The Benefits of a Keto Diet and Tips on How to Implement It
You may remember that under normal circumstances, glucose is the primary source of fuel for the body. It is derived from a wide variety of carbohydrate sources such as sugars, fruits, starchy vegetables (i.e., sweet potatoes, potatoes, beets, carrots), dairy products (i.e., milk, yogurt, cheese, ice cream), refined/processed grains (i.e., wheat, corn, soy, rice) grounded into flour (i.e., bread). When simple carbohydrates are dramatically reduced or cut out of the diet, and replaced with only whole plant based foods, the body will revert to using the storage form of sugar called glycogen as its alternative source of fuel (Paoli, 2014; Iacovides & Meiring, 2018). Typically, there are approximately 600 grams of glycogen stored in the liver and skeletal muscles with this value changing based on a person’s diet, body mass, and activity level (Murray & Rosenbloom, 2018).
Once the glycogen stores dwindle in the liver, muscle, and blood, the body will undergo gluconeogenesis where sugar is made from substrates such as lactic acid, glycerol, and certain amino acids. This means that glucose is still being delivered to your tissues at all times, but the original source derived from breaking down carbohydrates has been changed to fat and certain amino acids. This is a natural process that occurs all the time.
Nutritional ketosis pushes this physiologic state a little bit further. When the body puts the brakes on glucose production, it finally shifts into ketogenesis within a few days. Fat is broken down into fatty acids which are further metabolized into ketone bodies (the smallest fraction of a fat molecule) in the liver.
When fat replaces carbohydrate as the primary macronutrient, the body can produce 15 times more energy than when burning simple sugars and other carbohydrates. Ketosis is a fundamental and gradual shift the body has to make in order to thrive.
How can you tell if your body is burning fat instead of carbohydrates?
The benefits of the ketogenic diet depend on the body actually achieving a state of ketosis and its ability to produce adequate cellular energy. This means the diet has to be tailored correctly.
Ketone bodies are removed via the urine, and hence, high levels of ketones measured in urine are one indication that the body is in a state of ketosis. Another indication of ketosis is “fruity breath” that happens as a result of acetone, a byproduct of ketone acetoacetate decarboxylation, eliminated through respiration (Paoli, 2014).
Who should follow a ketogenic diet?
In integrative medicine, we treat every individual as unique and, like all therapeutic diets, the keto diet may not be for everyone. However, research has demonstrated the benefits of the ketogenic diet for a myriad of health conditions. The hallmark examples are metabolic conditions such as obesity, diabetes, high cholesterol, and seizure disorders.
The ketogenic diet has been gaining popularity because it promotes weight loss. Research clearly demonstrates that the diet is an effective weight loss strategy. The ketogenic diet has also been incredibly successful in improving biomarkers of metabolic syndrome, insulin resistance, and type 2 diabetes in overweight individuals, with improvements in blood glucose regulation, insulin sensitivity, triglyceride levels, and HDL cholesterol levels (Masood & Uppaluri, 2018).
In a recent review on the use of the ketogenic diet in the treatment of obesity, obese individuals following a very low carbohydrate diet demonstrated improved glycemic control, hemoglobin A1c levels, and lipid markers, corroborating earlier studies. Those with insulin resistance also demonstrated improved markers of metabolic syndrome. Although the specific mechanism has yet to be illuminated, the authors proposed several possible explanations for these benefits including (Paoli, 2014):
Reduction in appetite
Improved appetite control
Greater metabolic efficiency as a result of fat consumption
Increased lipolysis and reduced lipogenesis
Increased energy requirements of gluconeogenesis
In another study examining the effects of a long-term ketogenic diet in obese individuals, the plan was followed for 24 weeks, and participants followed a diet consisting of:
30 g of carbohydrate
1 g/kg body weight of protein
20% saturated fat
and 80% polyunsaturated and monounsaturated fat.
Results showed increases in HDL and decreases in total body weight, BMI, triglycerides, LDL cholesterol, and blood glucose. More importantly, with results like these (and those that came after it), the ketogenic diet demonstrates safety, indicating that it is all right to follow for longer periods of time without adverse side effects (Dashti et al., 2004).
Furthermore, in addition to the diet as a weight loss intervention, the ketogenic diet was originally developed in the 1920s to address pediatric epilepsy. As described above, the body undergoes ketogenesis as a result of severe carbohydrate restriction on the dietary plan, mimicking the effects of fasting. Over one hundred years ago, it was observed that fasting had protective, anti-seizure effects, which led to the implementation of the ketogenic diet (Barañano & Hartman, 2008).
In another assessment, one randomized controlled trial examined the effects of the diet in 145 children with treatment-intractable epilepsy (experiencing more than seven seizures per week). Seizure frequency measured after three months was significantly lower in the ketogenic diet group compared to the control group, supporting the use of the ketogenic diet as an effective lifestyle intervention (Neal et al., 2008).
