


The Clinical Use of Nutritional Ketosis

Story at-a-glance -

  • Nutritional ketosis, which involves eating a high-quality, high-fat diet that is low in net carbs, may be one of the most useful interventions for many chronic diseases, including cancer
  • If your mitochondria are functioning well, they will efficiently metabolize fat. When they don’t, it suggests you’re primarily burning carbohydrates as a primary fuel, which promotes disease
  • The key to success on a high-fat diet is to eat high-quality healthy fats, not the fats most commonly found in the American diet. MCT oil is particularly beneficial, but need to be implemented with some care

By Dr. Mercola

Eating a high-quality, high-fat diet may be one of the most useful interventions for many chronic diseases. Dr. Jeanne Drisko, who heads up the University of Kansas Integrative Medical Center, has used this nutritional protocol in a clinical setting for many years now.

Drisko is also the chairman and medical director for the Alliance for Natural Health (ANH), a grassroots organization that helps educate consumers and patients about natural health strategies and important political issues that affect your access to alternative medicine.

"As many of us in integrative medicine, I started out very conventionally," Drisko says. "But with a personal health crisis, you suddenly learn there's not a lot in conventional medicine that works. I turned to integrative medicine and got much better ...

I ended up doing a fellowship with Hugh Riordan in Wichita, Kansas, who was one of the pioneers in intravenous vitamin C and a number of other integrative therapies. That was really what launched me into integrative medicine."

In 1998, the dean of the University of Kansas asked her to launch the KU Medicine Center,1 which now teaches students in integrative medicine.

The fellowship, which is one additional year after completion of a residency program, is even eligible for the board certification through the American Board of Physician Specialties (ABPS).

Clinical Use of Nutritional Ketosis

Part of Drisko's focus has been on the clinical use of nutritional ketosis, which is what I recommend for nearly everyone to improve their health. This all began when, at the prompting of the clinic's naturopath, they began investigating how shifts in the diet could improve outcomes in cancer patients treated with intravenous (IV) vitamin C.

"[T]he naturopath kept saying, 'We need to get them off the sugar. We need to get their diets improved.'

We worked together and found the responses with IV vitamin C were improved with more good fat, the essential fatty acid, medium-chain fat diet; the low sugar; and some good-quality protein," Drisko says.

"I never really put a name to it until Thomas Seyfried's book ['Cancer as a Metabolic Disease'] came out. That book was seminal for me. I was fortunate to be able to sit down with Tom, to have dinner with him, and to have been in communication with him since that book came out."

Seyfried and I will both be speaking at the Conquering Cancer Conference in Orlando, September 22 through 24. The event is sponsored by the Academy of Comprehensive Integrative Medicine (ACIM).

Drisko will also participate in the brainstorming group at the ACIM Conquering Cancer Conference on September 25. You and/or your physician are invited to attend the general conference, which precedes this event. It should be one of the best cancer conferences of the year.

Cancer is not the only disease the KU Medical Center treats with a ketogenic diet. When asked what type of illness this intervention can benefit, she replies:

"Chronic illness generally ... We see a lot of young people that are very toxic and they have a lot of endocrine disruption, chronic illness and autoimmune disorders ... The ketogenic approach has been really helpful in getting them back [to] health with detoxification."


Assessment and Evaluation

Patients initially receive a personalized integrative health assessment, which includes a comprehensive digestive stool analysis and a genetic panel. The latter allows you to evaluate the function of the detoxification, methylation and sulfation pathways.

They also receive an individualized nutrient evaluation and essays to determine mitochondrial function.

"We really like to look at the urinary organic acids. We look at lactate, pyruvate and the urinary organic acids to see how the mitochondria are functioning," Drisko explains.

"We also like to look at some of the medium-chain fat levels and then try and figure out if they're spilling some of these important fats in the urine or if they're burning them in the mitochondria [for] energy, and if they need cofactors like carnitine or some of the B vitamins ...

