How to start a Keto Diet

The Ketogenic Diet (Part 1) 

For decades we’ve been told that fat is detrimental to consume and negatively impacts our health. We now know this message may have actually done more harm than good. The ketogenic diet is literally the opposite of a low-fat diet. It’s described as a high-fat diet, and is currently trending in the nutrition world. The word “keto” was the most Googled food-related term in 2020.  Let’s explore what the ketogenic diet is, its safety, and how to start the ketogenic diet healthfully. 

What is a Keto Diet? 

The ketogenic diet has origins dating back to 500 BC, but came to popularity in the modern medical community starting in the 1920’s as an incredibly effective treatment of epilepsy in children. The ketogenic diet is a low-carb, high-fat diet, but differs from regular low-carb dieting (Atkins, Southbeach, etc) as its purpose is to switch the body into a state of burning fatty acids for fuel (ketones) instead of carbohydrates (glucose). This process is called ketogenesis. Once in the natural metabolic state of ketosis, ketones are present in the blood and your body becomes increasingly capable of using them for energy. You get into ketosis by following a ketogenic diet, fasting, intense exercise, but it also happens naturally during pregnancy, infancy and starvation [1,2,3]. 

The Safety  of a Keto Diet

Unfortunately there is a lot of misleading information on the internet in regards to the safety of the ketogenic diet. For the majority of people, the ketogenic diet is perfectly safe and provides incredible health benefits including weight loss, blood sugar/insulin regulation, and decreased inflammation as discussed below [4,5,6,7,8,9]. More complicated cases, such as patients with diabetes, high blood pressure, liver/kidney/heart disease, or women who are pregnant, may require medical supervision when starting the ketogenic diet. Very rarely should the ketogenic diet be strictly avoided, including those that are breastfeeding and individuals with rare metabolic conditions or enzyme deficiencies that inhibit the production of ketones or digestion of fat [10]. 

Benefits of a Keto Diet

• Weight loss: Several studies have shown that the ketogenic diet consistently outperforms other diets when it comes to weight loss. One study suggested that those on keto lost 2.2 times more weight than those on a low-calorie, low-fat diet [11]. Another study in 2007 compared low-carb to the recommended dietary guidelines in the UK, and those on low-carb lost 3 times as much weight [12]. A PLoS One 2015 and a study in the British Journal of Nutrition in 2016 both indicate low-carb diets outperform low-fat diets in weight loss [13,14].

There are several reasons why the ketogenic diet outperforms other diets in the weight loss category. The first reason is that it improves appetite regulation. Most people find that they aren’t as hungry, which is due to ketosis suppressing appetite. Typically, hunger and cravings are an issue when someone embarks on a weight loss diet, so having less hunger initially can help patients experience longevity in their new way of eating. This decrease in hunger may be due to a decrease in the hormone ghrelin, the “hunger hormone.” The decrease in hunger may also come from switching from low-nutrient dense foods (breads, pasta, etc) to nutrient dense proteins and fats, which we know nourish and satiate the body. Several studies have indicated that being in ketosis may also increase the amount of fat burned during your daily life. Those in ketosis burn approximately 300 extra calories every day; mice studies have suggested that this is from increased thermogenesis [15,16].

• Metabolic Syndrome: As we know, metabolic syndrome encompasses several conditions including obesity, high blood sugar, high blood pressure, dyslipidemia, low HDL, and high TG. The following table highlights the studies that show a statistical advantage in improvement in multiple categories [17].

