ketogenic Diet?
We at the Charlie Foundation believe that a 3-month commitment to the diet is a minimum commitment to allow your body to fully acclimate to the new fat based fuel source. Since most people following a western diet are not proficient at metabolizing fat optimally, this period allows the body time to become “fat-adapted”, utilizing dietary fat efficiently and effectively. There are a variety of nutritional plans that will enable a ketogenic lifestyle, and flexibility is one of the hallmarks of the diet that make it easy to adopt as a life-long tool to enhance your health. Our nutritionists can help figure out both the short and long-term options best suited for you and your lifestyle.
Viewpoint from Our Lead Nutritionist, Beth Zupec-Kania
In my 33 years of working with nutrition therapies, none comes close to the remarkable results I’ve seen achieved with ketogenic diets. I’ve had the honor of working with hundreds of people on the diet, which has taken me all over the world where together with The Charlie Foundation we have trained over 200 hospitals in ten countries.
The ketogenic diet was used in several major U.S. medical centers as an epilepsy treatment until post-World War II development of new anti-seizure medications became standard protocol. The ketogenic diet was almost extinct in 1994 when a little boy named Charlie Abrahams developed difficult-to-control epilepsy. His parents learned about the diet in a medical textbook and took him to Johns Hopkins Hospital in Baltimore, Md. His seizures stopped within days of starting the diet and he remained on it for five years. He is now 21, remains seizure-free, lives on his own and attends college.
The family shared their story with the media and answered thousands of letters that followed. Charlie’s father, Jim Abrahams, wrote, directed and produced First Do No Harm, a 1997 television movie starring Meryl Streep and based on a true story of another child who also became seizure-free thanks to a ketogenic diet. This began a surge in interest worldwide and spurred further research which has proven the effectiveness of the diet as a treatment for epilepsy.
The ketogenic diet as a treatment for epilepsy was discovered in 1921 by Dr. Russel Wilder, MD, of the Mayo Clinic. At about the same time, German biochemist and Nobel laureate Otto Warburg published a study showing that cancer cells, unlike normal cells, use glucose for energy. (Recent interest in this theory has prompted both animal and human studies showing striking results of the low-carbohydrate [low-glucose] ketogenic diet in certain cancers.)
In 1995 I worked with a teenager who had a large inoperable brain tumor that caused seizures. He was given just weeks to live but his tenacious mother pursued all possible treatments and was referred to me to start the ketogenic diet. Not only did he stop having seizures, he became more alert and active, and was able to enjoy life for another year. His neurologist determined that the diet stopped his seizures and also slowed the rapid growth of his lethal brain tumor. It was then that I realized the diet worked for more than epilepsy.
In 1999 I was asked to initiate the diet in a girl who had been in intensive care for three months. She was suffering constant seizures and had been placed in a drug-induced coma several times in efforts to arrest her seizures. Within a week of providing her a ketogenic formula through a feeding tube, her seizures diminished and she was soon able to go home. This method of ketogenic diet delivery has since been reported effective in over 40 patients in a dozen separate medical publications. A recent publication that I co-wrote includes five such cases.
The diet is traditionally offered after the failure of two or more anti-seizure medications. Statistically, after a second drug has been tried, the likelihood of another one controlling seizures is less than 3 percent. Those are poor odds, yet many of the people I’ve worked with over the years have tried multiple combinations and as many as seven different drugs.
Ketogenic diets improve epilepsy in over half of those who try it. This has been documented in multiple prospective studies including a report summarizing the results from 19 hospitals that collectively treated over 1,000 children.
If the ketogenic diet can have such a strong impact where no drug or drug combination has helped, could it help others with less intense epilepsy?
Similarly, is it possible to prevent certain types of epilepsy simply by eating differently? It would seem that a clue may be found in the type of epilepsy.
And if we evaluate those who become seizure-free on ketogenic diets, could we determine the metabolic link to their epilepsy? Could they achieve seizure control or even prevent their epilepsy by following a special diet (without going to the extreme of a high-fat, low-carbohydrate ketogenic diet)?
My educated guess is this “special diet” would be based on whole (unprocessed) foods including fats and would eliminate sweets and added sugars. The Charlie Foundation has recently published guidelines on how to follow this type of special diet.
I feel privileged to be involved in the lives of people who have tried ketogenic diet therapies. Their cooperation and diligence has fueled my efforts to educate the community and professionals to make the diet more available, easier to manage and more delicious. With research underway on the impact of ketogenic diets in many different conditions, it is my greatest hope that these special diets evolve to the level of disease prevention.
On a personal note, I myself have adopted a low-carbohydrate diet with sufficient protein and liberal fat.
People are shocked when they see me pour olive oil over my fish or salad. Although I don’t attempt to achieve the extremely high fat content of ketogenic diets, fat is the main source of calories in my diet.
Eating this way I’ve experienced many benefits including clearer thinking and a greater energy level. No longer do I have the afternoon “slump.” My complexion is clearer and the post-meal bloating I experienced before is gone.
When I’m asked about my diet, my simplest explanation is that I'm on ancestral diet with generous fats—this means natural and unprocessed foods including meat, fish, poultry, vegetables, berries and fats from nut and olive oil. This is what our early ancestors ate. I feel full for long periods and typically eat only two meals a day (not advised for children).
Although it can be difficult to maintain this kind of diet in our carb-loaded society, eating at home is my best option. This lifestyle has also forced me to be a better advisor to my patients and students.
Think the ketogenic diet is right for you? Talk to your doctor before adopting a ketogenic diet, or connect with one of our qualified diet professionals to determine a course of action that is right for you. The below links provide access to diet professionals and hospitals with expertise in ketogenic therapies.