The ketogenic diet seems to be on everyone’s minds and googling fingertips. This ultra-low-carb, high-fat, moderate-protein eating plan is gaining a great deal of traction on social media. If you search #keto on Instagram, you’ll get nearly two million posts in return.
So what’s all the rage? Is it another fad diet, or is there some solid, evidence based substance behind this diet that you can count on as a real nutrition lifestyle solution? I gave this diet a shot, a couple different times, to find out what it’s all about, how my body would like it, how nutritionally balanced it is, and how practical it would be in everyday life.
Introduction to the Ketogenic Diet
The ketogenic diet is a high-fat, moderate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as nuts, cream and butter, and fatty meats. This explains the diet’s current popularity. You basically force your body into a permanent fat burning state. Fat burning!! Sounds awesome, right? Maybe it is, but knowing where the diet came from and what you are actually doing can be instrumental.
The classic therapeutic ketogenic diet was developed for treatment of pediatric epilepsy in the 1920s and was widely used into the next decade. Then it fell off the popular radar for a long time with the introduction of effective drugs that were able to treat the same conditions. But the diet made a come back in the mid-1990’s. Hollywood producer Jim Abrahams, whose son’s severe epilepsy was effectively controlled by the diet, created an entire foundation around the diet, followed by the well known Atkins Diet. The Atkins diet is basically a branded version of the ketogenic diet, with a couple nuances, created by Dr. Robert Atkins. The Atkins diet became wildly popular in the early 2000’s, but then seemed to drop off, unable to sustain a wide appeal for more than a handful of years.
Different Types of Ketogenic diet
There are four different types of Ketogenic diets, although, I will be focusing mostly on the standard version in this article. The four different types are:
- Standard ketogenic diet (SKD): This is a very low-carb, moderate-protein and high-fat diet. It typically contains 75-80% fat, 15-20% 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 carbs around workouts.
- 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. This version is probably the closest to the once very popular Atkins diet.
Only the standard and high-protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods, and primarily used by bodybuilders or athletes.
Is the Ketogenic Diet Safe for You?
The best person to answer that question is probably your doctor or RD. Like any diet that requires a substantial change in the way you eat, it is always a good idea to do some research, get educated, and get your doctor or licensed wellness practitioner on board. Having said that, many advocates of the ketogenic diet argue that the diet is misunderstood by most physicians. There is debate and confusion around what it means for your body to be in ketosis, as opposed to developing ketoacidosis. Being in ketosis simply means that your body has switched from being primarily a glucose burning body, to being a primarily fat burning body. Ketoacidosis is what occurs when you have an elevated level of blood ketones (ketosis) combined with an elevated level of blood glucose, which can be dangerous and even fatal. The pro-ketogenic experts argue that only people with type-1 diabetes are at risk of reaching a state of ketoacidosis, because people with a normal functioning pancreas will naturally regulate the ketones and glucose in the blood.
Another common concern about the ketogenic diet is the amount of animal fat consumed on the diet, and lack of fruits and vegetables that can provide fiber and vital phytonutrients and phytochemical benefits. I have to admit, with my primarily vegan training, I too was a bit skeptical. There are plenty of studies that point to higher mortality rates from eating an excess of animal meats and fats. Many leading pro-vegan doctors devote their life’s work to pointing this out. This lecture given by Michael Gregor, MD, and books like The China Study and Whole, by T. Colin Campbell, PhD, and The Food Prescription for Better Health by Baxter D. Montgomery, MD, all make compelling arguments to give up eating animals altogether.
But, on the other hand, books like The Wahls Protocol by Terry Wahl, MD make compelling arguments that, you guessed it, eating more animal fats is not only safe, but key to good health. And those claims are backed up by credible studies as well.
What I take away from this, and what I would encourage anyone to do who is considering the ketogenic diet, is to make sure you are aware of what is going on in your body while on the diet, by checking in with your doctor or licensed wellness professional regularly. Better yet, do the diet with some professional supervision.
So How Does the Ketogenic Diet Work?
The two different times that I successfully followed the ketogenic diet, I broke it down into phases, something I adapted from books written by experts, and my own experience. I will share a little bit here about how each phase works, and why I think they are important in the overall process of becoming fully keto-adapted.
First, Get Educated
Take a little time and really inform your self about the diet. Listening to the advice of friends, following a couple blogs, or purchasing fad products are all helpful, but nothing is more powerful in creating the best results from nutrition than the informed you. Keto Clarity is a great book written by an expert on the subject, with more than a dozen contributing medical and other experts. It is a fairly easy read and includes recipes and meal plans as well.
Phase One: Get Your Feet Wet
Probably the biggest shock for most when trying this or any low-carb diet, is coming to realize how much sugar and carbohydrates there are in the modern American diet. When I started, rather than jumping in with a big program and shift in my eating, I just took baby steps. So, this first phase just entails reading labels. Start reading the labels of everything you would normally ingest, like the packaged granola bar, the sugar packet at Starbucks, and your favorite almond milk. By doing this for about a week, and consciously pondering what you would do if you were to avoid many of these foods, without actually forcing yourself to do it yet, you give yourself, again, the advantage of empowered knowledge before jumping all the way in. As you begin to get your head wrapped around this, you can begin to make the changes that you are coming to realize will be ultimately necessary while on the diet.
