A client of mine asked for details of a ketogenic diet. Personally I don’t subscribe to the idea of taking lots of fat while trying to lose fat supposedly. I figured it portends more harm than good for the patient; especially in Nigeria where unsaturated fats sources (which are most ideal for a ketogenic diet) are not really available and expensive when found. So I decided to get comprehensive components, advantages and disadvantages of the diet, so let us talk about it shall we? This is quite comprehensive so kindly forgive it’s lengthy nature.
A ketogenic diet (keto) is basically a low-carb diet, which turns the body into a fat-burner. It is similar to other strict low-carb diets, like the Atkins diet or LCHF (low carb, high fat). These diets often end up being ketogenic more or less by accident. The main difference between strict LCHF and keto is that protein is restricted in the latter. A keto diet is designed specifically to result in ketosis.
What is Ketosis?
The “keto” in a ketogenic diet comes from the fact that it makes the body produce small fuel molecules called “ketones”
This is an alternative fuel for the body, used when blood sugar (glucose) is in short supply.
Ketones are produced if you eat very few carbs (that are quickly broken down into blood sugar) and only moderate amounts of protein (excess protein can also be converted to glucose). Ketones are produced in the liver, from fat. They are then used as fuel throughout the body, including the brain. The brain is a hungry organ that consumes lots of energy every day and it can’t run on fat directly. It can only run on glucose or ketones.
On a ketogenic diet the entire body switches its fuel supply to run almost entirely on fat. Insulin levels become very low and fat burning increases drastically. It becomes easy to access fat stores to burn them off. This is obviously great if the aim is to lose weight, but there are also other less obvious benefits, like less hunger and a steady supply of energy. Therefore when the body produces ketones it’s said to be in ketosis. The fastest way to get there is by fasting – not eating anything – but obviously it’s not possible to fast forever.
A ketogenic diet is one that forces your body to go into ketogenic state. It has many of the benefits of fasting – including weight loss – without having to fast.
There are several versions of the ketogenic diet, including:
Standard ketogenic diet (SKD):
This is a very low-carb, moderate-protein and high-fat diet. It usually contains 75% fat, 20% protein and only 5% carbs.
Cyclical ketogenic diet (CKD):
This diet involves periods of higher-carb refeeds, such as 5 ketogenic days followed by 2 high-carb days.
Targeted ketogenic diet (TKD):
This diet allows you to add carbohydrates around workouts periods only.
High-protein ketogenic diet:
This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein and 5% carbs.
How to Achieve Ketosis
There are many things that increase levels of ketones and ketosis. Here they are, from most to least important:
Restrict carbohydrates to 20 digestible grams per day or less – a strict low-carb diet. Fiber does not have to be restricted, it is beneficial to reduce glycemic index and increase satiety.
Restrict protein to moderate levels. If possible stay at or below 1 gram of protein per day per kg of body weight. So about 70 grams of protein per day if you weigh 70 kg (154 pounds). It might be beneficial to lower protein intake even more, especially when you’re overweight, and then aim for 1 gram of protein per kg of desired weight. The most common mistake that stops people from reaching optimal ketosis is too much protein.
Eat enough fat to feel satisfied. This is the big difference between a ketogenic diet and starvation, that also results in ketosis. A ketogenic diet is sustainable, starvation is not.
Avoid snacking when not hungry. Unnecessary snacking slows weight loss and reduces ketosis.
If necessary add intermittent fasting. This is very effective at boosting ketone levels, as well as accelerating weight loss and type 2 diabetes reversal.
The Benefits of a Ketogenic Diet
The benefits that accompany a ketogenic diet are similar to those of any strict low-carb diet. However, the effect might be even greater since protein is more restricted. This raises ketones more, and lowers insulin (the fat-storing hormone) more.
Turning your body into a fat-burning machine has obvious benefits for weight loss. Fat burning is vastly increased while insulin – the fat storing hormone – levels drop greatly. This creates ideal circumstances in which fat loss can occur, without hunger. Around 20 scientific studies of the highest class (RCTs) show that, compared to other diets, low-carbohydratee and ketogenic diets result in more effective weight loss.
Diabetes type 2 reversal:
A ketogenic diet is excellent for reversing type 2 diabetes, since it lowers blood sugar levels and the negative impact of high insulin levels.
