Diet

Are You Right For The Keto Diet?

These days, it seems like everyone is talking about the ketogenic (in short, keto) diet – the very low-carbohydrate, moderate protein, high-fat eating plan that transforms your body into a fat-burning machine. Hollywood stars and professional athletes have publicly touted this diet’s benefits, from losing weight, lowering blood sugar, fighting inflammation, reducing cancer risk, increasing energy, to slowing down aging. So is keto something that you should consider taking on? The following will explain what this diet is all about, the pros and cons, as well as the problems to look out for.

What Is Keto?

Normally, the body uses glucose as the main source of fuel for energy. When you are on a keto diet and you are eating very few carbs with only moderate amounts of protein (excess protein can be converted to carbs), your body switches its fuel supply to run mostly on fat. The liver produces ketones (a type of fatty acid) from fat. These ketones become a fuel source for the body, especially the brain which consumes plenty of energy and can run on either glucose or ketones.

When the body produces ketones, it enters a metabolic state called ketosis. Fasting is the easiest way to achieve ketosis. When you are fasting or eating very few carbs and only moderate amounts of protein, your body turns to burning stored fat for fuel. That is why people tend to lose more weight on the keto diet.

Benefits Of The Keto Diet

The keto diet is not new. It started being used in the 1920s as a medical therapy to treat epilepsy in children, but when anti-epileptic drugs came to the market, the diet fell into obscurity until recently. Given its success in reducing the number of seizures in epileptic patients, more and more research is being done on the ability of the diet to treat a range of neurologic disorders and other types of chronic illnesses.

  • Neurodegenerative diseases. New research indicates the benefits of keto in Alzheimer’s, Parkinson’s, autism, and multiple sclerosis (MS). It may also be protective in traumatic brain injury and stroke. One theory for keto’s neuroprotective effects is that the ketones produced during ketosis provide additional fuel to brain cells, which may help those cells resist the damage from inflammation caused by these diseases.
  • Obesity and weight loss. If you are trying to lose weight, the keto diet is very effective as it helps to access and shed your body fat. Constant hunger is the biggest issue when you try to lose weight. The keto diet helps avoid this problem because reducing carb consumption and increasing fat intake promote satiety, making it easier for people to adhere to the diet. In a study, obese test subjects lost double the amount of weight within 24 weeks going on a low-carb diet (20.7 lbs) compared to the group on a low-fat diet (10.5 lbs).
  • Type 2 diabetes. Apart from weight loss, the keto diet also helps enhance insulin sensitivity, which is ideal for anyone with type 2 diabetes. In a study published in Nutrition & Metabolism, researchers noted that diabetics who ate low-carb keto diets were able to significantly reduce their dependence on diabetes medication and may even reverse it eventually. Additionally, it improves other health markers such as lowering triglyceride and LDL (bad) cholesterol and raising HDL (good) cholesterol.
  • Cancer. Most people are not aware that cancer cells’ main fuel is glucose. That means eating the right diet may help suppress cancer growth. Since the keto diet is very low in carbs, it deprives the cancer cells of their primary source of fuel, which is sugar. When the body produces ketones, the healthy cells can use that as energy but not the cancer cells, so they are effectively being starved to death. As early as 1987, studies on keto diets have already demonstrated reduced tumor growth and improved survival for a number of cancers.

Comparing Standard American, Paleo, & Keto Diets

(As a % of total caloric intake)

__________________________Carbs__________Protein_________Fat

Standard American Diet_____40-60%_________15-30%_________15-40%

Paleo Diet_________________20-40%_________20-35%_________25-50%

Keo Diet________________ __5-10%__________10-15%_________70-80%

The key distinction between the keto diet and the standard American or Paleo diets is that it contains far fewer carbs and much more fat. The keto diet results in ketosis with circulating ketones ranging from 0.5-5.0 mM. This can be measured using a home blood ketone monitor with ketone test strips. (Please know that testing ketones in urine is not accurate.)

How To Formulate A Keto Diet

1. Carbohydrates

For most people, to achieve ketosis (getting ketones above 0.5 mM) requires them to restrict carbs to somewhere between 20-50 grams (g)/day. The actual amount of carbs will vary from person to person. Generally, the more insulin resistant a person is, the more resistant they are to ketosis. Some insulin sensitive athletes exercising vigorously can consume more than 50 g/day and remain in ketosis, whereas individuals with type 2 diabetes and insulin resistance may need to be closer to 20-30 g/day.

When calculating carbs, one is allowed to use net carbs, meaning total carbs minus fiber and sugar alcohols. The concept of net carbs is to incorporate only carbs that increase blood sugar and insulin. Fiber does not have any metabolic or hormonal impact and so do most sugar alcohols. The exception is maltitol, which can have a non-trivial impact on blood sugar and insulin. Therefore, if maltitol is on the ingredient list, sugar alcohol should not be deducted from total carbs.

