Q&A Wednesday

The ketogenic diet is quickly starting to be the new Paleo taking over the world for everyone who loves bacon and butter. I get a lot of questions around the ketogenic diet, what I think about it, and if I would advise anyone to go on it. That's a lot, so brace yourself for today's answers :-).

First of all, let me start off with saying that I am always excited when new diet trends emerge. We have been on a low-fat craze for too long, and I am beyond excited that the ketogenic diet is finally making fat cool again: butter, avocado, nuts, fatty meats. All of it is "allowed". Fat is vital for our body to function properly. It is a pre-cursor for our hormones (stress hormones, sex hormones, etc), it makes our skin smooth, our hair long, our nails strong, it gives protection around our organs so they don't break when we bump into someone, and fat is also responsible for cleaning up our arteries of build up and junk. That's a lot of work for one little food group. For too many years we have been afraid of fat because it has more calories than carbs or protein. However, if the low-fat era has showed us anything, it is that we are getting fatter, sicker, less fertile, and more stressed. Clearly cutting out fat was not the way to go.

What is a ketogenic diet?

The ketogenic diet is a diet primarily focused on fat. Around 70% of your daily calories will come from fat, 25% from protein, and only 5% or less (around 30g or less a day) come from carbohydrates. The ketogenic diet isn't actually new, it has been around since the early 1900s when is was used to treat children with epilepsy. To this day the ketogenic diet can keep children seizure free when anticonvulsant drugs are not effective.

As this diet continued to be studied, other positive side effects were improved alertness and better sleep. Many people who do go on the ketogenic diet report that they feel high, and like they can get a million things done in a day.

What actually happens to your body in ketosis?

Going on the ketogenic diet means that you are trying to get your body into ketosis, a fat burning state. You are basically simulating what fasting would do to a body without the need to actually stop eating. Sounds like a dream, right?

As you enter the ketogenic diet, you cut out the majority of your carbohydrate intake. A very important note is that your body can never live completely without carbohydrates, so even on the ketogenic diet you will still get a few calories from carbs (around 5% of your daily intake). Your red blood cells and liver cells need carbohydrates to function. I want to stress this, because a lot of people think carbohydrates are just evil. They are not :-)

Over the course of the next 2-7 days your body will use up all your carbohydrate storage in your body (called glycogen), specifically in your muscles. As carbohydrates break down into sugar and are your primary energy source for your body to run, think, breathe, really do anything, your body now needs to find a new energy source. It starts to take both protein and fats to make more energy. Protein comes directly from your muscles, so yes, you will start to break down your muscles to keep you fueled and alive. In the ketogenic diet this is kept to a minimum by still consuming 15-25% of your calories from protein. What we are aiming for with the ketogenic diet is to break down fat, specifically excess body fat. Your body will start to take fat from storage (for example from your hips), and bring this to the liver. Your liver will break down the fat into so called ketones: β-hydroxybutyrate, acetoacetate and acetone. These are then used by your body, for example your brain, your heart, and your muscles to create energy and keep you alive. Acetone is the reason your breath will start to smell like nail polish after a few days of being on the ketogenic diet. This will fade as your body adapts to using the ketones for energy. You will feel like you need to urinate a lot more, because ketones act as a diuretic. This means you will need to drastically increase your water intake on this diet - a reason that I truly believe most people have such good mental clarity.

What are you actually eating on the ketogenic diet?

As you can probably tell by now, you are limiting and restricting a lot of foods. Anything that has carbs - anything sweet, even salad dressings, sauces, marinades, etc is completely off limits. All fruit except for a cup of berries is not allowed, and most vegetables are limited. No root vegetables such as potatoes, beets or carrots can be eaten. You are mainly eating meats, seafood, eggs, plain dairy, oils, avocado, nuts and seeds with some leafy and mainly green vegetables.

Should you try the ketogenic diet?

