Keto or Not Keto? That is the Question...
You probably have heard some of your friends or neighbors bragging on how many pounds they have lost while in keto diet. This diet has become very trendy these days. There are many websites and programs in the Internet offering “Keto Plans” for $35, or memberships with recipes and information for $15/month. This is very tempting, but there are many things that those websites will NOT tell you.
There is no need to invest time and money in any of those websites. If you are considering this as an option, I highly recommend you to read the following comprehensive information including contra-indications, side effects and other considerations, so you can determine whether this is the right path for you. Knowledge is power, so let’s start by the definition…
What is Keto Diet?
The Ketogenic diet or better known as “Keto Diet” for short, it is a restrictive diet with very low carbohydrate consumption and moderate protein intake in order to induce a metabolic state called Ketosis where your body uses fat to transform into ketones bodies to use as fuel rather than glucose.
There are 3 types of ketone bodies:
· Acetoacetate (AcAc)
· Beta-hydroxybutyric acid (BHB)
· Acetone
Our body’s primary fuel is glucose mainly coming from carbohydrates. The glucose is converted into energy through a process called Glycolysis.
As part of evolution, the human body has other ways of survival when carbohydrates like fruits and veggies are scarce; mainly in winter where hunting and fishing used to be the primary source of food, or due to famine causing prolonged periods of fasting. There are two other alternatives:
Gluconeogenesis: This happens when the body uses non-sugar compounds like amino acids (building blocks from protein like alanine and glutamine) and other substances to break down as glucose to be utilized by the cells and mainly the brain.
Ketogenesis: When really there is not enough sources to convert food into glucose, either by glycolysis or gluconeogenesis; the body has a third option by using fat as a source rather than glucose. This process will produce ketone bodies by the liver that will be circulating as energy supply into the bloodstream instead of glucose. You will enter into a state called “nutritional ketosis”. This is the expected path when going into keto diet.
It is very important to understand the principle of the state of “nutritional ketosis” limiting the carbohydrate consumption to no more than 50 g/day; otherwise, you will be kicked out of ketosis state going back to either gluconeogenesis or even glycolysis – where glucose is used as primary source of energy.
A well-formulated ketogenic diet, besides limiting carbohydrates, also limits protein intake moderately to less than 1g/lb. body weight, unless individuals are performing heavy exercise involving weight training when the protein intake can be increased to 1.5g/lb. body weight.
As this diet is based on higher consumption of fats, it is easy to fall into the trap and take this as a free pass for all types of saturated fats or processed meats, bacon, cheese and butter causing oxidative stress and higher levels of cholesterol. It is better to focus on a balanced diet of fats, including foods rich in Omega 3 like salmon, chia seeds, avocados and nuts; and also, Medium-chain Triglycerides (MCT) from coconut products. Trans fats are never an option as they have been associated with higher risk of cardiovascular disease and oxidative stress causing other diseases like cancer. It is also recommended to limit lunchmeats and cured products as most of them contain nitrites and nitrates which in high consumption are associated with the risk of gastrointestinal cancer.
Types of Ketogenic Diets
The standard ketogenic diet (CKD) is the most popular of all keto diets. This may be a great option for people with celiac disease and any other sensitivity to grains, as there is no space for products made with grains like breads and tortillas.
At difference with other diets, the keto diets require much more discipline due to the ketosis state required; so a cheating meal or day is not really an option. Even when the Cyclical Ketogenic Diet (CKD) has periods of high carbohydrates, that does not mean that those days are a free pass for all types of refined carbs, sugars, cookies, cakes and junk food; but for complex carbohydrates in the form of whole grains, fruits and veggies.
Benefits of Keto Diet
Originally Keto Diet was not used for weight loss, but for therapeutic purposes. Russel Wilder was the first one to use it in 1921 as a therapeutic diet for pediatric epilepsy, and was widely used until its popularity ceased with the introduction of antiepileptic agents.