We use conventional labs or the Genova panel for the cardio-metabolic profile. It's an ION panel, but it adds some of the cardiac factors; lipid. That way, we can really assess some of the biochemical cofactors. I also like US Bio Tek ... [a] urinary metabolic panel. I get a lot of information from that."

Determining Mitochondrial Function

If your mitochondria are functioning well, they will efficiently metabolize fat. If they don't, it suggests you're primarily burning carbohydrates as a primary fuel. Elevated lactate is typically found in people whose mitochondria are working at max capacity. However, there's a continuum.

In a chronically ill patient, particularly if the individual is toxic, the lactate will be high while some of the mitochondrial cofactors in the Krebs cycle will be either elevated or too low, indicating that the mitochondria are not working properly.

Poorly functioning mitochondria will also cause butyrates and certain fats to be eliminated via urine rather than being burned as fuel in the mitochondria. In cancer patients, this pattern of poor mitochondrial function becomes clearly evident.

"We've even done some metabolic cart testing in these patients, and at rest, they're burning glucose and their glycogen stores if they're really metabolically impaired," Drisko says.

Seyfried's book, which catalyzed Drisko's interest in this field, is a great resource. On the downside, it's expensive and best suited for health professionals.

An easier read is Travis Christofferson's book, "Tripping Over the Truth: The Metabolic Theory of Cancer," which provides a great overview of how mitochondrial metabolic dysfunction contributes to cancer, and may in fact be the primary cause.

Sample Success Story

One sample success story from Drisko's clinical experience involves a young man who had been at an outdoor concert, spending the entire day in 98 degrees Fahrenheit heat. Prior to that day, he'd been healthy, but after that, he became chronically ill.

"He had thyroid dysfunction ... He had a drop in his testosterone levels. He had the onset of irritable bowel. He was a mess," Drisko says. "He went from doctor to doctor to doctor, as you can imagine. They finally told him he was just depressed and gave him antidepressants.

Someone referred him to our clinic. It turned out it was like sitting in a sauna all day for that young man, which released all these toxins that had built up ... He had lived near a farming community and been exposed to a lot of herbicides, pesticides and fungicides.

Those are stored in your tissues. In sitting in that heat, it was like sitting in the sauna and releasing it. He didn't have the mechanism to clean it up and get it out of him. It was a toxic hit. When he came to me, we put him on appropriate doses of testosterone, got his thyroid in range, and just made him generally feel a little bit better. We cleaned up his gut and changed his diet."

After doing a genetics panel and urinary metabolic profile to assess the functionality of his detoxification pathways, they found his mitochondria were hardly working at all.

By removing sugars and processed carbohydrates and adding in healthy fats, including medium-chain triglycerides and higher-quality protein, he was able to turn his health around. He also received IV vitamin C and IV glutathione to aid with the detox process. "In time, he was pretty much back to baseline; off testosterone, no more irritable bowel, and on small dose of thyroid medication," Drisko says.

Healthy Versus Dangerous Fats

When we're talking about implementing a high-fat diet, it's extremely important to identify which fats we're referring to, and how much.

As a general rule, you'll want at least 50 to 75 percent of your total calories (some may benefit from as much as 85 percent) from healthy fats, which include: olives, avocados, coconut oil, MCT oil, organic pastured butter, cacao butter, raw nuts such as macadamia and pecans, seeds such as black sesame, cumin, pumpkin and hemp seeds, organic pastured eggs, grass-fed meats, lard and tallow.

If you're using the fats found in the typical American diet, you're undoubtedly going to get worse, not better. This is actually one of the reasons why the low-fat diet is in fact beneficial for some; because it lowers their intake of harmful polyunsaturated (PUFA) refined vegetable oils, primarily omega-6.

Making matters worse, 85 to 90 percent of those oils are from corn and soy, most of which are genetically engineered (GE), which means they're more heavily contaminated with glyphosate residues from Roundup. I suspect glyphosate may be an important contributor to mitochondrial dysfunction.

