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Q&A with Dr. Kaye: Keto Considerations for Hypothyroidism, Diabetes, Gallstones, and More

Although the ketogenic diet has been used clinically since the early 20th century, with specific therapeutic use for seizure mitigation in children with intractable epilepsy, the “keto diet” is now discussed more broadly, having even entered colloquial use. With the ketogenic diet’s recent rise in mainstream popularity and increased clinical exposure, we compiled a Q&A with Mark Kaye, DC to answer specific questions from healthcare practitioners.

Does a ketogenic lifestyle work for hypothyroid patients?

Contributing factors to low thyroid function such as weight issues, inflammation, or blood sugar imbalance, may be the same reasons that a practitioner may consider a ketogenic program for their patients. However, in hypothyroid patients, caution need be exercised. Low-carbohydrate diets may further reduce the body’s production of thyroid hormone and patients with hypothyroidism can experience concerns related to electrolyte balance. For the hypothyroid patient, close team work between the endocrinologist and entire clinical team is important for ensuring desired health goals without further compromising thyroid function. 

Are there any issues using a ketogenic plan in patients with diabetes?

Contributing factors to type 2 diabetes and metabolic syndrome, such as weight issues and inflammation, may be the same factors that a practitioner may use to suggest a ketogenic program. However, exercise caution. Low-carbohydrate diets, particularly for patients taking insulin or oral hypoglycemic medications, would require very close monitoring of blood sugar and insulin with personalized adjustment to medication dosing and timing. A key concern for blood sugar issues seen in diabetes are concurrent issues such as lowered kidney function, hypertension, or elevated cholesterol, which would also necessitate very close monitoring by practitioners specialized in ketogenic diets in these patients, as well as conventional medical management of the condition.

Please address the potential increased risk for gallstones and oxidative stress with high-fat diets.

There is insufficient information in the literature to indicate that a ketogenic diet is clearly associated with increased risk of (cholesterol) gallstones. While a high-fat diet may be associated with gallstone formation, there are many other risk factors. Weight loss that is too rapid is associated with gallstone formation. Gallstones may be acute in formation (as with rapid weight loss) or may be literally years in the making. If gallstones are a concern, other diet plans may be implemented, typically plant-rich diets, which are naturally lower in saturated fats, cholesterol, and simple sugars, all which may contribute to gallstone risk.

As to oxidative stress, many lifestyle factors can be contributors. Phytonutrients and common nutritional antioxidants (specific vitamins and minerals) may still be obtained by consumption of quality low-starch vegetables. In addition to antioxidant vitamins and minerals, a low-starch, plant-rich diet provides numerous antioxidant phytonutrients. In addition to healthful foods, a quality multivitamin, multimineral, phytonutrient dietary supplement can complement a ketogenic food plan.

Would a ketogenic diet be advisable for a person who is APOE4/4?

At this time, while there is marked interest in the cognitive sparing or improving effects of a ketogenic diet, there is insufficient information at this time to state that a long-term ketogenic diet would impact risk for cardiovascular or cognitive decline in those with specific genetic predispositions.


Mark A. Kaye, DC

Dr. Mark Kaye is Senior Manager of Medical Information at Metagenics, where he has been leading seminars, speaking internationally, writing, and supporting practitioners through programs since 1995. Mark manages the Metagenics Medical Information team, providing practitioner support for medical foods, functional foods, and dietary supplements in clinical practice. Dr. Kaye received his Doctor of Chiropractic degree from the Los Angeles College of Chiropractic and was in private practice in Southern California for approximately 10 years prior to joining Metagenics. In addition to licensure in California, Dr. Kaye was also licensed to practice chiropractic in Arizona and Maine.






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