The resurgence of the ketogenic diet as a rapid weight loss formula is a relatively new concept that has shown to be quite effective, at least in the short run. People on a keto diet initially experience rapid weight loss up to 10 lbs. in 2 weeks or less. This diet has a diuretic effect, and some early weight loss is due to water weight loss followed by a fat loss. Interestingly with this diet plan, lean body muscle is largely spared.
Regarding the feasibility in the long term, several studies are still conducted to assess the effectivity and any possible health risks associated with kidney stones, low protein and nutrient deficiency. One study showed great benefits for obese patients on keto diet during a period of 24 weeks; improved levels of glucose and cholesterol were reported.
There is strong evidence that keto diet has been effective not only for weight loss but for the following:
Cardiovascular disease: Including improved levels of blood triglycerides, but there are also significant positive effects on total cholesterol reduction and increases in high-density lipoprotein (HDL) as long as diet is balanced on fats.
Type 2 Diabetes: Including metabolic syndrome, insulin resistance due to low consumption of carbohydrates and sugars.
Epilepsy: The effectiveness is strongly supported in a recent Cochrane review where all studies showed a 30–40% reduction in seizures compared with comparative controls, and the review authors reported that in children the effects were ‘comparable to modern antiepileptic drugs.
There is also emerging evidence, although not yet conclusive requiring more clinical trials that it may be helpful for other conditions:
Acne: Due to the influence of certain foods like sugars and milk that may trigger acne, the restriction through keto diet could be effective in reducing the severity and progression of acne.
Cancer: Perhaps through glucose ‘starvation’ of tumor cells and by reducing the effect of direct insulin-related actions on cell growth. While healthy cells are quite capable of using ketones for energy, cancer cells apparently cannot do so. Cancer cells are also quite dependent on glucose (blood sugar uptake) to fuel cellular damage repair (as our immune system tries to fight it), thus restricting glucose makes cancer cells more vulnerable over time. There is also some initial evidence in animal research that a ketogenic diet makes cancer cells more susceptible to conventional treatment such as radiation.
Polycystic Ovary Syndrome: Due to the high incidence of insulin resistance in women with PCOS; similar benefits may be seen than those with people with metabolic syndrome, as high levels of insulin can increase androgenous hormones observed in women with PCOS.
Neurological Diseases: Emerging data suggest a possible therapeutic utilization of ketogenic diets in multiple neurological disorders apart from epilepsy, including head ache, neurotrauma, Alzheimer’s and Parkinson’s disease, sleep disorders, brain cancer, autism and multiple sclerosis.
The term “Ketogenic Diet” may lead to apprehension in diabetic patients given its association with the well-known, life-threatening condition of ketoacidosis, where the body cannot produce enough insulin (needed to transport glucose into cells), so cells do not receive enough glucose (starving); so, the body produces excessive ketones from fat as fuel. This is a serious complication in people with diabetes, when there is a high and faster accumulation of ketones than what the body can utilize or eliminate, causing deadly changes of pH in blood.
It is important to note that during nutritional ketosis, the concentrations of ketones are of low levels and do not cause any alterations in the pH of blood, widely considered as safe. However, patients diagnosed with diabetes on insulin or oral hypoglycemic agents may suffer severe hypoglycemia if their medication regimen is not properly managed during the initiation of Keto Diet.
Please if you have diabetes and you are considering to follow a keto diet, first consult your physician.
Keto diet is limited and/or contraindicated in patients with:
Liver failure
Pancreatitis
Inborn disorders of fat metabolism
Primary carnitine deficiency
Carnitine palmitoyl transferase deficiency
Carnitine translocase deficiency
Porphyria
Pyruvate kinase deficiency
Please consult your physician in you have any of these health conditions.
Common Side Effects
Common short-term side effects resulting from the initiation of Keto Diet have been referred to as “keto flu,” which encompasses symptoms including:
· Fatigue
· Headache
· Dizziness
· Nausea
· Vomiting
· Constipation
· Acetone breath
· Low exercise tolerance
· Low alcohol tolerance
Symptoms typically resolve after a few days to weeks as the body adjusts to the low carbohydrate, ketosis state.
