The ketogenic diet (or keto diet) and cannabis can both individually have profound effects on the human body, but do these two popular lifestyle choices share more in common than meets the eye? Not only is it possible, but it’s reasonable to assume that the ketogenic diet and the effects of cannabis are related, as they both affect the endocannabinoid system. 1 2
The endocannabinoid system is a master regulatory system found in most animals on earth. The system serves a homeostatic role, helping creatures adjust to the dynamic life on earth. It is responsible for numerous body functions, and it produces its effects through something known as lipid signaling. In other words, the ECS is fueled by the fats we eat and those we have stored in our bodies.
A ketogenic diet is a dietary approach where the vast majority of what you eat is fat. The lack of carbohydrates in the diet leads to the breakdown of fats for energy and the production of ketones in lieu of sugars, hence the name ketogenic. The keto diet requires stringent carbohydrate avoidance, with carbs making up only about 5% of total daily calories. Protein will make up about 20% of total calories, and the rest of the calories come from dietary fats. 3
Can keto affect the way cannabis works?
More than likely, the effects of cannabinoids like CBD and THC are altered during the ketogenic diet, but unfortunately there has been very little research on this topic. Of the limited research, one study on mice suggests that a ketogenic diet alters the endocannabinoid system within the intestines. It found that CB1 and CB2 receptors were actually upregulated within the gut. In other words, while on a ketogenic diet, the rat intestines greatly increased the responsiveness of the ECS and the overall number of CB receptors. This would hypothetically correlate with the altered effects of cannabinoids like THC and CBD, but the study did not look at that.
We do not currently understand how the ketogenic diet affects the endocannabinoid system, or how it impacts the effectiveness of cannabis products. Anecdotally, the 32,000 members of the subreddit r/ketotrees feel keto and cannabis are a match made in heaven and many have achieved great success using the combination, but the science is still playing catch up.
Another potential situation where keto may come in handy for the average weed smoker is during a tolerance break or during drug test preparation. Since cannabinoids and their metabolites are stored primarily in fat cells, shifting the body into ketosis and burning those fats would more rapidly mobilize THC metabolites, thus may hasten time until a clean urine screen or potentially decrease the amount of time it takes to reduce tolerance on a “t-break.” And while it may be worth a shot if you’re feeling like you may not pass, it is unlikely to be the secret to passing drug tests, or the special sauce that makes tolerance breaks.
What is clear is that high fat, keto diets have an impact on the overall fat profile of the dieter, and there is good reason to believe that the keto diet has substantial impacts on the endocannabinoid system. As per usual, more data is needed.
The keto-canna connection: what do keto and cannabis have in common?
One of the most interesting aspects of the keto-canna connection is the overlap in conditions that may benefit from either cannabinoids, the ketogenic diet or both. Epilepsy is the most obvious example, where the ketogenic diet has been applied for 100 years, cannabis has long been treated as is now also an FDA-approved treatment for a number of seizure disorders.
Other diseases that may benefit from both keto include neurodegenerative diseases like Parkinsons or Alzheimers. The benefits of keto may be mostly from reducing oxidative stress, a function some cannabinoids also have. Some benefits of keto may have to do with a connection between the ketogenic diet and the gut microbiome, and cannabis has been shown to interact with this complex system of microorganisms. 4 5 6 7 8
What to know if you’re going to mix keto and cannabis
As part of the keto diet, you must adhere to strict carbohydrate restrictions. To anyone who has ever had the munchies, this may seem like an impossible feat. But while on the keto diet there can be no diving into the chips or crackers, as these foods are rich in carbohydrates and will kick your body out of ketosis. Is that a problem? Yes and no. You can certainly get back into ketosis, but switching can be tiresome, and kicking yourself out of ketosis puts you at risk of experiencing symptoms of the keto flu.
However, just because you’re restricted in what you can eat, doesn’t mean you’re restricted in how much you can eat. Feel free to dive into whatever low carb treats you may have around, as the keto diet is more about carb restriction less about calorie restriction. There are numerous keto-friendly salty snacks that can come in handy, but chicharrones (known as pork rinds) are one of the snackiest we could think of. There are plenty of other treats to hit the spot including salty snacks like pickles or olives, or sweet ones like homemade fat bombs.
