Orientation: Disease Improvement and the Plant-Based Ketogenic Diet

"Could sunlight... seep into our little one's heart too?"

 

"A plant-based ketogenic diet... let's let in a fresh new wind."

 

"Something... has a warm scent."

 

Child "Mommy, let's come again tomorrow."

 

Mother (startled) "O-oh, sure, sure—but how on earth did you just say three words at once? That's a first..."

 

"Through the power of plants — through the plant-based ketogenic diet — flowers bloomed in her heart, too."

Orientation: Disease Improvement and the Plant-Based Ketogenic Diet

Dr. Lee "Starting today, I'd like to introduce scientific studies on how the ketogenic diet has produced beneficial outcomes for various diseases, and the underlying causes behind those outcomes."

 

Grace "Dr. Lee, I think this will be very important. So many people live in pain because of chronic disease. For someone like me — older and living alone — illness is genuinely hard. So if we can see scientific evidence that the ketogenic diet improves specific diseases, we'll have more confidence to actually apply it in daily life."

 

Emily "I agree completely. Not just in Korea but worldwide, more people are living into older age, and the number of people who are sick has grown with that. But it isn't only the elderly — even young children seem to be falling ill more often, which worries me. I have a four-year-old and a first-grader, both with severe atopic dermatitis and a touch of asthma; we go to the clinic almost daily. If a dietary therapy could be practiced easily at home, and if it had real scientific grounding, it would help an enormous amount."

 

Zoe "It's the same for me, even at twenty-something. Among my friends, quite a few already struggle with diabetes and obesity. As you know, Korea's adolescent overweight rate has been above 30% for some time. What worries me even more — one of my close friends is already on kidney dialysis. Fortunately, there's a dialysis center in town, so she steps out from work, gets dialysis for about three hours, and goes back. But she has to do this twice a week, and it's exhausting. After dialysis she's drained and can barely work, and she has to tiptoe around her colleagues at the office."

 

Dr. Lee "Yes, I hear you all. The growing number of people in Korea with chronic conditions troubles me too. I once went through a serious illness myself — not from disease, but from a training accident in the military that left me bedridden for months. The pain was severe, and at the time I had no way of knowing whether I'd recover. That experience taught me how precious a healthy body is — one that can move and act freely. Looking back, I think one reason I came to care so deeply about the dietary habits that improve health is that this experience was etched into me. My desperate longing for health may have unconsciously shaped my long-term commitment to research on healthy living. When I see people suffering with chronic illness today, I find myself empathizing with their pain and difficulty. People in financial hardship sometimes can't access medical care as freely as they'd like. Insurance covers a great deal, of course, but there are always gaps. Another important reason we need real knowledge about diet is that many modern chronic diseases are linked to wrong eating. If the cause is in the diet, then the diet must change for true healing. Symptomatic treatment — masking pain, lowering fevers — while leaving the cause untouched only lets health decline further. Einstein is said to have remarked that expecting a different result while leaving the cause unchanged is madness. That phrase fits this situation perfectly. The principal cause of modern chronic disease is wrong eating habits, and improving them is how we treat chronic disease at the root."

Carbohydrate Overconsumption Leads to Caloric Excess and, in a Chain, to Many Chronic Diseases

Carbohydrate Overconsumption Leads to Caloric Excess and, in a Chain, to Many Chronic Diseases

Grace "I strongly agree. So many of the diseases of modern people come from consuming far too many calories. The classic example is metabolic syndrome. 'Metabolism' really means energy metabolism. Overweight, diabetes, hypertension, kidney disease, abdominal obesity — they all share the same cause. The body has stored more calories than it needs, and that excess itself becomes a kind of toxin."

 

Dr. Lee "Right. Grace lived in the U.S. for over thirty years, earned her registered dietitian credential there, and worked as a hospital dietitian for thirty years. So she may understand the seriousness of diseases caused by nutrient excess even better than the rest of us. Even fat cells, which are technically nutrient stores, will release toxins and inflammatory hormones once they exceed a healthy load. We have come to understand the cause of nutrient excess; the remaining problem is that we have not reached consensus on how to control caloric excess. To put my conclusion plainly: if you eat lots of carbohydrates, weight management becomes very difficult. There are several reasons. Carbohydrate intake stimulates the appetite center in the hypothalamus, making you want to eat even more. Carbohydrate intake also raises blood glucose, which triggers a large insulin release (see Figure 5-1). After hyperinsulinemia sets in, glucose is driven rapidly into cells and blood sugar plunges into hypoglycemia. You then eat ravenously again. High blood sugar, high insulin, plunge — the cycle repeats like a roller coaster, and the pancreas is gradually exhausted. Cells respond by reducing the number of glucose receptors, refusing further glucose uptake — insulin resistance, or glucose intolerance. Rising insulin also makes the body inflammation-prone, and it promotes lipogenesis — the conversion of carbohydrate into fat. So merely increasing carbohydrate intake produces different side-effects in different tissues across the whole body. In more technical language we call this tissue specificity: a single hormone produces different outcomes in different tissues."

