What is Ketogenic

In our regular diet, we consume food and our body breaks it down into its usable parts. The most well-known are carbohydrates (“carbs”) which are necessary part of life. The complex carbohydrate starches are broken down into simple sugars which are absorbed and sent into the blood stream and crucial for our living. We should have some blood sugar to survive and our liver is important in maintaining that. Any excess is then transformed back into starches called glycogen or fat. Fiber is a type of starch that we cannot break down. Fiber is essential to help keep our bowels regular but also can improve cardiovascular health.

Fats such as oils, butter etc. are important sources of energy are used to make parts of cells, nerve sheath, etc. The molecule includes a fatty acid of various lengths (number of carbons) attached to glycerol to make “triglyceride.” Some of these fatty acids are short chain: solid at room temperature such as butter; medium chain: usually solid or liquid like coconut oil and Long chain are liquid at room temperature.

Protein such as meat, egg white, tofu and nuts are the building blocks for our body to make up muscles, neurotransmitters and hormones.

Our body is unique because when food is plenty we use the extra energy into storage mode, but in a fasting state we break down our energy stores (fats and proteins) into glucose and if the fasting lasts long enough the fats get broken down into molecules can ketones. This allows the brain and body to continue to function in a state of low food. The liver makes some glucose to maintain blood glucose levels and molecules called Acetoacetate and B-hydroxybutyrate. A Ketone by-product Acetone is produced and this is breathed out (the so called sweet breath).

In 1920s the ketogenic diet as we know now (Classic ketogenic) was invented to mimic fasting state by eating very low carbohydrate, very high fat and minimal protein.

Are all diets the same?

No. Ketogenic diet is an umbrella term which means that the body is in a state of ketosis, or producing ketones

We now have three major types of ketogenic diet

  • Classic ketogenic diet
  • Modified Atkins diet
  • Medium Chain Triglyceride diet

There is also another type of diet used called the Low Glycemic diet

Is the ketogenic diet safe?
The ketogenic diet is not a natural diet as some people may think. It is unconvential and alternative. However, it puts a stress on the body to be in a “breakdown” mode so often we need to supplement with certain vitamins and minerals to prevent some long-term side effects (see below) and to maintain good health. While this is not a truly healthy diet, we aim in our clinic to make it as healthy as possible.
Are there side effects?

In the short term, the side effects are very mild but we need to make sure to look out for the long-term side effects and prevent them. Once a person knows how to monitor their ketones (urine sticks – see monitoring) and take proper supplements as prescribed by their team they can minimize the long-term side effects

  • Common
    • Constipation
    • Weight loss
  • Occasional
    • Reflux or GI upset
    • Dehydration/acidosis – usually with illness – Nausea/vomiting, lethargy, confusion, sleepiness (may have low sugar / too high ketones)
    • Dyslipidemia – can be transient and/or reversible
    • Osteopenia
    • Changes in menstruation
  • Rare
    • Pancreatitis
    • Kidney stones
    • Arrhythmia – prolonged QT
    • Cardiomyopathy secondary to selenium deficiency
    • Hair loss secondary to Zinc deficiency

*Reference: Wyllie’s Treatment of Epilepsy

How do I know if the ketogenic diet is working?
  • You are having fewer seizures.
  • Your urine ketones are within the 4 to 8 range. The range refers to the urine testing in the mornings with the dipstick. Your ketone level tells us whether the eating plan is working for you. You can check that your body is in ketosis by testing your urine. Visit your local pharmacy and buy the thin ketone urine testing strips such as Ketostix®. The pharmacist can also give you more information. Dip the ketone strip in your urine or let it pass through a stream of urine. Shake of any excess urine and wait 15 seconds. Check your ketosis number by comparing the ketone strip to the bar on the bottle. Compare the nearest colour to show the ketone number.
  • You are feeling well and you have no major side effects. Remember to stay hydrated!
  • You are managing well. You don’t feel overwhelmed by the diet. Often the diet can be become boring or tedious. There are plenty of resources available to make food interesting and delicious! Don’t be afraid to experiment. You may also wish to join a ketogenic diet group or visit the nonprofit organizations such as Matthews friends / Charlie foundation for more information.

*Reference: TWH / UHN patient diet

The “ketogenic” diet is a high fat low carbohydrate eating style which changes the body’s biochemistry to shift the energy the brain uses from glucose to these molecules called ketones. This has been shown in some patients with difficult to treat epilepsy to reduce their seizures along with medications.

To learn more about the ketogenic diet please follow these links or download educational pamphlets and guides below.


Modified Atkins Diet

Matthew’s Friends

Charlie’s Foundation


Cauliflower Rice


Shepherd's Pie

Cheesy Chicken Casserole

Colourful Cauliflower Salad

Cauliflower Grilled Cheese


Elena's Pantry

Dr. Axe's Recipes

Ruled Me

The Diet Doctor

20 min Recipes

Low Carb Recipes




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*Information on this page has bee adapted from the “Guide to Modified Atkins Diet” with permission from the University Health Network Patient and Family Education Program and from the “Toronto Western Hospital Adult Epilepsy Diet Clinic” with permission from the University Health Network Patient and Family Education Program


This website was made possible by unrestricted educational grants from several pharmaceutical companies including UCB and Sunovion. The views expressed herein are the independent views of Dr. Bercovici and the Southern Ontario Epilepsy Clinic and were formulated without the influence of any external partner.


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FAX: 416-620-7633


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