Ketogenic Diet 101

There is always a trending diet out there and right now I would have to say the ketogenic diet or “keto diet” is in the spotlight! With popular eating plans, there is always mixed information. Here’s what you need to know:

A ketogenic nutrition plan is a high fat, low carbohydrate, and moderate/adequate protein regimen that actually has been around since the 1920s when it was first introduced for the prevention of seizures in patients with epilepsy. The premise of the plan is to mimic a state of fasting so that the body and brain will turn to fat and ketones as a major source of energy instead of glucose (sugar). So, what exactly does this mean?

Simply put, glucose is what is normally used by our cells as a quick source of fuel (energy). However, when its presence is lacking, the body starts to burn fat and produce ketones instead. To give you a little more basic nutrition science… ketones are produced in the liver from the breakdown of fat into fatty acids and are then released into the bloodstream to be used for energy. Once ketone levels in the blood rise to a certain point, you enter into a state of ketosis. Ketones are present under normal resting conditions, but their production and use are greatly elevated during very low carbohydrate intake, prolonged exercise, or starvation periods. Ketones provide more energy per gram than glucose  provides.

Our bodies are pretty amazing, huh? You’re probably thinking- burn fat for energy? Umm, sign me up! Why wouldn’t I want this for myself?? Well, while the keto plan does bring on many benefits to our well-being (keep reading to learn more), it may be contraindicated in a number of conditions such as type 1 diabetes, kidney failure, liver failure, hyperlipidemia, pancreatitis, gallbladder disease, impaired fat digestion, gastric bypass surgery, metabolic disorders, or defects in fatty acid oxidation. Whether or not any of these health conditions pertain to you, it is crucial to discuss with your physician whether this eating plan is appropriate for you and make sure you are working with a nutrition expert throughout it. I cannot emphasize this enough.

Okay, let’s talk about the benefits that come from following a ketogenic eating plan.

  • Lessens the risk and/or improves type 2 diabetes & metabolic disorders by helping control the release of insulin (which plays a huge role in the development of diabetes and conditions like Polycystic Ovary Syndrome). When we eat carbohydrates, insulin is released as a response to elevated sugar circulating in our blood and as a result insulin levels rise. A ketogenic eating pattern keeps the body’s carbohydrate storage almost empty. Therefore preventing much insulin from being released following consumption of food, essentially helping “reverse” insulin resistance.
  • Despite the high fat intake, cardiovascular benefits seen with compliance on a keto plan are: a decrease in production of triglycerides, reduction of cholesterol precursors and production, increase in HDLs, and favorable increase in LDL particle size and volume.
  • Cancer benefits are also another reason that make a keto plan one to consider as it’s been shown to “starve” cancer cells. Cancer cells thrive on sugar (glucose) seeming to benefit from the presence of hyperglycemia and hyperinsulinemia, this enhancing tumor progression and imparts resistance to radiation therapy.
  • A ketogenic nutrition plan is still being used to help in the treatment of epilepsy along with other neurological disorders like cognitive impairments, Alzheimer’s, headaches, Parkinson’s Disease, sleep disorders, and others. Studies report the ketogenic diet appears to have “neuroprotective effects” — as it appears to correct abnormalities in how brain cells use energy, which is a common characteristic in many neurological disorders.
  • Last, but certainly not least, are all the benefits seen with weight loss. A ketogenic plan appears to be an ideal plan if you’re looking for weight loss. Contributing mechanisms appear to include some degree of appetite suppression (due to satiety from protein and fat intake, alterations in appetite hormones, ketosis), increase in fat breakdown, reduction in fat synthesis, thermic effect of protein, and the amount of energy utilized for gluconeogenesis. Low-carbohydrate ketogenic plans appear to promote more weight loss earlier on than low-fat, low-calorie plans although efficacy after one year appears to be comparable.

