Should You Follow a Ketogenic Diet?
The ketogenic diet was originally proposed as a diet to help with epilepsy and seizures. Now however this type of diet is widely promoted as a way to lose fat fast, maintain more energy and brain function. But does that mean you should follow a ketogenic diet?
Here’s the lowdown.
What is a ketogenic Diet?
In contrast to standard dietary recommendations for macronutrients a ketogenic diet is very low in carbohydrate.
Ketogenic diets are also high in fat with moderate levels of protein. While there are many variations of the diet – it generally works out as follows:
60-75% fat
15-30% protein
5-10% carbs
It relies on the metabolic state called ketosis. Instead of burning glucose for energy your body utilises fat. When you eat carbohydrates your body will produce two biochemical compounds:
- Glucose – sugar used by the cells for energy
- Insulin – hormone that pushes the glucose from the bloodstream into the cells so that the glucose can be converted into energy
Glucose is the primary source of energy – excess can be stored as fat in the body and stored also in the liver. If you diet is primarily carbs this then drives the usual metabolic pathway and may contribute to weight gain, insulin resistance and type 2 diabetes as well as cardiovascular disease.
Fats and particularly short chain fats (like coconut oil) can also be used for energy. They are made into acetyl CoA. Acetyl CoA can either enter the Krebs cycle or be converted to ketones.
As protein can also be used as an energy source on a ketogenic diet it is important that protein intake is not too high. The recommendation is to multiply your weight in lbs by 0.6-0.8 – this will give you your amount of protein in grams
So for a women who is 9stone = 126lb. The protein would be around 75g protein daily.
To more effectively achieve ketosis the fat you consume is important. Long chain fats are not able to produce ketones as easily as short chain fats.
Short-chain fats (12 carbons or less in length; often called medium-chain) are different from long chain fats. Short-chain fats do not appear in cell membranes and are not stored in adipose tissue (except for a little 12-carbon fatty acids). Rather than being transported throughout the body, they are shunted to the liver for disposal.
This means that if you eat a lot of coconut oil (which is 58% short-chain fats), you deliver a lot of fat to the liver for disposal. The disposal process for fat is conversion to acetyl CoA followed by either burning in the TCA cycle or conversion to ketones.
After a big cup of coconut oil is delivered to the liver, the liver’s ATP levels are quickly saturated. The TCA cycle is stuffed and the liver will dispose of the coconut oil by making ketones.
It will do this whether the rest of the body needs the ketones or not. The liver wants to get rid of the coconut oil, and it does it by making ketones whether the rest of the body wants them or not.
Therefore if you are following a ketogenic diet but not eating much short chain fats like coconut oil you will struggle to fully achieve ketosis.
Ketogenic Diet and Weight Loss
One of the first things people notice when they cut out carbs is a sudden loss of weight. However it is important to mention that the first few days this is likely to be water and not belly fat. The reason for this is that glycogen (the stored form of glucose) is stored with three to four parts water. So as the glycogen levels drop you will also lose water and hence the scales will show a weight loss.
That doesn’t mean of course that a ketogenic diet won’t help with weight loss but it is not necessarily the only way to successfully lose weight.
Remember there are a number of other factors to consider when it comes to losing weight.
- Insulin resistance / poor blood sugar control
- Adrenal stress / adrenal dysfunction / poor sleep
- Suboptimal thyroid function
- Imbalances in gut flora
- Toxic load – need for detoxification
- Inflammation
- Quantity of food eaten / imbalances in macronutrients
- Mindless eating
- Genetic SNPs influencing metabolism and utilisation of macronutrients
- Eating too many calories
One of the benefits of ketogenic diets is you don’t necessarily have to count calories – just monitor the carbs intake. For some people who complain of being hungry all the time this type of diet may be more satisfying and if you get the protein right it should not result in muscle loss like some restrictive diet. However if you are looking to build muscle it may not be the best approach. The reason for this is that protein levels may not be high enough and carbohydrates can improve protein synthesis. In addition as many people feel so exhausted on a ketogenic diet it may impact your training intensity.
