The ketogenic diet embraces healthy fats and asks you to kick carbs, sugar, and even some protein to the curb. It has proven to be successful in very overweight patients, but what does the research say about long-term potential, especially if you are not obese?
If you are an avid D2D reader, you know by now that our team is not a fan of crash diets, extreme weight loss programs, or the elimination of whole food groups. But, when a reader approached us with his success on the ketogenic program, we took pause. Like D2D, a ketogenic diet values the importance of healthy fat! (You may recall: Fat is our Friend). And since the ketogenic diet is less about crash dieting and more about achieving the state of ketosis, we were intrigued…
The ketogenic diet was first introduced in the 1920s to help treat epilepsy in children after several studies indicated that the ketone chemical could help to reduce seizures. However, it wasn’t until much later that it was developed into a weight loss program for adults. In 2012, Dr. Gianfranco Cappello, an associate professor of surgery at the Sapienza University in Rome, Italy, researched the effect ketosis could have on weight loss. He found that ketosis could help overweight patients with both fast and significant weight loss (with very few side effects) when they were given a healthy, full-fat diet. His research, which included 19,000 participants, was particularly effective in very overweight or obese patients and demonstrated successful one-year weight management in ‘long term’ participants.
So, we wondered if a ketogenic diet is healthy for those just trying to maintain a well-balanced lifestyle? And is there any research that supports following this program over a long period of time?
“Being in a state of ketosis forces a physiological shift from a sugar-based metabolism to a fatty acid and ketone-based metabolism. Nutritional ketosis suppresses insulin and forces a ‘fat adaptive state.’” (Keto Clarity)
Ketosis: using fat for energy
This diet program focuses on what fuel source the body uses for energy. The true purpose of the ketogenic diet is to enter a state called ketosis. Ketosis occurs when your body has successfully switched from using glucose for energy to using fat for energy. It takes at least three days to enter into ketosis. When you have entered ketosis and your body is burning your fat for fuel, ketone bodies, “ketones,” are created and used for energy. A ketone is a chemical that is inevitably turned into energy by the mitochondria in your cells.
There are three different types of ketone bodies, acetoacetate, beta-hydroxybutyric acid, and acetone. They vary in structure and can perform different roles within your body. Acetoacetate and beta-hydroxybutyrate, for example, take the energy from your liver and transport it to different organs in your body. Acetone is the least used ketone and will be eliminated quickly if it is not used. If you are practicing a ketogenic diet, you can test your urine to see if ketone bodies are being released. This is called “ketonuria.”
(Image source: Perfect Keto)
Entering a state of ketosis has been studied for its ability to possibly improve both mental and physical performance. In addition to the reduction of seizures, the ketogenic diet has also been associated with restful sleep, stabilized blood sugar levels, decreased inflammation, and increased HDL (“good”) cholesterol— however, many of these claims remain unproven.
Your body is programmed to use glucose for energy
ATP (adenosine triphosphate) is a high-energy molecule that is considered the “energy currency of life.” This energy molecule is created by glucose, fats, and proteins. Through evolution, your body is programmed to fuel itself on glucose. The benefits of glucose are twofold: it doesn’t require digestion and it yields 45-50% more energy than a ketone body.
Fat, on the other hand, takes energy to digest and does not produce as much energy for your body to use. So why switch? The purpose of this is, of course, to burn up fat stores.
In ketosis, fat is being burned for energy— but your brain cannot fuel itself on fat directly. So, the liver processes the fat and creates ketone bodies which are able to fuel your brain when glucose is not available. The rest of your body, like your muscles, can utilize the full fat for fuel.
(Source: Diet Doctor)
When the glucose from your diet is metabolized in the cell, it releases ATP that provides energy to the body. If you are consuming more glucose than is needed for energy, the excess glucose is stored in the liver as glycogen. When energy is needed glycogen is used first as a glucose source. However, for longer energy supply needs (especially in the brain) if the glycogen stored in your liver is depleted your body starts to convert fat to energy, which that can result in weight loss. This is the premise of the ketogenic diet.
Low-Carbohydrate, Moderate Protein, High Fat
At its core, the ketogenic diet pushes your body to switch from burning glucose as its primary energy source to burning fat. This is done by strictly limiting the amount of carbohydrates, sugar, and even protein you are allowed to eat during the day.
If you are thinking that this sounds similar to the Atkins Diet or High Fat Low Carb (HFLC) diet— you are correct! The keto approach is similar to these more mainstream programs; however, the ketogenic diet goes even further by limiting protein intake as well.
As a rule of thumb, a proper ketogenic diet should contain roughly 70% healthy fats, 20% protein, and 10% carbs. There is no strict limitation on the number of calories you can consume per day on this program. However, based on this percentage breakdown, most ketosis followers will actually consume less than on a traditional diet because of the satiety they experience when consuming higher volumes of fat. Unlike carbohydrates, fat takes longer for your body to digest and will keep you feeling full.
The ketogenic diet: 70% healthy fats, 20% protein, and 10% carbs
According to the ketogenic method, reducing protein intake (in addition to restricting carbohydrates and sugar) further forces your body into a state of starvation and enables it to utilize fat as fuel. The human body considers its fat stores to be a “last resort” in terms of fuel— glucose is its preferred fuel, with protein falling in second place. Because of this, if you are consuming normal levels of protein, it will use the protein as fuel as opposed to your fat stores. A Keto-approved meal indicates that roughly 3-6 ounces of meat per meal is acceptable.
