Ketogenic Therapy Protocol

Ketogenic diet: Very low-carb (<50g), moderate protein, high fat. Forces metabolism to use ketones (from fat) instead of glucose for fuel. Ketones are produced in liver from fat breakdown. Historical: Used for epilepsy since 1920s (60%+ seizure reduction in drug-resistant epilepsy). Modern resurgence for diabetes, obesity, neurological diseases. Type 2 diabetes: Virta Health study showed 60% diabetes reversal at 1 year (off medications, normal A1C) - most impressive diabetes intervention ever published. Mechanism: Carb restriction eliminates glucose load, insulin drops dramatically, insulin resistance improves. Weight loss: Rapid initial loss (water + glycogen), then fat loss. Ketones suppress appetite (easier calorie restriction). Multiple RCTs show superior weight loss vs low-fat diets. Neurological: Ketones are alternative brain fuel (glucose metabolism impaired in Alzheimer's, TBI), neuroprotective, reduce inflammation, improve mitochondrial function. Epilepsy mechanism: Unclear but alters neurotransmitters, reduces excitability. "Keto flu": Electrolyte loss as insulin drops (kidneys excrete sodium/water), not true flu. Prevent with salt, potassium, magnesium. Lipids: LDL-C often rises (controversial - triglycerides drop dramatically, HDL rises, particle size shifts to large fluffy). Monitor advanced lipids (NMR) not just LDL-C. Medication: Critical to adjust at start - diabetes meds cause hypoglycemia, BP meds cause hypotension if not reduced. Sustainability: Some do short-term (3-6 months), others lifelong. Many exit with improved metabolic flexibility and lower-carb maintenance. Not easy diet (restrictive, social challenges) but powerful therapeutic tool when indicated.