Ketogenic Diet Plan
The goal of a ketogenic diet plan is to improve wellbeing through a metabolic change in which the primary cellular fuel source switches from carbohydrate based fuels (glucose) to fat fuels and fat metabolism products called ketones. This is achieved through a metabolic process called ketogenesis, and a body state called ketosis. Ketosis is simply a normal metabolic pathway in which the body cells utilize ketones to make energy, instead of relying on sugar or carbohydrate. In fact, humans developed an evolutionary ability to burn ketones as an adaptation to periods of time when food was unavailable.
A great deal of research is being done on ketosis as it relates to disease, because ketone bodies have some very beneficial effects on the human body. Increasing the rate of metabolic ketogenesis is an effective treatment for many disease conditions, because the presence of ketone bodies in the blood improves our health at the cellular level, specifically in the function of cellular energy pathways and mitochondrial health. Ketogenic diets are now being used to treat medical conditions such as diabetes, epilepsy, autism, Alzheimer's, cancer and others and much of the success of these treatments is rooted in these cellular effects.
This page will answer some questions you may have about a ketogenic diet plan including:
But first a little legal and medical coverage: Although I have a Master's degree in Applied Clinical Nutrition, I am not a physician. I do have extensive experience with eating the ketogenic way, and I cured my health problems with a ketogenic diet. I am not guaranteeing that this diet will work for you or cure your health problems. I am just sharing what I know about ketogenic diets. Click here for the full legal disclaimer.
Note of Caution
You should check with your physician if you have any concerns about starting a ketogenic diet plan with pre-existing health conditions, especially if those conditions involve kidney or heart problems. People with kidney disease should definitely consult with their physician about starting a ketogenic diet. Other contraindicated conditions and health issues are listed here. Make sure you check this list and rule these out before starting the diet.
However, be aware that most doctors get very little training on nutrition and don't understand the general effect of foods on the body. They are also taught that ketosis is dangerous, and so they know even less about ketogenic diets. Hence, if you ask your physician about this diet, you may get push back and a scary "ketosis-is-dangerous" sermon.
Keep in mind that the doctor is getting nutritional ketosis confused with a much more dangerous condition called ketoacidosis. These are two different conditions. Ketoacidosis is mostly a concern for Type 1 diabetics and others whose bodies are unable to make or process insulin correctly. Ketoacidosis usually develops when a person with type 1 diabetes develops an serious infection, has a heart attack or other debilitating illness. It is accompanied by dehydration, high blood sugars and is precipitated by the inability of the sick patient to administer proper amounts of injected insulin.
For people who are interested in using a ketogenic diet as cancer therapy, please utilize the ebook I have written for this specific purpose. There are some important differences between the ketogenic diet for cancer therapy, and a "regular" ketogenic diet for other issues.
Now back to our regularly scheduled program..
Ketogenic Diet Plan Basics
There are many ways of implementing a low carbohydrate, ketogenic diet plans but most involve following a higher fat, moderate protein, low carb food plan. (The Atkins diet is one of the most famous ketogenic diets, but certainly not the only one). Many people think of ketogenic diets as high protein diets but this is not the case. There are differences in how most people view low carb diet plans and a ketogenic diet plan, and these differences center around the amount of carbohydrate and protein allowed on a daily basis:
- A ketogenic diet plan requires tracking the carb amounts in the foods eaten and reducing carbohydrate intake to about 20-60 grams per day. For some people, less than 100 grams per day may work, but this level of carb intake is too high for most people to achieve ketosis. In addition, the daily protein requirement should be driven by goal or ideal body weight or lean body mass. Protein intake also depends on height, gender and the amount of exercise done. Eating too much protein can interfere with ketosis. The balance of calories after calculating carbs and protein requirements will be from fats. These ratios ensure that most people go into ketosis and stay in that state. The state of ketosis has some beneficial affects so this is an important goal, especially for those people with health issues.
- The nutrient intake on a ketogenic diet typically works out to about 70-75% of calories from fat, 20-25% from protein, and 5-10% from carbohydrate on a daily basis when calories are not restricted. Although calorie counting is not required, it is important to understand how macronutrient percentages can be affected by caloric intake, so you may want to read my page on calorie counting to get more information on this subject. In short, low or very high calorie intake will skew the percentages of macronutrients, so keep this in mind.
