In my previous post, I go over the difference between High Protein Ketogenic Diet VS High Fat Ketogenic Diet and you now know that I support a High Healthy Fat Ketogenic Diet. But there are some instances where an individualized approach is recommended: Here’s a list with side notes:

Conditions requiring Medical or Nutritional Oversight During the Transition to a High Fat Ketogenic Diet:

• Primary metastatic liver cancer (care with fats, lipase is necessary). • Elevated Liver Enzymes – suggesting liver damage (better to wait until resolved but can still incorporate healthy fats, just not full ketosis). • Esophageal surgery and/or radiation • Head/neck radiation (healthy fats are ok plus digestive enzymes). • Poorly controlled Type 1 and 2 diabetes (must have the assistance of a Certified Nutritionist with experience in Ketogenic Diet). • Thyroid Imbalances (hypo/hyper/Hashimoto’s) – need a bit more carbs to control –cyclical ketosis is perfect for these types. • Gastric bypass/lap band – fat digestion is altered (add full spectrum digestive enzymes but very dependent on overall symptoms and type of surgery performed). • Impaired digestion (neuromuscular disorders, neurodegenerative diseases) but they also benefit from a high Fat Ketogenic Diet with targeted supplementation. • Intractable constipation (side effect of opiates) – care with high fat - compaction. • Food allergies/sensitivities or aversions (addressed individually). • Leaky gut – addressed individually. • Short bowel syndrome (part of small intestine removed) – must assess absorption of nutrients. • History of pancreatitis – digestive enzymes are not optimal (must add on a case-by-case basis). • Personal history of kidney stones – ketogenic diet increases risk (but this is easily addressed by avoiding foods high in oxalates) and adding alkali mixtures. • GI issues (IBS, Crohn’s, UC) – fat digestion can be a problem. • Renal disease – best to use with drainage protocols, monitor mineral balance. • Feeding tubes • Gallbladder issues – liver/gallbladder flush when there’s no flare (add bile). • No gallbladder – add targeted bile/enzyme supplement • Low body weight – cyclical ketogenic can be good but must be followed by a professional to determine the cause. • Cancer cachexia – care with cancers of the digestive tract and lung cancer. • A primary carnitine deficiency – not common • A fatty acid oxidation pathway defect – not common • Pyruvate carboxylase deficiency – not common (newborn). • Porphyria – affect the skin and nervous system.

Many of the above conditions I see on a regular basis where it is still beneficial to use a High Healthy Fat diet over any other diets. There is no “one-size fits all” approach to addressing someone’s health history. It is dependent on:

• Current Medications • Stage and type of any pre-existing diseases • Blood test results • Overall physical wellness • Emotional state • Gene predisposition

You will notice that I haven’t mentioned “High Cholesterol”. I will cover this part on my next High Healthy Fat Ketogenic Diet – Part 3.