Ketogenic diet
The Ketogenic diet is a common dietary approach used for rapid weight loss, and has been popularised by programs such as the Atkins Diet, Sure slim, and Ultra Lite. The diet involves quite a low carb intake and higher amounts of fat.
The human body has access to 2 main fuel sources:
Glucose and fat
Protein can provide energy if over consumed, but is negligible compared to the other sources. If the body is restricted in glucose (AKA carbs), it will begin to burn fat.
Traditional Keto Ratios
Carbohydrate, Fat & Protein Ratios for Keto
Although the basics are to eat lots of fat, moderate amounts of protein, and low carb, there are differing opinions about the ratios needed to get into to ketosis.
A traditional ketogenic diet limits carbs to 5% of your total calories, 80% fat, and 15% protein. This certainly works, but it’s very difficult to maintain. An Adapted Ketogenic diet is a bit more lenient, allowing up to around 14% of your calories from carbs, 68% fat, and 18% protein. Using programs such as My Fitness Pal or Cronometer are great ways to keep your ratios in check.
Adapted Keto Ratios
How to Measure Ketones
Acetoacetate
Measured in urine. This represents the amount of ketones spilled out into urine, so indicates your surplus. Ketostix are inexpensive and can be bought from most pharmacies to test your urine. They act as a strong motivator to stay on track with the diet. When these strips show any result, you’re burning fat. It’s as simple as that.
Acetone
Measured in breath. Acetone is one of the ketone bodies that result from the break down of acetoacetate. Breath testing can be done using a Ketonix device. This can be bought for personal use, or can be performed during a consultation. This is non-invasive, but can be affected by hydration, alcohol use, chewing gum etc. Aim for levels >45 on the Ketonix device
β-HBA (beta-hydroxybutyrate)
This is measured in blood and indicates specific levels at time of testing. A meter can be bought from pharmacies to check blood ketones, or can be done during consultation. Although beta-hydroxybutryate is not technically a ketone body, it is the most accurate way to measure ketosis. Aim for 0.6-1.0mmol in the morning and between 1.0 to 3.5 mmol for the rest of the day.
Weight Loss Potential
The more demand your body has for energy; the more fat can be burned. Although ketosis will cause weight loss without exercise, the more you move, the more you lose. Clinically, I regularly see weight loss of ~4kg in the first 4 weeks. Assessing biochemical factors such as thyroid and blood sugar control can influence the result in an even more favourable manner.
Other Benefits of Going Keto – It’s not just about Weight Loss
More Energy!
Initially crossing over into ketosis can be a rocky experience for some, causing brain fog, fatigue, and dizziness, but it’s short lasting. Once on the other side, things make a dramatic turn. Energy production becomes WAY more efficient, mental focus reaches a new high, and productivity skyrockets.
While glucose requires 11 steps to enter the citric acid cycle to make energy, ketones require only three steps. This increases mitochondrial efficiency and the subsequent production of ATP, which is the body’s functional unit of energy. It also increases mitogenesis, which is the production of new mitochondria. The more mitochondria you have the more energy you can make.
Keto for Heart Health
Eating keto can have amazing benefits to your cardiovascular system. Studies show a substantial increase in HDL, the good cholesterol, and a drop in LDL, the damaging cholesterol (although the LDL result is conflicted in other studies). In one study, triglycerides decreased by 42% in 16 weeks, which is quite impressive.
The old belief system around fat consumption causing an increase in body fat and cholesterol levels is severely out dated. Of course, trans fats still provide health risks and should be limited. Dietary cholesterol accounts for only about 15 to 20% of blood cholesterol, so diet changes do not weigh heavily on lipid elevations. People with genetic SNPs on the APOE4 gene will need to be monitored through out ketosis, as they have more trouble processing fat. This can be tested if required.
Metabolic Conditions
Since ketone bodies are released in the presence of high fat and reduced glucose, it has great benefits for regulating the release of insulin and lowering glucose levels. This can be therapeutic for insulin resistance, diabetes (types 1 & 2), and other metabolic conditions. HbA1c levels have been seen to reduce by 16% in 4 months following a low carb ketogenic diet.
Those on medication need to keep in touch with their doctor throughout their time in ketosis. Often, individuals need to reduce, or can eventually stop, their medication all altogether, so it will need to be tapered under medical supervision.
Alzheimer’s and Cognitive Function
Fatty acids, which include omega 3 and omega 6, are a vital part of cognitive functioning, and have seen to be protective against cognitive decline, and also depression and autism. The majority of the brain is made of fat, so increasing consumption of, particularly nucleotides, found in organ meats (but also meat in general), can help stimulate neurogenesis, the growth of new neurons. It’s always best to choose organic free-range meat, which has a more favourable omega 3 and omega 6 ratio.
Ketone bodies are considered neuroprotective, and studies show they also increase telomere length. Ketogenic diets have demonstrated efficacy in neurodegenerative disorders, which include Alzheimer’s disease, Parkinson’s disease, and ALS. Although ketones reduce the accumulation of beta amyloid, much of the benefit can be attributed to the increase in mitochondrial efficiency, and alteration of the brain’s normal reliance on glucose.
Epilepsy
Ketogenic diets have been used for epilepsy in children for almost 100 years. The efficacy relies on many potential actions. Some children have genetic issues with the GLUT-1 receptor, which moves glucose to the brain, or pyruvate dehydrogenase (PDH) deficiency, which prevents the metabolism of glucose. Relying on ketone bodies for energy instead of glucose negates the need for both of these.
Ketone bodies also balance the brain’s pH, which regulates neuronal excitability, and can increase the synthesis of the calming neurotransmitter GABA.
Precautions to Consider
Animal products are carb free, so easily become the foundation for a keto diet, along with oils. It contrast, fibrous vegetables are decreased due to their carb content, which can have some impact on the gut. Your gut bacteria require these fibres to help them colonise and proliferation, so dietary deficiencies can cause dysbiosis. It may also cause constipation. These need to be taken into consideration if using a ketogenic diet long term. In contrast, this way of eating has been seen to starve dysbiotic bacteria, which can reduce IBS symptoms, and the occurrence of SIBO.
The thyroid requires insulin to convert T3 to T4, so long term keto enthusiasts should get regular thyroid blood work done to assess this to avoid slowing of the thyroid.
Those with the APOE4 gene do not process fats well, and are generally not suited to a ketogenic diet. APOE4 testing can be done through your GP.