Intro to Keto
There's been a lot of buzz about the ketogenic diet in the past few years.
To be honest, I was a bit skeptical about its claims and how it could possibly be sustainable. Admittedly, I have been well-doctrinized by "evidence-based medicine" from my infancy as a doctor and it's hard to be open to deviations to something as stalwart as the USDA Food Pyramid:
Tweaks like Mediterranean Diet, Pritikin Diet, Blue Zone Diet, even the Daniel Plan and vegetarianism all hover around the old adage...but to flip the thing completely upside down? Ha!
My husband, Dr. Greg, has been reading up on all kinds of age-medicine related topics and he's been throwing around keto for months now. His pressuring me really hit the fan around the holidays and I pretty much told him to take a hike. Keto is life-changing eating! What woman on earth has time to plan for that during the holidays??
And so, the holidays came.
We went home to see my family for Christmas and I had already been thinking about coaching my mother in ketogenic diet come January to help her get off of her insulin. Why? Because a ketogenic diet is the most insulin and glucose-neutral way to eat. Once you gain control over blood glucose and insulin, type 2 diabetes becomes controlled. My mother's diabetes needs major control. I decided to go keto with her to help her navigate the transition and help her be accountable.
The other thing that becomes easier with lower insulin levels is fat loss. This is because in a fed-state, the body produces insulin in response to carbohydrate taken in via food and tells the body "we have an abundance of energy available; store it for a rainy day!" So, our body does store energy away...in our unlimited fat storage system! In the Standard American Diet (SAD) pushed on us by the USDA, what do you see as the basis of our eating? Why, it's carbohydrates! Wonder why we have an epidemic of obesity and type 2 diabetes? A high carbohydrate, low fat diet. Now, when you look at obesity, think of insulin and carbohydrates. The cure for this is not in starvation, although that works well in the short-term. The sustainable cure is ketosis.
So, what is "ketogenic," "ketones," "ketosis?"
Let's take a step back and define a couple of other terms here.
First: metabolism.
Simply put, metabolism is how your body breaks down 3 macronutrients -- carbohydrates, fat and protein -- to generate energy for our cells to use. You'll remember that cells are the individual building blocks of tissues, tissues make up organs, and organ systems together define our body.
So, a ketone body is a chemical our bodies make as a product of either fat or protein breakdown. It's a small chemical unit the body can send through it's chain reactions to make energy.
Ketosis is a metabolic state. Ketosis means that the body is using fat as its primary fuel source. That fat can come from either what you eat or from your own fat stores, but how you get there can be important.
I was surprised in my research to see this quote right there in my old med school biochemistry book, Basic Medical Biochemistry by Marks, Marks and Smith (1996) about ketone bodies:
"Ketone body synthesis occurs whenever fatty acid levels are elevated in the blood, that is during fasting, starvation or AS A RESULT OF A HIGH-FAT, LOW CARBOHYDRATE DIET" (p. 366, emphasis mine). This diet is really no diet at all. It's a biochemical state of metabolism that can be created by our diet. Let me explain:
If you were to fast or go into starvation, you will get into ketosis in about the same time as a high fat diet (about 3-7 days). The bad thing about starvation is two-fold: 1) your metabolic rate gets really slow (you don't make much energy) and 2) once you re-feed a starved body the SAD, it will go back into fat-stuffing mode almost immediately. Neither are good for weight loss in the long haul. (However, intermittent fasting as an adjunct to ketosis for improved fat loss and longevity is a topic we will discuss in later posts.)
You can do the same thing without starving by flooding the system with a high-fat diet. The liver is where metabolism starts. It doesn't care where the fat came from, it just sees a lot of it present! When fat is the dominant macronutrient available for metabolism, ketone bodies begin to be formed for distribution to the cells to use to make energy. Thus, the ketogenic, "keto" diet!
This basic biochemistry was first used therapeutically as a diet by Dr. Russell Wilder at Mayo Clinic in 1921. His application was to children with epilepsy. This was after several doctors showed improvement of seizures in children who were put into therapeutic fasts. Dr. Wilder simply applied biochemistry and got to the same biochemical state with a high fat diet! This could be sustained a heck of a lot longer than fasting and was used for decades as the go-to treatment for seizure disorder until the advent of anti-seizure medications. He was the first to call this a "ketogenic diet."
The original diet was based on body weight in kilograms and applied a ratio of 4:1:1 to fat:protein:carbohydrate in the diet. There are now at least 5 variations of the diet, and the one I propose uses the following percentages:
70% fat
25% protein
5% carbohydrate
To eat this way, one must plan.