First of all, I will never tell anyone to "go on a diet". I don't believe in going on a diet, because that means you will inevitably come off it, too. And the "off-season" is usually when we do the most damage to our body. There are definitely benefits to being in ketosis for a limited amount of time in order to reset your body’s response to sugar, also called insulin resistance. This is getting more prevalent in our society of constant snacking and fueling our bodies every few hours, even with healthy smoothies and snacks. Our blood sugar is on a constant rollercoaster all day, and our body gets tired from needing to regulate our blood sugar so often with the help of insulin. However, eating balanced meals, and keeping 12 hours of eating with 12 hours of fasting overnight will also help to reset insulin levels.

Of course you can absolutely burn more fat while on this diet, however I never suggest to go on a diet purely for the reason of more fat burning. Most people will want “cheat days” to binge on whatever carbs they want, crave, and miss, which fosters an unhealthy relationship with food perhaps leading to eating disorders such as binge eating, anorexia or bulimia.

While the state of ketosis gives us more mental clarity and less brain fog, we are putting our body in an artificial state of stress. Having abundant ketones in our body means that we are constantly in an acidic state. Our body tries extremely hard to keep our acid levels to a minimum. In order to do this, our body takes minerals, for example calcium from the bones, to buffer any excess acid. What does this mean? You start to get more brittle bones when in ketosis for an extended period of time.

When we cut out any food group, we are immediately putting our body in danger of being nutrient deficient - I mean a lack of minerals and vitamins. Carbohydrates, fats, and proteins are in our food for a reason. Each carries different minerals and vitamins that we need in order to survive. While a lack of nutrients for a few days won’t make us feel bad right away, a lack of certain nutrients longterm will make us feel exhausted, give us skin break outs, maybe we have brittle hair and nails, and we just feel anxious all the time. Especially carbohydrates carry essential B-vitamins that are hard go get from certain animal based foods. This is already a problem in the paleo lifestyle, and an even bigger issue with the ketogenic diet. Anytime we restrict foods so drastically, we cut out nutrients. We are supposed to eat the rainbow for exactly this reason - to get all the nutrient we need. As you can see above, eating in a ketogenic way cuts out pretty much all colorful produce.

On top of that, we are putting our body in a state of constipation and sluggish digestion. Carbohydrates - especially whole grains, fruit, and vegetables - are a source of fiber, which we need for our digestion to flow smoothly. When we take away fiber, we are taking away our body’s ability to naturally eliminate toxins and things it just doesn’t need. Lastly, I do want to mention that eating a lot of fat in every meal can make you feel extremely nauseous, perhaps even make you vomit. And honestly, who can sustain a diet that is so restricted, meaning you can pretty much only eat at home with your own food prep? That’s a killer for your social life!

Who is the ketogenic diet not for?

The ketogenic diet is definitely not for you if you have suffered from any kind of disordered eating, whether that is emotional eating, binge eating, anorexia, or bulimia or any other unhealthy relationship with food. There are also certain genetic mutations that just don’t do well with so much fat in their diet, where the ketogenic diet can be harmful. If you have kidney problems or often suffer from kidney stones, the ketogenic diet is also not for you. If you do high intensity exercise such as biking, running marathons or HIIT, then you need glycogen (carbs) to fuel your muscles, so eating completely ketogenic is also not for you. And lastly, I want to mention that this is not a diet for stressed out mamas. When you are already living on a state of stress with so many stress hormones floating in your body, you do not need to add more stress to your body by stressing out about the foods you eat.

Some more thoughts...

I like that the diet highlights our issues with insulin resistance, and the problems of the low-fat era. I do, however, believe that we can get the same benefits from the ketogenic diet by eating more balanced on our plate and in our days. I am never a fan of cutting out whole food groups for an extended period of time. Occasionally going into ketosis can have its benefits when done properly with a lot of preparation and the help of a nutritionist. If you are interested to learn more about the ketogenic diet, send me a love note.

Next week I will answer all questions around intermittent fasting, which goes hand in hand with the ketogenic diet. Until then, have a great week!