So now that you know all the benefits that come with sticking to a ketogetic eating plan, this is what your daily intake of foods would look like:

  • High intake of healthy fats like avocado, nuts, seeds, grass-fed butter, coconut oil
  • Lots of non-starchy vegetables like all leafy greens, broccoli, cauliflower, brussel sprouts, asparagus, cucumbers, carrots, and zucchini to name a few
  • Moderate amounts of high quality protein like grass-fed beef, pasture-raised poultry, cage free eggs, wild-caught fish, organ meats from grass-fed/pasture-raised sources

Foods that would be limited are:

  • Full-fat dairy
  • Starchy vegetables like peas, beets, potatoes
  • Legumes/ beans
  • Certain nuts and seeds (cashews, pistachios)

Foods that would be avoided include:

  • Any type of sweetener- this includes natural ones like raw honey or 100% maple syrup
  • All grains (wheat, rice, oats, quinoa, etc.)
  • All processed foods like crackers, cookies, snack bars, canned soups
  • Sweetened beverages, alcohol, milk

When it comes to macronutrient breakdown, variations of the ketogenic plan have emerged and are being used in a broader range. For the “classic” ketogenic plan (for seizure control) it’s typically a 3-4:1 ratio. This means 3-4 grams of fat to every gram of carbohydrate and protein combined; so, ~90% fat, 4% carbohydrate, and 6% protein. For weight management the breakdown would be 40-60% fat, 10-30% carbohydrate, and 20-30% protein. Monitoring for ketosis will be necessary- adjusting carbohydrate intake accordingly.

While the keto diet might sound like an ideal eating plan for you, there are many precautions and common side effects that result with implementing this type of eating plan and at the end of the day there are many factors to consider before starting, not just this plan, but any restrictive eating plan. Physician’s approval is recommended prior to plan initiation, and implementation requires the expertise and continued guidance of a qualified nutrition professional.


Basilia Theofilou is a contributor on our blog as well as one of the nutrition advisors here at PreviMedica. You can read more about her here.


Resources:

1 Schönfeld P, Reiser G. Why does brain metabolism not favor burning of fatty acids to provide energy? Reflections on disadvantages of the use of free fatty acids as fuel for brain. J Cereb Blood Flow Metab. 2013 Oct;33(10):1493-9. doi: 10.1038/jcbfm.2013.128. Epub 2013 Aug 7. Review. PubMed PMID: 23921897. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790936/ .Accessed January 29, 2018.

2. Berg, Jeremy M., John L. Tymoczko, and Lubert Stryer. Biochemistry. New York: W. H. Freeman, 2002. http://www.ncbi.nlm.nih.gov/books/NBK22436/ . Accessed January 29, 2018.

3. Paoli A, Rubini A, Volek JS, et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789-96. doi: 10.1038/ejcn.2013.116. Epub 2013 Jun 26. Review.Erratum in: Eur J Clin Nutr. 2014 May;68(5):641. PubMed PMID:23801097. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826507/ . Accessed January 29, 2018.

4. Panov A, Orynbayeva Z, Vavilin V, et al. Fatty acids in energy metabolism of the central nervous system. Biomed Res Int. 2014;2014:472459. doi: 10.1155/2014/472459. Epub 2014 May 4. Review. PubMed PMID: 24883315.

5. McPherson PA, McEneny J. The biochemistry of ketogenesis and its role in weight management, neurological disease and oxidative stress. J Physiol Biochem. 2012 Mar;68(1):141-51. doi: 10.1007/s13105-011-0112-4. Epub 2011 Oct 8. Review. PubMed PMID: 21983804.

6. Mitchell GA, Kassovska-Bratinova S, Boukaftane Y, et al. Medical aspects of ketone body metabolism. Clin Invest Med. 1995 Jun;18(3):193-216. Review. PubMed PMID: 7554586.

7. Manninen AH. Metabolic effects of the very-low-carbohydrate diets: misunderstood “villains” of human metabolism. J Int Soc Sports Nutr. 2004 Dec 31;1(2):7-11. doi: 10.1186/1550-2783-1-2-7. PubMed PMID: 18500949. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/ . Accessed January 29, 2018.

