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What is the Evidence Behind the ‘Palaeolithic Ketogenic Diet’?

The 'paleo-keto' diet, which combines two of the most popular diets is becoming more commonly used, but is the additional restriction necessary? What does the evidence tell us?

The Palaeolithic ketogenic diet is a version of the popular paleo diet. While ‘paleo’ typically involves the removal of processed and unrefined foods, along with grains, legumes, and dairy, typically, tubers and fruit are allowed. In the Palaeolithic ketogenic diet, these obligate carbohydrate foods are removed to bring the diet into line with a ketogenic diet that is higher in fat and very low in carbohydrate. It differs from a standard ketogenic diet in that it disallows dairy, which can be a common allergen, especially for people with autoimmune or inflammatory disorders.

[See Is Dairy Inflammatory?]

Case studies have shown promising results from the paleo-keto approach for Crohn’s disease, Gilbert’s syndrome,1 and childhood epilepsy.2

Case studies have shown promising results for Crohn’s disease, Gilbert’s syndrome, and childhood epilepsy

In one case, the diet resulted in complete remission from symptoms of Crohn’s disease, which was maintained.3

In other cases, insulin function was restored in two patients with type 1 diabetes (a 19 years adult and a child).4, 5 Similarly, a patient with type 2 diabetes was able to normalise high blood pressure and discontinue medications while also reducing triglycerides and blood glucose.6 It should be noted that the improvement in glucose and triglycerides were not meaningful but the patient had also ceased medications that were previously helping to control this.

Insulin function was restored in two patients with type 1 diabetes

The diet has also stabilised disease activity or reduced tumour size in several cancer patients,7 and resulted in the complete cessation of cervical intraepithelial neoplasia (pre-cancer of the cervix) after 26 months on paleo-keto.8 A patient with rectal cancer following paleo-keto improved markers and lab findings for 5 months. Following this (apparently) adherence worsened and surgery was needed at 24 months.9

While the case study evidence is promising, further randomised controlled trials need to be performed to compare this diet to others. The cases appear to indicate that people can achieve additional benefits to either paleo or a keto approach alone by following a ‘paleo-keto’ approach and this is likely to be due to two major factors:

  1. When people following keto eliminate dairy, they may identify an underlying intolerance to dairy proteins
  2. When people following paleo go low-carb, they may achieve benefits of carb-restriction if they are insulin resistant or have a medical condition that benefits from carbohydrate restriction.


While some people will benefit from a paleo-keto approach, the additional restrictions may not be necessary for many. If a paleo approach is working well for you, stick with it! Similarly, if a keto approach (including dairy) is working for you, there is no need to change. And if you’d like to try a paleo-keto approach to see how it feels, there’s nothing wrong with that either.


1.         Tóth C, Clemens Z. Gilbert’s Syndrome Successfully Treated with the Paleolithic Ketogenic Diet. American Journal of Medical Case Reports. 2015;3(4):117-20.

2.         Clemens Z, Kelemen A, Fogarasi A, Tóth C. Childhood Absence Epilepsy Successfully Treated with the Paleolithic Ketogenic Diet. Neurology and Therapy. 2013;2(1):71-6.

3.         Tóth C, Dabóczi A, Howard M, Miller NJ, Clemens Z. Crohn’s disease successfully treated with the paleolithic ketogenic diet. Int J Case Rep Images. 2016;7:570-8.

4.         Tóth C, Clemens Z. Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet. Int J Case Rep Images. 2014;5(10):699-703.

5.         Tóth C, Clemens Z. A child with type 1 diabetes mellitus (T1DM) successfully treated with the Paleolithic ketogenic diet: A 19-month insulin freedom. Int J Case Rep Images. 2015;6(12):752-7.

6.         Tóth C, Clemens Z. Successful treatment of a patient with obesity, type 2 diabetes and hypertension with the paleolithic ketogenic diet. Int J Case Rep Images. 2015;6(3):161-7.

7.         Clemens Z, Dabóczi A, Low CTIPH. Paleolithic ketogenic diet (PKD) as a stand-alone therapy in cancer: Case studies. Therapy. 2016;1:4.

8.         Tóth C, Schimmer ZCM, Clemens Z. Complete cessation of recurrent cervical intraepithelial neoplasia (CIN) by the paleolithic ketogenic diet: a case report. J Cancer Res Treat. 2018;6:1-5.

9.         Tóth C, Clemens Z. Treatment of rectal cancer with the paleolithic ketogenic diet: a 24-months follow-up. Am J Med Case Reports. 2017;5(8):205-16.

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