Keto. Ketosis. Ketogenic diet. I’m keto. He’s keto. She’s keto. Keto is healthy. Keto will kill you. Keto saved my life. Keto made me feel awful.
Keto. Love it? Hate it? Feel indifferent or unsure about it? Regardless of how you feel, keto is here to stay (in fact is always has been here, it just wasn’t as popular as it is now!)
Very brief explanation of nutritional ketosis:
Nutritional ketosis is a normal physiological state where the liver turns fat (dietary + body fat) into ketones as an energy source as opposed to the body running on glucose (“carbs”) for energy. Most people, especially in the US and other developed nations, are carb dependent for energy and do not have the “metabolic machinery” to comfortably go into ketosis for any length of time. In order to enter ketosis, carb intake has to be low enough for usually several days (especially for carb dependent keto newbies) and glycogen (stored “carbs” in the muscle) has to be low as well. Once the carb supply chain has been cut off the body can start turning fat (dietary and body fat) into ketones in the liver and use this as energy for the body. Ketones are a perfectly natural and safe alternative to using glucose (“carbs”) as fuel—our bodies are designed to do this as historically (like hundreds and thousands of years ago) we oftentimes went long periods of time without food. If humans were unable to burn fuel other than glucose we certainly would have become extinct during times of famine. Instead, our bodies are able to not only burn glucose, when available, but also able to burn ketones during times of low glucose/carb intake.
Intake of certain types of fats (such as medium chain triglycerides) can help induce ketosis and protein intake should be low to moderate (since protein can be turned into glucose via gluconeogenesis). That’s the simple definition and simple explanation of how to get into ketosis. The process of getting into ketosis and transitioning from a carb burner to a fat burner can be a bit “painful” for people and induce what’s known as “keto flu”. This is a short-lived thing, usually a couple days to a week or so, and then you start adapting to burning ketones for energy. Unfortunately, many people give up during this keto flu time period due to the brain fog, lack of energy and various ailments that, for some, feels like the “flu”.
Also, important to note, foods often get referred to as “keto” or not keto. No food is “keto”, but certain foods (such as low carb and high fat foods) can support ketosis. People are not keto. Rather, people can be in ketosis. Other people, such as myself, fluctuate in and out of ketosis. The majority of people in the US never reach ketosis due to eating foods high in simple carbs and constant grazing and snacking most of their waking hours from the time they get up until they go to bed. Their blood sugar levels and insulin levels are consistently elevated and glycogen stores are always full (or overflowing) so the chance of ever getting to the point of using fat as fuel is highly unlikely.
Achieving nutritional ketosis requires very few carbs, not too much protein and a high percentage of daily calories as fat (this will vary from person-to-person depending on several factors). Now, this can be achieved utilizing a very healthy strategy to an extremely unhealthy strategy. There are people in ketosis who put butter on their bacon and wash it down with cream. For lunch they order a double cheeseburger, throw the bun away and then wash it down with a diet soda. For dinner they grill 2 brats and fry up some pickles to go with it. Will this low-carb eating strategy support ketosis? Yes. But it is also highly inflammatory and void of nutrient dense foods and would not be an ideal way to do keto and will put you at higher risk for a host of health problems and maybe even an early death. It’s basically trading one bad diet for another. Can you lose weight and achieve positive body composition results from eating like this and getting into ketosis? Yes. But, for me, the end result is being healthy now and having a long, healthy life. Eating “dirty” keto is not the best method to achieve this. Part of the reason “diets”, such as the keto diet, get a bad rap is because of people pushing unhealthy versions, such as what I described above. In my mind, “dirty” keto and “clean” keto couldn’t be more different and it’s frustrating that it all gets lumped together under the same category in many circumstances, such as the news media or other people who don’t understand the many differences.
This is a good opportunity to introduce “clean” keto.
“Clean keto” is a healthy way of achieving nutritional ketosis. Honestly, it doesn’t look much different than my non-keto nutritional recommendations. The foundation of clean keto eating should still be plant-based, as healthy plant-based diets are crucial to both short and long-term health. Load up on non-starchy vegetables to provide your body with an array of vitamins, mineral and phytonutrients along with plenty of healthy fiber that will feed your gut the fuel it needs for optimal health. Most keto “experts” recommend counting “net carbs”, which is total carbs minus fiber. You see, fiber is essentially “indigestible” so doesn’t technically “count” towards total carb count. Plus, plenty of plant fiber is associated with a host of health benefits and many of the longest-lived populations of the world consume large amounts of plant-based fiber. A huge issue I have with “dirty” keto is the lack of fiber. If all you eat is fat and protein you will definitely be cutting it too short on fiber. Too little fiber robs your gut of the fuel it needs to maintain a healthy gut flora which, in turn, can have disastrous long-term health effects. Plants should make up the majority of your carbs, which might range anywhere from under 5% of your calories to as much as 20-30% (for active people who have metabolic flexibility). Small amounts of fruit from time-to-time might be ok, but stick to low glycemic fruits such as berries to minimize any increase in blood sugar which will work against ketosis.