8. Paoli A, Rubini A, Volek JS, et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789-96. doi: 10.1038/ejcn.2013.116. Epub 2013 Jun 26. Review.Erratum in: Eur J Clin Nutr. 2014 May;68(5):641. PubMed PMID: 23801097. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826507/ . Accessed February 5, 2018.

9. Sumithran P, Proietto J. Ketogenic diets for weight loss: A review of their principles, safety and efficacy. Obes Res Clin Pract. 2008 Mar;2(1):I-II. doi:10.1016/j.orcp.2007.11.003. PubMed PMID: 24351673. http://www.sochob.cl/pdf/obesidad_adulto/Ketogenic%20diets%20for%20weight%20loss%20A%20review%20of%20their%20principles%20safety%20and%20efficacy.pdf . Accessed February 5, 2018.

10. Dhamija R, Eckert S, Wirrell E. Ketogenic diet. Can J Neurol Sci. 2013 Mar;40(2):158-67. Review. PubMed PMID: 23419562.

11. Turner Z, Kossoff EH. The Ketogenic and Atkins Diets: Recipes for Seizure Control. Practical Gastroenterology. June 2006. https://www.cignaturehealth.com/wp-content/uploads/2017/05/Article6.pdf . Accessed February 5, 2018.

12. Epilepsy Foundation. Ketogenic Diet. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet . Accessed February 5, 2018.

13. The Charlie Foundation for Ketogenic Therapies. What is the Ketogenic Diet? http://www.charliefoundation.org/explore-ketogenic-diet/explore-1/introducing-the-diet . Accessed February 5, 2018.

14. Paoli A. Ketogenic diet for obesity: friend or foe? Int J Environ Res Public Health. 2014 Feb 19;11(2):2092-107. doi: 10.3390/ijerph110202092. Review. PubMed PMID: 24557522. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945587/ . Accessed February 5, 2018.

15. Paoli A, Bianco A, Damiani E, Bosco G. Ketogenic diet in neuromuscular and neurodegenerative diseases. Biomed Res Int. 2014;2014:474296. doi: 10.1155/2014/474296. Epub 2014 Jul 3. Review. PubMed PMID: 25101284.

16. Mayo Clinic Healthy Lifestyle Weight Loss. http://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/low-carb-diet/art-20045831?pg=2 . Accessed February 5, 2018.

17. Schugar RC, Crawford PA. Low-carbohydrate ketogenic diets, glucose homeostasis, and nonalcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care. 2012 Jul;15(4):374-80. doi: 10.1097/MCO.0b013e3283547157. Review. PubMed PMID: 22617564.

18. Bergqvist AG. Long-term monitoring of the ketogenic diet: Do’s and Don’ts. Epilepsy Res. 2012 Jul;100(3):261-6. doi: 10.1016/j.eplepsyres.2011.05.020. Epub 2011 Aug 19. Review. PubMed PMID: 21855296.

19. Kossoff EH, Hartman AL. Ketogenic diets: new advances for metabolism-based therapies. Curr Opin Neurol. 2012 Apr;25(2):173-8. doi: 10.1097/WCO.0b013e3283515e4a. Review. PubMed PMID: 22322415. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002181/ . Accessed February 5, 2018.

20. Simone BA, Champ CE, Rosenberg AL,et al. Selectively starving cancer cells through dietary manipulation: methods and clinical implications. Future Oncol. 2013 Jul;9(7):959-76. doi: 10.2217/fon.13.31. Review. PubMed PMID: 23837760. http://www.researchgate.net/profile/Adam_Dicker2/publication/248383072_Selectively_starving_cancer_cells_through_dietary_manipulation_methods_and_clinical_implications/links/0f31752e721ca22f57000000.pdf . Accessed February 5, 2018.

21. Kapelner A, Vorsanger M. Starvation of cancer via induced ketogenesis and severe hypoglycemia. Med Hypotheses. 2015 Mar;84(3):162-8. doi:10.1016/j.mehy.2014.11.002. Epub 2014 Dec 10. PubMed PMID: 25579853.

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