Follow the Simple Tips Below to Adhere to a Keto Diet
# 1: Know your macronutrient breakdown
On the keto plan, one must adhere to a strict macronutrient breakdown. It is essential to consume the right proportions of fat, protein, and carbohydrates to ensure you actually remain in a state of ketosis. Otherwise, if you’re not consuming enough fat during your meals (or you accidentally consume too many carbohydrates during a meal), your body will always prioritize glucose as a primary source of fuel. If you remember from last month, the body does this because it won’t have to spend extra energy going out of its way to make glucose from fat or certain amino acids. The same is true if you eat too much protein at a meal; it will be converted to glucose and inhibit ketosis.
The macronutrient breakdown for a ketogenic diet is as follows, though it may change depending on each person’s needs and goals:
70-75% from anti-inflammatory fat
20-25% from high quality protein sources
5-10% from low-glycemic, nutrient-dense carbohydrates
#2: Stay plant-based
One of the biggest misconceptions about the ketogenic diet is that you have to consume animal products in order to adhere to the diet. That’s not true. With proper planning and education, it’s possible to follow a plant-based keto plan. Even though you need not strictly cut out all animal products, it’s best to incorporate anti-inflammatory, plant-based foods such as nuts, seeds, coconut, and avocado since they are rich in anti-inflammatory fats.
#3: Quality is paramount
It is not necessary to consume animal products to be on a ketogenic diet. If you do choose to have animal protein, please lean towards having high quality products. For instance, go to your local farmers market and look for products with labels such as organic, free-range, pasture-raised, wild-caught or sustainable or speak with the farmer to see how they raise their livestock. But please note that even if you do consume high quality animal products, it is not possible in today’s world to avoid not being exposed to high concentrations of synthetic hormones, pesticides, antibiotic residues, petroleum-derived pollutants, heavy metals and pathogenic microorganisms when you consume any amount of animal protein. It is just the reality we are facing today based on current farming and agriculture conditions.
#4: Organic produce only
As with most treatment plans, the goal is to heal the body in as many ways as possible. So choose organic produce whenever it's possible. The reason is to avoid excessive exposure to pesticides and herbicides which contributes to your body’s toxicant load. With a lifetime of exposure to toxins, it becomes increasingly difficult with time for your body to be able to effectively cleanse itself of toxins since most are stored in fat deposits located within your organs and tissues.
#5: Avoid refined products
To help your body maintain its repair mechanism and heal, it is best to skip refined foods. This includes items like deli meats and dairy products which are typically loaded with added preservatives and nitrates that cause extensive inflammation in the body, weight gain and numerous other chronic health conditions.
#6: Supplement your diet when needed
When beginning a ketogenic diet, you may experience something called “the keto flu”, which is characterized by flu-like symptoms such as nausea, headaches, fatigue, and dizziness within the first few weeks. This occurs when your body is getting used to shifting from burning glucose to fat. Therefore, staying hydrated and supplementing your diet with electrolytes and magnesium can help ameliorate some of these side effects (Masood & Uppaluri, 2018).
Another side effect commonly experienced in the early stages of a ketogenic diet is low energy because the body is adjusting to burning fuel in a different way. B vitamins and green protein powders (with Chlorophyll and Chlorella) can help provide the body with essential nutrients and an extra boost of energy. It’s no surprise that vitamin and mineral deficiencies have been noted as a potential negative side effect of the ketogenic diet (Masood & Uppaluri, 2018); and I’m willing to bet a lot of people who begin the diet are already nutritionally depleted. Again, going back to #1, a well-planned diet will prevent micronutrient deficiencies, and taking a multivitamin can help ensure the body is getting all the nutrients it needs to function optimally.
Is the keto diet safe for you?
Generally speaking, YES. Studies have found the beneficial effects and safety of a ketogenic diet for up to 6–12 months, with a gradual transition back to a standard, more balanced nutrient-dense whole foods plant-based diet. As previously mentioned, short-term side effects, such as the “keto flu” have been reported, but this is only temporary. Some long-term adverse effects may include hepatic steatosis (fatty liver), hypoproteinemia (low blood protein levels), and kidney stones especially in those consuming animal protein as a part of a ketogenic diet.
Due to the ketogenic diet’s possible impact on the kidneys, it’s essential to know the status of your kidneys and monitor its functionality when you are on the plan (Paoli, 2014; Masood & Uppaluri, 2018). Because the kidneys are essential for bone health, monitoring bone density may also be recommended especially for those continuing to consume animal protein since long-term studies have shown progressive reduction in bone mineral content in children with epilepsy on a long-term ketogenic diet (Paoli, 2014).
