The Ketogenic Diet

Backstory: Back in 2017, I followed a ketogenic diet for about a year. I lost a fair amount of weight and improved my overall health and mood significantly. I presented on this topic at work through our wellness program and received very positive feedback. One coworker emailed me and told me that she and husband were using the diet and were having good success with their weight loss goals. Another coworker reached out to me and asked for meal planning advice. I’ve been wanting to write about this type of diet for awhile now, so I have tried to condense what I know into a single article presented here:

Image Credit: Boston Magazine

What is a Ketogenic Diet?

A ketogenic diet is an eating strategy that restricts carbohydrates to the point of putting the body into a state known as “ketosis”. In this state, the body is burning fat for fuel instead of carbohydrates. The liver converts fats (from our body or the food we eat) into fatty acids and ketone bodies that are used by the cells for energy. The production of ketone bodies is the hallmark signature of a ketogenic diet and is usually achieved with a daily carbohydrate consumption of less than 50 grams, or 200 Calories.

Ketosis is simply an alternative energy system we all have access to but rarely find ourselves in because of the abundant availability of carbs in our modern environment. Some of our nomadic ancestors, however, used this “energy system” quite frequently, walking many miles each day in a fasted state in search of food. Along with carbohydrate restriction, other factors that encourage ketosis include calorie deficits, prolonged exercise and fasting. A typically ketogenic diet from a macronutrient viewpoint looks something like this:

Carbohydrates: 5-15% of calories

Fats: 55-80% of calories

Proteins: 15-25% of calories.

Note: The ketogenic diet is not a high protein diet. High levels of protein in the diet will convert to sugar in the body and kick you out of ketosis. A high protein diet can also be hard on the kidneys.

Why Use a Ketogenic Diet?

There are many reasons to consider using a ketogenic diet. It was originally used as a treatment for epilepsy. In those with epilepsy the number of seizures they experience is often drastically reduced, sometimes eliminated altogether.

Many people who try the diet often find weight loss easy and rapid. There is some debate as to why this is but one thing I noticed is that my appetite was greatly reduced when on this diet.

The ketogenic diet has many therapeutic roles and it is highly effective at lowering inflammation in the body and getting control over blood sugar levels. It is also great for lowering fatty acid levels in the blood – a risk factor for many diseases. This may seem counterintuitive since the ketogenic diet is high in fat, but when you are using fat for fuel, the fatty acids in the blood are easily shuttled into the cells and burnt for fuel. The diet is highly effective at reversing metabolic syndrome and correcting Type II diabetes.

The ketogenic diet can provide athletic performance benefits. This is especially true for lower intensity exercises like marathon running. A key benefit of exercising in a ketogenic state is that you no longer hit “the wall” and nutrient timing before and during races is much less critical since you are burning your body fat; of which you have tens-of-thousands of Calories in reserve at any time. In contrast, athletes burning glycogen (stored carbohydrates) for fuel only have about 2,000 Calories in reserve and once they are used up, the athlete “bonks” or “hits the wall” and must consume food. The 100 mile world record is held by runner, Zach Bitter, a ketogenic athlete. (Link)

What to Eat

Eat lots of healthy fats, moderate amounts of high quality proteins and intelligently consume small amounts of carbohydrates. Of the three major fat types, eat mainly monounsaturated and saturated fats. Only eat small amounts of polyunsaturated fats, perhaps no more than 10-15% of fat calories, from things like salmon or flax oil. This shouldn’t be too challenging because most food high in “polys” are artificial or processed sources like common soybean oil. Eat a moderate amount of protein – the ketogenic diet is not a high protein diet. A high protein intake will convert to sugars in the body and can kick you out of ketosis. Aim for 20-25% protein.

Some examples of foods that are okay to eat are:

• Low carb vegetables
• Avocados and avocado oil
• Coconut oil
• Butter, from grass-fed, pasture-raised cows
• Leafy greens, like kale – preferably organic
• Some lower-carb fruits, like blueberries
• Olives
• Tomatoes
• Lemons
• Onions
• Garlic
• Peppers
• Purple cabbage
• Mushrooms
• Fatty cuts of meat, like ribeye from grass-fed cows
• Nitrate-free bacon
• Bacon grease left over from cooking bacon
• Eggs, from free-range chickens
• Nuts and seeds – preferable soaked and sprouted
• Olive oil
• Cheese, from grass-fed cows
• Cream and sour cream, from grass-fed cows
• Organ-meats like liver and heart
• Wild caught fish and seafood, like salmon
• Coffee, organic
• Tea

Whatever you decide to eat, it helps to keep track of carbs throughout the day and try to stick to less than 50 grams.

