For those of you that have not heard of a ketogenic diet and are not technical, you may wish to skip over the heavier parts, but I have endeavored to keep the information as simple as possible, but I can only do this to a degree, because both the average person and the health professional needs some technical information, to understand properly the implications this diet has on your health and well being.
When you are in ketosis your blood contains ketones or ‘ketone bodies’ which are small organic molecules made by your liver from fatty acids. They are manufactured so your body has an alternative fuel source when you are in a glucose deprived state. (low carbohydrates = low glucose) “Ketone bodies” consist of 3 main molecules - Acetone, Acetoacetate, and Beta-Hydroxybutyrate (B-OHB). B-OHB is the more active ketone and is a cleaner burning fuel, and is often preferred more by the body than sugar/glucose.
The reason a starving person can live for 40-60 days is because we can turn fat into ketones, and then convert ketones into energy to power our bodies and brain. The more fat you store on your body, the longer you can survive. A case report of a medically supervised fast in the US many years ago showed that with only water and electrolytes a person survived 382 days. If we had to rely on glucose, we’d die in a few days, and if we could only rely on protein, we’d live a few more days but would become completely debilitated from muscle wastage.
I have known about ketones and basic ketogenic diets from the early nineties when one of the members of my gym was competing in a body building competition. He was eating high fat, high protein and high sugar, and succeeded to cut fat levels down considerably. I didn’t know at the time why, but he was less hungry and had a steady supply of energy compared to glucose burning athletes.
There was a down side though to this crude ketogenic diet and there were many side effects to his version of ketosis - tooth decay, high blood pressure, high cholesterol and others, and it didn’t give me the confidence that it was worth pursuing. But the one thing that stuck in my head, was how is he getting so lean eating high amounts of fat and sugar. In those days the general population was eating high carbs and low fat. As a body builder I knew we had to cut down carbs to strip off body fat, but cutting out nearly all carbs was way out there, and virtually unknown, even in the body building world. However, I realized that there was something going on in the body that I needed to learn about.
Note: Later, after a lot of learning and research, I realized he was handling the sugar consumption because of a number of things. He was doing high intense resistance workouts which was suppressing his insulin and stimulating ketone production. His body would have been using the sugar/glucose that he was eating, during his workouts (anaerobic), and the ketones in his body would be coming from stored and dietary fat which would be manufactured when he was resting between workouts and at night when asleep. So the sugar he was eating was being burned and maybe some stored as glycogen rather than being converted to fat. The fat he was eating would have been converted into ketones and also used for energy. Remember this, he was not a normal sedentary person, he was an advanced athlete and had a high amount of muscle, so this bumped up his Metabolic Rate (BMR) which is the rate at which he burned calories. All interesting, but what did I learn to help the average person.
Skip forward to around 2014 when I started seriously researching ketogenic diets. In 2015 I I had learned a lot and decided to see what a ‘scientifically constructed nutritional ketogenic diet’ would do to my health and body fat levels. So for the last couple of years it has been an interesting learning curve, because there are many trials and tribulations and things to learn and be aware of when you are eating a ketogenic diet.
A message to any health professionals that may be reading this. A nutritional ketogenic diet is not “Diabetic Ketoacidosis” which is a life threatening condition often seen in type 1 diabetics. This condition occurs when blood ketones rise over 10mmols. When you are in nutritional ketosis the normal range is .5 - 3mmols. When a diabetic, usually a Type I diabetic, (sometimes it can occur in very late-stage, insulin-dependent, Type II diabetics) fails to receive enough insulin, they go into an effective state of starvation. Whilst they may have all the glucose they need in their bloodstream, without insulin, they can’t get any into their cells, hence, they are effectively going into starvation. So the body does what it would do normally in any person, it starts making ketones out of fat and proteins. Here’s the problem though! The T1 diabetic patient can’t produce any insulin, so there is no feedback loop and they continue to produce more and more ketones. By the time ketone levels (specifically, beta-hydroxybutyrate) approach 15 to 25 mmols, the resulting pH imbalance leads to profound ‘metabolic derangements’ making the patient critically ill.
