Updated: Mar 3, 2021
Much has been written about ketogenic diets recently.
Advocates pitch them as the antidote to many chronic diseases-of-the-day from heart-disease to cancer, Alzheimer's, dementia to obesity. They have also been used to treat epilepsy with much success.
Ketogenic diets are also sometimes suggested as a weight-loss alternative to reduced carbohydrate diets (although both diets also seem to support the general principle that one should maintain a calorie deficit to lose weight).
By the detractors, they are considered a fad, associated with poor adherence, due to the difficulty giving-up carbs and sugar that drive hunger cravings in most people.
So how does the ketogenic (keto) diet work and what exactly does it do?
The Ketone Creation Process:
When you reduce the amount of carbohydrates you eat, or fast for any period of time, your glycogen stores are depleted. These are stores of readily usable energy in your muscles and liver, and which circulate in your blood after you eat carbohydrates and sugars.
When glycogen is depleted your "blood sugar" (actually glucose specifically) levels drop.
This reduces the need for your body to secrete insulin, which is the hormone responsible for "shuttling" glucose, and other substances, into cells that need energy or nutrients. This is good for your body, because continual elevated insulin is a stressor, promotes inflammation, and signals fat cells to lock-up their energy sources.
When there is no glucose available for energy your body turns to fat as its fuel source, and fat cells open-up. Additionally, other hormonal regulators are not antagonised by insulin.
Depleting your glycogen and blood sugar is achieved by limiting carbohydrates to less than 5% and protein between 20 – 25% of your daily calorie intake. (Fasting and exercise also help deplete glycogen stores). The remaining calories should come from healthy fats, such as the fats found in milk, cheese, avocados, nuts, red meat, oily fish, etc.
As your body begins breaking down fats, ketones are produced, putting you into what is described as a state of “ketosis”.
What Are Ketones Health Benefits?
Mental acuity, preventing brain fog throughout the day and keeping stress levels low.
Enhanced focus and thought processing.
Long-lasting energy - high-fat, low-carb diets provide is valuable for endurance athletes, sportspeople and those who exercise at length.
Control of seizures - for some people with epilepsy....for around a century ketosis has been used to treat epileptic seizures. (this does not work in all cases).
Fat loss. Low-carb diets have the benefit of burning the bodies stored fat. Low insulin levels open-up fat cells to release energy. High-carb diets do the opposite as insulin keeps fat cells locked-down.
Blunting hunger pangs. The ketogenic diet controls the hunger hormone ghrelin. Controlling ghrelin helps you keep from craving food.
Diabetes reversal - Research indicates that an LCHF (low-carbohydrate, high-fat) diet has the potential to reverse insulin resistance and possibly type two diabetes. Up to 82% of American adults are thought to be diabetic or insulin-resistant.
Positive blood lipid profile - levels and heart health.
Ketosis is created by cutting back on, or completely eliminating, most carb sources in your diet, including:
Whole and processed grains
Fruit juices and sugary soft drinks
Beans and legume
Besides cutting back on carbs, a ketone-centric diet also involves eating moderate amounts of protein and, most importantly, high amounts of fats. (Saturated fats are most healthy).
The shift, from using circulating glucose to breaking down stored fat, and transitioning to ketones as a source of energy, usually happens over two to four days of eating fewer than 20 to 50 grams of carbohydrates per day. Keep in mind that this is a highly individualised process.
It lacks carbohydrates but a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, sausages, cheeses, fish, nuts, butter, oils and seeds.
There is an incorrect assumption that, because it is so restrictive of carbohydrates, it is really hard to follow a ketogenic diet over the long term. Carbohydrates normally account for at least 50% of the typical western diet.
In my opinion, however, there are less feelings of hunger and less insulin induced “cravings” on a ketogenic diet, so my experience is that they are actually pretty easy to stick to.
If my experiences were anything to go-by, however, when you lapse and have a carbohydrate “binge” whilst on a ketogenic diet, you will probably experience a period of time soon afterwards where the surge of insulin makes you very hungry to repeat the binge, and that can be challenging.