The key to correctly implement a ketogenic diet plan is to remember that you are exchanging carbohydrate containing foods with a higher fat intake and a moderate protein consumption.
Why high fat and moderate protein? Fats have little to no effect on blood sugar and insulin levels. Protein does affect both blood sugar and insulin. If you eat too much protein for your ideal body weight or lean muscle mass (usually more than 1.5-2.0 grams/kg lean body mass), it can spark gluconeogenesis and raise blood sugar and protein will also spike blood insulin levels temporarily. Higher insulin levels will interfere with ketone body production. In addition, eating a diet that is heavy on lean protein (without enough fat) can make one sick with a condition know as "rabbit starvation". Rabbit starvation is a form of malnutrition experienced by explorers and native Americans eating exclusively from the land during the Winter season, when food is scarce. It's caused by a diet restricted to the lean meat of animals such as rabbits, in the absence of carbohydrate and fat. Anthropologist and wilderness explorer Vilhjalmur Stefansson wrote about it in several of his books. A diet heavy in protein and low in fat and carb can also wreck the metabolism in other ways.
How to Start A Ketogenic Diet Plan
Although this website contains all the information you need, there are also several books which explain the science behind ketogenic diets as well. They were my "go to" sources and I recommend that you get one or two and read them.
The bottom line here is to make sure to understand everything that will happen when carbohydrate intake drops. Ketogenic diets are very, very powerful, metabolically speaking and this is especially important if you take any kind of medication for blood pressure, diabetes, cholesterol or triglycerides. The amount taken of these medications will most likely need to be sharply reduced while on a ketogenic diet to avoid negative effects such as excessively low blood sugar or blood pressure.
These books are highly recommended:
Once you have a good understanding and are ready to start, download the Basic Ketogenic Diet Plan (the plan is in PDF format, so you need Adobe reader to open it) and use the tips below to get prepared for success:
- Get a carb counter guide (see sidebar) to help learn and remember the carb counts of the foods being eaten. Counting carbs is a critical part of the program, and it's important to understand how to do this correctly.
- Go on a carbohydrate sweep. Inspect kitchen cupboards and refrigerator, and remove all of the high carb foods. This includes any whole grain "complex carbs".
- Restock the kitchen, so that the foods on this low carb food list are available. This will help keep you on the path, grasshopper, and out of the cookies. Here's a low carb grocery list to help with food shopping.
- A ketogenic diet plan is not a "special diet" that requires special foods. There is no need to buy any "low carb" packaged foods. Ketogenic foods are essentially just real, whole foods which are close to their natural state. In other words, they are not highly processed. The only exception to this is the category of artificial sweeteners. These are highly processed. However, I think these are important to include in a low carb diet plan, because a small amount of fake sweetener has less of a negative effect on health than the standard amounts of sugar in sweetened foods. Some people may prefer more natural sugar alcohol sweeteners, but studies have shown these are "antiketogenic" and can derail the process of ketosis for some. They effect each person differently, so you'll have to test to see if they effect your health or weight loss goals.
- Be prepared to spend more time in the kitchen. This is an important point. A ketogenic diet menu involves cooking and eating real foods. If you don't know how to cook, this would be a good time to learn about cooking in general and specifically low carb cooking.
- Think about your meals, and how you will plan them. This will help in buying the right foods at the grocery store, and give a framework to follow when meal time arrives. If you know you're supposed to have salmon and broccoli for dinner tonight, it makes it a lot easier to avoid choosing the old high carb foods you used to eat.
- Replace old habits with new ones. If you're used to hitting the coffee place for a bagel, start making coffee at home, and have it with the eggs instead.
- Stay hydrated. As carb intake is lowered, the kidneys will start dumping excess water being retained as a result of the former higher carb intake. Make sure to drink enough water to replace what gets lost. The old 6-8 glasses is a good rule, I guess, although just drinking to thirst will probably do the trick. If you find yourself getting headaches and muscle cramps, you need more water, and more minerals such as salt, magnesium and potassium, because the water loss also takes minerals with it. (See my low carb diet side effects page for more info).