Another major consideration for the keto-diet is the makeup of your cannabis edibles. Most edibles contain a lot of sugar, be it a baked good, candy, gummy, or drink, so be sure to check the labeling to ensure the edible has minimal carbohydrates. On the other hand, most cannabis oils (sometimes called tinctures) are sugar-free and should be compatible with the ketogenic diet.
One perk of eating a fatty keto-friendly snack with your cannabis is better absorption of the cannabinoids. Cannabinoids are fat-loving molecules, so when you take them orally alongside other fats, they are even better absorbed. So while you can’t nibble on gummies, rest assured that edibles are very much still on the table; just hold the sugar.
To help boost your endocannabinoid system while on keto is to incorporate omega-3 fatty acids. Your ECS is heavily influenced by the fats you consume, so if you’re on keto ensure that you are getting omega-3 rich foods to support your ECS. Some examples of omega-3 rich foods include avocados, walnuts and macadamia nuts, salmon, hemp hearts, or chia seeds.
Hydration is critical to feeling normal on keto. Keeping hydrated and replacing electrolytes is key to avoiding the keto flu. Beyond that, getting adequate hydration can be harder when carbs are off the table, as many common drinks contain sugar.
We will need to wait for more data before we can make broad assessments about how the keto diet and cannabis overlap, but it’s clear that our diet influences the way our body uses fats. Since fats are the precursor molecules to endocannabinoids, the ketogenic diet, the endocannabinoid system, and the effects of cannabis are intrinsically linked.
Pros and cons of the keto diet
- Weight loss. The ketogenic diet has become extremely popular over the past few years, likely because of its ability to jump start weight loss. During the early phases of initiating a keto diet, there is a significant diuresis (loss of water). This water weight is lost rapidly in the beginning of a keto diet, with some individuals reporting over 10lbs in the first couple of weeks. This sort of jumpstart can be a serious motivator for anyone who is trying to lose weight.
- Seizures. Perhaps the best known effect of the keto diet is its ability to help reduce seizures in epileptic patients. It has been used since the 1920’s for treating refractory epilepsy and is still employed regularly today. The mechanism of how the keto diet reduced seizures remains unclear, but alterations to some aspects of the endocannabinoid system have been observed during a ketogenic diet. It’s possible, especially in the context of how the keto diet reduces seizures, that the ECS is highly involved in the antiepileptic effects but we cannot yet discern how. 9 10
- Other conditions. Aside from the above, there are numerous other conditions that keto may be beneficial for, and the underlying mechanisms remain unclear. Type II diabetes, also called insulin resistance, can be greatly improved by implementing a low-carb, ketogenic diet. The cardiovascular risk may also be reduced by the keto diet thanks to the reduction in other risk factors like body weight, inflammation, and cholesterol levels, but more studies are needed to know definitely. Other diseases that may be treated with keto include polycystic ovarian syndrome, certain types of cancer, certain neurological conditions, inflammatory conditions, and even acne. 11 12 13 14
- Keto flu. The most common complaint with going keto is something called the keto flu. This nausea, malaise, brain fog and overall feeling of being unwell (think of the regular flu) is present during the fat adaption stage of keto. It is likely due to hydration, as switching from a high-carb diet to a ketogenic diet can cause a serious loss of water and electrolytes, which can be managed with mindful hydration and salt replacement. Once the body adjusts to using fats as its primary mode of fuel, which can take from days to months, the keto flu is no longer an issue. Though there is no scientific data looking at this, anecdotally some keto-dieters may actually be able to keep keto-flu symptoms at bay by leveraging cannabis’ well established role at combating flu-like symptoms including nausea and headache. 15 16
- Long-term effects. One of the biggest concerns about the ketogenic diet stem from concerns about its long term tolerability. Not only is it hard to imagine ignoring all of the delicious sweets that surround us every day, there are also concerns about nutrient deficiencies and cholesterol surplus. Getting all of your calories from fat results in an increase in animal protein and fats, which have long been criticized for being unhealthy and high in cholesterol.