So it is not that sticking to a ketogenic diet that is difficult, but more the swapping between high-carb and low-carb that is challenging. This does improve over time, and one starts to notice something referred to as metabolic flexibility, where it is easier to switch between ketones and glucose as a fuel source with less noticeable transition periods.
One does tend to feel free from a dependence on food when you follow a ketogenic eating pattern.
It is common not to feel hungry at all throughout the day and to have quite high levels of mental acuity and stable energy. Apparently, to my friends and family I seemed more relaxed than when I was eating ”normally”.
My improved concentration levels and feelings of alertness were a couple of surprising benefits that I noticed when I started on this eating style, and if I do eat carbs on a day-off for example, I tend to notice feeling sluggish and tired quite soon after eating them.
Another noticeable change is in skin tone and hair. My skin (which is quite sensitive and dry generally) looked great..and moisturiser that I had been applying daily for years became completely surplus to requirements.
One of the questions often asked is if sweeteners can be used and maintain adherence to a ketogenic diet, and sweeteners such as stevia extract, erythritol, and xylitol all have been found to have positive health effects and are able to be used with little or no negative effects on ketosis.
This, along with the use of almond flour, coconut flour and other keto-friendly ingredients has opened the doors to a multitude of books, social media pages and other resources (check out the Diet Doctor app) sharing very tasty keto versions of deserts and puddings...so being on a ketogenic diet enables one to eat foods that would probably be considered "out-of-bounds" on a traditional diet.
The real magic of a ketogenic diet, in my opinion, is the way that it reduces inflammation and enables hormones to re-balance.
This helps with mood, anxiety, stress, hunger, sexual health & vitality, & decreased insulin (reducing risk for cancer, diabetes, heart disease, Alzheimer’s & dementia).
It also decreases blood triglycerides and increases HDL...both of which are factors that dramatically improve risk factors for cardio-vascular disease such as heart attacks and strokes.
Additionally ketogenic diets have been shown to increase the mean particle size of LDL molecules, which again significantly reduces heart disease risk.
I would highly recommend trying the ketogenic diet if you are high risk of heart disease or have any auto-immune conditions or feel sluggish, bloated and low on energy. In my opinion, the exclusion of sugar and starchy carbohydrates tends to improve things that you may have lived with for years and presumed were not addressable.
Start with a 4 week programme and see how you feel on it. After the initial period of adaptation you will soon know whether you feel better, and if is working for you, and at the very least, your risk factors for heart disease will have dramatically improved.
Further Reading & References:
Ketogenic Diet Modifies The Risk Factors Of Heart Disease In Obese Patients
A Ketogenic Diet Favorably Affects Serum Biomarkers for Cardiovascular Disease in Normal-Weight Men
Mathew J Sharman, Willian J Kraemer, Dawn M Love, Neva G Avery, Ana L Gomez, Timothy P. Scheet, Jeff S Volek
The Journal of Nutrition, Volume 132, Issue 7, July 2002, Pages 1879–1885. Published: 01 July 2002
“The ketogenic diet with nutritional supplementation led to beneficial changes in serum lipid subclasses during weight loss. While the LCKD did not lower total LDL cholesterol , it did result in a shift from small, dense LDL to large, buoyant LDL, which could lower cardiovascular disease risk”.
Low carbohydrate ketogenic diet enhances cardiac tolerance to global ischaemia
“This study suggests that the LCKD is cardio-protective functionally”.
“The ketogenic diet in this study resulted in favorable responses in fasting TAG, postprandial lipemia, HDL-C, LDL particle size, and insulin levels in healthy normolipidemic men”.
Ann Intern Med. 2014 Sep 2;161(5):309-18. doi: 10.7326/M14-0180.
Effects of low-carbohydrate and low-fat diets: a randomized trial.
Bazzano LA, Hu T, Reynolds K, Yao L, Bunol C, Liu Y, Chen CS, Klag MJ, Whelton PK, He J.
“The low-carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction than the low-fat diet. Restricting carbohydrate may be an option for persons seeking to lose weight and reduce cardiovascular risk factors”.
Ann Intern Med. 2004 May 18;140(10):769-77.
A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial.
Yancy WS Jr1, Olsen MK, Guyton JR, Bakst RP, Westman EC.
“During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than with the low-fat diet”.
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