What Not to Eat

Obviously, you won’t be eating a lot of carbs.

Don’t eat:

• Grains
• Pasta
• Bread
• Crackers
• Oatmeal
• Rice
• Potatoes
• Beans
• Chips
• Cookies
• Cakes
• Ice Cream
• High carb fruits like bananas. (Although you should try to include them once in awhile while keeping your total carbs for the day in check or if you decide to have “cheat days.”)

There are some fats you’ll want to make sure to avoid:

• Artificial trans fats, e.g. partially hydrogenated oils
• Refined, processed vegetable oils like soybean oil, corn oil, canola oil, etc. The fats in these oils are damaged during high-temperature processing which makes them inflammatory in the body. Many of them are very high in polyunsaturated fats, which are inflammatory when consumed in large amounts
• Margarine, because it’s made with processed vegetable oils
• Vegetable shortening, because it’s made with processed vegetable oil
• Packaged snacks, which often contain soybean oil
• Damaged fats – these would be fried foods or some fats cooked at high temperatures. For example, polyunsaturated oils should not be used to cook with because heat easily damages them. Saturated fats, like coconut oil or butter, and monounsaturated fats, like avocado oil, are best for cooking at higher temperatures since they are more stable and have higher smoke points.

Are there Any Concerns with the Ketogenic Diet?

Electrolytes

The ketogenic diet results in an increase of electrolyte loss in the body. This is corrected by increasing your consumption of electrolytes, like sodium, potassium, magnesium, etc. Learn about electrolytes and how to replenish them and maintain healthy levels. Don’t consume refined table salt (the white salt you see at restaurants and possibly your kitchen cabinet). Consume an unrefined salt that contains trace minerals, like Himalayan sea salt. You might also consider high-quality supplements.

Keto Flu

When entering ketosis, some people may get what is called the “keto flu” in the first 2 weeks. This is partly a result of asking your body to use an energy system it has never relied on before. It takes time to adapt. It will pass.

How long should I stay on the ketogenic diet?

If it’s working for you, you may consider using it until you reach your goals (e.g. weight loss, etc.) and then transition into a low carb, high fat diet that is not ketogenic. Some people find it challenging to maintain it long-term for one reason or another. Sometimes they don’t maintain their electrolytes, or they consume too many of the bad fats or too much protein, or perhaps their body just works better on a higher level of carbs. I used the ketogenic diet for approximately a year then transitioned back and forth between ketosis and a low carb, higher fat diet. While the ketogenic diet has been proven to be safe and effective in the short term, there aren’t a lot of studies looking at long term outcomes. For that reason, I recommend using the ketogenic diet for no more than 3-6 months and if you want to go longer than that, proceed with medical supervision and get regular check ups and blood tests to ensure your eating style continues to promote good health.

Should I be concerned with eating higher levels of fats, especially saturated fat? 

No, and here’s why: Persistently high levels of fat in the blood stream are not a good thing, but the ketogenic diet is actually one of the most effective ways to lower blood lipid levels. The reason for this is because without carbs to burn, your cells will efficiently pull fat from the blood stream and use it as fuel. Furthermore, most of the concerns about saturated fat, like it’s alleged role in heart disease, have turned out to be false since newer studies have replaced outdated science (and unfortunately in some cases, outright lies were told by the food industry to shift blame away from the true culprits of many chronic illnesses: trans fats, added sugars, heavily-processed foods and many refined vegetable oils.) In the 21st century, we are learning that saturated fat is no longer the boogyman we thought it was. If you are still not convinced, consider human breast milk: Half of the calories in breast milk are fat and of those fats, half of them are saturated. Do you really think mother nature would allow a mother to nourish her baby with food consisting of 25% “toxin”?

Moving Forward

The ketogenic diet allows the body to access an energy system that offers many unique benefits. It is a state that many of our ancestors found themselves in quite often: going without food for periods of time (or not having access to abundant carbs) triggers a ketogenic state in the body. Our ancestors weren’t fortunate enough to have a grocery store down the street. Due to the abundant availability of carbs in our society, it is an energy system some people will never use unless they deliberately try to. If you struggle with health issues or are looking to increase athletic performance, the ketogenic diet is worth looking into.

If you decide to give the ketogenic diet a try, I would love to hear about your experience.