By Doc Mok

Ah, the ketogenic diet.  A highly effective and recently popularized method for fat loss with biochemical roots.  This method is NOT new, but newly en vogue.  This week at maximalbeing.com, we take a deep dive into Big Fat Fuel: the Ketogenic Diet Science and Action.

What is the ketogenic diet?

The basic concept of the ketogenic diet is low carbohydrate intake (20-50 grams/day) which shifts the body into an alternative energy source: ketones.  Ketones are breakdown products of fat metabolism.  Essentially, the body takes long-chain fats in the liver and converts them to ketone bodies to be used for energy.  However, the secret behind ketone is NOT THAT SIMPLE.

There are many types of ketones, not just acetone, acetoacetate, and beta-hydroxybutyrate (ketone bodies commonly cited on the diet approach).  Also, to further blow your mind, these compounds are NOT created from fat only!

 

You have two fuel pathways glucose and ketones

Ketones are derived from carbohydrates, amino acids, and fats via various pathways.  In addition to ketone bodies, there are sugars that also are ketones, namely fructose.  Fructose is a simple carbohydrate found in table sugar (sucrose = glucose + fructose) and in fruit.  You may see ketones in protein supplements, examples include sugar-alcohols like xylulose and erythrulose.  These ketones lend sweetness without metabolically impacting the body the way that table sugar. 

Some hormones are ketones as well, these are known as ketosteroids.  Examples of these steroids include androsterone and testosterone.  Regardless of whether you are male or female, testosterone is important for fitness and muscle function.  That said, the effects of a ketogenic diet on testosterone are debated and study results are varied.  (Pro 1, 2, Con 1, 2)

Now that we have covered the makeup of various ketones, let’s explore why your healthcare provider may be hesitant about the ketogenic diet.

Ketoacidosis

In medicine, students are taught about diabetic ketoacidosis (DKA).  This is a life-threatening condition that happens in patients with uncontrolled diabetes (especially type I diabetes). For these patients, there is no insulin available to control high glucose levels, ketones are produced in very high numbers causing changes in blood pH and electrolytes. This can be life-threatening. A similar situation can occur with toxins and alcohol. Because of these issues, your healthcare provider may be hesitant about this dietary approach.  For your own safety, it is important to clearly understand what ketosis can do to your body.  If you have diabetes, please discuss the ketogenic diet with your doctor before starting a ketogenic diet. Though DKA is potentially dangerous, the ketogenic diet has numerous potential benefits.

The Positive Side of Ketosis

Dating as far back as the 1920s and 30s, the ketogenic diet has been paired with intermittent fasting.  Some may even argue that fasting and ketosis date back to the time of Hippocrates in ancient Greece.  

 

Ketogenic diet has historic roots

Both fasting and the ketogenic diet generate ketones for fuel, making them a natural pair. Many organs can use ketone bodies as a source of fuel, one of the most important is the brain.  Ketones easily sneak through the gate between the brain and your circulation (blood-brain barrier) and can be used to fuel thought.  As a result, one doctor theorized that ketosis and fasting could be used to treat neurological conditions, namely seizures. 

If you would like to learn more about the science of intermittent fasting, please SEE Our Article. 

Ketosis can Benefit the Brain

In 1911, the first scientific paper was produced by Dr. Guelpa showing potential for the ketogenic diet to assist in epilepsy.  

This research was followed by the landmark publications of Dr. Conklin on his use of ketosis (via fasting) for seizures.

Numerous papers followed examining the effects of ketosis on neurologic conditions ranging from Lou Gehrig’s Disease to Alzheimer’s Disease, and even brain trauma.  

 

Ketones can be used to combat epilepsy

Yet, ketosis was buried for the latter part of the 20th century, most likely because of the invention of more effective anti-epileptic drugs.  It was not until a mention on the show Dateline in 1994, that the ketogenic diet emerged again. This episode focused on childhood epilepsy and the impact of ketosis on the condition.  Dr. John M. Freeman, a pediatric neurologist, revived the ketogenic diet for refractory seizures, leading to increased popularization in the modern era.  This led to a rediscovery of this dietary approach.  However, the modern era of ketogenic research pivoted toward the benefit for body composition and insulin resistance.

The Ketogenic Diet Can Lead to Fat Loss

From this point, the ketogenic and similar low carbohydrate plans gained traction. It was at this point that the research on ketosis and weight loss began.

A meta-analysis of 13 randomized controlled trials evaluating the ketogenic (low carb) diet versus a low-fat diet favored the ketogenic approach for lowering weight, cholesterol, and blood pressure.  However, at 2 years the ketogenic diet was not sustainable to the majority of the study participants.   

A similar systematic review evaluated 26 trials comparing ketogenic (under 50 grams of carbohydrates daily) with low calorie (800 kCal/day) diets.  The main difference in this analysis was lower satiety in the ketogenic group versus the low-calorie diet, thought to be due to the suppression of ghrelin, the hunger hormone.  

This concept was supported in a study of 38 obese individuals on a low-calorie ketogenic diet for 2 weeks.  Participants saw a 13% reduction in weight, waist/hip circumference, insulin levels, and no increase in ghrelin, which promptly increased after the diet was stopped.

So does the ketogenic diet lead to weight loss?  It seems likely.  Yet what about muscle gain?

