What is Keto?

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The keto or ketogenic diet is a way of eating that consists of higher fat, moderate protein, and very low-carbohydrate foods. 

Low-carb diets are becoming more popular as research has begun to show that chronic high carbohydrate consumption, especially processed carbohydrates, can promote health impairments and contribute to the progression of many of the most popular diseases we face today. 

While keto is a low-carb diet, it is different from other low-carb diets like Paleo and Atkins in its purpose of inducing a metabolic state known as ketosis. Nutritional ketosis, not to be confused with diabetic ketoacidosis, is a state in which the body has elevated blood ketones levels and low blood glucose. Why does this happen?

What we eat can determine what our bodies use to fuel the various processes it must complete.  When we eat a diet containing carbohydrates, our primary energy source is glucose, which comes from the breakdown of carbohydrates.  When we restrict carbohydrates, our bodies must find a completely different source of energy and this source is fat and ketones.

The fat you eat on keto as well as the fat that is stored in your body are both able to be used as an energy source by nearly all of the cells in the human body. However, the brain is not able to directly utilize fat for energy, therefore creating a demand for the body to produce an energy source it can use. This is where ketone come in.

Ketones are energy molecules that are produced in the liver from the breakdown of stored fat during carbohydrate restriction. Ketones cannot be used by the liver directly, so instead they are shuttled into the blood stream where they can travel around to be taken in for energy usage, particularly by the brain.

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Ketones can be produced by the body within just hours of carbohydrate or calorie restriction. However, it takes the body a little longer to transition to efficiently and effectively using these ketones in place of carbohydrates.  This adjustment period is known as the keto-adaptation period, and the duration of this period is different depending on the individual person and approach taken.

Definition:

Keto-Adaptation Period- The period where the body transitions from using carbohydrates to fat and ketones for fuel.

Now, you may be wondering why someone would want to follow a ketogenic diet.

Keto Diet Benefits

In the early 1900s, it was discovered that fasting was able to dramatically improve symptoms for children suffering from drug resistant epilepsy. In the 1920s, doctors discovered that when carbohydrates were avoided and replaced with fat, the body was able to mimic the metabolic state that occurs while fasting without having to restrict food, what we now know as ketosis (1).

This was a monumental finding since asking children to abstain from food is not the most sustainable treatment method. The keto diet allowed children to still manage their epilepsy symptoms while also getting to eat (2).

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While keto is still often used for the treatment of epilepsy today, the rise of better anti-epileptic drugs has caused many to forget about the diet in both clinical and research settings. However, now many people have realized the potential benefits of this diet and research as well as its use in general and therapeutic populations has skyrocketed. Let’s take a dive into some of these benefits:

Weight Loss/Body Composition:

One of the most mainstream uses of a ketogenic diet is for weight loss.  During keto, the body is forced to relying on fat from the foods we eat as well as fat that is stored in our body. This leads to robust weight loss and improvements in body composition.

There is a lot more to the weight loss potential of a keto diet besides just burning fat. For example, keto also has an ability to combat inflammation, a common contributor to not only weight gain but also impaired health and many diseases (3).

It’s not all about weight loss though, the composition of weight loss is also important. When we diet, maintaining muscle can be a challenge. However, research on ketone infusions has demonstrated that ketones can exhibit an anti-catabolic or muscle sparing effect (4). This is one of the reasons why many people report preserving muscle while losing weight on keto.

To learn more about keto for weight loss, check out my article The Truth About Keto for Weight Loss.

Athletic Performance: 

The ketogenic diet is commonly used by endurance athletes. In fact, one of the best keto researchers, Dr. Jeff Volek from Ohio State University, has had incredible findings while studying keto ultra-endurance athletes (5).  This is because being keto-adapted means an easy ability to tap into stored fat, which is a much larger energy source compared to consumed carbohydrates and carbs stored in the body, known as glycogen. This is usually met with improved exercise performance and body composition in endurance athletes (6).

When it comes to keto for strength and power, the verdict is still not out. Many people assume that carbohydrates are needed for these types of exercise. The problem is there has not been any science to say this is definitively true. There are many studies that demonstrate keto dieting being inferior for strength and power; however, the majority of these studies do not allow enough time for the body to become keto-adapted. Longer duration keto studies tend to demonstrate either improvements or maintenance of strength and power (7).

Brain Function:

Ketones are actually a preferred fuel source for the brain. As blood ketone levels rise, the uptake of glucose by the brain decreases (8). This is due to the fact that ketones not only provide more energy to the brain, but they are also a cleaner source of energy meaning they create less oxidative stress when burned.

This increase in energy to the brain is met with improvements in cognitive or brain function, especially in those suffering from cognitive decline where impaired glucose metabolism by the brain is common (9).

Therapeutics:

Besides its early uses for epilepsy, the ketogenic diet is now gaining popularity as a way to treat or help manage a variety of conditions including:

  • Diabetes

  • Metabolic Syndrome

  • Alzheimer’s Disease

  • Cancer

  • Parkinson’s Disease

  • PCOS

  • Heart Disease

  • Certain Digestive Disorders

In addition, there is more and more research coming out on the diets use in conditions like autism, multiple sclerosis, ALS, migraines, anxiety, addiction, PTSD, and many more.  While some of these areas of interest have not been studied as in depth, we are hearing a lot of anecdotal evidence that is making a strong case for continued research.

The ability for keto to play a role in the treatment of so many conditions causes many to be skeptical and describe the diet as a panacea. The truth is keto targets two of the most common contributors to nearly every serious condition; insulin resistance and inflammation, thus giving the diet potent treatment capabilities.