- Avoid the foods on this list of high carb foods. These are the foods that drive up your blood sugar and insulin levels. In addition, cereal grains like wheat are toxic for more people than is widely known. I think that most people with diet related health issues have an untreated gluten intolerance.
- Consider taking these natural supplements. I recommend them for the specific issues I discuss on my low carb diet side effects page.
- You may also want to buy some Ketostix Reagent Strips so that you can check to see if you are in ketosis for the first few weeks. However, after the first 3-4 weeks on the plan, the goal is to become "keto-adapted". Once adapted, the body should be burning the ketones for fuel. The stick shouldn't register as deep purple if you are using the ketones as a fuel source. And recently, a blood ketones meter has become available to track ketosis at home. This is a much more accurate way to track your individual ketone levels. See the sidebar on my ketosis page for more information.
- Find some way to track daily food intake and carb counts. Keep a spreadsheet, use one of the online food intake trackers, or simply write it down in a journal. Not only will journaling help you stay on track carb count wise, you'll want to have a record of the foods you are eating, how you felt and the changes you make so that if you go off track, you can look back and see what worked for you. This is a good place to track ketone levels as well. I've created a free printable food diary for you to use. The Atkins website also has some nice tools for tracking your progress on a ketogenic diet plan. And this database is an excellent resource for food information.
- Think about any social situations that will be encountered, and devise ways to handle those times when temptations to eat the "old" way will be high. You don't want to be blind sided when someone at the office brings in a box of your favorite chocolates and puts them right under your nose. Likewise, a beer with your friends usually turns into a date with potato skins and nachos. Think salad and steak instead.
- Even if you are starting a ketogenic diet plan for weight loss purposes, don't focus on your weight. Don't weigh yourself every day. Your weight can vary between 2-4 pounds each day because of changes in water intake and absorption. You won't be able to track any fat loss accurately on a daily basis, and the fluctuations will make you crazy if you focus on them. Instead, weigh yourself once a week, or keep track of your body measurements to track your progress. Better yet, focus on the health benefits and the long term health changes that come with eating a low carb diet. Knowing that you are greatly improving your health is a powerful reason to stay with a ketogenic diet plan, even if you don't lose any weight. I discuss in more depth the health benefits of a ketogenic diet in this article published in the July/August issue of the Well Being Journal.I recommend getting a health check up and a blood panel test done just before starting the diet, so that you can track the effect of the change in your eating habits on your cholesterol, blood pressure, and other health markers. Four to eight weeks later, you can get another blood test done and see if there are improvements.
- Learn how to stop sugar cravings. There are supplements and techniques that can help you overcome those nagging thoughts of dessert and get your blood sugar under control. As time passes, you'll find that ketosis is a powerful appetite suppressant, so it should get easier to abstain the longer you eat ketogenically.
Fallacies and Fears: Is a Ketogenic Diet Plan Dangerous?
The "dangers of low carb diets" are really just myths told by people who have a limited understanding of how low carb diets work.
The main criticisms include fears about fat intake and the process of ketosis.
- Fears about fat: Most people have trouble on a ketogenic diet plan because they are scared to increase the amount of fat they eat, especially saturated fat. The message that fat is bad has been pounded into the collective American consciousness for the last 30 years. It's hard to unlearn the message that fat makes you fat, and saturated fat especially is very bad for you. I understand that message has been repeated over and over, but it is a lie.
Here's the reality: A high carb diet drives up blood sugar and insulin levels. All that sugar and insulin are inflammatory. The standard American diet offers lots of foods that are high sugar AND high in saturated fat, and in studies, these two factors were lumped together. So although saturated fat is healthy, it got the blame for the inflammation that causes heart disease because it was studied in combination with a high carb diet. A ketogenic diet plan which is high in saturated fat and very low in carbohydrate will REDUCE inflammation. (Reference here.)
