Ketogenic Therapy Protocol

Indications: Type 2 diabetes (reversal/medication reduction), obesity (rapid weight loss), epilepsy (seizure reduction), neurodegenerative diseases (Alzheimer's, Parkinson's), cancer (adjunct therapy - controversial), PCOS, traumatic brain injury

Baseline testing: Metabolic panel, lipid panel, liver/kidney function, A1C, fasting insulin, thyroid, micronutrients (especially magnesium, sodium, potassium), medications review

Medication adjustment: Critical - diabetes medications must be reduced/eliminated at start (insulin, sulfonylureas cause dangerous hypoglycemia on keto), blood pressure meds often need reduction (keto lowers BP) - work with prescribing physician

Macros: Fat 70-80%, protein 15-20% (moderate, not high - excess protein converts to glucose), carbs <20-50g daily (net carbs - total minus fiber)

Food choices: Emphasize: Fatty fish, grass-fed meats, eggs, non-starchy vegetables, avocados, nuts/seeds, olive oil, coconut oil, butter/ghee, full-fat dairy (if tolerated)

Avoid: All grains, sugar, starchy vegetables (potatoes, corn), most fruit (except berries in moderation), beans/legumes, processed foods, seed oils

Electrolytes: Critical - keto is diuretic (insulin drops, kidneys excrete water and electrolytes): Sodium 5-7g daily (add salt liberally, drink broth), potassium 3-5g (avocado, spinach, salt substitute), magnesium 400-600mg supplement

Hydration: 3+ liters water daily (prevent "keto flu")

Transition phase ("keto flu"): Week 1-2 often fatigue, headache, irritability (electrolyte loss, metabolic shift) - manage with electrolytes, hydration, rest, consider gradual carb reduction if severe

Monitoring ketones: Blood ketone meter (gold standard) - nutritional ketosis 0.5-3.0 mmol, therapeutic ketosis 3-6 mmol for neurological conditions

Urine strips (cheap but inaccurate after adaptation), breath meter (acetone)

Exogenous ketones: Optional - ketone salts or esters to boost ketone levels (expensive, GI side effects, not necessary but can help in transition or for athletes)

MCT oil: 1-3 tbsp daily (rapidly converts to ketones, can boost levels, start low to avoid GI upset)

Supplements: Omega-3 2-3g, vitamin D, multivitamin, electrolytes, fiber (psyllium), probiotics

Epilepsy protocol: More restrictive - 4:1 fat:protein+carb ratio (80-90% fat), requires neurologist supervision, used when 2+ seizure meds fail

Carnivore variation: Some do meat-only keto (zero carb) - eliminates all plant foods, helps some with autoimmune issues

Cyclical keto: Keto 5-6 days, carb refeed 1-2 days (for athletes, metabolic flexibility) - less therapeutic than continuous keto

Exercise: Aerobic exercise in ketosis (fat-burning), resistance training (maintain muscle - eat adequate protein), performance adapts in 4-12 weeks

Social strategies: Plan ahead, bring food to events, educate friends/family, connect with keto community

Reintroduction: If ending therapeutic keto, slowly add back complex carbs (50g increments every 1-2 weeks) to avoid rapid weight regain

Monitor: Every 1-3 months: lipids (LDL often rises - focus on particle number, triglycerides drop dramatically), liver/kidney function, glucose, A1C, ketones, blood pressure, weight