Improved mental focus:
Ketosis results in a steady flow of fuel (ketones) to the brain. A ketogenic diet prevents sharp fluctuations in blood glucose. This often results in the experience of increased focus and improved concentration. A lot of people specifically use keto diets specifically for increased mental performance.
Interestingly, there’s a common misperception that eating lots of carbohydrates is needed for proper brain function. But this is only true when ketones are not available. After a few days (up to a week) of keto-adaptation – during which people may experience some difficulty concentrating, have headaches and become easily irritated – the body and brain can run effortlessly on ketones. In this state many people experience more energy and improved mental focus.
Increased Physical Endurance:
Ketogenic diets can vastly increase physical endurance, by giving constant access to all the energy of fat stores. The body’s supply of stored carbohydrates (glycogen) only lasts for a couple of hours of intense exercise, or less. But your fat stores carry enough energy to easily last for weeks or even months.
When you’re adapted to burning primarily carbohydrates – like most people are today – fat stores are not easily available, and they can’t fuel the brain. This results in constantly having to fill up by eating before, during and after longer exercise sessions. Or even just to fuel daily activities and avoid “hanger” (hungry and irritable states). On a ketogenic diet this problem is solved. As the body and brain can easily be fueled 24/7 by your powerful and abundant fat stores, you can keep going forever like the Energizer Bunny (lol, I kid). Whether you are competing in a physical endurance event, or just trying to stay focused on reaching some other goal, your body has the fuel it needs to keep you going and going even without a carbohydrate fill up.
So how is it possible that most people believe that carbs are necessary to perform exercise? There are two reasons. To unlock the power of ketogenic diets for physical endurance, and not instead suffer reduced performance, you need:
*Enough fluid and salt (minerals and vitamins) for fluid and electrolyte replacement;
*Two weeks of adaptation to burning fat – it does not happen instantly.
There are many studies showing that low-carb diets improve markers of metabolic syndrome such as blood lipids, insulin levels, HDL-cholesterol, LDL particle size and fasting blood sugar levels. Improvements have been shown to be even greater when carbohydrates and protein are restricted to the point of being steadily in nutritional ketosis.
The ketogenic diet is a proven medical therapy for epilepsy that has been used since the 1920s. Traditionally it has mainly been used in children with uncontrolled epilepsy despite medication. More recently it has also been tested successfully by adults with epilepsy, with similar good results. There are many randomized controlled trials that demonstrate the effectiveness of the ketogenic diet in decreasing seizures in patients with epilepsy.
Using a ketogenic diet in epilepsy is that usually allows people to take less anti-epileptic drugs, while remaining seizure-free. It’s not unusual to even be able to completely stop taking these drugs while staying seizure-free. As all anti-seizure medications have side effects – like drowsiness, reduced concentration, personality changes or even reduced IQ – being able to take less or no drugs can be hugely beneficial.
Myelin sheathes which are the connecting points of neurons are made up primarily of fats. This may explain why a high fat diet would cause a positive improvement on a neurological disorder.
Other benefits of the ketogenic diet includes:
Many people experience a marked reduction in hunger. This may possibly be caused by an increased ability of the body to be fueled by its fat stores. Many people feel great while eating just once or twice a day, automatically ending up doing a form of intermittent fasting. This saves both time and money, while also speeding up weight loss.
Perhaps after a few days of feeling tired (the “keto flu“) many people experience a clear increase in energy levels. This can also be experienced as clear thinking, a lack of “brain fog” or even as a sense of euphoria.
Protein Sparing Effect:
Ketosis has a protein-sparing effect, assuming that one consumes adequate quantities of protein and calories—0.7 grams per kg of body weight per day—in the first place.Once in ketosis, the body actually prefers ketones to glucose. Since the body has copious quantities of fat, this means there is no need to oxidize protein to generate glucose through gluconeogenesis.
Reduction in Blood Insulin Level:
Another benefit has to do with the low levels of insulin in the body, which causes greater lipolysis and free-glycerol release compared to a normal diet when insulin is around 80-120 mmol/dm. Insulin has a lipolysis-blocking effect, which can inhibit the use of fatty acids as energy. Also, when insulin is brought to low levels, beneficial hormones are released in the body, such as growth hormone and other powerful growth factors.
