It’s 2019 and over the past couple of years the ketogenic (keto) diet has gained quite a bit of popularity…and criticism. I get asked quite a bit about my thoughts regarding “going keto” so I figured I’d write a blog post sharing my observations, some facts and my own opinions.
First and foremost: we are all UNIQUE individuals with a unique set of genetics, a unique set of circumstances with differing levels of stress. Some of us are very active and some of us are more sedentary. We have different bodies with differing levels of bodyfat and differing levels of muscle. We have different family histories and different risks of heart disease and diabetes and cancer. Some of us are insulin sensitive (a good thing) and some of us are more prone to insulin resistance (a bad thing) and some of us are somewhere in between. Some of us are men and some of us are women. The women are either pre-menopausal, peri-menopausal or post-menopausal. Some of us have really messed up hormones and some of us don’t (this can be both women and men).
Some basic understanding of how we use energy from food. Firstly, carbs, which are broken down into glucose after being eaten, are the “preferred” source of fuel for our brain function and our body as they are easily absorbed and digested and enter the blood stream for quick energy. The problem with this scenario is our current modern culture is drowning in carbohydrates, especially the unhealthy refined and highly processed carbs that spike blood sugar and easily turn into bodyfat. You see, our bodies can only store so many grams of carbohydrates (called glycogen in our muscles and liver) and anything above and beyond that gets stored as bodyfat. This is a protective mechanism as, prior to modern civilization, a little extra bodyfat might have been the difference between surviving a cold winter or starving to death. Of course, it’s now 2019 in North America and most of our kitchens are overflowing with food (or you are a quick trip away from fast-food or a convenience mart) so starving to death is not a concern. Think about carbohydrate storage in our body like a car’s gas tank. The gas tank can only hold so much gas and if you keep putting gas in the tank when it reaches full capacity it will start overflowing. In our modern society of cheap, processed carbs, our body’s “gas tank” is almost always full or overflowing and, unlike a car where the gas just spills all over, the extra “gas” (carbs) gets converted into bodyfat (blubber) and visceral fat (fat around the organs). Just look up a condition called “non-alcoholic fatty liver disease” (NAFLD). This disorder is increasing in number mostly due to our “gas tanks” overflowing. In addition, all this extra bodyfat puts people at risk for a host of chronic diseases: metabolic syndrome/type 2 diabetes, cardiovascular disease (heart attack, stroke, heart failure), hormonal disturbances, infertility, polycystic ovarian syndrome (PCOS), so on and so forth. It’s important to remember that we all have different sized gas tanks and we all “drive” differently. Most Americans either just let their car idle while keeping it connected to the gas hose (couch potato who snacks/eats all day). Others are V8 trucks with the pedal to the medal getting 10 mpg! They seem to burn gas faster than it can be filled (think of the guy/girl with a fast metabolism who also works out and is always on the move). There are many others who fall somewhere in between these two examples. Make sense??
Now that we’ve got this topic out of the way let’s talk about keto.
Keto is a physiological state your body goes into when it no longer has glucose (sugar/carbs) to use for energy so it starts burning ketones made by your liver from both dietary fats and your own body fat. Carb consumption is drastically reduced, usually under 50 grams/day and oftentimes under 30 grams/day, and fat intake is increased, often up to 75% of total calories. Protein is typically kept “low to moderate” (too much protein can actually be converted into “sugar” by a process called gluconeogenesis thus preventing ketosis). Ketosis is a normal physiological state in the absence of carbs. Our bodies evolved over time to go into ketosis during periods of food scarcity or when carbs were scarce since our brains require a constant flow of energy. Ketosis is an innate survival mechanism! So, in the absence of glucose, instead of our brains shutting down and dying our bodies have ketosis as a “backup” during times of food scarcity or fasting. So basically, during ketosis your “gas tank” (muscle glycogen) is kept very low and instead of running on gas (carbs) you convert bodyfat and dietary fat into ketones for energy. This process is not as efficient as burning glucose so it takes some time for your body to adapt to this process. Once you enter ketosis and teach your body to be a “fat burner”, your body will become increasingly efficient at using ketones and adapting to a ketogenic state. When transitioning from “normal” eating to keto most people suffer what’s known as keto “flu” as their body adjusts having less carbs (can cause withdrawal-like symptoms) and to the various metabolic changes taking place and “learning” to use another fuel source (our bodies really don’t have to learn to do this—it’s how we are made). It’s called “keto flu” for a reason—people feel sick, fatigued, achy, foggy-headed, have a headache, etc. The good thing is it’s only a temporary thing and usually wears off after only a few days, but some people give up on keto before the “flu” wears off. Keto “flu” can be minimized and even prevented if you take the right steps to transition into ketosis (I’m not going to get into this in this post but will link to a great resource at the bottom of the article).
So who’s a good candidate for keto?
In MY opinion, some of the best candidates for keto are those people who are significantly obese with evidence of metabolic dysregulation such as pre-diabetes, type 2 diabetes, PCOS and NAFLD and other “insulin-resistance” related disorders. These people tend to be rather sedentary and somewhat “addicted” to carbs. They oftentimes have low-energy, low-libido, depression, anxiety and the like. By transitioning to keto, they break the carb dependence, and all the side-effects of a high-carb, “gas-tank overflowing” lifestyle. There are people who have completely reversed their type 2 diabetes and other disorders, have lost pounds and pounds of bodyfat and improved their overall quality of life by “going keto”. People who are on medications and/or closely monitoring their blood sugar need to be very cognizant of this if they decide to try keto and keep their health care provider(s) in the loop.