 

Figure 5-1. The metabolic-syndrome cascade triggered by carbohydrate-heavy and meat-heavy eating.

 

Zoe "Dr. Lee, my father actually collapsed not long ago. He had hypertension, and one day a vessel in his brain burst. Thankfully it was caught early so the brain damage wasn't severe, but his speech is a bit slurred now. We live on edge wondering whether another vessel might burst. My mother has hypertension too. Are there ketogenic-diet studies on improving hypertension?"

 

Dr. Lee "Oh, I'm sorry to hear that. You must be very worried. When even one family member is unwell, the whole family worries — that's natural, because families are bonded by attachment and care for each other. Yes, there are many scientific studies showing the ketogenic diet helps with hypertension, and I'll introduce them as we go. Many people, like your parents, struggle with hypertension. According to press reports, in Korea alone about 12 million people are affected. Hypertension has many causes, but excess nutrients and high body waste levels are major ones. People with hypertension often also have hyperlipidemia, depressive symptoms, and diabetes — partly because the diseases share root causes. So the ketogenic diet often improves hypertension as well. Looking at the scientific evidence in detail will help confirm this. Behind each paper I introduce briefly in class lie enormous amounts of social and economic resources, time, effort, expert personnel, and analytical equipment — keeping that in mind makes the results even more meaningful."

 

Don't Expect Miracles. But Many Studies Report Improvement of Various Diseases with the Plant-Based Ketogenic Diet

Don't Expect Miracles. But Many Studies Report Improvement of Various Diseases with the Plant-Based Ketogenic Diet

Zoe "I have a close friend from very early childhood whose baby has autism. She had to leave her job to care for him. She's tried every supplement and program people recommend, but says nothing seems to change much. She tells me autism rates have multiplied recently. She and her husband are wonderful, kind people, but their lives have become hard since the diagnosis. They weren't financially struggling before, but now they are. Listening to her, my heart aches, and there's nothing I can do but listen. Caring for the child seems extremely difficult. — Are there ketogenic-diet studies on autism?"

 

Dr. Lee "Yes, there are. There are studies on the ketogenic diet's beneficial effects in autism, and there are also molecular studies on the mechanisms behind those effects. 'Molecular' here refers to investigations into more fundamental causes — gene-level effects, biochemical mechanisms, neurotransmitter relationships, and so on. As we look at these studies, please keep two things in mind. First, even when scientific results are good, we cannot guarantee 100% effectiveness for every individual. The literature itself shows a spectrum — some respond strongly, some moderately, and some not at all. So please don't have outsized expectations. Second, the improvement effects of a ketogenic diet on any given disease are not produced through a single pathway. Although the phrase 'ketogenic diet' is one term, in the body it acts through many improvement pathways. For example, the diet lowers blood glucose and insulin and raises ketone bodies. This smooths blood flow and improves the delivery of oxygen and nutrients body-wide. Lower insulin reduces blood inflammation. Reduced inflammation and smoother blood flow let white blood cells work better, raising immunity. Beyond what I've just sketched, there are many more benefits. A plant-based ketogenic diet adds antioxidants, vitamins and phytochemicals on top of all this, while abundant fiber helps stabilize blood sugar and adsorbs metabolic waste and excess cholesterol for elimination — providing more positive inputs to the body. These effects also synergize with each other, producing even more remarkable outcomes."

 

 

Grace "It's true of all therapies and drugs — not just dietary therapy — that an effect can't be guaranteed for every patient. We don't expect a medication to cure everyone. But given that the ketogenic diet's positive effects are scientifically documented and that it's a dietary adjustment one can practice in daily life, I can't see any reason for someone seeking improvement to refuse to try it."

 

Zoe "Right. If it can help even a little, and that help is grounded in scientific research, I want to share it with my friend. And food, by definition, is what we eat without side-effects. Of course extreme overeating is a problem, but how many people really do that?"

