If you’re looking for a way of eating that can improve your health, prevent disease, reduce body fat, and allow you to eat whole, unprocessed food, there is a good chance you might benefit from the ketogenic diet.
Originally designed by doctors as a way of treating epilepsy, the ketogenic diet is a very high-fat, low-carb diet that is becoming increasingly popular due to the therapeutic benefits and the fact that it is centered delicious foods that people actually want to eat.
To better understand how the ketogenic diet works, it’s important to know that it was originally designed to mimic some of the beneficial effects of fasting in the body. Doctors realized that fasting was a way to reduce the frequency of epileptic seizures. When you fast, glucose levels in the blood drop, which has a protective effect on the brain.
Since a person can’t fast indefinitely, doctors proposed a very high-fat, low-carb diet as an alternative. By restricting carbohydrates and radically increasing fat, glucose levels fall and the liver starts producing ketones from fat (both dietary and stored body fat). Ketones can be used for energy in cells throughout the body and in the brain. The shift from glucose to ketones has a calming effect on the electrical system of the brain, reducing the seizure threshold and treating epilepsy.
More recently, studies have shown health and body composition benefits in a wide range of populations:
In overweight populations at risk for heart disease and diabetes, the ketogenic can lower insulin, triglycerides, LDL cholesterol, and blood pressure as much or more than low-fat calorie-restricted diets.
A ketogenic diet can also treat obesity. A review of 13 studies found that the ketogenic diet produced greater weight loss than low-fat diets (about 1 kg greater).
The ketogenic diet can also be used in non-obese populations that need to optimize body composition: A 2012 study found that elite gymnasts who ate a ketogenic diet for a month in conjunction with regular training lost 2 kg of body fat and decreased body fat by 2.6 percent to achieve an extremely lean body fat of 5.1 percent.
A 2013 study shows how the ketogenic diet can be successfully incorporated into a long-term weight loss program. Obese volunteers were instructed to follow a 20-day ketogenic Mediterranean diet followed by 4 months on a non-restrictive Mediterranean diet, followed by another 20 days of ketogenic eating, with a final 6 months on the non-restrictive Mediterranean diet. The majority of subjects (88 percent) successfully complied with the ketogenic portion of the diet and lost an average 15 kg and lowered body fat from 43 percent to 33 percent by the end of the study.
Many nutritionists are critical of the ketogenic diet as being unsustainable or dangerous. The Mediterranean diet trial provides insight into strategies for overcoming these concerns.
First, the ketogenic diet is rarely used as a long-term solution for weight loss. Rather the ketogenic phases were time-limited and short (20 days), making them easier to stick to than longer term restrictive diets.
Second, the foods allowed on the ketogenic diet were all unprocessed whole foods (meat, fish, poultry, green vegetables, eggs, cheese, coffee, and tea) that are normally included on a Mediterranean diet, so the transition only required elimination of certain foods, not an entirely new way of eating.
Third, the ketogenic portion of the diet included supplementation of a protein, fiber, and an herbal blend to help combat common symptoms that occur during adaptation to a ketogenic diet such as fatigue, decreased bile secretion, and constipation. A vitamin-mineral complex was also provided to avoid nutrient deficits.
Other common pitfalls to a ketogenic diet include the following:
#1: Eating Too Much Protein
As the ketogenic diet has gained popularity, it somehow morphed into a high-protein modified ketogenic diet in which people eat anywhere from 15 to 35 percent of the diet from protein. Although there may be a benefit to this sort of a higher protein, lower carb approach, it is not technically a ketogenic diet and may impede the process via which the body produces ketones. If you go overboard and eat more protein than the body needs to sustain lean tissue, some of the amino acids in the protein will be turned into glucose via a process called gluconeogenesis. This will reduce the production of ketones and may impede fat loss.
#2: Not Eating Enough Fat
Not eating enough fat is the other part of the “too much protein” equation. The ketogenic diet is a VERY high-fat diet, not a low-carb, high-protein diet. In order to reap the metabolic benefits, you need to ensure your fat calories are supplying upwards of 80 percent of your total energy intake. This will avoid the use of protein for glucose, facilitate the production of ketones in the liver, and help avoid common pitfalls to low-carb intake such as gut problems and constipation.
#3: Sneaky Carbs
Making the transition to a ketogenic diet can be challenging in and of itself, and it’s all the harder if you are used to eating processed or packaged foods because they often have added sugar. For example, sauces (tomato sauce and soy sauce), beef jerky, and pickled vegetables tend to have sugar added to them, making them inappropriate on a ketogenic diet. Even foods that we think of as being high in fat such as salad dressings, peanut butter, and processed cheese all can have sugar added. Yogurt, ice cream, and chocolate are other examples of foods that are high in fat but can’t be included when your goal is ketosis.
#4: Never Having A Re-feed Day
The body normally stores carbohydrates in muscle and the liver in the form of glycogen to be used when it needs energy. Ketogenic diets deplete these stores, which can impair intense exercise performance and cause fatigue in some people.
An easy solution once you complete the initial adaptation process (typically taking two weeks) is to have a weekly re-feed in which you have a higher carb intake to replenish glycogen stores and give yourself a mental break. When you’d normally eat around 20 grams of carbs on a ketogenic diet, your re-feed day can include anywhere from 100 grams of carb on up and should be dependent on goals and physical activity levels. Best results typically come from whole carbs (versus refined foods) such as fruit, starchy vegetables, beans, or grains.
Final Words: Hopefully, with these recommendations, you will have the necessary knowledge to design a successful ketogenic diet that meets your nutrition and body composition needs.
Bueno, N., et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomized controlled trials. British Journal of Nutrition. 2013. 110(7):1178-87.
Moreno, B., et al. Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease. Endocrine. 2016. 54(3):681-690.
Paoli, A., et al. Long Term Successful Weight Loss with a Combination Biphasic Ketogenic Mediterranean Diet and Mediterranean Diet Maintenance Protocol. Nutrients. 2015. 5, 5205-5217.
Paoli, A., et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition. 2013. 67, 789-796.
Paoli, A., Grimaldi, K., et al. Ketogenic Diet Does Not Affect Strength Performance in Elite Artistic Gymnasts. Journal of the International Society of Sports Nutrition. 2012. 9(34).