Phase Two: Inducing Ketosis
This is what I call the “balls to the wall” phase. Forgive the crude expression, but it basically sums it up. In this phase, you would start eating what would normally be considered an inordinate amount of fats from cheese, cream, coconut oil, and other mostly animal based fats. On the same token, you would drastically reduce your carbohydrate intake. In my experience, this phase is most efficiently accomplished by keeping all carbs under 20g per day. Some argue that you can deduct grams of fiber from carbohydrates from your total carbs, and count “net carbs,” but in my research, that just delays the desired result. Both times I did the diet, I was able to induce Ketosis with this approach in just a few days, but this amount of time will vary, depending on how much glycogen your body has to use up.
Phase Three: Finding Your Carb Tolerance
Once you are in Ketosis, you then begin to re-introduce some carbohydrates back into your diet, very carefully, until you are able to determine exactly how many grams of carbs per day your body will tolerate, without throwing you out of ketosis. In this phase, I reintroduced nutrient-dense greens and vegetables that were also low carb like kale, romaine lettuce, and any colorful vegetable I could get that didn’t drive up the carb count too much. In doing this, I was also increasing my phytonutrient intake, something that concerned me about being on a diet like this. What I absolutely did not add back in were grains or beans. So it was pretty much meat, cheese, butter, cream, as many vegetables as I could get away with, nuts, nut butters, seeds, and seed butters. Once you are in this phase, you switch from counting carbs in grams, to monitoring your overall macronutrient ratios. In this phase, your carbohydrates shouldn’t exceed 5% of total calorie distribution.
Phase Four: Finding Your Protein Threshold
Yep, believe it or not, in order to be a truly genuine keto-file, you have to also monitor your protein. The argument for this is that protein, when eaten in excess, can convert to glucose in a process called gluconeogenesis. Advocates of the Paleo and other low carb diets love talking about gluconeogenesis and how the liver can create glucose from protein, avoiding the need for added carbs to the diet, and making carbohydrates essentially “non essential.” But, this can be a problem in ketosis, because if you eat too much protein on a ketogenic diet, you risk your body creating glucose, therefore throwing you out of ketosis. For this reason, it is believed that the ideal daily ratio of calories from protein should be around 15%, and no more than 20%. Once you get your carb tolerance figured out, you will need to hone in on your protein threshold as well.
Phase Five: Becoming Fully Keto-Adapted
By following the steps and doing it right, you will eventually get to a point where your body has fully adapted to burning fat as its primary fuel source. I have to admit I loved being fully keto-adapted. I had tons of energy, slept like a baby, and never felt hungry throughout the day. I can see how it could be a great way to fuel your body for some people. Once you are fully keto-adapted, rather than having to feed your body carbs every two hours, which burns up pretty fast, you eat fat, which sustains you for longer periods of time. There are even intermittent fasting approaches that people take while in ketosis, where they go for 12-24 hour periods not eating anything at all, just burning their fat as fuel. When you are fully keto-adapted, you should be able to have carb rich cheat meals every once in a while, and not have it set you back in your keto-accomplishment. Pro-ketogenic experts claim that you can keep this going forever, and live a happy ketogenic lifestyle for as long as you want. There are entire websites, blogs, and social media groups devoted to this endeavor.
The two biggest benefits for me were the energy I felt, and finally getting off the blood sugar roller coaster. Until you free yourself from the vicious cycle of unhealthy hunger response and unstable blood sugar, you probably won’t know the difference. By relying on fat as primary fuel, my body really did a healing 180 in this area. I also like that the diet provides you a built-in way to avoid unhealthy processed foods, sugar, and alcoholic beverages. When you know a glass of wine might throw you out of ketosis, you may think twice before having one. On the other hand, that could be a bummer for wine lovers or anyone who likes to drink.
According to this article by Dr. Axe, here are some additional possible benefits from following a ketogenic lifestyle:
- Improved weight loss
- Reduce risk of type-2 diabetes (and others claim you can reverse insulin resistance and heal diabetes) However, it is worth noting that many doctors believe that fat is the main cause of insulin resistance. Neal Barnard wrote a book about it.
- Possible protection against cancer
- Protection against heart disease risk factors
The Down Sides- Yes There Are a Few
- First of all, you need to make some fundamental changes to the foods you normally turn to. Sugar and most refined carbohydrates in any form will basically need to disappear from your life, if you are serious about nutritional ketosis. Anything that converts to sugar quickly can be a problem, like many fruits, grains, and your favorite snack crackers. If you dislike the taste of Stevia, you kind of have to get over it, because that is what’s left for your sweetener, besides monk fruit or a sugar alcohol like xylitol.
- Fat, fat, and more fat. Sometimes, no matter what any studies say, eating a lot of fat just feels gross. And, even though bacon is super yummy, you could start to miss all of the vegetables, grains, fresh fruit, and legumes that may or may not have a place in your ketogenic lifestyle. Because it depends on your individual carb tolerance.
