The Ketogenic Diet: How and Why Ketogenic Interventions Can Improve Outcomes

The ketogenic diet refers to a high fat, low carbohydrate style of eating. In recent years nutritionists and other professionals have begun recognizing the potential clinical benefit of ketogenic interventions. To many though, its implementation and use still raises concern – often because it is used incorrectly, misunderstood, or like other eating styles, may be followed in an unhealthy way. It is important to understand what constitutes a true ketogenic diet, how it is impacting the body, where might it be beneficial, and especially emphasize the importance of maintaining quality food choices.

Ketones and ketosis

Core concepts of the ketogenic diet can make you feel like you are back in biochemistry, but they are fundamental to understanding the nature of the nutrition intervention. Our body typically converts glucose from carbohydrates for energy through glycolysis. If there is an absence of glucose, ketones are produced as an alternative energy source from the breakdown of fatty acids. Ketosis refers to the state of the body producing ketones. Ketosis can occur due to prolonged fasting or through a carefully planned ketogenic diet, where fat is your primary fuel source and carbohydrate intake is very low. (1)

Why is this beneficial?

Ketosis has shown benefit across many systems in the body:

  • Mitochondrial health:

Mitochondria play a critical role in our health. They are the “powerhouse” organelles within cells that are responsible for generating energy for the body. If mitochondria are damaged, energy production decreases Over time, this can lead to mitochondrial dysfunction and loss. There are various reasons mitochondria may be damaged, but among the top is the loss of metabolic flexibility that can happen if we become overly dependent on glycolysis and unable to convert fatty acids for energy. (2,3)

  • Microbiome influences:

A plant rich, ketogenic diet has shown favorable impact over key families of commensal bacteria in the gut, particularly higher levels of bacteria that promote overall gut health and wellness

Composition of a ketogenic diet

Part of the confusion surrounding the benefits of a ketogenic diet is that much of what is included under the umbrella of a ketogenic diet, is not truly ketogenic. (9) Someone may be eating high fat, low carbohydrate, but without the parameters that promote nutritional ketosis and the related benefits. While there can be some variability between individuals, the following is a breakdown of a properly designed ketogenic diet: (10)


  • Ratio of 2:1 or higher (fat: protein/carb combined)
  • 85% of calories as fat
  • 10% of calories as protein
  • 5% of calories as carbohydrate
  • Consider additional support with creatine, choline, L-carnitine and possibly BCAAs


Quality – not just quantity

Ketogenic diets should be carefully planned to not only define composition, but of equal importance, to emphasize quality nutrients. Too often ketogenic diets appear synonymous with poor quality fat and protein sources, products composed of industrial seed oils, and lacking in plant foods. While macronutrient levels may fall within the ketogenic category, in the end, it will not be supportive of overall health. Studies using a whole food, plant rich, Mediterranean style ketogenic diet have shown positive benefits when compared to a high carb/low fat diet (4, 5, 6), Emphasis should be placed on:

  • Healthy fats from monounsaturated and saturated fat sources
  • Higher ratio of omega 3: omega 6 fatty acids (anti-inflammatory)
  • Include MCT and/or MCT-rich coconut oil (10)
  • Quality protein with all essential amino acids
  • Ample vegetable fiber for microbiome diversity
  • Minimal fructose

Research on the benefits of a ketogenic diet continues to grow, along with interest in this area. To know if a ketogenic diet may be right for you, work with a practitioner who is skilled in ketogenic diets. They will also monitor labs to assess your personal health markers on an ongoing basis. (11,12) It is important that you feel supported and confident in your approach.


Katherine Wohl, RDN, LD, IFNCP