Recently, many of my patients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss.

Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome,[35] which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[36] However, it is absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria, and other rare genetic disorders of fat metabolism.[9] Persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[37]
Increases in cholesterol levels need discussion too. We do see temporary increases in cholesterol levels often as individuals transition onto a ketogenic diet. However, when you examine lipid particle size (a more important way to look at the cardiovascular risks), the risk pattern doesn’t seem to increase with a ketogenic diet. Harvard Health has written about lipid particle size here before: http://www.health.harvard.edu/womens-health/should-you-seek-advanced-cholesterol-testing-
High-density lipoprotein (HDL – the "good" cholesterol) ordinarily transports excess cholesterol from the tissues back to the liver. In the liver, the cholesterol is either recycled for future use or excreted into bile. HDL's reverse transport is the only way that cells can get rid of excess cholesterol. It helps protect the arteries and, if there is enough HDL present, it can even reverse the build up of fatty plaques in the arteries. When there are excessive amounts of VLDL and triglyceride present, however, HDL concentrations in the blood decrease.
Eat more protein. Protein is required by the body to repair damaged cells and plays a vital role in growth and development.[3] But it can also play a role in weight loss. Diets high in protein tend to make people feel fuller, and when paired with a reduction in carbohydrate intake these diets can help with weight loss.[4] However, it's important to remember that not all sources of protein are good for you: red meat and full-fat dairy products, though high in protein, can also increase the risk of heart disease.[5] Good sources of protein include:[6]
Fortunately, since peaking in 2001-2002, the overall prevalence of metabolic syndrome in the United States has fallen, primarily due to decreases in the prevalences of hypertriglyceridemia and hypertension—and in spite of increases in the prevalences of hyperglycemia and obesity/waist circumference. [27]  Data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) showed that the age-adjusted prevalence of metabolic syndrome had fallen to approximately 24% in men and 22% in women. [28]

Excess abdominal fat leads to excess free fatty acids in the portal vein, increasing fat accumulation in the liver. Fat also accumulates in muscle cells. Insulin resistance develops, with hyperinsulinemia. Glucose metabolism is impaired, and dyslipidemias and hypertension develop. Serum uric acid levels are typically elevated (increasing risk of gout), and a prothrombotic state (with increased levels of fibrinogen and plasminogen activator inhibitor I) and an inflammatory state develop.
Tumescent liposuction is a common approach used by surgeons. It is a suction-assisted (SAL) form of lipo that first injects a liquid agent into the area that is to be treated. The liquid agent includes saline, Lidocaine (a numbing agent) and Epinephrine (a medication that controls bleeding). A cannula is then inserted and passed through the fat deposits, suctioning them out. An attached power-aided motor allows the surgeon to control the speed of the fat removal, which can be as great as a few pounds or as little as several ounces. 
Get enough calcium. Adults typically need around 1,000 milligrams of calcium every day to help maintain muscle and nerve function, and it's necessary for healthy bones and teeth.[21] But calcium may also help prevent the body from storing visceral fat in the abdomen. Though studies have not shown a drastic change in weight due to increased calcium intake, researchers suggest that it may have a small effect in some people. Calcium requires vitamin D to be absorbed into the body; therefore, be sure to get enough vitamin D as well.[22] Sources of calcium include:[23]
When your cortisol levels are through the roof, it triggers the release of insulin, and this is where things go awry. Initially, the ‘fight-or-flight’ response shuts down your digestive system so you can deal with the “threat”, like a very hungry lion or, more realistically, heavy traffic on your way to work. Once the danger has passed, your body seeks to replenish the hundreds of calories you burned fighting to the death/swearing at rush hour traffic and makes you ravenously hungry.

Localized fat accumulation patterns also vary by race and age. A decrease in the subcutaneous fatty layer and elevations in intra-abdominal fat contents are seen with increasing age. Women have a proportionately higher percentage of body fat than men and have a gynaecoid pattern of fat deposition characterized by increased deposits over the lateral thigh, buttock, hips, and truncal region, while men show an android pattern that centres on the truncal and abdominal regions.
As you get older, your body changes how it gains and loses weight. Both men and women experience a declining metabolic rate, or the number of calories the body needs to function normally. On top of that, women have to deal with menopause. "If women gain weight after menopause, it's more likely to be in their bellies," says Michael Jensen, MD, professor of medicine in the Mayo Clinic's endocrinology division. In menopause, production of the hormones estrogen and progesterone slows down. Meanwhile, testosterone levels also start to drop, but at a slower rate. This shift in hormones causes women to hold onto weight in their bellies. The good news: you can fight this process. Read on.
Metabolic syndrome is quite common. Approximately 32% of the population in the U.S. has metabolic syndrome, and about 85% of those with type 2 diabetes have metabolic syndrome. Around 25% of adults in Europe and Latin America are estimated to have the condition, and rates are rising in developing East Asian countries. Within the US, Mexican Americans have the highest prevalence of metabolic syndrome. The prevalence of metabolic syndrome increases with age, and about 40% of people over 60 are affected.
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