Questions about the ketogenic diet

by Dr. Gifford Jones

What is a ketogenic diet? How does it differ and is it more effective than other diets? Apart from the hype surrounding this diet, what are the medical concerns about it?

Recent marketing of the ketogenic diet suggests it’s a new one. But a report from the University of California says it’s been used for years to treat medical problems such as epilepsy in children.

But what is it about the ketogenic diet that causes weight loss? A major factor is that it’s low in carbohydrates and high in fats.
Blood sugar (glucose) is normally the body’s main source of energy. But when blood sugar is diminished by eating less carbohydrates, the body is unable to maintain needed levels. To compensate, the body must start burning fat for energy. It also obtains more energy by converting some amino acids from protein in foods. And if this does not suffice, it gets energy from muscles.

The breakdown of fat, and to a lesser extent, protein, creates a condition called “ketosis” which is also used for energy. Hopefully none of us will ever be in a situation where we’re starving. But if that happens, we develop ketosis. It also occurs in uncontrolled diabetes.

Ketosis starts within a few days after carbohydrates are decreased to between 20 and 50 grams a day. This is not much carbohydrate, as two one-ounce slices of bread contain 28 grams of carbs!

How does a ketogenic diet compare with a normal diet? The average North American gets 50-55% of energy from carbohydrates, 30-35% from fats, and 15-20% from protein. The ketogenic diet obtains 5-10% from carbohydrates, 70-75% from fats, and 20% from protein.

A ketogenic diet contains full-fat dairy, eggs, fish, poultry, meat, nuts, non-starchy vegetables and butter. You are allowed to eat as many of these foods until you are full. It eliminates starchy vegetables, most fruits, grains, and sweets.

The British Journal of Nutrition analyzed 13 diet studies and reported that most, but not all, found that patients on a ketogenic diet lost more weight than those on other diets. They also ended up with lower blood pressure and blood triglycerides. And it helped those with type 2 diabetes. The negative of this diet is that it also increases bad cholesterol because of its high content of saturated fat.

Another negative is that the low carbohydrate content makes it hard for people to stick to it. Also, by eliminating most fruits, many vegetables, whole grains, and fiber, constipation is more likely to be a problem. Moreover, it removes ingredients essential for good health. No one should start a ketogenic diet without the help of your trusted family doctor.

It’s unfortunate that most diets wouldn’t be needed if people would follow a sound lifestyle. The first error is not having a bathroom scale that you step on every day. Scales tell it the way it is. Focus on losing any gained weight the same day the scale reports an increase.

This means saying no to high calorie desserts, eating smaller portions on smaller plates, and declining any offered second portions. Healthy weight loss also means an increase in daily exercise. Loss of excess weight and common-sense healthy living significantly reduces the risks associated with the epidemics of obesity, heart disease, and Type 2 diabetes. A sustained commitment can add years of longevity.

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Dr. Ken Walker (who writes under the pseudonym of Dr. W. Gifford-Jones, MD) is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million. His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!” Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation. His hobby is trap shooting. He is married to Susan and has four children and twelve grandchildren.Diana MacKay writes in collaboration with her father under the pen name, Diana Gifford-Jones. The daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health. For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at to receive our weekly e-newsletter. For comments,