Unfortunately, those with the following conditions are advised to consult with an integrative functional medicine practitioner like Dr. Bhandari M.D. with a strong background in nutrition before starting a ketogenic diet. They include:
Liver failure
Pancreatitis
Fat metabolism disorders
Porphyrias
Primary carnitine deficiency
Carnitine palmitoyltransferase deficiency
Carnitine translocase deficiency
Pyruvate kinase deficiency
Diabetes mellitus
In diabetes, insulin or other hypoglycemic medications may need to be modified to account for carbohydrate restriction in order to prevent severe hypoglycemia from occurring (Masood & Uppaluri, 2018).
Summary
The benefits and safety of the keto diet have been well-reported with its benefits noted for up to 2 years and beyond (Masood & Uppaluri, 2018). Do note weight gain may occur once stopping this diet as one may return back to eating “normally”. The good news is that one study found people who followed the ketogenic diet for two brief periods (separated by the Mediterranean diet for maintenance) demonstrated improvements in health risk factors without regaining weight (Paoli, 2014).
Bottom line: If you want to try any therapeutic diet, it’s important to consult a holistic integrative medicine healthcare provider to ensure the diet is right for you and troubleshoot problems that arise. Together, you can help plan your diet and monitor your progress to ensure the diet is followed safely and effectively.
Dr. Bhandari Is Here to Support Your Health.
As one of nation’s top integrative functional medicine physicians, Dr. Bhandari work with patients suffering from chronic health concerns which modern medicine can only provide side effect-ridden solutions without a cure. By taking the best in Eastern and Western Medicine, Dr. Bhandari understands the root cause of diseases on a cellular level and designs personalized treatment plans which drive positive results. Reach out to SF Advanced Health to learn more.
Reference
Barañano, K. W., & Hartman, A. L. (2008). The ketogenic diet: Uses in epilepsy and other neurologic illnesses. Current Treatment Options in Neurology, 10(6), 410-419.
Berg, J.M., Tymoczko, J.L., & Stryer, L. (2002). Biochemistry. 5th edition. New York: W H Freeman.
Dashti, H.M., Mathew, T.C., Hussein, T., Asfar, S.K., Behbahani, A., Khoursheed, M.A., Al-Sayer, H.M., Bo-Abbas, Y.Y., & Al-Zaid, N.S. (2004). Long-term effects of a ketogenic diet in obese patients. Experimental & Clinical Cardiology, 9(3), 200-205.
Iacovides, S., & Meiring, R. M. (2018). The effect of a ketogenic diet versus a high-carbohydrate, low-fat diet on sleep, cognition, thyroid function, and cardiovascular health independent of weight loss: Study protocol for a randomized controlled trial. Trials, 19(1).
Khakh, B. S., & Burnstock, G. (2009). The double life of ATP. Scientific American, 301(6), 84-92.
Lefevre, F., & Aronson, N. (2000). Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics, 105(4).
Masood, W., & Uppaluri, K.R. (2018). Ketogenic diet. Treasure Island, FL: StatPearls Publishing.
Murray, B., & Rosenbloom, C. (2018). Fundamentals of glycogen metabolism for coaches and athletes. Nutrition Reviews, 76(4): 243–259.
Neal, E. G., Chaffe, H., Schwartz, R. H., Lawson, M. S., Edwards, N., Fitzsimmons, G., . . . Cross, J. H. (2008). The ketogenic diet for the treatment of childhood epilepsy: A randomised controlled trial. The Lancet Neurology, 7(6), 500-506.
Paoli, A. (2014). Ketogenic diet for obesity: Friend or foe? International Journal of Environmental Research and Public Health, 11(2), 2092-2107.
Masood, W., & Uppaluri, K.R. (2018). Ketogenic diet. Treasure Island, FL: StatPearls Publishing.
Paoli, A. (2014). Ketogenic diet for obesity: Friend or foe? International Journal of Environmental Research and Public Health, 11(2), 2092-2107.
AUTHOR
Dr. Payal Bhandari M.D. is one of U.S.'s top leading integrative functional medical physicians and the founder of SF Advanced Health. She combines the best in Eastern and Western Medicine to understand the root causes of diseases and provide patients with personalized treatment plans that quickly deliver effective results. Dr. Bhandari specializes in cell function to understand how the whole body works. Dr. Bhandari received her Bachelor of Arts degree in biology in 1997 and Doctor of Medicine degree in 2001 from West Virginia University. She the completed her Family Medicine residency in 2004 from the University of Massachusetts and joined a family medicine practice in 2005 which was eventually nationally recognized as San Francisco’s 1st patient-centered medical home. To learn more, go to www.sfadvancedhealth.com.