The level of carbs one can consume and remain in ketosis may also change over time depending on keto adaptation, weight loss, exercise habits, medications, etc. Therefore, one should measure his/her ketone levels on a routine basis.

In terms of the overall diet, carb-dense foods like pastas, cereals, potatoes, rice, beans, sugary sweets, sodas, juices, and beer are not suitable.

Most dairy products contain carbs in the form of lactose (milk sugar). However, some have less carbs and can be used regularly. These include hard cheeses (Parmesan, cheddar), soft, high-fat cheeses (Brie), full-fat cream cheese, heavy whipping cream, and sour cream.

A carb level less than 50 g/day generally breaks down to the following:

  • 5-10 g carbs from protein-based foods. Eggs, cheese, and shellfish will carry a few residual grams of carbs from natural sources and added marinades and spices.
  • 10-15 g carbs from non-starchy vegetables.
  • 5-10 g carbs from nuts/seeds. Most nuts contain 5-6 g carbs per ounce.
  • 5-10 g carbs from fruits such as berries, olives, tomatoes, and avocados.
  • 5-10 g carbs from miscellaneous sources such as low-carb desserts, high-fat dressings, or drinks with very small amounts of sugar.

BeveragesMost people require at least half a gallon of total fluid per day. The best sources are filtered water, organic coffee and tea (regular and decaf, unsweetened), and unsweetened almond and coconut milk. Diet sodas and drinks are best avoided as they contain artificial sweeteners. If you drink red or white wine, limit to 1-2 glasses, the dryer the better. If you drink spirits, avoid the sweetened mixed drinks.

2. Protein

A keto diet is not a high protein diet. The reason is that protein increases insulin and can be converted to glucose through a process called gluconeogenesis, hence, inhibiting ketosis. However, a keto diet should not be too low in protein either as it can lead to loss of muscle tissue and function.

The average adult requires about 0.8-1.5 g per kilogram (kg) of lean body mass per day. It is important to make the calculation based on lean body mass, not total body weight. The reason is because fat mass does not require protein to maintain, only the lean muscle mass.

For example, if an individual weighs 150 lbs (or 150/2.2 = 68.18 kg) and has a body fat content of 20% (or lean body mass of 80% = 68.18 kg x 0.8 = 54.55 kg), the protein requirement may range from 44 (= 54.55 x 0.8) to 82 (= 54.55 x 1.5) g/day.

Those who are insulin resistant or doing the keto diet for therapeutic reasons (cancer, epilepsy, etc.) should aim to be closer to the lower protein limit. The higher limit is for those who are very active or athletic. For everyone else who is using the keto diet for weight loss or other health benefits, the amount of daily protein can be somewhere in between.

Best sources of high quality protein include:

  • Organic, pastured eggs (6-8 g of protein/egg)
  • Grass-fed meats (6-9 g of protein/oz)
  • Animal-based sources of omega-3 fats, such as wild-caught Alaskan salmon, sardines, and anchovies, and herrings. (6-9 g of protein/oz)
  • Nuts and seeds, such as macadamia, almonds, pecans, flax, hemp, and sesame seeds. (4-8 g of protein/quarter cup)
  • Vegetables (1-2 g of protein/oz)

3. Fat

Having figured out the exact amounts of carbs and protein to eat, the rest of the diet comes from fat. A keto diet is necessarily high in fat. If sufficient fat is eaten, body weight is maintained. If weigh loss is desired, one should consume less dietary fat and rely on stored body fat for energy expenditure instead.

(As a % of total caloric intake)

_________________________Maintain Weight_______Lose Weight

Carbs____________________5-10%________________5-10%

Protein__________________10-15%_______________10-15%

Fat from diet_____________70-80%_______________35-40%

Fat from stored body fat___0%___________________35-40%

For individuals who consume 2,000 calories a day to maintain their weight, daily fat intakes range from about 156-178 g/day. For large or very active individuals with high energy requirements who are maintaining weight, fat intakes may even exceed 300 g/day.

Most people can tolerate high intakes of fat, but certain conditions such as gallbladder removal may affect the amount of fat that can be consumed at a single meal. In which case, more frequent meals or use of bile salts or pancreatic enzymes high in lipase may be helpful.

Avoid eating undesirable fats such as trans fat, highly refined polyunsaturated vegetable oils, as well as high amounts of omega-6 polyunsaturated fats.

Best foods to obtain high quality fats include:

  • Avocados and avocado oil
  • Coconuts and coconut oil
  • Grass-fed butter, ghee, and beef fat
  • Organic, pastured heavy cream
  • Olive oil
  • Lard from pastured pigs
  • Medium chain triglycerides (MCTs)

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