This state of ‘metabolic derangement’ is not actually possible in a person who can produce insulin, even in small amounts. The reason is that a feedback loop prevents the ketone level from getting high enough to cause the change in pH that leads to the cascade of ailments. As I mentioned above a person who is said to be “keto-adapted,” or in a state of nutritional ketosis, generally has beta-hydroxybutyrate levels between about 0.5 and 3.0 mmols. This is far less than the levels required to cause harm through acid-base abnormalities. A person with a normal pancreas, regardless of how long they fast or how much they restrict carbohydrates, can not enter “Diabetic Ketoacidosis”, because even a trace amount of insulin will keep B-OHB levels below about 7 or 8 mmol, well below the threshold to develop the pathologic acid-base abnormalities associated with “Diabetic Ketoacidosis”.
An interesting point here I will mention. A starving person, or those on a severely restricted carbohydrate intake, glucose levels will normalize at about 3.7 mmol within days of fasting, (normal 3.6-6mmol) despite no source of exogenous (external) glucose. Why? Because with so much fat being converted into B-OHB and acetoacetic acid by the liver, a significant amount of glycerol (the sugar part of the triglyceride molecule) is liberated and converted by the liver into glycogen. This is why someone in nutritional ketosis, even if eating zero carbohydrates, still has about 50-70% of normal glycogen levels, as demonstrated by muscle biopsies in these subjects.
The body can store about 100 to 120 gm of glucose in the liver, and in muscle tissues around 300 to 350 gm. Because muscles lack an enzyme that breaks down glycogen into glucose for energy use, it has to come from liver stores. Muscle glycogen is only for use in muscles. If we can only get stored glucose from the liver how long can it supply our brain with sufficient glucose? In a state of starvation, we’ve only got about one to three days before we’re in trouble. If our brain doesn’t get a hold of something else besides glucose, we will die.
So if there is no glucose for 24-72 hours we need something else the brain can use for energy, other than fat or protein. Neurons can’t oxidize fat and we don’t want to start burning hard gained muscle protein and invoke muscle wasting, so the body makes ketones from fatty acids in the liver, so we now have fuel to power our brain and muscles.
Note: As I have mentioned in a past post, those of us with good glucose metabolism and low resistance to insulin can slip in and out of ketosis quite easily. This mainly happens between meals and whilst fasting at night, so you don’t have to be in a ketogenic state for this to happen. For many of us though especially as we age, it doesn’t happen at all or very occasional because our insulin levels are too high and we are in a fat storing state rather than a fat burning one.
When it comes to energy requirements our brain is a greedy organ. Our brain is only about 2% of our body mass, yet it accounts for about 20% of our energy expenditure (In children, it is closer to 40-50% of basal metabolic demand). The good thing is our brain is very happy using ketones for fuel and ketones have a protective mechanism when blood glucose is very low, (even as low as 1mmol) allowing a person to function quite normally, where glucose burning patients would fall into a coma below 40mmol and certainly be dead at 1mmol. George Cahill actually did these experiments years ago. These days he would be thrown in goal if experiments like this were attempted.
What is the purpose of going on a ketogenic diet
There are 3 quick answers I can give you.
1. To lose fat
2. To gain back your health
3. To start feeling more energetic and well, both physiologically and psychologically
When you eat carbohydrates your body turns them into glucose and circulates them around your body, and depending on all these factors,
· The glycemic index
· The bulk amount of carbs
· The amount of fiber they contain
· The quality and type of carbohydrate
· Your sensitivity to important regulatory hormones like insulin and leptin
these will determine whether you burn them for energy in muscle cells or store them as glycogen in the liver and muscles. Our fat cells can also convert them into triglycerides and store them as fat. (lipogenesis) It is important to remember that excess glucose can be converted to fat in our liver, and either stored as fat in the liver or packaged up as low density lipoproteins and sent out into the blood to be used either to make cell membranes, synthesize steroid hormones, burned as energy or stored as fat in body fat cells.
If insulin levels are high, you will store fat rather than burn it.
Most people, (to some degree) especially as we age, find it harder and harder to lose fat and keep it off. The well know weight loss centres that we see and hear about on TV, radio and social media, only have limited success, especially over the long term, because they are not concentrating on altering the physiology of the body only on achieving short term body fat loss. Usually when you lose the weight you eventually will go back to eating and living your life like you did before you started your diet.
You will only achieve long term fat loss and health benefits, if you change the hormonal homeostasis (balance) of your body.