Another small but very important benefit of the ketogenic diet is that when in the state of ketosis, ketones, along with a high protein intake, seem to suppress appetite. A high-carbohydrate diet, on the other hand, increases hunger levels. Because you have to consume a lot of fat on a ketogenic diet, which hold 9 calories per gram, you are not getting much food volume. It’s not mandatory to be hungry on a reduced-calorie diet.
What About The Anticatabolic Effects Of The Ketogenic Diet?
Every reduced-calorie diet is catabolic, meaning the diet can cause initiate muscle break down. ‘This is largely due to the fact that you are consuming less energy, so your body relies on other tissue (i.e., protein) to serve as an energy source. Added to that, some dieters do copious amounts of aerobic exercise when dieting, which can cause further breakdown of muscle. The brain can also call on protein to create more glucose for energy needs—a process called gluconeogenesis.
Ketosis is different, because, when in the state of ketosis, the brain will prefer ketones over glucose. For the dieter this is good! The body will not have to break down protein for energy. In turn the body will be forced to use its fat reserves, a.k.a. your love handles, for its energy. This is why a low-carb diet is such a good method of dieting.
Where Is The Scientific Data?
Fatty acid production in fat tissue is stimulated by epinephrine and glucagon, and inhibited by insulin. Insulin is one of the hormones the pancreas secretes in the presence of carbohydrates. Insulin’s purpose is to keep blood glucose levels in check by acting like a driver, pushing the glucose into cells. If insulin were not to be secreted, blood glucose levels would get out of control.
Glucagon is on the other side of the spectrum; it is insulin’s antagonistic hormone. Glucagon is also secreted by the pancreas when glucose levels fall too low. This usually happens when a person skips meals, or does not consume adequate amounts of carbohydrates for an extended period of time. When this happens, glucagon is secreted by the pancreas to break down stored glycogen in the liver into a more usable form, glucose.
When the body’s glycogen stores begin to get depleted, rates of beta-oxidation increase, resulting in the mobilization of free fatty acids from fat tissue. This is where the metabolic state of ketosis comes in. During beta-oxidation, ketone bodies are released from the liver—because they cannot be utilized by the liver—and travel to the brain to be used for fuel. The free fatty acids can then be turned into a usable energy substrate.
Potential Side Effects of Ketosis
Can ketones get too high, dangerously high? Not under normal circumstances.
For most people it’s quite a challenge to even get to optimal ketosis. Getting into dangerously high ketone levels (more than 8 – 10 mmol/l) is most often simply impossible. The main exception is type 1 diabetes, where the pancreas does not produce enough insulin. In type 1 diabetes, it’s very possible to get dangerously high ketone levels – just by forgetting to take your insulin injection. There are also other situations like breastfeeding and taking type 2 diabetes medications called SGLT-2 inhibitors25 that in rare situations can result in too high ketone levels.
This will result in feeling sick, nauseous and very weak. It can lead to a life-threatening condition called ketoacidosis. There’s a simple treatment if you suspect this may be happening: eat some carbohydrates right away (e.g. a couple of fruits or a sandwich, a soft drink or a glass of juice). If you have type 1 diabetes take more insulin. Then contact emergency medical services if you do not immediately start feeling better.
Dry mouth and Increased thirst:
Unless you drink enough and get enough electrolytes (minerals and vitamins), you may feel a dry mouth. Try a cup of tea or two daily, plus as much water as you need.
Another ketone body, acetoacetate, can end up in the urine. This makes it possible to test for ketosis using urine strips. It also – at least at startup – can result in having to go to the bathroom more often (Polyuria). This is the main cause of the increased thirst (above).
This is due to a ketone body called acetone escaping via our breath. It can make a person’s breath smell “fruity”, or similar to nail polish remover. This smell can sometimes also be perceived from sweat, when working out. It’s often a temporary situation.
The Keto Flu:
While ketosis is normally safe, it is common to experience some time-limited side effects.
People transitioning from sugar-burning to fat-burning mode often initially experience a side effect referred to as the keto flu, since symptoms are similar to those of the flu: fatigue, nausea, headaches, cramps, etc. There are two main therapies that can prevent or alleviate these symptoms:
- Drink water with salt and lemon – alternatively have a daily cup of bouillon.