- High cholesterol. Some evidence suggests keto diet may increase bad cholesterol (LDL) levels. Despite these concerns, scientific reviews of the topic have suggested that cholesterol and triglycerides profiles of overweight individuals may actually improve on the ketogenic diet. Also, since most fruits and even some vegetables are off limits on the keto diet, fears about nutritional shortcomings are common. These are possible and concerns may be somewhat warranted, especially if the keto diet is not well rounded and nutritious. 17 18
- Gigante I, Tutino V, Russo F, et al. Cannabinoid Receptors Overexpression in a Rat Model of Irritable Bowel Syndrome (IBS) after Treatment with a Ketogenic Diet. Int J Mol Sci. 2021;22(6):2880. Published 2021 Mar 12. doi:10.3390/ijms22062880
- Alger BE. Getting high on the endocannabinoid system. Cerebrum. 2013;2013:14. Published 2013 Nov
- Batch JT, Lamsal SP, Adkins M, Sultan S, Ramirez MN. Advantages and Disadvantages of the Ketogenic Diet: A Review Article. Cureus. 2020;12(8):e9639. Published 2020 Aug 10. doi:10.7759/cureus.9639
- Rusek M, Pluta R, Ułamek-Kozioł M, Czuczwar SJ. Ketogenic Diet in Alzheimer’s Disease. Int J Mol Sci. 2019;20(16):3892. Published 2019 Aug 9. doi:10.3390/ijms20163892
- Phillips MCL, Murtagh DKJ, Gilbertson LJ, Asztely FJS, Lynch CDP. Low-fat versus ketogenic diet in Parkinson’s disease: A pilot randomized controlled trial [published correction appears in Mov Disord. 2019 Jan;34(1):157]. Mov Disord. 2018;33(8):1306-1314. doi:10.1002/mds.27390
- Cassano T, Villani R, Pace L, et al. From Cannabis sativa to Cannabidiol: Promising Therapeutic Candidate for the Treatment of Neurodegenerative Diseases. Front Pharmacol. 2020;11:124. Published 2020 Mar 6. doi:10.3389/fphar.2020.00124
- Beam A, Clinger E, Hao L. Effect of Diet and Dietary Components on the Composition of the Gut Microbiota. Nutrients. 2021;13(8):2795. Published 2021 Aug 15. doi:10.3390/nu13082795
- Karoly HC, Mueller RL, Bidwell LC, Hutchison KE. Cannabinoids and the Microbiota-Gut-Brain Axis: Emerging Effects of Cannabidiol and Potential Applications to Alcohol Use Disorders. Alcohol Clin Exp Res. 2020;44(2):340-353. doi:10.1111/acer.14256
- D’Andrea Meira I, Romão TT, Pires do Prado HJ, Krüger LT, Pires MEP, da Conceição PO. Ketogenic Diet and Epilepsy: What We Know So Far. Front Neurosci. 2019;13:5. Published 2019 Jan 29. doi:10.3389/fnins.2019.00005
- Hansen SL, Nielsen AH, Knudsen KE, et al. Ketogenic diet is antiepileptogenic in pentylenetetrazole kindled mice and decrease levels of N-acylethanolamines in hippocampus. Neurochem Int. 2009;54(3-4):199-204. doi:10.1016/j.neuint.2008.10.012
- Boison D. New insights into the mechanisms of the ketogenic diet. Curr Opin Neurol. 2017;30(2):187-192. doi:10.1097/WCO.0000000000000432
- Dashti HM, Mathew TC, Al-Zaid NS. Efficacy of Low-Carbohydrate Ketogenic Diet in the Treatment of Type 2 Diabetes. Med Princ Pract. 2021;30(3):223-235. doi:10.1159/000512142
- Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets [published correction appears in Eur J Clin Nutr. 2014 May;68(5):641]. Eur J Clin Nutr. 2013;67(8):789-796. doi:10.1038/ejcn.2013.116
- Kosinski C, Jornayvaz FR. Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies. Nutrients. 2017;9(5):517. Published 2017 May 19. doi:10.3390/nu9050517
- Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011;163(7):1411-1422. doi:10.1111/j.1476-5381.2010.01176.x
- Poudel S, Quinonez J, Choudhari J, et al. (August 24, 2021) Medical Cannabis, Headaches, and Migraines: A Review of the Current Literature. Cureus 13(8): e17407. doi:10.7759/cureus.17407
- Kwiterovich, Jr PO, Vining EPG, Pyzik P, Skolasky, Jr R, Freeman JM. Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children. JAMA. 2003;290(7):912–920. doi:10.1001/jama.290.7.912
- Choi YJ, Jeon S-M, Shin S. Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020; 12(7):2005. https://doi.org/10.3390/nu12072005
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