On the Ketogenic Diet, your protein serving size should be the size on your old iPhone!
Carbohydrates, on the other hand, should barely touch your plate! On average, ketogenic dieters consume between 20-50 grams of carbohydrates per day. The maximum amount of carbohydrates allowed per day on this program is 100 grams, however, most followers have reported that they reach optimum ketosis when they maintain their carbs in the 20-50g range.
Blood Sugar = 100
Innately, your body is programmed to have a blood sugar level of 100. When you hear of a drastically dropping or spiking blood sugar level, that means it is varying from the baseline of 100. To put this into perspective, a normal blood sugar level of 100 is equal to 2 teaspoons (or 8 grams) of sugar in your blood! In order to stabilize your blood sugar levels, your body secretes insulin.
Insulin is a hormone that acts as a key for your cell. It attaches to the cell wall and allows glucose to enter in order to provide energy. Insulin works to lower your blood sugar levels by converting sugar to fat.
Regulating your insulin levels is one of the key components to the ketogenic diet as you are effectively eliminating sugar, including naturally occurring sugar from fruit. By preventing major spikes in your blood sugar levels, ketosis helps to stabilize your appetite and your body cravings. Low insulin levels can also help with weight management.
Be warned, however, when you enter into a ketogenic program, you might experience the “ketogenic flu.” Due to the absence of carbohydrates and sugar in your diet, your body goes into a state of shock. In the beginning, the lack of glucose will make you feel sick, sluggish, and dizzy. Not to mention you are also losing a lot of water very quickly because every gram of glycogen (aka the storage of excess glucose) contains 2.7 grams of water! In order to fight these symptoms, you must be diligent about drinking water and replenishing electrolytes!
Ketogenics is redefining the food pyramid and telling you to embrace the fat!
While there are promising studies on ketosis and your body’s use of ketones, the body of research that exists today is inconclusive. Unfortunately, there is a lack of depth in the research that makes many positive claims for the benefits of ketosis. As we discussed in When is Science Truly Science, in order for a scientific study to be credible it must meet a host of qualifications. For example: Has it been peer-reviewed?Has it been replicated? Was it performed by scientists who are unbiased?
And while some of the important criteria may have been met, there has not been enough replicated research to make any claims definitively. Additionally, this program and its research are in its infancy as it was only first introduced as a weight loss program in 2012.
One particularly noteworthy growing body of research is the link between cancer and a state of ketosis.
There are a few dynamic areas, however, that require further exploration. One particularly noteworthy growing body of research is the link between cancer and a state of ketosis. Science has proven that cancer cells hate fat and love sugar.
When a cancer cell needs to feed itself it turns directly to glucose. So, by effectively eliminating the sources of glucose in your diet, the cancer cell would starve. Is that to say that keeping a ketogenic diet will make you cancer-immune— no! But, there is a need for more research in this space.
Additionally, there have been a few stand-alone studies that discuss the ability for ketones to demonstrate disease-fighting abilities, specifically neurologically. For these reasons, the ketogenic diet has also been positively linked to reducing some of the symptoms of Parkinson’s and Alzheimer’s diseases. And while maintaining a state of ketosis is by no means a cure for neurological diseases, it is an exciting avenue to be explored.
It is also important to note that organizations like the Mayo Clinic, the American Heart Association, and the American Medical Association believe that a state of ketosis is considered “abnormal” because you are essentially forcing your body into starvation mode in order to utilize stored fat. This side of the argument believes that your body was designed to use glucose as fuel and starving yourself to the point where you are forced to use “last ditch” energy reserves is unnatural and may put excess stress on your body.
The ketogenic diet can be very harmful to people with diabetes. Unlike people without diabetes—who have insulin to help prevent the build-up of ketone bodies in your blood— diabetics are at risk for ketone build up which can result in ketoacidosis.
After reading a significant amount of literature on the subject, one thing is clear: a ketogenic diet is not for the faint of heart. 20-50 grams of carbs a day is next to impossible. For reference: there are 20 grams of carbs in an apple! Remember, carbs are not just in foods like rice, pizza, and pasta, they are in vegetables and fruits as well! A D2D member even tried going “low carb high fat” for her wedding, keeping it to 90 grams of carbs a day and voiced how incredibly challenging it was.
So, we had to speak with keto followers that transitioned into this eating program and were happy about it. The recounts were astonishing. Almost unanimously, we were told “once you change your mindset about carbohydrates you will feel great.” However, we also learned that the ketogenic diet also calls for moderate exercise. If you increase your heart rate too much, your body will require more food and it will be harder to maintain a state of ketosis.
We then turned to personal trainer and ketogenic follower Chris Clarke of Tiger Fit. He indicated that he follows “keto cycling” where he incorporates carbohydrates on the days he is doing high-intensity training. Therefore, if you are intrigued by the nature of this program and you are highly active, there are ways to build ketogenics into your life.
However, ketogenics still controversial with supporters and opponents in part because its long term implications haven’t been studied. So, if you do decide to go on such a strict regime, it is best to consult with your doctor first to make sure it is the right choice for you given your weight, your genetics, and your lifestyle.
The Bottom Line:
The research into the ketogenic diet is promising but remains inconclusive at this time. Healthy fat is certainly not something to be afraid of, but it is extremely difficult to consume only 5-10% of your diet in carbohydrates— and may not be the safest thing for your body over long periods of time. At D2D, we still believe that a nutrient-dense and well-balanced diet, along with exercise, hydration, and plenty of sleep is the long term winner.