A ketogenic diet can improve insulin resistance and blood glucose control – so if you have stubborn fat that seem hard to shift this style of eating for a while may help. It is important though that you get sufficient electrolytes and drink plenty of water. Sodium, magnesium and potassium are often low on a ketogenic diet. Many people benefit from taking an electrolyte formula.
Is a ketogenic Diet for you?
For some people this style of eating can achieve results quickly. However just because the diet has worked for someone you know DOES NOT mean it is right for you.
Potential benefits of a ketogenic diet
- You do not need to count calories just carbs – meals are often very filling
- Energy initially can be reduced but after a couple of days energy levels often increase as the body enters ketosis
- Many people notice clearer thinking. On a ketogenic or high-fat diet, more CoA is created and it is more often bound in water-soluble forms (such as acetyl-CoA, acetoacetyl-CoA, and HMG-CoA) that can cross cell membranes and enter the brain.
- Ketogenic diet works well for many people since it induces fat digestion because of the decreased level of insulin in the body. Insulin can promote fat storage – hence reduced levels can help with weight loss and reducing belly fat.
- Can be useful to reverse diabetes type 2 / better blood sugar control and address insulin resistance. It may also benefit PCOS.
- Helps with overeating and cravings. A ketogenic may be useful approach if you are overweight / obese and are not working out hard in the gym.
- Better cholesterol and blood pressure profile – ironically it may improve your triglyceride levels
- Can be useful for epilepsy and neurological conditions including migraines.
- May improve skin conditions like acne
- May be helpful for Parkinson’s disease and Alzheimer’s disease
- May help with certain types of cancer.
However here are some situations where I would not follow a ketogenic diet.
Pregnancy
Carbohydrates help with foetal brain development and growth. The Institute of Medicine recommends a minimum of 175 grams of carbohydrates per day during pregnancy, which is 29% of calories on a 2400 calorie diet. For example if you are planning to get pregnant and want to consume around 30% carbs. If we determine that her daily needs are roughly 2000 calories per day, 30% of calories from carbs is 600 calories. As there are 4 calories in a gram of carbohydrate, this works out to be 150 grams of carbs per day.
Athletes
While there are athletes who thrive on a well-planned low carb approach, there are many others who do not. Each athlete is completely unique in their ability to perform well on a low carb diet, and there’s nothing wrong with testing out the diet to see how it affects your athletic ability.
But if you’ve been trying a low carb diet for months now and your workouts are suffering, your weight isn’t budging (or maybe you’ve even gained weight!), and your recovery time is increasing, you’re probably not the type of person who can handle a low carb diet combined with regular intense physical activity. Equally as mentioned above if you are seriously looking to build muscle too little carbohydrate may be counterproductive. You may need anything from 20-40% carbs in your diet
Hypothyroidism
Hypothyroidism is one of the most commonly cited medical reasons for needing to eat a moderate carb diet. The main reason why carbs affect thyroid function so directly is because insulin is needed for the conversion of the inactive T4 hormone into the active T3 hormone, and insulin is generally quite low on very low carbohydrate diets.
Adrenal fatigue
HPA axis dysregulation, also known as adrenal fatigue, is another condition where a moderate carb intake is important for general health. The main hormone that gets dysregulated in adrenal fatigue is cortisol, and cortisol has been shown to increase on a low carb diet. This means that a low carb diet is a potential adrenal stressor in susceptible individuals.
Gut Health
One of the less discussed downsides of a very low carbohydrate diet over the long run is the potential for alteration of the gut flora – this is because you are often taking out fibres – prebiotics. Studies have suggested such as diet could actually promote inflammation – this may in part be due to the changes in gut flora
These prebiotics are essential for promoting the growth of beneficial gut flora. Without them, your beneficial flora can’t produce as much gut-healing substances like butyrate and other short chain fatty acids, and your microbiome composition may even shift in an undesirable direction.