• Diabetes Type II: In a recent survey titled, Prevalence of Optimal Metabolic Health in American Adults, it was found that “Less than one-third of normal weight adults were metabolically healthy and the prevalence decreased to 8.0% and 0.5% in overweight and obese individuals, respectively.”  Nutritional ketosis can greatly decrease blood sugar, improve insulin sensitivity, and reduce inflammation [18,19,20,21] . The ketogenic diet is so effective at reducing blood sugar, oftentimes people have to rapidly reduce blood glucose lowering medications [22].  In this study, blood glucose levels decreased 16.6% using the ketogenic diet [23]. Not only do blood sugar and A1C improve, but insulin sensitivity is also significantly impacted with a ketogenic diet. In a study conducted in 2005, researchers found that insulin sensitivity improved by approximately 75% after just a 2 week period on a high-fat ketogenic diet. When treating type II diabetes, the ketogenic diet aided patients in four ways: 1) maintenance of a caloric deficit (which increases insulin sensitivity, lowers blood sugar, and HbA1C), 2) weight loss (which in turn reduces inflammation), 3) blood sugar regulation (by reducing carbs), and 4) encouragement of ketone usage (which impact insulin resistance through multiple mechanisms)[24].
• Several Others: As noted above, the ketogenic diet greatly improves insulin sensitivity, which is a major factor in most chronic diseases and conditions. With the improvement of insulin sensitivity, reduction of inflammation, and ketone metabolism, you can use the ketogenic diet in treatment for a variety of conditions including non-alcoholic fatty liver disease, PCOS, migraines, Alzheimer’s, Parkinson’s, Multiple Sclerosis, Reflux/Heartburn, and even type I diabetes [25,26, 27,28,29,30,31,32,33] . 

How to Successfully Start a Keto Diet

The first key to starting the ketogenic diet is coming to the conclusion that your health really matters! Without discipline and consistency, any diet or lifestyle change is futile. Here are the next steps to take to ensure you’re setting yourself up for success: 

• Clean up your environment: Get the junk food out of your house. As the saying goes, “Out of sight, out of mind.” Go through your pantry, refrigerator, freezer, etc. and remove foods that are high carb, contain many ingredients, and aren’t whole food based. 
• Purchase mostly whole foods:  These are the foods that don’t need nutrition labels. Pick a variety of proteins (chicken, beef, fatty fish, eggs, full-fat dairy, nuts/seeds), and non-starchy vegetables (broccoli, cauliflower, tomatoes, carrots, leafy greens, bell peppers, celery, cucumbers, etc). As well as cooking oils, like olive, coconut, and avocado. 
• Learn to read labels: You need to understand what’s in the foods you’re eating. To stay in ketosis it’s really important to cut sugar in all forms. Sugar can go by many names – high fructose corn syrup, maple syrup, agave nectar, corn sweetener, dextrose, fructose, glucose, fruit juice concentrates, malt syrup, barley malt, rice syrup, carob syrup, etc. Look for products with very small ingredient lists and < 10 g net carbohydrates. 
• Find keto versions of your favorite foods: Following the ketogenic diet doesn’t mean you’ll have to give up your favorite foods – it just means you’ll need to find some keto alternatives! There are thousands of keto alternatives replacement recipes online. 
• Calculate your macronutrients and start using a tracker: I will be diving into this step much more in the next blog post. Figuring out your individual macronutrient goals is an easy process, and tracking can help you learn how many carbohydrates are in each food. Tracking doesn’t have to be done for a lifetime, but can be super helpful in the beginning to give you a better understanding of what is in each food. 

I hope that this article gives you a better understanding of the ketogenic diet and its many benefits to health. Stay tuned for more information on following the ketogenic diet successfully, troubleshooting side effects, and staying on track long-term. As always, before making any diet change it’s very important that you work with a medical professional, especially if you have a pre-existing medical condition. 