- Saturated fat is not harmful in the context of a low carb diet. This study from Johns Hopkins Medical School confirms this.The ketogenic diet plan is healthier because the higher saturated fat intake increases your HDL cholesterol, and at the same time, a lower carb intake decreases your triglycerides levels. These two factors are the major markers for heart disease, and the closer your triglyceride/HDL ratio is to 1, the healthier your heart. In reality, the cause of heart disease is a chronically high carbohydrate consumption, not a high saturated fat and cholesterol intake.I think the best way to learn this is to get a full blood test before you start a ketogenic diet plan, then do the diet faithfully for 3 months. Then have your blood work checked again. You'll see the difference and discover how much better you feel. (See my Healthy Eating Politics website for more information on the how the lie that "cholesterol and saturated fat cause heart disease" got started and gets repeated.
- Some people don't do well in ketosis. As I mentioned above, you should check with your physician if you have any concerns about starting a ketogenic diet plan with pre-existing health conditions, especially if those conditions involve kidney or heart problems. Although there is evidence that many people do well with reducing carb intake, I don't recommend going much lower than 10-20 carbs per day. The ketogenic is a very low carb diet, but it is not a zero carb diet. If you find (after at least a month on the diet) that you are one of the people who doesn't feel well at very low carb levels, adding enough carbohydrate in the form of sweet potatoes and other starchier vegetables back into your diet should bring you out of ketosis and resolve the issues. If you stay away from grains and rely on vegetables, a moderately higher carb content (60-100 grams/day) should result in health benefits. You won't be in ketosis of course, but still, you should feel better. (I think grain consumption is one of the root causes of illness, but also acknowledge that everyone is different.)
General Side Effects
Switching to a ketogenic diet plan can be uncomfortable at first because your body metabolism is refitting itself to burn fat instead of relying on glucose. However, you can avoid most of the symptoms. Here's a list of all of the common side effects that will happen the first week or so of starting a ketogenic diet. Knowing about them allows you to take steps to minimize them, and save yourself some carb withdrawal misery. Dr. Mike Eades has a great analogy for this process in this blog post. I highly recommend you read it.
I want to give special mention one of the side effects of carb withdrawal because it can really be scary if you don't know what it is. During the first week or so of cutting your carb intake, your blood sugar levels will fall, and you may experience a mild insulin overload and reactive hypoglycemia. This usually happens to people who are severely insulin resistant. It takes about 2-3 days to burn through all of your stored glycogen (carb energy stored in your muscles and liver), and after that you may get these low blood sugar symptoms of shakiness, dizziness, tremors, a pounding heart and more. (See the link above for more info). For those of you that have been living on a high carb diet for a long time, the effects may be even more pronounced, as your blood sugar and insulin levels are probably chronically high.
Benefits and Dangers
As mentioned above, the "dangers of low carb diets" are false beliefs and unsubstantiated fears communicated by people who have a limited understanding of how low carb diets work, or by people with financial or professional reasons to maintain support for the low fat, high carb message.
For instance, since the privately owned Academy of Nutrition and Dietetics (formerly the American Dietetics Association) receives great sums of money from processed food manufacturers, they can't just suddenly start saying that a high fat, low grain diet is healthiest - they would lose all their funding from companies like Kraft Foods, Hershey's and Coca-Cola. I know that sounds harsh, and now in 2016, they seem to be coming around to the low carb idea because they are backing off the dogma on the evils of saturated fat and cholesterol. It's a start.
The more likely result of a ketogenic diet plan, once you've adapted to it, is that you will feel much better and be much healthier. One of the long list of health benefits of a ketogenic diet is that it lowers your fasting blood sugar and insulin levels, helps reverse insulin resistant conditions such as type 2 diabetes, PCOS, fatty liver and Metabolic Syndrome, cools inflammation and in turn, leads to better overall health.
If you have any lingering concerns, please remember that there is plenty of solid research showing that following a ketogenic diet plan is not detrimental to human health.
It's only when you combine lots of fat and lots of carbohydrates in your diet that you get into trouble. The sugar from the carbohydrates drives up your insulin levels, and those high insulin levels cause the body to mishandle the way fats are metabolized. More fat is stored or circulates in the blood. This causes the metabolic syndrome and weight gain associated with insulin resistance and starts the health problems that should be associated with a high carb diet, not a ketogenic diet plan.
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