While typically never measured, Drisko has a new integrative medicine fellow who will be doing a research project to actually measure glyphosate residues in patients. I look forward to seeing the results of that research. In short, the key to success on a high-fat diet is to eat high-quality healthy fats. MCT oil is particularly beneficial, but need to be implemented with some care.

"I think a person, a physician or a health food coach really needs to be well versed in the use of these fats, because they can be difficult for patients to take. I have one patient that comes to mind that have a lot of GI distress from the use of these fats. We're always looking for a different way to administer these important medium-chain triglycerides (MCT)," Drisko says.

MCT Versus Coconut Oil

One of the challenges with MCT oils is that if you consume high amounts, they can cause loose stools and gastrointestinal side effects. I've experienced that myself, even though I thought I was tolerant to it from eating high amounts of fat already and previously using 5 to 6 tablespoons of MCT. The problem was I'd stopped taking the MCT oil for awhile, and when you stop and restart it takes a while for your GI system to readjust.

Once your tolerance increases, you can have 5 to 6 tablespoons of MCT oil per day. But you wouldn't want to start with more than a teaspoon of MCT oil. Interestingly, Drisko notes that chronically ill people actually tend to have an increased tolerance to MCT, whereas healthy people have a lower tolerance. One of the ways you can improve your tolerance is by taking the powdered form.

Most of the commercial brands have eight-carbon (C8) and 10-carbon (C10) fats. They usually contain a 50/50 combination of both. I prefer taking C8 alone (caprylic acid), as it converts to ketones far more rapidly than the C10 fats.

Using coconut oil will provide a mixture of C6, C8, C10 and C12 fats, the latter of which is lauric acid. There are benefits to all of them. However, MCT oil is very refined, making it more appropriate for clinical use. When MCT oils are therapeutically used to fuel the mitochondria, they can be very effective.

"With cancer care, combining all of these approaches into a package: the ketogenic diet, the intravenous vitamin C, lifestyle changes ... we have seen some really life-threatening cancer cases become a chronic illness, such as ovarian cancer ... We have a handful of [ovarian cancer patients] that are 10 years out from their diagnosis of Stage 4.

It can work. It does not always work, but I think we're fine-tuning our approach such that I think we're going to find more and more benefit as we progress," Drisko says.

Compliance Is Everything

It goes without saying that treating your illness with nutrition and lifestyle changes requires you to change and stick with it. It's not easy. However, the more severely ill a person is, the more apt they are to make drastic changes in order to save their life. Although, sometimes not even the prospect of death can sufficiently inspire a person to do everything that is necessary.

"We have pretty compliant patients by the time they end up here," Drisko says. "It is a cash-paid clinic. It's outside of the university insurance system. Very motivated patients come here, which is what we want. We have so many patients; we don't have time for people that aren't interested.

The best way to make the system work is to have integrative dietitians as part of the team. I lay everything out, do all the testing, and then I hand them over to the dietitian ... They're the coach of that patient. They don't just see them one time. They're on a regular schedule. They're coming back. They're having phone conferences. It's a real aggressive time commitment for that patient, but it really keeps them on the straight and narrow...

[P]atients are actually asking the oncologists if they can come over here or they're telling them they are going to come over here. Then they get proper nutritional advice. But if they are in an oncology clinic, they are going to get the pink M&Ms for the breast cancer. They're going to get the donuts on the cart. I think conventionally, there still isn't a lot of understanding of how important basic diet is in cancer care."

One tool that will radically improve your ability to understand what you're eating and follow a ketogenic diet is a nutrient tracker. There are a number of them available, but the most accurate one is That's our revision of the basic tracker, and it's already set up for nutritional ketosis.

More Information

You can find more information about the KU Medicine Center on, including contact information should you want to make an appointment.

Also, if you have an interest in or passion for learning more about cancer, be sure to attend the ACIM Conquering Cancer Conference in Orlando, September 22 through 24. I will be there along with a long list of other excellent speakers. There, you'll learn more about how to implement a ketogenic diet and so much more.

You may also attend the Conference for Intravenous Vitamin C hosted by KU Integrative Medicine September 30 through October 1, 2016.

+ Sources and References