I love the ketogenic diet. I use this myself to help control my blood sugar, and find that it can be extremely helpful for a range of medical conditions. For the right patient, using this diet can be life changing. I have several patients who have struggled with weight their entire life find that the ketogenic det was the first diet where they realized steady weight loss that stayed off. Others have been able to suppress seizures and reduce their need for seizure medication. Still others love the convenience of staying energetic for long periods of time, and find that they think better and are more productive when they use this diet.
Your body’s cells can use two types of energy to function: sugar in the form of glucose and fat in the form of molecules called ketones. (Amino acids from protein can’t be directly used as fuel, but instead are converted to sugar to be burned for energy). In the ketogenic diet you will be eating in a way that causes your body to switch from primarily burning sugar for energy to burning fat, a metabolic state called ketosis. A ketogenic state mimics how your body utilizes fat for energy when you are fasting. You are in ketosis when a specific ketone, beta-hydroxybutyrate (BHB), rises above 0.5. The diet is used medically to help reverse diabetes, treat seizures, improve cognition, promote weight loss and even treat cancer.
What do I eat?
You’ll eat a high fat, moderate protein, low carb diet. To do this you drop your carbs to a very low level, eating a moderate amount of protein, then focusing on adding lots of calories from fat to meet your energy needs. Around 70% of your calories will come from fats, 20% from protein and 10% from carbs.
When you eat in this way, the glucose in your bloodstream slowly drops. At the same time, ketones increase to meet the energy needs of your body. Unfortunately, if you eat above a certain threshold of carbs, your body will quickly revert to burning sugar and your ketones will drop.The threshold varies from person to person so plan to do some experimentation to learn what works the best for you.
How do I start?
The easiest way is to start with protein and keep this level steady, which allows you to determine the fat and sugar balance you will need to stay in ketosis.. Determine how much protein you will eat in a day. Most patients find that eating half their ideal body weight in grams is a good strategy, and this usually comes out to 20-30g per meal or 60-100g of protein a day. Because so many patients feel their best on diets that emphasize protein, feel free to aiming a little high on the protein at first - you can always back down later if you are having trouble entering ketosis. You want to eat enough protein to optimize muscle health, while not eating so much that the excess amino acids get converted to sugar and hamper our ability to enter ketosis.
Next, slowly lower your carbohydrate intake toward a target goal of 50g of total carbs, because some people are able to enter ketosis at this level of carbs. There’s no rush, and I recommend dropping slowly to let your body accustomize itself to a new metabolic state. However, if you aren’t entering ketosis after a week then slowly go down on the total carbs (Dropping 10g total per week until you get into ketosis is a good rule of thumb). Some people only enter ketosis when they drop their carbs to a total of 20g daily. The quality of the carbs that you eat is crucial - focus on adding a large variety of vegetables to get as much fiber and nutrient diversity as possible. A good way to do this is to eat a large green salad with a variety of toppings (extra olive oil, cheese, seeds, onions, carrots, peppers) daily. Most people focus on vegetables like broccoli, spinach, green beans, asparagus and cauliflower due to their relatively low carb counts.
Then, add all sorts of delicious fatty foods until you hit your caloric needs. I recommend using olive oil as your primary source of calories, and this should be poured over each meal until the food is shiny. Olive oil is 120 calories per tablespoon, so 3 tablespoons x 3 meals gives you 1,080 calories. The rest of your fat calories will come from butter, cheeses, avocado, nuts, cream, fatty cuts of meat. Just as we need to make sure carbs don’t get too high, we need to make sure that you eat enough fat to sustain a state of ketosis. While a few patients can stay in ketosis by eating only 50% of their calories by fat, most need to be around 60-70%.
FAQ:
Is Carnivore or Atkins keto?
No. For most people, these diets are too high in protein to put you into ketosis.After your body meets its metabolic protein needs it converts the excess amino acids into sugar, which is then stored in the liver. The body then continually taps this reservoir of extra sugar to meet its energy needs and never produces ketones for energy.
Can I fast on a ketogenic diet?
Absolutely, and you will find that you can fast for much longer periods of time without hunger, weakness, headaches or fatigue because the body has been trained to efficiently use body fat as a fuel source. Fasting is an excellent way to prime the body to enter ketosis, and can also be used to boost ketone production. This happens because when you stop eating you force the body to start burning the sugar reserves that are stored in the liver. This short term sugar depot usually provides enough energy for 1-2 days. However, when this reservoir of sugar is depleted, the body is forced to then start making ketones for energy.
Can I exercise on a ketogenic diet?
Of course. If you are adjusting to the diet, simply listen to your body and alter your exercise program as needed. Medium term you may find that your endurance and stamina are improved on this diet. Check out the ketogenic endurance athlete Zach Bitter
Does a ketogenic diet cause constipation?
