The Truth About the Keto / Ketogenic Diet with Dr. Sarah Ballantyne

15 Dec 2025 · 44 min
Episode

15 Dec 2025 · 44 min

0:00

Podcast (recorded Dec 2018) hosted by JJ Virgin interviewing Dr. Sarah Ballantyne about the ketogenic diet. Covers keto history and therapeutic origins (fasting → ketogenic diet for refractory epilepsy), typical macronutrient ratios used clinically, and expanding off-label adoption (weight loss, cancer, neuro conditions). Dr. Ballantyne outlines acute side effects (keto flu: lethargy, headaches, GI issues, brain fog), longer-term risks observed in studies including immune suppression, elevated lipids in some individuals, kidney stones, and notable endocrine effects: a cited long-term epilepsy study found ~1 in 6 patients developed clinical hypothyroidism within months (reduced T3, elevated TSH, required levothyroxine), and menstrual irregularities/amenorrhea occurred frequently in small studies. She explains mechanisms linking very low carbohydrate/low-insulin states to reduced type 2 deiodinase activity (less conversion of T4→T3), sex-hormone dysregulation, and loss of metabolic flexibility leading to lean mass loss and lower basal metabolic rate. Practical recommendations: for most people seeking weight loss prefer higher protein, abundant non-starchy vegetables, moderate carbs (commonly ~30–40% of calories; population ranges mentioned 30–55% with many 40–50%), caloric deficit, exercise, and prioritize sleep (~8 hours).

Questions this episode answers

Recorded December 2018 (podcast episode metadata).

About 80% fat, ~10% protein, 5–10% carbohydrate (historical ketogenic formula for epilepsy).

About 1 in 6 patients developed hypothyroidism (most within first month; all within six months) requiring thyroid hormone replacement.

Cited as about 1 in 200 in the general population (speaker's comparison).

Examples reported: a small study (n≈9) where 7 of 9 women lost menses on keto and 6 of 7 regained menses after stopping; other reports cited rates up to ~63% for amenorrhea in some cohorts.

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