These symptoms are due to your body transitioning on use ketones rather than glucose as fuel. It takes your brain and other organs some time to adapt to using this new fuel. When insulin levels drop, you body responds by excreting more sodium and water through urine. Because of this, you will likely find yourself urinating a lot more often in the first week or so of the keto diet.
To minimize the symptoms of keto flu, it is recommended to transition slowly, get enough rest, drink enough water, and increase salt or electrolyte consumption. Some people drink during the first days extra cups of chicken bouillon to replenish those salt losses or by sugar free electrolytes drinks.
It is very rare, but people on a keto diet may have a false positive breath alcohol test due to acetone in the body can sometimes be reduced to isopropanol by hepatic alcohol dehydrogenase.
The following points are not commonly mentioned in most of the commercial websites offering keto plans or subscriptions. Most of the considerations mentioned here (mainly on point 2) not only apply for keto diet but for any other weight loss protocol. As mentioned before in the Goals post, weight loss is the tip of the iceberg but there are many other health issues underneath that we need to address.
These are important questions as keto diet requires some planning. If you are considering this for weight loss purposes in a temporary mode, would you be on keto diet until you reach your weight loss goal? Personally, I recommend using this type of plan until reaching at least 80% of target loss. After that, it is important begin a slow, gradual reintroduction of more carbohydrate foods to an amount appropriate that we still see gradual weight loss until goal is reached. This slower, final approach helps you to ensure longer-term sustainability, and avoid yo-yo effect.
Most keto plans and subscriptions are great to help you getting into ketosis state and losing weight, but they commonly forget to guide you on going back to a standard non-keto diet when doing it temporarily, causing many people to gain back or even more the weight it was lost during the keto diet.
When we are considering starting a keto diet, we are going through a metabolic process called Ketogenesis as mentioned before. That metabolic process has a path with certain steps that require certain ingredients in the formula that if we are depleted or not optimized may impair part of the process. Below we present the list of critical points to consider that are not normally communicated to people which will make the difference between a successful ketosis or an impaired process full of frustration:
- Carnitine Levels: Carnitine is a compound which has an essential role in fat metabolism; it combines with long chain fatty acids to form acylcarnitines(esters) to enable their transport into the cell mitochondria for fat oxidation to convert into ketones. This process is well known as carnitine shuttle as it goes back and forth transporting fats; so, if for any reason you are carnitine deficient, the shuttle will not work properly; hence it will be difficult to achieve adequate ketosis.
Carnitine deficiency is not very common unless you were born with some of the deficiencies mentioned in the contra-indications section. It is still possible that you can get what is called a secondary carnitine deficiency (not from birth) caused by certain metabolic disorders, enzyme deficiencies, viral infections; but also, from certain medications like:
Cyclosporine
Pivampicillin
Valproate
Anticancer drugs: Etoposide, actinomycin D and vinblastine
Omeprazole
Antibiotics: Cephaloridine, cefepime, cefluprenam, levofloxacin and grepafloxacin
If you suspect you may be carnitine deficient or have been taking any of these medications, you may want to consider to check your levels at a lab. If you are below carnitine normal ranges, you may want consider supplementation with L-carnitine.
- We need energy to create more energy: There are many steps from eating food to the conversion into energy (ATP) starting from chewing our food, digest our food, absorb the nutrients into the blood, nutrient absorption into the cells and production of energy as ATP(Adenosine Triphosphate) in the mitochondria(our little energy factories). If any of these steps is not optimal, the amount of energy that we will produce would not be enough. We need to crank the engine! These are some of examples in the steps to observe:
o Good quality and variety in the food: Not because you will start your keto diet means that you will skip your veggies. We still need to consume a variety of good quality food, free of pesticides and artificial ingredients before, on and after keto diet. We still have a quota of vitamins, minerals, antioxidants and phytonutrients to meet.
o Good digestion: Digestion starts with chewing your food; it may sound very basic but it is crucial that you chew your food at least 20 – 30 times. If you have acid reflux or any other digestive disorder, you may want to find ways to address them before starting keto diet due to two main reasons: we want to have good amount of nutrients and energy for ketosis, and because high consumption of fats may be troublesome with certain digestive disorders like Acid Reflux, Small intestinal bacteria overgrowth (SIBO) or any fat malabsorption issue.
