Ketogenic Diet Plan
The goal of a low carb, ketogenic diet plan is to improve health through switching the metabolism to burn fat instead of sugar or glucose. This is achieved through a metabolic state called ketosis. Ketosis is simply a normal metabolic process in which the body cells burn molecules called ketones to make energy, instead of relying on sugar or carbohydrate.
Ketosis is a beneficial process which the human body has developed as an adaptation to times when food is unavailable. Ketone bodies have been shown to improve disease conditions and protect the body and are now being used to treat medical conditions such as diabetes, epilepsy, autism, Alzheimer's, cancer and others.
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, remember too that most classically trained doctors don't understand the effect of foods on the body, much less ketogenic diets, so if you ask your physician, you may get push back, and a terrifying "danger of ketosis" sermon.
Just remember the doctor is confusing nutritional ketosis with a more dangerous condition called ketoacidosis. These are two different conditions. Ketoacidosis is a concern for Type 1 diabetics and others whose bodies are unable to make or process insulin correctly.
Also, if you are using the diet to manage a cancer condition, 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..
The Basic Concepts
There are many low carbohydrate, ketogenic diet plans from which to choose. (The Atkins diet is just the most famous). They all involve following a higher fat, moderate protein, low carb food plan.
The main difference between a regular low carb diet plan and a ketogenic diet plan is 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 keeping carbohydrate intake between 20-60 grams per day. The daily protein requirement will be moderate, and depends on height, gender and how much exercise is done. The balance of calories will be from fats. These ratios ensure that most people go into ketosis and stay there, which is the main objective of the ketogenic diet.
- 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. Since a ketogenic diet reduces hunger, calorie counting is optional. However it's important to understand how macronutrient percentages can be affected by caloric intake, so you may want to read the calorie counting page to clarify your thoughts on this subject.
The key to understanding a ketogenic diet plan is to remember that one is swapping out the carbs in the diet with a higher fat and a moderate protein intake.
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 large quantities are consumed. If you overeat protein (more than 1.5-2.0 grams/kg lean body mass), it can drive up your blood insulin levels temporarily. High insulin levels can put the brakes on the body's ability to release and burn the fatty acids which provide the substrate for ketosis. This affects some people more than others, however. It most likely depends on how insulin resistant you are and how much you exercise.
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". It 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 is not easy at first. Here's a list of all of the common side effects that will happen the first week or so of starting a ketogenic diet. If you know about them, you can take steps to minimize them, and save yourself some carb withdrawal misery.
That withdrawal period and side effects are associated with the time it takes for your body to refit itself to burn mostly fat instead of sugar. New enzymes have to be created.
Dr. Mike Eades has a great analogy for this process in this blog post. He writes:
"When you’ve been on the standard American high-carb diet, you’re loaded with enzymes ready to convert those carbs to energy. You’ve got some enzymes laying in the weeds waiting to deal with the fat, but mainly dealing with it by storing it, not necessarily burning it. All the pathways to deal with carbs and their resultant blood glucose are well-oiled and operating smoothly.
Then you start a low-carb diet. Suddenly, you’ve idled most of the enzyme force you have built to process the carbs in your diet while at the same time you don’t have a ready supply of the enzymes in the quantities needed to deal with your new diet.
It would be like a Ford automobile factory changing in one day into a plant that made iPads. All the autoworkers would show up and be clueless as how to make an iPad. It would take a while – not to mention a lot of chaos – to get rid of the autoworkers and replace them with iPad workers. In a way, that’s kind of what’s happening during the low-carb adaptation period.
Over the first few days to few weeks of low-carb adaptation, your body is laying off the carbohydrate worker enzymes and building new fat worker enzymes. Once the workforce in your body is changed out, you start functioning properly on your new low-carb, higher-fat diet. The carbs you used to burn for energy are now replaced to a great extent by ketones..."
In addition, during the first week or so, your blood sugar will drop, and you may experience insulin overload and reactive hypoglycemia once you burn through all of your stored glycogen (carb energy stored in your muscles and liver). 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.
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 the latest scientific studies (visit the Nutrition and Metabolism Society) have shown that following a ketogenic diet plan is not detrimental to human health, if it is eaten while also minimizing carbohydrate intake.
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 any fat you eat to be stored immediately. This causes the 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.
Last tip: You may be able to find a doctor who has actually read the latest studies on ketogenic diets, understands how to manage a ketogenic diet plan, and who practices in your area by checking this resource.
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