In addition to the benefits listed, many keto dieters also report experiencing the following benefits:

  • Increased Energy

  • Improved Focus

  • Better Endurance

  • Enhanced Feelings of Well-Being

  • Reductions in Hunger

How to Eat Keto

As we mentioned earlier, keto is not the same as other low carb diets. Compared to Paleo, keto consists of a much lower carbohydrate intake, typically less than 20-30 grams per day. Compared to Atkins, keto encourages a greater consumption of dietary fat. All together, the biggest difference between keto and other low carb diets is the presence of ketones in the blood, or ketosis.

Like most diets, keto does not have a one-size-fits-all approach.  While it is common for people to make recommendations on the proper macronutrient approach for keto, I believe it is better to first look at what foods we should and should not eat.

Carbohydrates: Some may choose to completely avoid carbohydrates, like many carnivore dieters out there, while others will only consume carbohydrates from low glycemic sources like leafy green vegetables.  Regardless, carbohydrates should consist of a very small portion of your total calories, should be primarily fiber, and should not come from foods like bread, pasta, fruit, or other sugars. You can replace the need for vegetables by consuming higher quality meat and organ meat due to its richness in micronutrients. But for now we can save that for the more advanced keto dieters.

Fat: Typically, we associate fat with being bad for us but really it is the presence of a high fat diet in conjunction with a high carb diet that is the problem.  Independent of carbs, dietary fat is not dangerous to the body and can become a reliable fuel source. In fact, fat is essential to numerous body functions and not getting enough of it can cause numerous health impairments.  On keto, it is good to get a mix of different types of fat including omega-3 and MCTs.

Protein: Due to the popularity of the Atkins diet, the keto diet is often mistaken for being high in protein.  While some people may elect to consume a higher protein version of the ketogenic diet, for most people protein will be controlled or consumed at a “moderate level”.  When choosing your protein sources, it is again important to include variety by eating things like red meat, eggs, and fish. 

It’s important to note that some studies with lower amounts of protein on keto demonstrate a loss of muscle mass (10). If you are not doing keto for therapeutics (even then it is yet to be determined what higher protein intake will do) then you may benefit from a slightly higher protein keto diet.

Again, there is no one-size-fits-all approach for a ketogenic diet.  If you are familiar with the term macronutrients (proteins, fat, and carbs) then it should be noted that the typical prescription for keto is 70% of your total calories coming from fat, 25% from protein, and 5% from carbs.  However, these standards were set a long time ago and with a different goal in mind. The optimal macronutrient ratio will vary slightly from person to person depending on goals and various other health parameters, such as insulin sensitivity, current body composition, gender, and activity level.

My personal approach to keto dieting is to not start by worrying about macronutrients and focusing mostly on eating the right foods and removing the wrong foods.  Be sure to check out my downloadable Keto shopping list.  Use this list to take your first keto trip to the grocery store!

Is Keto Safe?

The safety of keto is put into question primarily because of two reasons:

  1. People confuse nutritional ketosis with diabetic ketoacidosis.

  2. People think fat is bad

It is important to note that there is a huge difference between nutritional ketosis and diabetic ketoacidosis or DKA. When in nutritional ketosis, we see a very controlled and safe rise in blood ketones accompanied with a reduction in blood glucose. This is completely healthy and safe. DKA, which occurs in diabetics, is characterized by an uncontrolled dangerous rise in ketones and subsequent high blood glucose levels, a recipe for disaster.

We have been programmed to believe that fat is bad for us.  As stated earlier, fat isn’t the problem alone.  It is fat in conjunction with carbohydrates where the issues start to arise. The body loves to take the path of least resistance and to put it simply, it is easier for the body to burn carbs for fuel because it has been trained to do so.  This means when we consume fat and carbs together, the fat we eat is more likely to be stored than used for energy.  Removing the carbs fixes this problem! 

In addition, much of our fear of fat has come from poorly conducted and manipulated research from as far back as the 50s that still shapes our society today. To learn more about this and our war on fat, be sure to check out the book: The Big Fat Surprise by Nina Teicholz.

The truth is that keto is not only safe but extremely healthy for the majority of people. There are certain conditions such as pyruvate carboxylase deficiency, porphyria, and other fat metabolism disorders that keto may not be recommended for. Additionally, other potential concerns for keto dieting that have not been well researched are pancreatitis, impaired liver function, gallbladder disease, gastric bypass surgery, and kidney failure.

The verdict is also still not out on women who are pregnant or nursing. While it seems like the diet should be safe for these women, and has been reported as being safe and effective anecdotally, it is likely not advised to start the diet during pregnancy or nursing since keto-adaptation takes time.

Finally, if you are taking medication for conditions like heart disease or diabetes, you will want to check with a doctor (one that knows keto) to see if keto is right for you and to make sure that your medications are being adjusted accordingly

If you are interested in learning more about the safety of Keto, check out my article Is Keto Safe?

Conclusion:

The ketogenic diet is growing in popularity and for good reason, it has the ability to not only dramatically improve our health but also our quality of life.

It is true that starting keto can be a big step that can come with its own set of challenges.  Check out my 7 Steps to Starting a Keto for more on how you can best start keto and set yourself up for sustained success!

References:

  1. History of the ketogenic diet

  2. The ketogenic diet and epilepsy

  3. Ketogenic diet exhibits anti-inflammatory properties

  4. Effect of ketone infusion on amino acid and nitrogen metabolism in man

  5. Metabolic characteristics of keto-adapted ultra-endurance runners

  6. Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes

  7. A low-carbohydrate ketogenic diet combined with 6-Weeks of Crossfit training improves body composition and Performance

  8. Ketones suppress brain glucose metabolism

  9. Brain fuel metabolism, aging, and Alzheimer’s disease

  10. Weight loss, improved physical performance, cognitive function, eating behavior, and metabolic profile in a 12-week ketogenic diet in obese adults

Christopher Irvin