Step 1. Get a book you can understand and is from a trusted source. I am recommending The Keto Cure by Dr. Adam Nally to my patients. It's half "why" and half "how-to." Very easy to read and addresses many of what he calls the "diseases of civilization" that a ketogenic diet can help.
Step 2. Get rid of the crap food in your home if it tempts you. Most books on keto tell you what to buy and what to pitch.
Step 3. Get the help of your doctor if you have Type 2 Diabetes, thyroid disease, high cholesterol or high blood pressure. You're going to have to come off of medications the longer you adhere to this type of metabolic state and you need some professional help. Staying on some medications without modification can be life threatening!
Step 4. Get some ketone test strips for urine testing. If you don't test, you won't know if you've achieved or are maintaining ketosis! You cannot rely on physical signs or symptoms.
Step 5. Read up on the phases of ketosis. Yes, there are phases you must endure to get your body to shift into preferred fat metabolism. You must be able to anticipate such things as "keto flu" or GI upsets and stay ahead of them so you won't quit. Most sources say full "keto-adaptation" takes 2-3 months!
Step 6. Get some cookbooks with reliable reported per-serving macros in grams. If you just rely on the internet and don't watch your serving size and the amount of protein and carbohydrate in the recipes, you'll kick yourself OUT of ketosis in no time!
Step 7. When in doubt, eat fat.
Step 8. Beware of sugar substitutes! Erythritol and stevia (not granular) are about the only two out there that won't spike insulin levels. Swerve is an excellent substitute in baking.
Step 9. Don't skimp on salt. You will lose a lot of water with ketosis in the beginning. With that water goes salt. Drink salted water to help maintain hydration in the first few phases of ketosis to prevent side effects.
Step 10. Be a Nutrition Fact label-reader. Know what you are about to eat: the correct serving size, macronutrient content, etc. Don't worry about calories, look at the Total Fat, Total Carbohydrates and Protein composition of your food. The magic number for carbohydrates is 20 grams/day or less, which is about 7g Total Carbs/meal!
This is where to start and a little bit of the why behind nutritional ketosis. If you'd like more information, check out the sources I've referenced and give it a try!
More tips and tricks on the next post!
To your good health,
Dr. Lydia
To be honest, I was a bit skeptical about its claims and how it could possibly be sustainable. Admittedly, I have been well-doctrinized by "evidence-based medicine" from my infancy as a doctor and it's hard to be open to deviations to something as stalwart as the USDA Food Pyramid:
My husband, Dr. Greg, has been reading up on all kinds of age-medicine related topics and he's been throwing around keto for months now. His pressuring me really hit the fan around the holidays and I pretty much told him to take a hike. Keto is life-changing eating! What woman on earth has time to plan for that during the holidays??
And so, the holidays came.
We went home to see my family for Christmas and I had already been thinking about coaching my mother in ketogenic diet come January to help her get off of her insulin. Why? Because a ketogenic diet is the most insulin and glucose-neutral way to eat. Once you gain control over blood glucose and insulin, type 2 diabetes becomes controlled. My mother's diabetes needs major control. I decided to go keto with her to help her navigate the transition and help her be accountable.
The other thing that becomes easier with lower insulin levels is fat loss. This is because in a fed-state, the body produces insulin in response to carbohydrate taken in via food and tells the body "we have an abundance of energy available; store it for a rainy day!" So, our body does store energy away...in our unlimited fat storage system! In the Standard American Diet (SAD) pushed on us by the USDA, what do you see as the basis of our eating? Why, it's carbohydrates! Wonder why we have an epidemic of obesity and type 2 diabetes? A high carbohydrate, low fat diet. Now, when you look at obesity, think of insulin and carbohydrates. The cure for this is not in starvation, although that works well in the short-term. The sustainable cure is ketosis.
So, what is "ketogenic," "ketones," "ketosis?"
Let's take a step back and define a couple of other terms here.
First: metabolism.
Simply put, metabolism is how your body breaks down 3 macronutrients -- carbohydrates, fat and protein -- to generate energy for our cells to use. You'll remember that cells are the individual building blocks of tissues, tissues make up organs, and organ systems together define our body.
- Carbohydrates break down to glucose that cells use to make energy.
- Proteins break down into either glucose or only while severely fasting, ketone bodies, that cells use to make energy.
- Fat breaks down into ketone bodies that cells use to make energy.
