The Ketogenic Diet, Is it Right for Me?

It seems that every few years a new fad diet comes along and everyone jumps on the bandwagon. The newest diet to hit the scene is the ketogenic diet, otherwise known as the “keto” diet. The basic premise is to restrict carbs to less than 20-30 grams per day and increasing fat intake to comprise 60-80% of your daily intake of calories.

The ketogenic diet has been used successfully for over 100 years for children who have epileptic seizures. Currently, the “Keto” diet is being used to help patients with metabolic syndrome, polycystic ovarian syndrome, cancer, diabetes, Parkinson’s, and autism. Many people are also using it for weight loss.

Does it work? For most people, yes. To understand why this way of eating can be beneficial, and how to do keto correctly, you have to have a foundation of understanding on how our metabolism works.

Human Blood Sugar Metabolism
Human metabolism has the benefit of being very flexible. We eat foods that can either be burned immediately for energy or, if we eat an excess, our body will store that energy as fat. This was especially beneficial for our ancestors who did not have constant availability of food like we do today. In humans, if a particular hormone called insulin dropped, that was the signal to the body to start converting fat into a useable form of energy called ketones (this is where the name “ketogenic,” or building of ketones, comes from). In this way, humans could access the stored energy they carried around with them as fat.

Most people have heard about insulin in the context of managing blood sugar. When people are pre-diabetic or diabetic (Type II diabetes), insulin levels go up. This is true because insulin is the hormone that “unlocks” cellular utilization of glucose. The more glucose you consume, the more insulin your body releases. If insulin levels stay elevated and you consume an excess of calories, the body will be signaling to store that as fat. In that way, insulin is a very powerful hormone for signaling either the storage or utilization of fat.

The Standard American Diet (SAD) is very high in foods that signal the release of insulin. Foods that are high in sugar, or that easily get converted into sugar, create this response.

How Keto Works
The ketogenic diet uses a basic premise of human metabolism to help people lose weight: eating fat does not stimulate an insulin response. This is so very important because, as previously mentioned, insulin signals fat storage. When people follow keto and reduce their carbohydrates and increase consumption of fats, this effectively lowers insulin levels. As insulin goes down, this signals the body to convert stored fat into ketones and burn those for energy. Below is a diagram that illustrates this concept.

The additional benefits of burning ketones for energy, as opposed to burning sugar, are:

• More stable blood sugar and less hunger
• Increased mental clarity
• Fat loss (not just weight loss)
• Sustained energy
• Lowered risk of blood sugar-related chronic diseases
• Lowered inflammation

How to Do Keto Correctly
Most people have a diet that is high in refined carbohydrates, which leads to dysregulation of blood sugar. Someone who eats this way might have a daily diet that looks like this: breakfast is high-sugar cereal with cow’s milk, a chocolate chip granola bar for a snack, a sandwich and chips for lunch with a piece of fruit, a soda mid-afternoon to boost energy, and pasta for dinner. This sort of diet keeps a person hungry because all day long blood sugar is spiking and falling. With this pattern of eating insulin levels stay high and it is unlikely that the person’s metabolism has a chance to get into ketosis, because there is always sugar to burn!

Someone with this pattern will have a harder time re-training his/her body to burn fat as a fuel. It is recommended to become “keto-adapted” slowly by decreasing carbohydrates and increasing fat consumption. This process can take up to 2 months to fully re-train the metabolism.

To get fully into ketosis, most people need to restrict their carbohydrates to less than 20-30 grams per day (this is about 5-10% of their daily calories). Protein should make up 15-30% of their diet. Fats should comprise 60-80% of their diet. The best fats to include are ones that are easily burned for fuel, including MCT (medium chain triglyceride) oil, avocado oil, olive oil and coconut oil. The higher amount of fat will more quickly get the body into ketosis.

A big mistake that people make when doing keto is not getting enough colorful vegetables. It’s much easier to subsist on cream cheese and cured meats rather than broccoli cooked in coconut oil. There are many rich, colorful vegetables that are low glycemic and encouraged on the keto diet (see chart below). When eating keto, 75% of your plate should still consist of vegetables cooked in good fats and the other 25% should be a good quality protein source.

Foods to Eat on Keto:

• Avocados / avocado oil
• MCT oil / coconut oil
• Olive oil
• Grassfed butter / ghee
• Pasture-raised animal protein
• Eggs
• Wild caught fish
• Leafy greens (spinach, Swiss chard, kale, collard greens)
• Cruciferous vegetables (broccoli, cauliflower, Brussel sprouts)
• Celery, onion, leeks, garlic, chives, zucchini
• Fresh herbs and spices
• Asparagus, bell peppers, green beans, mushrooms, tomatoes
• Nuts and nut butter, seeds
• Limited full-fat dairy (organic full-fat cream, organic cheese)

As you can see, a keto diet can be a nutrient-rich diet if done correctly. Combining this with other strategies of lowering insulin levels (intermittent fasting and exercise) can be a powerful way of regulating blood sugar and lowering weight in a healthy, sustainable way.

This article is for informational purpose only. Please consult a physician before starting any new dietary program.

Dr. Anne Zauderer will be teaching a lecture series that will dive deeper into some of the foundational questions about what food we should eat for our individual needs. The four-part series will be offered multiple times throughout the year. You are welcome to sign up for the whole series or individual lectures.

Please visit riordanclinic.org/events for more information about class dates and times.