It can, especially if you neglect fiber intake. However, I want you to take on the challenge of eating a diet that has more vegetables and fiber than you were previously eating. Most patients who focus on adding as many healthy low carb veggies as possible into this way have no problem with constipation at all.
Dr. Joe’s Keto Salad: 1 cup spinach, 1/2 cup romaine, ½ cup cabbage, diced onion, tomatoes, peppers, ¼ cup crushed walnuts, 6-8 baby carrots, a small handful of dried cranberries, lots of salt to taste, 5 Tbsp Olive Oil. Eating this for one meal a day essentially means that you are eating more vegetables and fiber than most Americans get a day, and you are also eating a meal that is roughly 750 calories., 80g fat, 20g, 7g protein, but packed with fiber and nutrients.
However, it’s important to note that constipation is typically completely prevented by taking a combination of probiotics and small dose of magnesium. The supplements from Moss Nutrition work extremely well here.
Can a ketogenic diet cause muscle cramps or fatigue?
Many people who go onto a ketogenic diet do so because of blood sugar problems that have caused the hormone insulin to be inappropriately high. One of the effects of insulin is to cause the body to hold onto extra fluid. When you stop eating carbs, you no longer need so much insulin to control your blood sugar. As your insulin levels drop you begin peeing out a lot of that extra water you were holding onto. While this is perfectly normal (and can be therapeutic for patients with high blood pressure) one of the side effects is that extra urine causes the body to lose too much potassium or magnesium. The shift in potassium and magnesium can cause cramps.
In addition to this issue with electrolytes, the reality is that most Americans have gone decades without being in a fasted or a ketogenic state, and the body needs time to adjust. Sometimes, going too quickly can cause “keto flu” where you get fatigued, headachy and nauseous. If this happens, then I recommend raising your carbs until symptoms go away, then more slowly working your way down on the carbs. (This can even happen at 50g of carbs a day, so don’t be afraid to bump the carbs to a higher starting point and work down as tolerated.)
Happily, these issues are usually easily prevented simply by taking extra minerals. So I ask all patients starting a ketogenic diet to start taking extra minerals right away, and this typically prevents any cramping whatsoever. I find that the potassium bicarbonate (K Alkaline) from Moss Nutrition as well as Electrolyte Select to be particularly helpful to support the body as it adapts to the diet.
Can I go in and out of ketosis?
Yes, for most uses of the diet such as optimizing body composition or lowering blood sugar. In fact, regardless of your diet type,I recommend reevaluating your diet every 3-6 months. This gives you an opportunity to make sure that your current way of eating best serves your current needs, it makes sure that you are getting a diverse group of nutrients, and simply gives you some freedom and flexibility.
However, if you are using the diet to control seizures or to help with cancer treatment then I advise sticking with the diet and being more strict. The reason for this as it does take time to re-enter ketosis, and using the diet successfully for these conditions depends on keeping your ketone levels consistently high.
How do I test my ketones?
Many people like using urine strips because they are quick and easy. They detect a particular ketone that is present at high levels when you first go into ketosis, but unfortunately this ketone drops after you’ve done the diet for a while making the strips less accurate. The result is that these are not accurate enough to make sure that you are in ketosis. To do this diet correctly, you need to do finger sticks to test blood sugar levels and ketones.
I personally use Abbott’s Precision Xtra. The meter itself costs about $25, and the ketone strips are roughly $1 each. This device can also measure blood glucose. That said, I prefer a separate device for glucose, and use Bayer’s Contour next EZ, as I find it is easier to load the testers with the strips separately, prick my finger, then test each on using a single drop of blood.
I recommend testing ketones once daily, first thing in the morning, as a baseline until you are confident in your levels. Once you are more confident in the diet, then you can test more periodically.
Can the ketogenic diet increase my LDL?
Yes, in my experience about 25% of people who go on a ketogenic diet see large increases in their LDL. These patients usually don’t feel great on the diet, and may complain of being extra achy or have fatigue that didn’t go away with some time.
The culprit here usually has to do with the types of fat they are eating. You see fats can be broken up into different categories, saturated fat which primarily come from animal products (red meat, dairy) and unsaturated or polyunsaturated fats. Some people are not good at metabolizing saturated fats, and these “hyperresponders” usually see their LDL skyrocket when eating a lot of saturated fat. If continuing on a ketogenic diet is a goal, then these patients need to replace their saturated fat intake with unsaturated and polyunsaturated fats into what I call a Mediterranean Keto diet that leans extra heavily on olive oil, olives, fish, sardines & nuts as fat sources and reducing the red meat and dairy consumption.
However, for most people who start a ketogenic diet, especially those with a tendency towards obesity or diabetes, eating a ketogenic diet is amazingly effective at dropping LDL (and triglycerides, blood sugar, weight, body fat, blood pressure).
It comes down to working with a doctor who can help individualize a treatment plan rather than giving you a one size fits all recommendation or cookie cutter plan.
If you want to work with an expert in ketogenic diets, schedule an appointment today.