Those who are doing very low carbohydrate diets, and who simply can’t increase their starch intake for whatever reason, should use prebiotic supplements such as resistant starch-rich unmodified potato starch or FOS powder. However introduce slowly otherwise they will cause bloating and gastric pain.
What Foods to eat on a Ketogenic Diet
Fats – these will form a large focus on the diet – good choices include:
Avocado
Butter
Chicken
Mayonnaise
Olives & olive oil
Coconut meat & coconut oil
Nuts & nut butters like peanuts, pecans, almonds, macadamias, and walnuts
Most seed & nut oils like sesame oil, flaxseed oil, almond oil, etc.
Whole-fat diary like milk, heavy cream, sour cream, cottage cheese, and cream cheese (they’re fattier than they are protein-rich, so I’m including here)
Protein Foods
Here are some of the popular choices of protein for ketogenic diets
Red meats like beef, lamb, pork, and veal
White meats like chicken, turkey, duck
Fish and seafood of all kinds like salmon, sardines, snapper, calamari, and anchovies
Shellfish like crab, lobster, shrimp, oysters, and mussels
Eggs
Bacon and sausage
Nuts and nut butters
Protein powders
Low Carb Vegetables
If you’re following a ketogenic diet, you have to avoid starchy vegetables like corn, peas, potatoes, and sweet potatoes. Other veggies will need to be eaten in limited amounts. Here are some of the best low carb veggies to consume
Asparagus
Bamboo shoots
Bok Choy
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Celery
Chives
Cucumbers
Courgettes
Garlic
fennel
Leafy greens
leeks
Lettuces and salad greens
Mushrooms
Olives
Okra
Onions
Sauerkraut
Sea vegetables
Spring onions
Shallots
Spinach and Kale
Sprouts of all kinds
What Not to Eat
Grains – all grains even gluten free
Sugars and Syrups – avoid all sugars and syrups like maple syrup, fruit syrups
Fruit juices and smoothies
Root vegetables
Processed oils
Alcohol
Beans and pulses
Avoid processed foods and sauces – often high in sugars.
Avoid all tropical fruits, dried fruit, fruit juices, grapes, watermelon, bananas etc
Did Our Ancestors follow a ketogenic diet?
Some low-carb advocates have claimed that most traditional hunter-gatherer societies consumed diets that were very low in carbohydrates. However this is not the case
The majority of studies have shown that traditional hunter-gatherer (HG) societies typically consume between 30–40% of their total calories from carbohydrate, though the range can vary between 3–50% depending on the population studied and the latitude at which they live.
The only HG societies observed to eat fewer than 20% of calories as carbohydrate were those living at latitudes quite distant from the equator, often in marginalized environments where fruits, vegetables, starches, and honey were not readily available.
Yet even these cultures—such as the traditional Inuit—often made an effort to obtain carbohydrates from berries, corms, nuts, seaweed, and tubers whenever they could. What’s more, contrary to popular claims, studies have shown that it’s unlikely the Inuit spent much time—if any—in nutritional ketosis. Their high protein intake would have prevented ketosis from occurring.
So, while ancestral diets were certainly lower in carbohydrate than the diet currently recommended by the USDA (45–65% of calories), they were not typically “very low” in carbohydrate (<15% of calories). With virtually no historical examples of human beings following ketogenic diets for any significant length of time, and few examples of very low-carb diets, it’s difficult to imagine how these diets could be considered our “default” nutritional state or the optimal approach for most people.
If you want to reap some of the benefits of a ketogenic approach without actually following a ketogenic diet there variations of the diet you can use such as including intermittent fasting and carbohydrate cycling.
Like many diets, the ketogenic diet isn’t a cure-all. There are a number of advantages and disadvantages and while it may be beneficial for some people it not appropriate for everyone.