With the abundance of information out there regarding popular diets, how do you wade through it all and figure out what’s best for you as an individual? How do you determine what is actually effective and what is simply a passing “quick-fix” craze? In this article, I wanted to give you the low-down on the ketogenic diet, an increasingly popular style of eating, boasting it’s effects for significant weight loss and a “diet that doesn’t really feel like a diet.”
Ketogenic Diet Basics
The ketogenic diet is outlined as a high-fat, adequate-protein, and low-carbohydrate diet. With the very low availability of carbohydrates, the body switches to fats rather than carbohydrates to provide energy. The liver converts fat into fatty acids, producing ketone bodies, which replace glucose as your primary energy source. This accumulation of ketones in blood is also known as nutritional ketosis, meaning the body is using and burning fats as it's primary source of fuel (1).
One of the biggest advantages of training your body to use fat as opposed to glucose, is that ketone bodies are a superior respiratory fuel. 100g of glucose generates 8.7 kg of ATP (our body’s main energy source) vs. 100 g of ketones (the main ones being 3-hydroxybutyrate & acetoacetate) which generate 9.4 and 10.5kg of ATP, respectively. Not only do ketones burn more efficiently then glucose, providing increased energy, it has been shown to reduce inflammation in the body AND creates an environment where less insulin is needed to access this energy (1,2,3).
The most commonly used ketogenic ratio are 4:1 and 3:1. This translates into eating 4 grams of fat for every 1 gram of protein + carbohydrate, with about 70-80% of your overall calorie intake coming from fat and 15-25% coming from protein. Ideally, carbohydrates are restricted to less than 20g per day, equating to less than 5% of total caloric intake to keep your body in ketosis (2,3). Everyone will have different macronutrient needs, based on height, sex, weight, gender, body fat percentage, activity level, body composition goals and personal protein intake preferences.
How do I get into ketosis? How do I know?
To successfully complete this diet, many experts recommend downloading a macronutrient calculator and purchasing urine strips to help track and maintain nutritional ketosis. Urine strips are used to monitor levels of ketones in your urine, and generally the higher the lever of ketones, the more fat is being burned, and a sign that your body is adapting to using fat as fuel (2). If using urine strips isn’t your thing, there are also some free, physical symptoms that can let you know you’re in ketosis, like increased urination, dry mouth and a sharp acetone-like odour on your breath (2,3).
Who might not be right for the ketogenic diet? What are the drawbacks? (1,2)
Despite the hype surrounding the ketogenic diet, there are a few cons that may make it hard to follow, or not the ideal style of eating for everyone:
If you hate tracking food: as there are many “hidden” carbohydrates in foods that you wouldn’t necessarily suspect, using a macronutrient calculator is crucial to keeping your daily intake of carbohydrate on target, as well as ensuring you’re reaching your very high fat needs to get and remain in ketosis.
If you love carbs (say goodbye to bananas!):foods to completely avoid are grains, starchy vegetables, trans fats, high-glycemic fruits, basically translating into any food that will force your carbohydrate intake over the daily goal.
If you have pre-existing health conditions: people with type 1 diabetes (4), gout, high levels of triglycerides or severe dyslipidemia, at an increased risk of kidney stones or decreased kidney function, competitive athletes, or very active people at risk for electrolyte imbalances, may have a higher risk of adverse events following a ketogenic style of eating.
The ketogenic “flu”: especially when initiating keto, there is a period of time where you may feel some side effects, most commonly headache, constipation, cramping, indigestion and insomnia. This typically goes away after being in ketosis for a few weeks, but symptoms may be severe and intolerable for some.
Vitamin & electrolyte deficiencies: due to the severe restriction in many fruits and some vegetables (like carrots, squash, potatoes, beans and beets), it may create deficiencies in some vitamins - specifically A and C. In addition, being in ketosis acts like a diuretic, causing increased urination which may make you at risk for a loss of essential electrolytes, including magnesium, calcium, sodium and potassium.
Tips for those thinking about going keto!
Drink plenty of water - 2.5-3.5 L a day is the general recommendation to help combat headaches, constipation, cramping and dehydration (2)!
Fibre, fibre, fibre - load up on low-glycemic veggies and incorporate as much fibre as possible to keep bowel movements regular - psyllium and chia are great options (5).
Incorporate whole food forms to avoid the more common mineral deficiencies and consider adding in a greens powder to replace the off-limits fruit and vegetables (5)! Magnesium: green leafy vegetables, almonds & pumpkin seeds Sodium: addition of ground pink sea salt to meals Calcium: bok-choy, broccoli, high-fat dairy, fortified dairy-alternatives (almond milk) Potassium: avocado, salmon, nuts, mushrooms, green leafy vegetables
Integrate omega-3’s into your daily line-up - if you have pre-existing higher triglycerides or find that they are increasing over the first 6 months (not uncommon!), supplementing with an omega-3 fish oil has been shown to significantly lessen this effect!
*At a dose of 3-4g/day, omega-3s have been shown to reduce serum triglycerides anywhere from 22-50% over one month! Subjects with initially higher levels of triglycerides (>200 mg/dl) experienced a greater effect landing higher in this percentage range, but even people with initially healthy levels showed an average 25% reduction (5,6)!
As always, please speak to your health care practitioner about what dose of omega-3’s would be best for you as an individual.
About the Author
Dr. Morgan Ramsay
As a type-one diabetic of over 15 years, one of my greatest passions is educating and supporting patients living with diabetes, and other conditions related to insulin resistance, including - PCOS, infertility, weight loss resistance and metabolic syndrome. Much of my clinical focus lies in researching and teaching patients about how to best optimize their blood sugars, with an emphasis on the use of nutrition, exercise and supplementation as fundamentals to success.
Manninen, A. H. (2004). Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood “Villains” of Human Metabolism. Journal of the International Society of Sports Nutrition, 1(2), 7–11. http://doi.org/10.1186/1550-2783-1-2-7
A Comprehensive Beginner’s Guide to the Ketogenic Diet. Retrieved from: https://www.ruled.me/guide-keto-diet/#
Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789–796. http://doi.org/10.1038/ejcn.2013.116
Gupta, L.. Khandelwal, D., Kalra, S., Gupta, P., Dutta, D., & Aggarwal, S. (2017). Ketogenic diet in endocrine disorders: Current perspectives. Journal of Postgraduate Medicine, 63(4), 242-251. doi: 10.4103/jpgm.JPGM_16_17
Paoli, A., Moro, T., Bosco, G., Bianco, A., Grimaldi, K. A., Camporesi, E., & Mangar, D. (2015). Effects of n-3 polyunsaturated fatty acids (ω-3) supplementation on some cardiovascular risk factors with a ketogenic Mediterranean diet. Marine drugs, 13(2), 996–1009. https://doi.org/10.3390/md13020996
Shearer, G. C., Savinova, O. V., & Harris, W. S. (2012). Fish oil -- how does it reduce plasma triglycerides?. Biochimica et biophysica acta, 1821(5), 843–851. https://doi.org/10.1016/j.bbalip.2011.10.011
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