A ketogenic diet is one that encourages your body to rely less on sugar-based fuels and rather to turn to fat and ketones (produced in the liver by metabolizing fat) for fuel. The benefits of a consistently ketogenic diet are primarily recognized in the sphere of neurological problems, where there has been evidence of benefit in treating obesity, type 2 diabetes, high cholesterol, epilepsy, Alzheimer’s and Parkinson’s Disease A ketogenic diet is one that encourages your body to rely less on sugar-based fuels and rather to turn to fat and ketones (produced in the liver by metabolizing fat) for fuel. Some folks notice improved mood, sleep, mental focus, blood sugar regulation and reduction of general inflammation. Once you are adapted to a ketogenic diet, going in and out of ketosis intermittently is thought to yield some of the longevity, anti-inflammatory and cancer-fighting benefits previously attributed to calorie restricted diets.
Staying in ketosis makes it easier for many people to maintain weight loss. For a good discussion of that process, as well as the research behind that observation, you can read this blog post from the "low carb dietitian" here.
A ketogenic diet is one that encourages the body to burn fat for fuel and in that process fat burned in the liver produces ketones and a state of ketosis. We naturally burned fat and produced ketones for fuel when we were breast-feeding infants, if we were so lucky to have wise mothers! Since then, most bodies have lost the knack for burning ketones, which is too bad because our sugar-craving brains would be content with a lot less sugar if our bodies remembered how to supply our brains with ketones. (Ketosis is not to be confused with diabetic keto-acidosis which is life-threatening and only a risk for people with type 1 diabetes.)
For energy, a body relies on dietary energy sources as well as stored energy. On a ketogenic diet, dietary carbohydrates are kept very low, protein is moderate and fat consumption is increased, gently encouraging our body to remember how to rely on fat as a primary fuel and to produce ketones from stored body fat. Even if you are very lean, you have lots more stored body fat, to use in ketone production, than you have stored carbohydrate fuels.
Yes, the ketogenic diet is a high fat diet, not the high protein diet which is often portrayed. Reminding your body to burn ketones requires a period of “keto-adaptation” in which severe carbohydrate restriction is paired with high fat consumption. For some folks the adjustment is downright uncomfortable and for others it is quite effortless. You can only know that you are keto-adapted by checking ketones in your blood, which you can do with the Precision Xtra Monitor Glucose And Ketone Test System and Precision Xtra Blood Ketone Test Strips, available through Amazon, but most economically purchased through Universal Drug Store in Canada. You want to see a blood ketone level from 0.5-5.0. Urine ketone testing yields inconsistent results. Once you’ve tested for a while, you should be able to “feel” whether you are in ketosis: cheerful, energetic, not hungry even though you haven’t eaten for hours!
The diet is usually followed for 4-6 weeks to achieve full keto-adaptation. I will describe the two methods of ketogenic diets I use with my patients.
Caution: People with medical problems, a tendency to gout or kidney stones, or who are serious athletes, will want to consult with a health care practitioner before starting any experimentation with a ketogenic diet.
Protein is kept to a moderate amount because our bodies can turn protein into carbohydrates more easily than they can remember how to burn fat for fuel. So we don’t want to make it too easy.
- No more than 30 grams per meal. (For examples of 30 grams of protein, see this blog post of mine
- Protein should be of high quality, and feel free to enjoy all the fat that is part of the meat, it will speed keto-adaptation. Gently cook pasture-raised meat, wild-caught fish and game, pasture-raised eggs and poultry.
- Dairy is a good source of protein, particularly for vegetarians, but it often comes with too much carbohydrate. Focus on butter or ghee, cream, cheese, and some of the high-fat Greek yogurts available.
Fats are very important and must be eaten more on this diet than most folks are used to.
- Butter, ghee, sour cream and coconut oil can be added to everything!
- “Bulletproof Coffee” or Turbo-charged Tea if you prefer can be made with coffee (decaff or regular) or tea (my favorite for this is Numi Organic Tea Chocolate Puerh, Full Leaf Black Tea, 16-Count Tea Bags (Pack of 2) made hot and blended with 2 Tbsp butter and 1-3 Tbsp MCT oil. The recipe may not sound appealing, but if you like blended coffee drinks, this is a great one.
- Macadamia nuts and cashews are the highest fat nuts, so limited consumption is fine. (They still contain carbohydrates.
- Bacon or sausage or other high-fat cuts of meat.
Carbohydrates can still be a big volume of your meals, but without much diversity. Carbohydrate restriction can cause constipation, so be sure to include these foods in your ketogenic diet.
- Leafy greens will be your primary vegetable, either in cold salads or cooked alone or in soups or stir-fries.
- Garlic and onions are good sources of sulfur and feed gut bacteria.
- Fermented greens (sauerkraut) should be consumed regularly.
- Small amounts of very low sugar vegetables (radishes, celery, cauliflower, brussel sprouts, etc.) can usually be tolerated without interrupting ketosis.
- No root or starchy vegetables during keto-adaptation.
- No grains or legumes.
Follow the same food recommendations as in Method One, but allow more starchy vegetables: half a sweet potato, or a cup of white rice, tomatoes and carrots. Your food alone will not be ketogenic when you add these starches, though your gut may be happier. To stay ketogenic, you must add some highly ketogenic oils, either
- Coconut oil, 1-3 Tbsp taken 3 times a day
- MCT oil, which is made from coconut oil, but tasteless, 1-3 Tbsp taken 3 times a day.
You will need to test the effectiveness of this supplementation to find the amount that works for you.
- Salt! Whichever path you choose: salt your food to taste. Salt is depleted on a low carbohydrate diet.
- Potassium often leaves the body with salt. You can easily find an inexpensive 99 mg potassium supplement in drug or health food stores. Take 3-5 a day.
- Magnesium – for everyone, and particularly if you tend to constipation. Designs for Health Magnesium Glycinate, 2-3 daily, is well tolerated and effective
- Barlean's Fish Oil - anti-inflammatory
- Vitamin C – to feed your adrenals a little extra while this low-carb eating might stress them a bit. Innate Response, C Formula Powder, is a good food-based form.
- Probiotics also for constipation. I recommend Allergy Research Group, SymBiotics with FOS Powder.
- Potato Starch Unmodified, Gluten Free – resistant starch can help with bowel motility and reduce insulin resistance for someone with metabolic syndrome or pre-diabetes. 1-2 Tbsp taken 1-3 times daily.
From Dr. Deborah’s Desk
I first used the ketogenic diet in my practice with a young man who survived a near SIDS death more than twenty years ago. We had always controlled his seizures with homeopathic remedies and he has been lovingly cared for by parents and health attendants, requiring extra care as he is blind, non-verbal, and limited in what he can do. He has grown into a strapping young man who unfortunately developed grand mal seizures that homeopathy was not controlling. A trip to the neurologist yielded a prescription for a medication that controlled his seizures but left him nearly asleep. We put him on a ketogenic diet (a gentle one, and his “monitoring” was not by blood tests but by seizure count) that significantly reduced his seizure frequency and severity and enabled us to reduce his prescription to a “homeopathic” amount.
I am most recently using it on myself, engaging (for the month of January 2014) in a ketogenic trial. I am motivated partly by curiosity and partly to see if my knee tendinitis improves. I’ll let you know!