 

Emily "I love cooking, so once I'm confident about the plant-based ketogenic diet I'll happily develop varied dishes — feed them to my children and serve them to friends. My husband loves vegetarian food, too. There's almost no meat in our home; we taste it now and then when we meet friends. We're functionally a vegetarian family. Maybe that's why my family rarely gets sick and the children are bright and lively — my trust in plant-based eating is high."

 

Dr. Lee "Wonderful. So we'll cover the ketogenic diet's improvement effects across various diseases through scientific studies. People sometimes assume 'ketogenic diet' means a narrow palette of ingredients. In fact, plant foods come in roughly ten times the variety of animal foods. By adjusting proportions according to the Trinity Plate method we covered earlier, an almost limitless variety of dishes is possible. The keys are good use of beans, nuts, and seeds."

 

Emily "Doctor, I once made pizza using nuts and the family loved it."

 

Dr. Lee "Tell me more — could you share a quick recipe?"

 

Emily "Of course. Grind cashews and mix with a little tapioca; the result behaves like cheese, and you can use it as the dough. For toppings, tomato and bell pepper sliced thin go on first. Then I add boiled green peas, kidney beans, and lentils. Pecans, walnuts, and cashews go on top as garnish."

 

Zoe "Wow, that sounds delicious — and the nutrition must be outstanding."

 

Dr. Lee "Thank you, Emily, for sharing that valuable recipe. As Emily shows, anyone with a little interest in cooking and love for their family can develop varied ketogenic dishes without much difficulty. Another example: at family events when you'd serve cold noodle soup, grind various nuts and use them as a topping — that, too, is a fine ketogenic dish. Roasting, boiling, grinding, mashing — these different methods give you different textures. Adding tapioca starch to cashews, like Emily, transforms texture, too. To me, one of the greatest expressions of love for family is cooking them delicious meals. And in the lessons ahead, please feel free to raise questions whenever you have them."

 

Everyone "Yes!"

 

They answer brightly with smiling faces and bright eyes.

A Korean Case: A Plant-Based Ketogenic Diet Improving Autism

A Korean Case: A Plant-Based Ketogenic Diet Improving Autism

Dr. Lee "Today is our first session on disease healing through the ketogenic diet. I'd like to begin with autism — partly because Zoe shared that her close friend's child has it. As it happens, I've also had personal experience with the diet's effects on autism in a child. There was a parent who tried a plant-based ketogenic diet for one month. After hearing my lecture, she experimentally provided plant-based ketogenic meals to a 10-year-old girl. Autism is about three times more common in boys than girls, and at age 10 it's considered hard to improve. But after starting the diet, the 10-year-old slowly began making eye contact and responding when her parents spoke to her.

For example, while putting her pants on her the mother muttered to herself, 'It would be nice if you could fasten your buttons,' and the child suddenly started fastening them on her own. Another time the father took her to an amusement park. The girl had always insisted on the same route. After the diet, she went on a different route. The father, in good spirits, said aloud to himself, 'Let's come again next time,' and the child suddenly asked, 'Daddy, are you not going to work?' Startled, the father answered, 'Ah, when Daddy's not working — on a holiday — let's come.'

The mother sent me a brief one-month diary. I found it deeply moving and asked permission to share it on YouTube under a pseudonym for the child, for the benefit of others. She agreed and I posted it."

 

Susan "Thank you, Doctor. I hope many people get to share this kind of good information."

 

Zoe "Yes, today's session feels especially important to me — I want to share what I learn with my friend."

 

Dr. Lee "Good. To give such information real credibility when we share it, though, we need trustworthy sources. So from now on I'd like to begin each session with the titles of the relevant reference papers."

 

Everyone "Yes — sounds great!"

 

Dr. Lee "Today we'll center on research reports about ketogenic-diet effects on autism. First, a note on ketone bodies themselves: structurally they are both water-soluble (they dissolve well in water) and lipid-soluble (they cross lipid barriers easily). These twin properties not only smooth blood flow but also let ketones cross the brain's lipid barrier easily, supplying nutrients to cells throughout the body. As a result, the ketogenic diet shows improvement effects not only in cancer treatment but also in dementia, autism, depression, epilepsy, ADHD, and more. The diet's beneficial effects on the neuropsychiatric system involve not only the properties of ketone bodies themselves but also the promotion of inhibitory neurotransmitter generation — particularly GABA."