Secondly, and vitally important, are adequate amounts and the right kinds of dietary fats. Fats are going to be your fuel while in the ketogenic state. A popular fat source for ketosis are medium chain triglycerides (MCT, MCT oil). MCTs are not absorbed by the body and are easily metabolized and converted into ketones, hence their popularity as part of inducing ketosis in a ketogenic diet. Commercial MCT oils are usually a combination of coconut and palm kernel oils. MCT oils are a saturated fat, and saturated fats carry quite a bit of controversy with them. For many years we have been told to avoid saturated fats due to poorly designed correlational studies implicating saturated fat with cardiovascular disease. In reality, small amounts (and in some people larger amounts) of saturated fat on a daily basis when consumed on a low carb/keto diet is likely unharmful and possibly even beneficial. Now, there is a caveat here. Some people, myself included, carry one or two copies of a gene called APOE4. This APOE4 gene negatively effects the body’s ability to metabolize saturated fats and excess saturated fats might predispose these individuals to developing cardiovascular disease and Alzheimer’s disease. Now, this is not completely understood and, like most things involving nutrition and the human body, there are likely multiple other factors that play a role in the development of chronic disease (such as being obese, sedentary, smoking, stress, lack of sleep, family history). If you are an APOE4 carrier then you will need to educate yourself about potential risks of saturated fat and then draw your own conclusions.
Another healthy fat source (for everybody) are your primarily monounsaturated fats, such as extra virgin olive oil, avocados and avocado oil and various nuts and seeds (these still contain some degree of saturated fat as well). I recommend generous consumption of extra virgin olive oil and avocados and avocado-based products. Another great source of healthy fat is fish. Stick with the low mercury and high omega 3 fish such as wild caught salmon, sardines, mackerel and anchovies. Avoid fish with high mercury content such as tuna, shark and swordfish (typically the larger and longer-lived fish have higher mercury content). These healthy fats are widely accepted and deemed healthy by many types of cultures and dietary plans from keto, to paleo, to primal, to Mediterranean diet, pescatarian and others. While eating keto, clean or dirty, fats will need to make up quite a substantial percentage of your overall calories, probably somewhere in the 70% range (once again, there is variation from person-to-person). You definitely want to avoid fats from unhealthy sources such as vegetable oil, canola oil, corn oil, trans fats (usually found in processed foods and fast foods) and limit fats from sources like peanuts as these are high in omega 6 fats which can be inflammatory. Many of these fats contain high amounts of PUFAs (poly-unsaturated fatty acids) which are very unstable and prone to oxidative damage.
The final macronutrient is protein. Protein is oftentimes thought of as, “if some is good, then more is better,” and this is definitely not the case, especially for ketosis. Too much protein can be converted (albeit not very efficiently) to glucose by a process called gluconeogenesis. As with all of these health topics, this concept is highly debated, but one thing commonly reported by people (myself included) who were having a hard time getting into ketosis (with very low carbs) were finally able to achieve ketosis after decreasing protein intake. Are there people who can eat higher amounts of protein and stay in ketosis? Sure. But many people have to decrease protein in order to dip into ketosis. What are good sources of protein? Responsibly and ethically sourced animal products are the #1 source as far as I’m concerned. Grass fed beef, free range eggs, healthy fish (as described above), wild game—these are all safe and excellent sources of protein. I recommend eating “nose to tail”, consuming organ meats, marrow and other often forgotten about and discarded animal parts as these carry with them all sorts of unique nutrients and health benefits. Avoid highly processed meats (bacon, lunch meat, cold cuts, salami) and irresponsibly sourced meats, such as your run of the mill grocery store red meat that likely came from a concentrated animal feeding operation (CAFO). These are subpar from a humane and nutritional perspective and contain various additives and hormones and who knows what else that will likely interfere with your health goals. Other sources of protein are nuts and seeds and dairy. Dairy needs to be grass fed and minimally processed and should be the full-fat version. There are many reported health benefits with dairy but I personally recommend limiting dairy intake due to its potential inflammatory properties. Some people might be better off avoiding dairy altogether depending one of several health conditions that can be aggravated by dairy products.
I hope you found this helpful whether you are pursuing ketosis or just trying to eat healthier. The only thing that really changes all that much when trying to achieve nutritional ketosis is your macronutrient ratios and your physiological state (either in ketosis or not in ketosis). Otherwise, try to consume the types of foods I mentioned above whether you are doing keto or not. As Mark Sisson (creator of The Primal Blueprint and The Keto Reset diet) has stated many times the goal isn’t necessarily keto, it’s training your body to be metabolically flexible. Metabolic flexibility means you can easily go in and out of ketosis and use fat as fuel or glucose as fuel. When you are metabolically flexible and consuming foods that nourish your body everything else will fall into place. Your hormone levels will regulate, your appetite will regulate and your body composition will improve. Our body knows what to do, we just need to provide the tools for it to be healthy. This includes not only a nutrient dense, whole food diet, but also adequate sleep, stress management, sunlight, movement and healthy social interactions, to name a few. Just think of clean keto as a tool to use to help you on your path to optimal health.
Thanks for reading!