- Gradually reduce carbohydrate intake – abrupt abstinence results in severity and duration of symptoms. When starting on a ketogenic diet, it is typical to experience both fuid and electrolyte loss. This occurs because carbohydrates retain water and salts in the body, so when you stop eating carbs your body loses this water. If the keto flu is happening due to too little hydration, it might help to drink a glass of salt water with a little bit of squeezed lemon (for taste). When carbohydrates are suddenly removed from the diet, the brain can run slightly low on energy before it learns to use ketone bodies for fuel instead of the usual glucose. This means that if you drastically reduce carbs from one day to another, you may get symptoms of such as tiredness, nausea and headaches. Replacing fluids and electrolytes as described above can alleviate the symptoms. Or by instead gradually lowering carb intake over a period of a week or more, the body gets used to burning fat and ketones instead of glucose and there will usually be no symptoms. If you do not wish to gradually reduce carbs, make sure to get enough fluid and salt (like 1-2 cups of bouillon per day) to minimize symptoms. After a week or so the body is usually adapted to a ketogenic diet.
Blood Lipid Profile:
Blood-lipid profile is also a concern on the ketogenic diet due to the staggering amounts of saturated fats in the diet, although the diet can be centered around healthier unsaturated fats—which isn’t as fun as eating an egg and cheese omelet, fried in butter, with bacon on the side.
This is still under debate though as various people get different results during a ketogenic diet; some people following the ketogenic diet will experience a drop in cholesterol levels, but for some people, cholesterol levels will increase.
In a ketogenic diet regimen, carbohydrates are restricted to less than 50 grams a day, therefore micronutrient deficiencies could occur. Thiamin, folate, calcium, iron, potassium, and magnesium are typically inadequate in low-carb diets because grains which are major source of these micronutrients are restricted. The best thing to do to avoid this is to make sure you take high-quality multivitamin supplements to ensure 100 percent supply of the daily recommended values. Also supplementing with a fiber supplement is a good idea to make sure your plumbing doesn’t get clogged.
Ketoacidosis occurs when the level of ketones in the blood gets out of control, which poses a severe health risk especially for diabetics. When massive quantities of ketones are produced, the pH level of the blood drops, creating a high-acidic environment. Non-diabetics need not fear, as the regulated and controlled production of ketone bodies allows the blood pH to remain within normal limits.
Foods to Avoid:
Any food that is high in carbohydrates should be limited. Here is a list of foods that need to be reduced or eliminated on a ketogenic diet:
- Sugary foods: Soda, fruit juice, smoothies, cake, ice cream, candy, etc.
- Grains or starches: Wheat-based products, rice, pasta, cereal, etc.
- Fruit: All fruit, except small portions of berries like strawberries.
- Beans or legumes: Peas, kidney beans, lentils, chickpeas, etc.
- Root vegetables and tubers: Potatoes, sweet potatoes, carrots, parsnips, etc.
- Some condiments or sauces:Especially those that contain sugar and saturated fat.
- Unhealthy fat: Limit your intake of processed vegetable oils, mayonnaise, etc.
- Alcohol: Due to its high empty calorie content, many alcoholic beverages (if not all) can throw you out of ketosis.
- Sugar-free diet foods: These are often high in synthetic sugars, which can affect ketone levels in some cases. These foods are also usually highly processed.
You should base the majority of your meals around these foods:
- Meat: Red meat, steak, ham, sausage, bacon, chicken and turkey.
- Fatty fish: Such as salmon, trout, tuna and mackerel. These fishes are high in omegaa 3 fatty acids which are quite heart healthy.
- Eggs: Look for pastured or whole eggs.
- Cheese: Unprocessed cheese (cheddar, goat, cream, blue or mozzarella).
- Nuts and seeds: Almonds, cashew nuts, walnuts, flaxseeds, pumpkin seeds, chia seeds, etc.
- Healthy oils: Primarily extra virgin olive oil, coconut oil and avocado oil.
- Avocados: Whole avocados or freshly made guacamole.
- Low-carb veggies: Most green veggies, tomatoes, onions, peppers, etc.
- Many keto activists advise that number to be 30 grams of carbohydrates but most individuals can still maintain ketosis while consuming the 50 grams and this allows for a little more leeway in the diet since you can increase the consumption of vegetables and a variety of flavoring’s that contain a few grams of carbohydrates.
- Condiments: You can use salt, pepper and various healthy herbs and spices.
The Art and Science of Low-Carbohydrate Performance by Stephen Phinney and Jeff Volek.