Should I try the ketogenic diet?

The ketogenic diet, particularly when composed of real whole foods, can lead to significant weight loss and improve numerous metabolic biomarkers, according to Peter Attia. Paul Saladino notes that ketosis is an adaptive state for humans, distinct from starvation, and the evidence for its harm is not substantial. However, concerns about long-term effects and potential detriments to human health in perpetual chronic ketosis have been raised by Paul Saladino.

Classical ketogenic diets, used for pediatric epilepsy, are typically 90% fat (e.g., 4:1 ratio), while modified versions like modified Atkins or low glycemic index therapy are more liberal (e.g., 1:1 ratio) and can produce a mild state of ketosis suitable for lifestyle, as Rhonda Patrick explains. Peter Attia advises prioritizing unsaturated fats from nuts, seeds, extra virgin olive oil, avocados, and oily fish over cream, cheese, butter, and red meat. Paul Saladino suggests that athletes on ketogenic diets and heavy exercise may benefit from consuming up to 15 grams of sodium chloride per day.

• 01Paul Saladino states that ketosis is an adaptive state for humans, distinct from the starvation state seen in rodents.
• 02Andrew Huberman notes that high-fat meals can upregulate aromatase, which may be a concern for individuals on a ketogenic diet with hyperestrogenism.
• 03Paul Saladino claims the evidence that ketogenic diets are harmful to humans is not substantial.
• 04Peter Attia states that a ketogenic diet with real whole foods can lead to significant weight loss.
• 05Andrew Huberman and Paul Saladino observe that individuals transitioning from a ketogenic diet to a higher-carbohydrate diet may perform poorly on glucose tolerance tests for a few weeks.
• 06Paul Saladino suggests that athletes on ketogenic diets and heavy exercise may benefit from consuming up to 15 grams of sodium chloride per day.
• 07Paul Saladino mentions that the book 'The Fat of the Land' provides information on prolonged meat diets and kidney function in ketosis.
• 08Paul Saladino indicates that ketosis can lead to electrolyte imbalances, hormonal issues related to 11 beta hydroxysteroid dehydrogenase type 1, and sleep disturbances.
• 09Peter Attia advises that a high-fat diet should prioritize unsaturated fats from nuts, seeds, extra virgin olive oil, avocados, and oily fish over cream, cheese, butter, and red meat.
• 10Rhonda Patrick explains that classical ketogenic diets (e.g., 4:1 ratio) are 90% fat and used for pediatric epilepsy, while modified versions like modified Atkins or low glycemic index therapy are more liberal (e.g., 1:1 ratio) and can produce a mild state of ketosis suitable for lifestyle.
• 11Paul Saladino describes a dietary continuum for health improvement that can start with eliminating processed foods, followed by a paleo diet, then removing nuts, seeds, and nightshade vegetables, and potentially progressing to a ketogenic or carnivore diet.
• 12Paul Saladino states that a carnivore diet can be considered a low-level ketogenic diet, characterized by cycling in and out of low-level ketosis (serum ketones between 0.1-0.8 mmol/L) due to adequate protein and fat intake, and subsequent liver glycogen depletion overnight.
• 13Peter Attia notes that the ketogenic diet is being studied for its application in psychiatric disorders, including bipolar disorder, schizophrenia, major depression, anxiety disorders, anorexia, alcohol use disorders, alcohol withdrawal, traumatic brain injury, and autism.
• 14Peter Attia claims that ketogenic adaptation improves numerous metabolic biomarkers and can mitigate the negative effects of chemotherapy and radiation, such as inflammation, metabolic derangement, insulin resistance, chemo brain, and immune suppression.

Paul Saladino expresses concerns about the long-term effects of ketogenic diets and believes that long-term ketosis is detrimental to human health, with perpetual chronic ketosis no longer favored. Rhonda Patrick states that the carnivore diet is considered sub-optimal compared to a well-designed ketogenic diet and warns that a ketogenic diet can be deadly for individuals with carnitine transferase (CPT1) deficiency. She also points out that increased fatty acid metabolism in many cancers is a reason why ketogenic diets are not beneficial for all cancer types. Paul Saladino cautions that focusing excessively on ketone levels can lead to limiting protein intake to a detrimental degree and that a ketogenic carnivore diet led to electrolyte insufficiency and feeling generally horrible for him. He also notes that ketosis is not necessarily muscle-sparing, citing personal experience of significant muscle loss, and that prolonged adherence to a ketogenic or zero-carb diet may lead to metabolic issues such as persistent insulin resistance, hormonal decline, and electrolyte imbalances. Peter Attia states that a ketogenic diet does not inherently cause a person to burn significantly more energy than a balanced diet at the same caloric intake. Rhonda Patrick also highlights that some products marketed as 'keto' contain added sugar, leading to significant glycemic spikes.

The verdict could change with further understanding of the long-term effects of ketogenic diets on the microbiome, including diversity and dysbiosis, as noted by Andrew Huberman. Paul Saladino also points to uncertainty regarding the impact of ketogenic diets on muscle growth and maintenance, and whether humans should be in a constant state of ketosis. Peter Attia raises questions about the ketogenic diet's potential negative impact on women's fertility and its optimal application for professional athletes during competitive seasons. The belief that APOE4 genotype makes individuals unsuitable for a ketogenic diet is not definitively proven, according to Paul Saladino.