So, a ketone body is a chemical our bodies make as a product of either fat or protein breakdown. It's a small chemical unit the body can send through it's chain reactions to make energy.
Ketosis is a metabolic state. Ketosis means that the body is using fat as its primary fuel source. That fat can come from either what you eat or from your own fat stores, but how you get there can be important.
I was surprised in my research to see this quote right there in my old med school biochemistry book, Basic Medical Biochemistry by Marks, Marks and Smith (1996) about ketone bodies:
"Ketone body synthesis occurs whenever fatty acid levels are elevated in the blood, that is during fasting, starvation or AS A RESULT OF A HIGH-FAT, LOW CARBOHYDRATE DIET" (p. 366, emphasis mine). This diet is really no diet at all. It's a biochemical state of metabolism that can be created by our diet. Let me explain:
If you were to fast or go into starvation, you will get into ketosis in about the same time as a high fat diet (about 3-7 days). The bad thing about starvation is two-fold: 1) your metabolic rate gets really slow (you don't make much energy) and 2) once you re-feed a starved body the SAD, it will go back into fat-stuffing mode almost immediately. Neither are good for weight loss in the long haul. (However, intermittent fasting as an adjunct to ketosis for improved fat loss and longevity is a topic we will discuss in later posts.)
You can do the same thing without starving by flooding the system with a high-fat diet. The liver is where metabolism starts. It doesn't care where the fat came from, it just sees a lot of it present! When fat is the dominant macronutrient available for metabolism, ketone bodies begin to be formed for distribution to the cells to use to make energy. Thus, the ketogenic, "keto" diet!
This basic biochemistry was first used therapeutically as a diet by Dr. Russell Wilder at Mayo Clinic in 1921. His application was to children with epilepsy. This was after several doctors showed improvement of seizures in children who were put into therapeutic fasts. Dr. Wilder simply applied biochemistry and got to the same biochemical state with a high fat diet! This could be sustained a heck of a lot longer than fasting and was used for decades as the go-to treatment for seizure disorder until the advent of anti-seizure medications. He was the first to call this a "ketogenic diet."
The original diet was based on body weight in kilograms and applied a ratio of 4:1:1 to fat:protein:carbohydrate in the diet. There are now at least 5 variations of the diet, and the one I propose uses the following percentages:
70% fat
25% protein
5% carbohydrate
To eat this way, one must plan.
Step 1. Get a book you can understand and is from a trusted source. I am recommending The Keto Cure by Dr. Adam Nally to my patients. It's half "why" and half "how-to." Very easy to read and addresses many of what he calls the "diseases of civilization" that a ketogenic diet can help.
Step 2. Get rid of the crap food in your home if it tempts you. Most books on keto tell you what to buy and what to pitch.
Step 3. Get the help of your doctor if you have Type 2 Diabetes, thyroid disease, high cholesterol or high blood pressure. You're going to have to come off of medications the longer you adhere to this type of metabolic state and you need some professional help. Staying on some medications without modification can be life threatening!
Step 4. Get some ketone test strips for urine testing. If you don't test, you won't know if you've achieved or are maintaining ketosis! You cannot rely on physical signs or symptoms.
Step 5. Read up on the phases of ketosis. Yes, there are phases you must endure to get your body to shift into preferred fat metabolism. You must be able to anticipate such things as "keto flu" or GI upsets and stay ahead of them so you won't quit. Most sources say full "keto-adaptation" takes 2-3 months!
Step 6. Get some cookbooks with reliable reported per-serving macros in grams. If you just rely on the internet and don't watch your serving size and the amount of protein and carbohydrate in the recipes, you'll kick yourself OUT of ketosis in no time!
Step 7. When in doubt, eat fat.
Step 8. Beware of sugar substitutes! Erythritol and stevia (not granular) are about the only two out there that won't spike insulin levels. Swerve is an excellent substitute in baking.
Step 9. Don't skimp on salt. You will lose a lot of water with ketosis in the beginning. With that water goes salt. Drink salted water to help maintain hydration in the first few phases of ketosis to prevent side effects.
Step 10. Be a Nutrition Fact label-reader. Know what you are about to eat: the correct serving size, macronutrient content, etc. Don't worry about calories, look at the Total Fat, Total Carbohydrates and Protein composition of your food. The magic number for carbohydrates is 20 grams/day or less, which is about 7g Total Carbs/meal!
This is where to start and a little bit of the why behind nutritional ketosis. If you'd like more information, check out the sources I've referenced and give it a try!
More tips and tricks on the next post!
To your good health,
Dr. Lydia
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