It is important for you to remember that everyone is different in the way they metabolize carbohydrates. If you are a normal sized 16-year-old with normal hormone sensitivity you can probably eat as many carbs as you like, and not get fat. The reason for this is partly because you are more active, and more importantly, it is how your body metabolizes fat. ie Store it or burn it.
Someone who is over weight, and in their 50s or 60s isn’t going to be able to metabolize carbs like the 16-year-old. He or she’s body is going to store fat rather than burn it regardless of his/her exercise levels. Of course being active helps but it doesn’t overcome the years of abuse that a bad lifestyle has done, and that is wreaking havoc on hormonal endocrine and nervous systems.
So burning fat is a matter of eating what you need to eat to control fat oxidation, (burning) and a ketogenic diet is a very handy tool to have for anyone especially those that are up in years, unfit and have impaired glucose metabolism.
Because everyone is different, a nutritional program for one won’t necessarily fit another.
Each individual needs to be properly assessed (blood tests, questionnaires, detailed fitness assessments) so a customized program can be worked out for that individual.
To Gain Back Your Health
The good thing about a nutritional ketogenic diet is, it’s effect on health markers in the body. There is one exception that really is not a problem, and that is when you are in a ketogenic state your total cholesterol (TC) and LDL-C cholesterol will go up. (LDL-C is the amount of cholesterol contained in that LDL particle and TC includes all cholesterol including HDL) The numbers will peak and over time and will slowly come down, but not to a low number. The reason for this is that when you lower carbs and eat more fats, especially saturated fats, this will raise large harmless LDL particles but still keep atherogenic (small/dense) particles low. The large LDL particles do not cause artery blockage. The only numbers an Australian doctor will see though is high LDL and TC. In America you can get these low density lipoproteins sub divided, giving you are more accurate cardio risk profile.
What happens is fat cells shrink and cholesterol is released and enters the blood stream, increasing LDL-C. The good news is, as weight stabilizes LDL-C will come down. It is true that circulating saturated fat has a correlation to heart disease, but eating saturated fat has no correlation to blood saturated fat levels, especially if you exercise and eat low carb. It is dietary carbohydrates that cause high blood saturated fat levels.
This is proven science and many trials and studies have shown this to be true. Unfortunately, most doctors including GPs and even cardiologists haven’t accepted this data yet, but I am confident in the near future they will have to accept these findings. Nutritional guidelines around the world are now starting to change because of the research that has been done in the last few years.
With blood tests the important things to look for are levels of triglycerides, fasting glucose, insulin, HDL, thyroid levels, inflammation markers like A1C and others. These will give a more accurate picture about heart disease (and other diseases), rather than total cholesterol and LDL. It is likely you will see a big improvement in many of these blood test numbers when you are on a ketogenic diet.
A report published in 'Science' journal in 2012 said that B-OHB is a potent regulator of a group of genes that protects cells against oxidative stress. Oxidative stress can cause inflammation and have many negative effects on diseases in the body, including heart disease and cancer to name only two. When you eat high carbs these protective genes will get turned off, and so does your oxidative stress protection mechanism. So you need to eat plenty of antioxidants when eating carbs to keep oxidation at bay. The researchers also found that respiratory diseases like asthma was caused by the down regulation of antioxidant enzymes when eating high amounts of carbs.
Antioxidants enzymes are frequently used as markers of oxidative stress. One of the important biomarkers is glutathione peroxidase (GPX), which is important in the preservation of homeostasis for normal cell function. In trials B-OHB It has been shown to extend lifespan in worms by the modulation of Histone Deacetylases. (HDACs)
Alteration in the pattern of gene expression, including induction or repression of numerous genes involved in longevity by changing the level and the pattern of histone acetylation may be an important factor in determining the longevity of animals – and perhaps us.
Rule # 4
A ketogenic diet is a great way to optimize your health, especially if you are over weight, have metabolic syndrome, are diabetic or have a disease that is caused by metabolic dysfunction – and it may even prolong your life. If your doctor doesn’t like low carb or ketosis, get another health professional who does.