Who else should try keto? Well, the keto-curious. Anyone can try keto. It won’t kill you. As I mentioned, our bodies are designed to go into ketosis and run on ketones in the absence of carbohydrates. Some people swear they feel the best ever while doing keto. Some of these people are already fit and healthy and following a healthy lifestyle. They “go keto” and find a new sense of mental clarity, energy and improved body composition and health. Some of these people stay in keto for years, some cycle in and out of it and others just do it once in a while, such as a “reset” type approach.
Who might NOT be a good candidate for keto (this is not necessarily an exhaustive list)?
- People who don’t feel good on keto. If you’ve followed all the right steps and transition into ketosis and try it out for several weeks but still don’t feel good then keto might not be for you. I’d say I fall into this category. Continuous keto doesn’t work well for me. I feel better with more healthy carbs in my diet. I do practice intermittent fasting/time-restricted eating so during the prolonged fasts I likely do dip into ketosis (once again, this is normal) and I tolerate it just fine. I can do a 24 hour fast without any problem, even following a day where I eat as many as 200 g of carbs. That’s because I’ve built the “metabolic machinery” to go back and forth between being a carb burner and a fat burner. In the Primal/Paleo/Keto world we call this “metabolic flexibility”. This is a good thing to have.
- Pre-menopausal women. Women have complicated hormones that can be thrown off balance very easily. Some of the hardcore keto enthusiasts may not agree with my opinion on this but, basically, women need to be careful with keto. There are many practitioners out there (I listen to lots of podcasts on these topics from some of the top functional medicine and integrative practitioners dealing with this stuff) and many of these people report significant hormonal issues in women who do keto for a prolonged time period (I don’t know exactly how to define the time period as it varies). Now, can some pre-menopausal women do well with keto? Absolutely. Especially some of the ones listed above with the metabolic derangement. Do these people have to do keto only to improve their health? Absolutely not. Simply changing from a Standard American Diet (SAD) full of processed carbs to a diet of little to no refined carbs and lots of veggies, plants and healthy proteins and fats will also provide healing and improvement in the metabolic disorders. Can keto provide an extra edge? Possibly. A temporary run of keto, like for a few weeks, can be a great strategy to “reset” the body and incorporate a healthy lifestyle.
- High output power athletes. Sprinters. Crossfitters. Laborers. Basically, people who have to generate short bouts of high intensity over a prolonged period of time might not do well on keto. These types of activities are glycolytic, meaning they need immediate “sugar”, in order to perform the activity at the highest level possible That being said, you will find many people doing these things who are in ketosis and report they perform just as fine, if not better, than they did before. Like I said at the beginning of the post, it’s all an individual thing.
- People already lean and healthy. If you are already lean, healthy and eating a whole foods diet then why mess with what’s working? The lower you reduce your carbs usually your appetite will be lower and your satiety will be higher so it is quite possible you might not eat ENOUGH calories while keto and end up losing weight (oftentimes muscle mass) you didn’t really need or want to lose. Once again, there are exceptions to all of these so this is not all inclusive for all people lean and healthy.
Now, there is a right and wrong way to do keto. Many people following a ketogenic diet put butter on their bacon and wash it down with heavy cream and call it “keto”, which, technically, is accurate. That’s all fine and dandy, but I think we can all agree this isn’t the healthiest way to eat. A much healthier option, in this example, is a 3-egg omelet packed with veggies and cheese and ½ an avocado. Keto? Yes. Healthy? Yes. Lunchtime might be a big salad with spinach, broccoli, cauliflower, nuts, cheese, extra-virgin olive oil and topped with steak. Avoid going through the drive-through at McDonald’s and ditching the bun off of the double cheeseburger and washing down the patties and cheese with a diet soda. Once again, both of these lunch options support ketosis but the first lunch option is obviously much healthier than the second option. Also, a big money maker right now are all these “Keto” supplements and snacks. Most of these are garbage and these companies are simply trying to capitalize on this keto craze. As with any dietary plan, focus on real foods including lots of plants, healthy animal products, some nuts and seeds and healthy sources of fat.
I could just keep writing and writing about this topic as there are so many questions and caveats surrounding the “keto diet”. I want to emphasize that keto is NOT the only way to improve health, shed bodyfat, reverse type 2 diabetes or cure autoimmune disease. Simply ditching the Standard American Diet and adopting a whole foods diet focusing on plants, healthy animal products, healthy fats, nuts/seeds and healthy sources of carbs (such as sweet potatoes and fruit) can and will improve all of these disorders. At best, keto can help provide a significant positive life change for some people, and at worst it can be possibly detrimental to health if done incorrectly or done by the wrong person or, for some, it’s done for too long. For most people, keto probably falls somewhere in between these 2 extremes. After adopting a healthy eating and lifestyle approach, such as a Primal or paleo lifestyle, keto can be used as an extremely effective TOOL. By building the “metabolic machinery” to switch from glucose to fat burning we have the ability to break our addiction to eating all of the time. We can live free of being “hangry” if we go more than a couple of hours in between meals. At times, such as after the holidays or a vacation when eating hasn’t been as good as usual, doing a keto “reset” for a few weeks can help get your body back on track and may have other potential health benefits as well. I am going to link up to one of the foremost experts in keto as his website is a slew of resources not only about keto, but on many health and wellness topics. His name is Mark Sisson and he’s the founder of the Primal movement—click here to read his keto-related posts: https://www.marksdailyapple.com/keto/
Thanks for reading! Please post any questions or comments you might have!