References

1. Paterson P, Sheath J, Taft P, Wood C. Maternal and foetal ketone concentrations in plasma and urine. Lancet. 1967;1(7495):862–865. doi:10.1016/S0140-6736(67)91426-2
2. Felig P, Lynch V. Starvation in Human Pregnancy: Hypoglycemia, Hypoinsulinemia, and Hyperketonemia. Science. 1970;170(3961):990-992. https://science.sciencemag.org/content/170/3961/990.long.
3. Metzger BE. “Accelerated starvation” and the skipped breakfast in late normal pregnancy. The Lancet. 1982;319(8272):588-592. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(82)91750-0/fulltext#articleInformation.
4. PLoS One 2015: Dietary intervention for overweight and obese adults: Comparison of low-carbohydrate and low-fat diets. A meta-analysis
5. The British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials
6. Nutrients 2020: Impact of a ketogenic diet on metabolic parameters in patients with obesity or overweight and with or without type 2 diabetes: A meta-analysis of randomized controlled trials
7. Diabetes Research and Clinical Practice 2018: Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis
8. Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer’s Disease
9. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease
10. Franziska Spritzler, R. (2021, June 20). What Is Ketosis, What Are the Benefits, and Is It Safe? Retrieved from https://www.dietdoctor.com/low-carb/ketosis#side-effects
11. Bonnie J. Brehm, Randy J. Seeley, Stephen R. Daniels, David A. D’Alessio, A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 4, 1 April 2003, Pages 1617–1623, https://doi.org/10.1210/jc.2002-021480
12. DR;, D. P. (n.d.). A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Retrieved from https://pubmed.ncbi.nlm.nih.gov/17971178/
13. PLoS One 2015: Dietary intervention for overweight and obese adults: Comparison of low-carbohydrate and low-fat diets. A meta-analysis
14. The British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and
15. Obesity Review 2015: Do ketogenic diets really suppress appetite? A systematic review and meta-analysis
16. Gao, Z., Yin, J., Zhang, J., Ward, R. E., Martin, R. J., Lefevre, M., . . . Ye, J. (2009, July 01). Butyrate Improves Insulin Sensitivity and Increases Energy Expenditure in Mice. Retrieved from https://diabetes.diabetesjournals.org/content/58/7/1509
17. Dr. Andreas Eenfeldt, M., & Dr. Bret Scher, M. (2021, June 17). The science of low carb and keto – Diet Doctor. Retrieved from https://www.dietdoctor.com/low-carb/science#weightloss
18. McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, Glon RM, McCarter JP, Volek JS, Phinney SD. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes 2017;2(1):e5. DOI: 10.2196/diabetes.6981
19. Dashti HM, Mathew TC, Khadada M, Al-Mousawi M, Talib H, Asfar SK, et al. Beneficial effects of ketogenic diet in obese diabetic subjects. Mol Cell Biochem. 2007; 302:249–56
20. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005 Mar 15;142(6):403–11
21. Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, Kraemer WJ, Bibus DM, Fernandez ML, Feinman RD. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2009; 44:297-309. doi: 10.1007/s11745-008-3274-2.
22. Yancy, W. S., Jr, Foy, M., Chalecki, A. M., Vernon, M. C., & Westman, E. C. (2005). A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition & metabolism, 2, 34. https://doi.org/10.1186/1743-7075-2-34
23. Yancy, W. S., Jr, Foy, M., Chalecki, A. M., Vernon, M. C., & Westman, E. C. (2005). A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition & metabolism, 2, 34. https://doi.org/10.1186/1743-7075-2-34
24. The Ketogenic Diet and Diabetes. (2021, April 29). Retrieved from https://www.ruled.me/the-ketogenic-diet-and-diabetes/
25. Journal of Hepatology Reports 2021: Treatment of NAFLD with intermittent calorie restriction or low-carb high-fat diet – a randomized controlled trial[moderate evidence]
26. Journal of Obesity & Weight Loss Therapy 2015: Low-starch/low-dairy diet results in successful treatment of obesity and co-morbidities linked to polycystic ovary syndrome (PCOS)
27. Nutrients 2017: The effect of low-carbohydrate diets on fertility hormones and outcomes in overweight and obese women: a systematic review
28. Journal of Headache and Pain 2016: Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study
29. Alzheimer’s Research and Therapy 2021: Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease
30. Movement Disorders 2018: Low‐fat versus ketogenic diet in parkinson’s disease: a pilot randomized controlled trial
31. European Committee For Treatment and Research in Multiple Sclerosis 2015: Ketogenic diet and prolonged fasting improve health-related quality of life and lipid profiles in multiple sclerosis – a randomized controlled trial
32. Alimentary Pharmacology and Therapeutics 2016: Dietary carbohydrate intake, insulin resistance and gastro‐oesophageal reflux disease: a pilot study in European‐ and African‐American obese women
33. Diabetes, Obesity and Metabolism 2019: Low versus high carbohydrate diet in type 1 diabetes: a 12-week randomized open-label crossover study