Start feeling more energetic and well, both physiologically and psychologically
When you are keto adapted, you’re changing over from using glycogen reserves (glycogen is the storage form of glucose in the body) to fat reserves, and the benefits are you don't have to suffer the highs and lows of glucose metabolism. (hungry, irritable, having no energy)
When you eat carbs and burn glucose, like the average person does, it usually takes about 3 hours for insulin to bring your glucose levels back to a normal range. Once levels hit what would be called normal, they don’t stop falling, they keep going down until you eat something. The problem is, if you don’t eat two things happen to make things worse. The hypothalamus gland in your brain perceives the low blood sugar as a signal to implement physiological and psychological responses, because it is protecting you against dying of starvation. It releases Ghrelin, the hunger hormone, making you feel hungry, and as blood sugar levels decrease further, you will want to eat those high sugar type foods. The second thing the hypothalamus does is slow up your metabolism, all aimed at holding on to fat reserves.
Because you are very hungry you will inevitably eat highly processed simple carbs, which will send you blood sugar levels back up, and the process will start all over again. This is called the yoyo effect, where energy levels, mood swings and fat storage all goes awry.
On a nutritional ketogenic diet you don't get those lows where your brain is telling your body it has too eat because energy (glucose) is too low. But remember this, to stay low carb long term you can't chop and change. Being on a ketogenic diet is like standing on the top of a pyramid, it's easy to stay there but if you start eating carbs you easily slip back down the side and is hard to get back up.
B-OHB is also good for the gut and colon. Like fiber it's a preferred fuel for gut health and also good for IBS. New research shows that good gut health has a positive effect on neurological conditions in the brain and this can impact how you feel and perform emotionally, psychologically and physiologically.
Ketogenic diets have also been used to successfully treat drug-resistant epilepsy in children since the 1920s. It seems from new studies being done in animal models that other neurological disorders, including head aches, bipolar disorder, autism, brain cancer, parkinson’s disease and other neurodegenerative diseases can be greatly helped using a keto diet, and importantly with no side effects.
So if the brain is happily getting its energy from ketones, why does this protect against these brain diseases? The journal, “Scientic American” said in a post that brain diseases suffer from deficient energy and B-OHB is, molecule to molecule, more energy efficient than glucose, providing more energy per unit of oxygen used, so it gives the brain more energy when using ketone bodies.
Ketosis also increases the number of mitochondria (energy factories) in each neuron also giving more energy reserves to ward off disease stressors, that would usually exhaust and kill the cell.
The other advantage with a ketogenic diet is ketones directly inhibit a major source of neuronal stress – ‘Reactive Oxygen Species’ (ROS), which are bad byproducts of cellular metabolism. The highly reactive ROS destroys cellular structure. Increased oxidants are a hallmark of aging, stroke and neurodegeneration.
Note: I wrote briefly about ROS in my FB post entitled “Cancer and Nutrition”. As I mentioned above, ketones also directly increase the activity of the powerful anti oxidant called glutathione peroxidase. When you eat a low carbohydrate diet you reduce glycolysis (glucose oxidation), which activates neuron stress proteins, which then lowers ROS and stabilizes our mitochondria.
Rule # 5
We evolved to produce ketone bodies so we could operate our brains and power our bodies very effectively in the absence of glucose for prolonged periods of time. No ability to produce ketone bodies equals no human species.
What then do you eat?
This is the hard part as everyone is different and everyone needs an individualized program because a number of factors are involved. But I can give you some basic information about the way I teach them, and maybe you will be able to find someone knowledgeable about ketogenic diets in your area.
Another thing I will mention, and I know I have said this before in a previous post, you may not need to go all the way into ketosis, a Mediterranean or a Paleo diet may be right for you. It all depends on how you metabolize proteins, fats and carbohydrates, your age, fitness level, blood test results and your health. All answers to these will determine the degree of a nutritional program. Below I will give you a basic list of ketogenic foods you can eat. Bear in mind that if you are eating Paleo or Mediterranean you will have other options.