 

"Application of a Ketogenic Diet in Children with Autistic Behavior"

"Application of a Ketogenic Diet in Children with Autistic Behavior"

 

Dr. Lee "The first study I'll introduce examined the effect of the ketogenic diet in autistic children. The English title is 'Application of a Ketogenic Diet in Children with Autistic Behavior: Pilot Study' (Evangeliou et al., 2003). The study was conducted between 1999 and 2000 in the pediatric department of the University of Heraklion Hospital, recruiting 30 children aged 4 to 10 — 16 boys and 14 girls. Before the trial, all of the children were on haloperidol, a medication used for autism-spectrum disorder. Haloperidol is used to reduce aggression, hyperactivity, self-injury, and attention deficit. It is a neuroleptic also used in schizophrenia, with possible movement-disorder side-effects."

 

Dr. Lee "The first 4 weeks were on the ketogenic diet, followed by 2 weeks of free eating. Most ketogenic-diet studies use animal-based ingredients, which causes high mid-study dropout. In this study as well, of the 30 starters, only 18 remained at the end. I expect future plant-based ketogenic studies will have higher retention."

 

Pediatric ketogenic menu composition (Evangeliou et al., 2003)

Component	Ratio	Note
Medium-chain triglyceride (MCT) oil	30%	fat — readily ketogenic
Fresh cream	30%	fat
Saturated fat	11%	fat
Carbohydrate	19%	non-fat
Protein	10%	non-fat
Ketogenic ratio	71 : 29 ≈ 2.4	fat ÷ (carb + protein)

 

Dr. Lee "The pediatric ketogenic menu was matched to age-appropriate calories, comprising 30% medium-chain triglyceride (MCT) oil, 30% fresh cream, 11% saturated fat, 19% carbohydrate, and 10% protein. Computed as a ketogenic ratio — fat 71 divided by carbohydrate plus protein 29 — that's about 2.4. The dietary..."

 

The dietary trial ran for 6 months, with the autism scale measured before and after. Pediatric psychiatrists assessed autism severity before and after the diet using a validated children's autism scale. On that scale, scores of 30–36 indicate moderate autism and 37+ indicates severe."

 

Dr. Lee "Final results: 2 children showed substantial improvement in autism symptoms, 8 showed moderate improvement, and 8 showed mild improvement."

 

CARS — Childhood Autism Rating Scale (15 items)

No.	Item
1	Impaired interpersonal relationships
2	Imitation (degree of imitating)
3	Inappropriate emotion (timing of laughter or crying)
4	Bizarre body movements; stereotyped behavior
5	Unusual relationship with objects
6	Resistance to environmental change
7	Atypical visual response (e.g., avoidance of eye contact)
8	Atypical auditory response
9	Putting objects in mouth, licking, sniffing, rubbing
10	Stress response
11	Verbal communication (echolalia, pronoun reversal)
12	Non-verbal communication (gestures, response)
13	Activity level (apathy or hyperactivity)
14	Mental functioning (cognitive heterogeneity)
15	General impression (overall ranking)

Scoring: Normal = 1, Mild = 2, Moderate = 3, Severe = 4.

 

Figure 5-3. Study flow and outcomes of the ketogenic-diet trial in autistic children.

 

Zoe "Doctor — 18 out of 18 showing some effect feels almost certain to be real, even allowing for the 5 who discontinued mid-study. The 5 who dropped out probably also saw some symptom improvement."

 

Grace "Remarkable. In the U.S., autism is treated mostly with medication, and the side-effects can be a real dilemma. And the medications tend to mitigate symptoms rather than improve autism itself."

 

Dr. Lee "Yes. It's worth trying the ketogenic diet alongside one's regular treatments. Since it's an everyday food regimen, there are no side-effects. Using plant ingredients allows a wide variety of dishes — anyone with even a little culinary skill can adapt to personal taste. And you can find recipes easily online these days. Let me give you the title of the second study I'll introduce."

 

 

Medium-Chain Fatty Acids Travel Directly to the Liver via Capillaries and the Portal Vein

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"A Modified Ketogenic Gluten-Free Diet with MCT Improves Behavior in Children with Autism Spectrum Disorder"

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"A Ketogenic Diet and the Treatment of Autism Spectrum Disorder"

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Stable Brain Function Depends on the Orbitofrontal Cortex (the "Personality" Region) and on GABA, the Inhibitory Neurotransmitter

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