- Bad breath and smelly urine. Although this never happened to me, many people report this as a byproduct of being in ketosis.
- The keto flu. This is something that occurs sometimes as your body makes an adjustment to the diet. For me it did not happen the first time, but did happen for one day the second time. Making sure you get enough sodium and potassium are the two primary ways to address this.
- Plateauing with weight loss. Supposedly, you can eat to satiety on the keto diet and not worry about calories. But many people do reach a plateau. I suspect that the drastic weight loss that many people experience in the beginning is due to the decrease in refined carbohydrates, causing an anti-infammatory effect on the body, and therefore release of unwanted weight. But after that initial drop in pounds, many people plateau or even gain weight back. At the end of the day, it comes down to good old fashioned “energy in, energy out.” Even if you are in a fat burning state, you still need to give your body a reason to burn the fat. Otherwise, it just gets stored for a future need. And in some cases, even more so, when you consider that your body in ketosis could likely be deliberately storing fat because it has been denied the carbohydrates it has depended on for primary fuel over your lifetime. That is your body’s job, to help you survive famine, and that is the whole reason blood ketones exist, as a survival mechanism for long periods between adequate fuel intake. So, it seems that long term effectiveness of the keto diet for weight loss probably requires that you remain very active, or be aware of your calorie management to some extent.
- Logging food and constant ketone testing. Effective implementation of this diet requires that you test your blood ketones daily at first, and that you keep them monitored throughout the life of the diet. Sometimes, it becomes necessary to log all your carbs to make sure you aren’t accidentally overdoing it. This can become tedious after a while unless you really master the lifestyle to the point that you don’t need to monitor anything and still maintain nutritional ketosis.
- Relapsing. Sometimes you might get off track, and then have to start over again with the process of inducing ketosis.
- Cost. Blood ketone strips can run several dollars for one strip, not to mention the cost of the blood test meter. Then, if you want truly high quality fats, from grass fed animals and organic plants, there is an added cost there. And, if you are seeing your doctor more often to monitor yourself on the diet, add that to the cost. On the other hand, you will be saving money on packaged junk food and other processed carbohydrates, drinking less alcohol, and not snacking as often, so that will offset the expenses a bit.
Why Didn’t I Stay on the Ketogenic Diet?
Like I always explain to my clients, there is no “one size fits all” in diets. Furthermore, any diet can be a fad diet, if it is not followed up with permanent, sustainable healthy habits, that will support you for years, and years, and years! I am not convinced the Ketogenic diet will sustain you holistically in this way. I trust you are planning to out-survive whatever diet products or protocols you are currently using or following. That is why it is crucial that these products and protocols actually serve you in the far reaching future.
I am not saying the ketogenic diet can’t do this for the right person. I have spoken to several people who are really happy on the diet, and have done some impressive healing using the protocol. I just prefer a more moderate and balanced macronutrient ratio in my diet. And, I can’t ignore study after study that point to higher rates of disease risk related to a diet high in animal protein and fats. I love lots of varieties of fruits, vegetables legumes, and some grains. And my body has a pretty low tolerance of carbohydrates, making it a little harder for me to remain fully keto-adapted all the time. My current diet meets a macronutrient ratio a little more akin to a vegan- Paleo diet, with a heavier emphasis on plant based proteins. I am definitely sold on the idea that most of the carbs in our standard American diet are unnecessary and probably messing with our blood sugar, and harming many of us. So, I keep the carbs in check, and focus on whole food carbohydrates, resistant starches and carbs that are high in fiber. When I explain this to my clients, I call it being a “carbohydrate snob.” Meaning, make sure the carbs you eat are nutrient dense, high in fiber, and as unprocessed as possible. This helps to contribute to a better fat burning distribution, as these kinds of carbs digest more slowly and don’t spike your blood sugar.
If I tested my ketones today, it would probably show that I am in a low-moderate state of ketosis, which means I am still burning some fat as part of my fuel mix. and that works great for me. Or maybe not? My carbs are up pretty hight these days yet I am burning fat, losing weight, and my blood sugar and energy levels feel nice and balanced. In summary, I don’t believe you need to go to this extreme to burn fat. Especially if you have to exercise and watch your calorie management anyway. I guess a question I would ask at this point is: Would you rather eat a lot of butter and bacon and burn a little fat this month, or eat those foods as an occasional treat, and live a longer life?
If you are thinking of trying the ketogenic diet, just keep in mind that this is no regular diet, not at first anyway. In my professional opinion, it requires some degree of clinical supervision, and guidance from a professional that can help you avoid frustrating set backs. You can design your own keto-strategy, or better yet, become truly informed and receive unbiased, objective guidance with the assistance of nutrition coaching. I provide personal meal planing strategies, coaching, nutrition education, weight management consulting and other nutrition coaching services, designed to help you develop truly healthful lifestyle habits to achieve your wellness objectives in a sustainable, safe way. I’m available in person or remotely by video conferencing. Schedule a complimentary initial consultation and start getting clearer on how the keto diet might or might not look for you!