List of Foods To Eat
Here is a list of some of the foods you can eat from - https://ketodietapp.com/
Grass-fed and wild animal sources
grass-fed meat (beef, lamb, goat, venison), wild-caught fish & seafood (avoid farmed fish), pastured pork and poultry, pastured eggs, gelatin, ghee, butter - these are high in healthy omega 3 fatty acids (avoid sausages and meat covered in breadcrumbs, hot dogs, meat that comes with sugary or starchy sauces)
offal, grass-fed (liver, heart, kidneys and other organ meats)
saturated (lard, tallow, chicken fat, duck fat, goose fat, clarified butter / ghee, butter, coconut oil)
monounsaturated (avocado, macadamia and olive oil)
polyunsaturated omega 3s, especially from animal sources (fatty fish and seafood)
leafy greens (Swiss chard, bok choy, spinach, lettuce, chard, chives, endive, radicchio, etc.)
some cruciferous vegetables like kale (dark leaf), kohlrabi, radishes
celery stalk, asparagus, cucumber, summer squash (zucchini, spaghetti squash), bamboo shoots
Beverages and Condiments
- water (still), coffee (black or with cream or coconut milk), tea (black, herbal)
Pork rinds (crackling)
Mayonnaise (made with olive oil), mustard, pesto, bone broth
Pickles, fermented foods (kimchi, kombucha and sauerkraut)
All spices and herbs, lemon or lime juice and zest
Whey protein (beware of additives, artificial sweeteners, hormones and soy lecithin), egg white protein and gelatin (grass-fed, hormone free)
Vegetables, Mushrooms and Fruits
- some cruciferous vegetables (white and green cabbage, red cabbage, cauliflower, broccoli, Brussels sprouts, fennel, turnips, rutabaga / swede)
eggplant, tomatoes, peppers
- some root vegetables (parsley root), spring onion, leek, onion, garlic, mushrooms, winter squash (pumpkin)
sea vegetables (nori, kombu), okra, bean sprouts, sugar snap peas, beans, artichokes, water chestnuts
berries (blackberries, blueberries, strawberries, raspberries, cranberries, mulberries, etc.)
- coconut, rhubarb, olives
Grain-fed animal sources and full-fat Dairy
- beef, poultry, eggs and ghee (avoid farmed pork, it's too high in omega 6s!)
- dairy products (plain full-fat yogurt, cottage cheese, cream, sour cream, cheese) - avoid products labeled "low-fat", most of them are packed with sugar and starch and have little sating effect
- bacon - beware of preservatives and added starches (nitrates are acceptable if you eat enough antioxidants)
Nuts and seeds
macadamia nuts (very low in carbs, high in omega 3s)
pecans, almonds, walnuts, hazelnuts, pine nuts, flaxseed, pumpkin seeds, sesame seeds, sunflower seeds, hemp seeds
brazil nuts (beware of very high level of selenium - don't eat too many of them!)
Fermented soy products
if eaten, only non GMO and fermented soy products (Natto, Tempeh, soy sauce or paleo-friendly coconut aminos)
Edamame (green soy beans), black soybeans - unprocessed
- Healthy "zero-carb" sweeteners (Stevia, Swerve, Erythritol, etc.)
- thickeners: arrowroot powder, xanthan gum (keep in mind xanthan gum is not paleo-friendly - some people following the paleo diet use it, as you only need a very little amount)
- sugar-free tomato products (puree, passata, ketchup)
- cocoa and carob powder, extra dark chocolate (more than 70%, better 90% and beware of soy lecithin), cocoa powder
- beware of sugar-free chewing gums and mints - some of them have carbs
Some Vegetables, Fruits, Nuts and Seeds with Average Carbohydrates - depends on your daily carb limit
- root vegetables (celery root, carrot, beetroot, parsnip and sweet potato)
- watermelon, Cantaloupe / Galia / Honeydew melons
- pistachio and cashew nuts, chestnuts
Only very small amounts, better avoided completely:
- apricot, dragon fruit (Pitaya), peach, nectarine, apple, grapefruit, kiwifruit, kiwi berries, orange, plums, cherries, pears, figs (fresh)
- dry red wine, dry white wine, spirits (unsweetened) - avoid for weight loss, only for weight maintenance
- Food rich in carbohydrates, factory farmed meat and processed foods
- All grains, even whole meal (wheat, rye, oats, corn, barley, millet, bulgur, sorghum, rice, amaranth, buckwheat, sprouted grains), quinoa and white potatoes. this includes all products made from grains (pasta, bread, pizza, cookies, crackers, etc.) sugar and sweets (table sugar, HFCS, agave syrup, ice creams, cakes, sweet puddings and sugary soft-drinks)
- Factory-farmed pork and fish are high in omega 6 fatty acids and farmed fish which may contain PCBs. Avoid fish with high mercury.
