Therapeutic Keto vs Weight-Loss Keto: An RD’s 6-Step Safety Protocol

Authored by: Joy Erdile, MSc, RD

Some people think that a Therapeutic Keto diet and a Weight-Loss Keto diet are the same, and while there are similarities, they are very different.

A Therapeutic Ketogenic Diet is a type of Medical Nutrition Therapy (MNT) that may be prescribed by a doctor or implemented by a Dietitian under a doctor’s supervision as part of treatment for mental or physical health. These diets have been used for more than 100 years in the treatment of epilepsy and diabetes, and more recently as adjunct treatment in some types of cancer and in mental health. 

• These diets are very high in fat, from 65–72% (2:1) up to 90% (4:1). 
• Protein, fat, and carbohydrate are strictly controlled, so each ingredient must be accurately weighed. 
• Blood glucose and ketone levels are monitored to reach the desired Glucose to Ketone Index (GKI).

 

Three Types of Therapeutic Ketogenic Diets

A therapeutic ketogenic diet is like a prescription, where each ingredient is weighed to achieve the specific ratio. High-fat, low-protein diets such as 4:1 and 3:1 ketogenic diets make Meal Plan design both time-consuming and challenging. People need to realize that “meals” in a therapeutic ketogenic diet are really an assembly of specific ingredients in precise amounts assembled to be as palatable as possible.

The classic Ketogenic Diet (KD) has a 4:1 ratio, i.e., 4 parts of fat for every 1-part protein and carbohydrate. 

The Modified Ketogenic Diet (MKD) has a 3:1 ratio, i.e., 3 parts fat for every 1-part protein and carbohydrate 

The Modified Atkins Diet (MAD) has a 2:1 ratio, with 2 parts fat for every 1-part protein and carbohydrate. Fat is set at 60% of calories, protein at 30% of calories, and carbohydrate at 10% of calories.

Over the past 5 years, I have designed different types of Therapeutic Ketogenic Diets as an adjunct treatment along with medication for people with a range of physical and mental health disorders, including seizure disorder, glioblastoma (an aggressive form of brain cancer), and various mental health conditions, including anxiety, depression, bipolar disorder, and schizophrenia. It has been very rewarding to see the effect that these therapeutic diets can have on health and quality of life, with medical support.

A Weight-Loss Keto diet restricts carbohydrates and provides varying percentages of protein. They do not require weighing food or checking blood sugar or ketones, although some people do. There is no one “keto diet”, but rather a range of keto diets. They all limit carbs to about 10% of daily calories to encourage ketone production. The popular high fat / moderate protein version of a keto diet is ~75% fat and 15% protein is commonly referred to as “the keto diet,” but this is not the only keto diet.

A Dietitian’s 6-Step Safety Protocol

Weight-Loss Keto diet 

1. Ensure there is medical oversight for clients taking certain types of medication, including insulin, SGLT2 inhibitors, blood pressure medications (ACE inhibitors, Beta-blockers), and psychiatric medication

Therapeutic Ketogenic Diet

1. Ensure that the client has consulted with their doctor and that the doctor has provided a signed form indicating that they will monitor electrolytes, blood glucose and ketones, and monitor medications
2. For use in mental health, clients should trial the diet for a period of 3 months 
3. If the doctor finds that the diet is helping, they may begin to gradually deprescribe some medications. 
4. Clients should be advised not to change dosages of medication on their own
5. Taking “cheat days” is not an option in a therapeutic context; breaking the diet can cause symptoms to reappear dramatically as ketosis is lost

Author Bio: Joy Erdile, MSc, RD, Registered Dietitian & Founder of Better by Design Nutrition Ltd.