Ketones a Source for Fueling Workouts

Though glycogen (stored carbohydrates) are a primary source of energy during exercise, individuals on the keto diet can also use ketones as a primary source of energy.  During the adaption process, it is important to note that people will lose strength at first.  This is a temporary problem per this cited study.

Once this temporary period of declining performance ends, it appears that individuals on this diet will both lose fat and improve performance with time.  These differences have been examined in resistance training, CrossFit and gymnastics. 

 

Training is possible on keto

All studies demonstrate no loss in lean muscle mass during the training periods.  However, it is possible that other issues may arise. 

Potential Ketogenic Pitfalls

Potential concerns include the formation of kidney stones and the demineralization of bone. This is due to the acidic pH that is created in the body.  Low pH or acidity can release calcium from the bones, leading to high urinary concentrations, lower citrate in the urine, and high uric acid, all with the potential for stone formation.  

As a result, some recommend giving potassium supplements to reduce this risk.   

Another consideration with growth and development is that insulin-like growth factor is suppressed while in ketosis.  For children and young adults in puberty, this hormone assists with growth and development.  Therefore, there is the possibility that ketosis can potentially alter the growth trajectory in young people. 

There is also a concept called the “keto flu.”  This involves, fatigue, nausea, sometimes vomiting, and diarrhea present when your body is transitioning from carbohydrate burning to ketone burning.  This is essentially from a withdrawal from carbohydrates, yipes!  The only way to get rid of it is time, rest (including avoiding training), ensure proper macros, hydration, and electrolyte support through nutritious food. 

Interpretations of the diet itself can be a concern.  Knowledge is powerful and lacking a full understanding of nutrition may lead to undesirable results, also known as “dirty keto.”

Keep Your Keto Diet Clean

“Dirty keto” involves the ingestion of processed high-fat foods to meet macronutrient goals.  By this I mean hydrogenated and trans/“bad” fats.  Hydrogenated oils force the hydrogen bond into the fat for stability.  They allow food to last longer on the shelf, but lack nutrition density and are unnatural. 

 

Dirty Keto is bad for you

Eating a pound of bacon on a burger, with a block of cheese is NOT HEALTHY!  Ingesting highly-processed “keto” foods, like all franken foods, increase your risk of cardiovascular disease, stroke, diabetes and many other conditions, due to inflammation.  

Sure, these foods fit the fat concept of the ketogenic diet but miss the mark on the overall wellness goal.  Not all fats are evil but they are not all created equally. 

As an alternative, choose “good fats.”  These include monounsaturated fats, which commonly come from vegetable sources (olive oil, avocado, nuts), and polyunsaturated fats (vegetable oils and wild-caught fish).  These fats will easily line up with the ketogenic diet principles, while also meeting your optimal wellness plan.

An area of debate, in terms of wellness, remains saturated fats.  Saturated fats come from animal sources, lard, coconut oil, and butter.  My thought is to moderate these fat choices.  Select mostly monounsaturated and polyunsaturated with some saturated fats and you will be in the clear.  Stay away from “dirty keto” hydrogenated and trans-fat selections.

If you would like to learn more about fats, please READ OUR ARTICLE on Fat. 

How to Do The Ketogenic Diet

Following the ketogenic diet takes time, precision, and discipline.  Like all dietary plans, you have to commit and there are no cheat days when you begin. Macro counting is important, the MyFitnessPal app is a great resource. The app will allow you to count macros and understand potential sources for each macro in your diet.  With time you can eyeball things but start with precision.

 

Do the math to do keto

Again, the goal is to stay under 50 grams of carbohydrates daily.  Look for hidden carbs!  They are present in many foods, even some advertised as “keto.”  Check labels and use math.  You then increase your fat to compensate for the calories you need each day. 

An example would be the following:

A 155 lb man on a strength-training diet is calculated to consume 2,300 kCal.  If you eat 110 grams of protein and 50 grams of carbs, the remaining 1,660 kCal will be eaten as fat.  At 8 kCal/gram for fat, that means 185 grams of fat daily.

If you would like to know how to calculate your macros, please SEE OUR POST on Calculating MACROS and also download our FREE macro calculator.

To add accuracy, buy urine dipstick strips.  These will inform you when you have entered ketosis as indicated by the ketone indicator.  Typically, you can enter ketosis with 8-12 hours of fasting and without fasting 2-4 days. 

Like all changes related to health, seeing benefits takes time, measure your body when you start, and do not focus on weight.  Coupled with a fitness program, your weight may go up if you are gaining muscle.  Set realistic metrics and you will see gradual changes with time!

Summary

The ketogenic diet is a recently revitalized, but classically developed plan involving the use of your body’s biochemical pathways for fuel.  The origins of the diet date back to Ancient Greece, having a value in neurologic conditions, particularly epilepsy. Ketones come in many forms including fructose (often categorized as a carb), hormones, along ketone bodies.  Potentially harmful ketosis as in type I diabetic and alcoholic can be deadly.  Please consult your doctor prior to starting on the ketogenic diet, if you have health conditions like diabetes a ketogenic diet may be harmful to your health.  Know that the dangers can include growth issues, kidney stones, and the potentially harmful effects of “dirty keto.”  Eat clean monounsaturated, polyunsaturated, and some saturated fats, less than 50 grams of carbs daily.  With this precision, discipline, and time you will reach the goals that you desire on your pathway to optimizing your wellness.

Ketogenic diet inforgraphic