- Processed foods containing carrageenan (e.g. almond milk products), MSG (e.g. in some whey protein products), sulphites (e.g. in dried fruits, gelatin), BPAs (they don't have to be labeled!), wheat gluten
- Artificial sweeteners Splenda, Equal, sweeteners containing Aspartame, Acesulfame, Sucralose, Saccharin, etc - these may cause cravings and other issues
- Refined fats / oils (e.g. sunflower, safflower, cottonseed, canola, soybean, grapeseed, corn oil), trans fats such as margarine.
- "Low-fat", "low-carb" and "zero-carb" products (Atkins products, diet soda and drinks, chewing gums and mints may be high in carbs or contain artificial additives, gluten, etc.)
- Milk (only small amounts of raw, full-fat milk is allowed). Milk is not recommended for several reasons. Firstly, from all the dairy products, milk is difficult to digest, as it lacks the "good" bacteria (eliminated through pasteurization) and may even contain hormones. Secondly, it is quite high in carbs (4-5 grams of carbs per 100 ml). For coffee and tea, replace milk with cream in reasonable amounts. You may have a small amount of raw milk but be aware of the extra carbs.
- Alcoholic, sweet drinks (beer, sweet wine, cocktails, etc.) -
- Tropical fruit (pineapple, mango, banana, papaya, etc.) and some high-carb fruit (tangerine, grapes, etc.) Also avoid fruit juices (yes, even 100% fresh juices!) - better to drink smoothies if any, but either way very limited. Juices are just like sugary water, but smoothies have fiber, which is at least more satiated. This also includes dried fruit (dates, raisins, etc.) if eaten in large quantities.
- A question mark is soy products There is mixed information about soy, hopefully we will know more in the near future. Also avoid wheat gluten which may be used in low-carb foods. When you give up bread, you shouldn't eat any part of it. Beware of BPA-lined cans. If possible, use naturally BPA-free packaging like glass jars. BPA has been linked to many negative health effects such as impaired thyroid function and cancer. Other additives to avoid: carrageenan (e.g. almond milk products), MSG (e.g. in some whey protein products) and sulfites(e.g. in dried fruits, gelatin)
1. Start with around 50g net carbs (less fiber gms) per day. Yes it is hard to get down to 50gms if you are a big carb eater. Once you get there, you may need to make another step down to 40gm, 30 or even 20gm. Once your body gets used to lower carbs things start to get easier.
2. Keep protein around 20% of your daily calories. You will need to buy a macronutrient (carbs, protein, fat) counter and a good set of kitchen scales. There are some macronutrient measuring apps that you could try that I have heard are good. Too much protein will quickly knock you out of ketosis as access will be converted into glucose. (gluconeogenesis)
3. Make sure you eat enough fat and add it to your meals so it makes up around 70% of your daily calories. (protein and carbs contains 4 cals per gm and fat has 9 cals per gm - approx)
4. Eat enough salt because when insulin levels are low your kidneys will tend to expel sodium whilst in ketosis. You need to keep in balance sodium, potassium, zinc and magnesium levels. (blood test will check these)
5. Forget calories, just concentrate on carb/protein/fat balance. Eat until you feel sated but not stuffed.
6. Get yourself a keto measuring device. This could be urine measure, (ketostix) or blood measure, (more accurate because it measure bood ketones, but is more expensive) breath, (these are newer but I believe work well)
7. Don’t expect to get into ketosis quickly, it can take as little as 2 weeks or sometimes 2 months. It depends on a number of things including whether you cheat, and how many carb, protein and fat grams you consume every day.
So I hope this has answered some of your questions and given you interesting and informative information you can digest. It is too complicated and has too many variables to answer all of your questions and give you all of the information out there. It is still evolving and results of studies and trials are continually coming in. I’ll say it again, that it is better to have someone to guide you through the journey, because it is an evolving and dynamic process. If you go it alone keep researching on the internet and if possible ask questions. Regular changes need to be made as your body adapts. I believe the ketogenic diet is impacting on human health in a revolutionary and profound way, try it and decide for yourself.
PS This new website has yet to be finished, I will have resources in there that will help you on your journey very soon. All my articles are now on my “Exercise Guru Graeme” facebook page.
References: Dr Peter Attia. MD. BScDr Stephen Finney. MD. PhDProf Jeff Volek. PhD. R.D.