o Oxidative damage in the mitochondria: If our little furnaces are with oxidative damage, they will not work in optimal conditions. The mother of all antioxidants is called Glutathione. If our levels of glutathione are not optimal, more oxidation will be present. If you feel constantly tired, with brain fog, poor sleep or high toxin exposure; there is a chance that you may have a glutathione deficiency. You can test this through a lab in the form of glutathione or homocysteine levels. If either glutathione is low or homocysteine is high, you may need supplementation of glutathione in the form of S-Acetyl Glutathione. You may also need Vitamins B, zinc and magnesium.
- Insulin Resistance: For many people, a strong predisposition toward insulin resistance is part of how they became obese initially. Thus, they will need to adapt to a long-term diet that might contain substantially less carbohydrate foods than what they might think of as "normal". This may be challenging at the beginning, and will require time to adapt. With the help of a wellness expert, we can make sure a slowly entrance and exit from keto diet without yo-yo effects.
- Toxins accumulated into Fat Tissue: Most toxins are fat-soluble getting stored into fat tissue. This includes certain heavy metals and other toxins coming from pesticides and all kinds of chemical substances in our beauty and household products. This is a very tricky but important point as keto diet may cause you to shed good amounts of fat where all those toxins are trapped. If all those toxic substances are released abruptly, it may create a toxic overload which will cause more harm than good. If for any reason you suspect that you may have levels of toxins, metallic dental fillings or any symptom associated with toxins as brain fog or any other neurological problem; you may want to consult a wellness expert for testing and proper steps.
- Adrenal and Thyroid hormones: High stress causing high levels of cortisol and adrenaline, and thyroid conditions may impair proper ketogenesis. Lab panels for these hormones are a helpful tool to identify any conditions like hypothyroidism and others, and find ways to address any imbalance before starting on keto diet.
- A food tracker app like MyFitnessPal : You will need to set the macronutrient ratio goals based on the type of ketogenic diet you are planning to follow, and log all the foods you eat to make sure you are meeting the daily requirements to stay in ketosis state.
- A method to test ketones: In order to make sure you stay in ketosis state, it is recommended to measure ketone levels every day. The most common methods are:
o Blood Ketone Meter: It’s the most accurate way to measure ketone bodies. You need to prick your finger and place some drops on a special test strip that is analyzed by a meter. Blood ketone meters can precisely determine the level of ketones in your blood but they are also pricey, around $40 and the test strips cost. If you want to test yourself daily, it may cost you up to $150 per month plus the cost of the meter.
o Breath testing: This is a non-invasive and cheaper alternative by measuring breath acetone concentration which is one of the ketone bodies; due to that, measurements will not correlate with blood ketones and results may be less accurate as they are affected by factors as the amount of water and alcohol consumed.
o Urine ketone strips: This is a very simple method where you just have to place a stick in direct contact with urine and it will change to a certain color. There is a chart in the bottle where you can compare and determine the level of ketosis. This method is the cheapest but it is not the most reliable.
Basic Keto Diet Protocol
- Carbohydrates: Less than 50g of net carbohydrates per day. They should be consumed mainly in the form of non-starchy vegetables, leafy greens and small amounts of fruits like berries and melons.
Note: When calculating carbs consumed, it needs to be net carbs which is the subtraction of total carbs minus the grams of fiber and/or sugar alcohols as these two do not provide any nutritional value.
Net carbs (g) = Total carbs(g) – Fiber(g) – Sugar alcohols(g)
- Fat: 70% of daily consumed calories: As mentioned before, it is important to balance the different types of fat, proper ratio of Omega 6 to Omega 3 no more than 5:1. Good options to include are:
o Omega 6 sources: Walnuts, Hemp seeds, peanut butter, sunflower seeds
o Omega 3 sources: Fatty fish like salmon, cod fish, oysters, sardines, flax seeds, chia seeds, avocados, olive oil, avocado oil
o Moderate dairy in the form of cheese and butter
o Limit processed and lunch meats like bacon, salami, ham, prosciutto
o Avoid trans-fats
o Medium Chain Triglycerides: Coconut Milk, Coconut oil, MCT oil
- Protein: 20 – 35% protein of daily consumed calories: It may come from animal or plant-based proteins.
o Animal protein: Eggs, chicken, fish, turkey, red meat in moderation
o Plant-based protein: Edamame, tofu, broccoli, spirulina, nuts and seeds.
For keto diet, there is no a calorie limit to consume as with other diets. Fats are caloric and more satisfying than carbs. As mentioned before variety is important to make sure we are getting all the necessary nutrients.
Powerful tools as Mindful Eating and Hunger-Satiety Scale discussed previously are still applicable and helpful: Listen to your body: Eat when you feel hungry, stop eating when you feel satisfied.
Keto Diet Tips
- Psyllium husk is your best friend: This is an amazing type of fiber with only 1 net carb/Tbsp. It will not only help you with your daily fiber intake and avoid constipation, but also it is a great ally to make delicious keto breads and pancakes (recipe here).
- Almond and coconut flour: Great alternative for breading, cakes, cookies and even tortillas! No need to feel deprived. We have a keto-friendly crab cake recipe here.
- Chocolate is allowed! As long as is sugar free. Preferably dark chocolate with more than 70% cacao. You can buy keto-friendly chocolates or follow this recipe here.
- Good sweetener options: Monk fruit, Stevia, Erythritol
- Get support from your family and friends: Create a safe space and of support with your family and friends, so they know your new dietary restrictions.
- Eating outside is most of the times easy. You can order any steak, seafood, poultry with some vegetables grilled or with butter. Fast food is not an option for keto and any other diet protocol anyway.
- Many people combine the keto diet protocol with intermittent fasting which includes prolonged periods of fasting to trigger even further ketosis. There are different protocols for intermittent fasting that may be further discussed. It is recommended to introduce intermittent fasting a couple weeks after the body is fully adapted to the keto diet, and not simultaneously.
Our Final Words to You...
I hope all the information provided to you is enough helpful and gives you a good overview regarding the mechanisms behind ketosis and the different aspects to consider, so you can wisely determine if this is the right type of diet and moment for you.
What it is delighting about all these different dietary discussions for me is that experts may not agree in which diet is the best; but we ALL agree that eating real food is the best. It does not matter which dietary theory you want to follow, absolutely everybody agrees that simple carbohydrates, flours and sugars are NOT the option, that processed foods are NOT the option, that fast food is NOT the option, that junk food is NOT the option in a daily basis. Moderation and balance are the key. The same principles that we have discussed previously in other posts which are also part of the foundations in the guides of Splendhealth Learning are still applicable.
If you need personalized support or more information about keto diet or any other dietary theory, book today your free consultation here.
#splendhealth #keto #ketosis #intermittentfasting #wellness #health
https://www.ncbi.nlm.nih.gov/books/NBK21150/ Glycolysis and Gluconeogenesis
https://www.ncbi.nlm.nih.gov/books/NBK499830/ Ketogenic Diet
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551118/ Trans fats —sources, health risks and alternative approach
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139399/ Nitrates/Nitrites in Food
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251269/ Ketogenic diets: Boon or bane?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480775/Advantages and Disadvantages of the Ketogenic Diet
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/ Long-term effects of a ketogenic diet in obese patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826507/ Beyond weight loss
https://pubmed.ncbi.nlm.nih.gov/9478987/ Glucose deprivation
https://pubmed.ncbi.nlm.nih.gov/10863552/ Glucose deprivation
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036197
https://journals.physiology.org/doi/full/10.1152/ajprenal.00149.2007 Insulin’s impact on renal sodium transport and blood pressure in health, obesity, and diabetes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967041/ Carnitine Transport and Fatty Acid Oxidation
https://www.ncbi.nlm.nih.gov/books/NBK553106/ Malabsorption Syndromes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101675/ Adipose Tissue as a Site of Toxin Accumulation
