Keto Diet: Common barriers and success factors

Science by Temple Stewart, RD

The Ketogenic Diet (Part 3) 

Welcome to the last blog in our Ketogenic Diet series. If you missed the first two, please check them out here. For the third and final topic, we’re going to discuss total vs. net carbs, common barriers, and personalizing the ketogenic diet to fit your needs. We’ve chosen these topics to help you navigate the challenges that arise when following a ketogenic diet, so that you’re set up for success in the long-run.

Total Carbs vs. NET Carbs?

One of the most common questions asked when following the ketogenic diet is, “Should I count total carbohydrates or net carbohydrates?” For definition sake, “total” includes all carbohydrate types in a food (ex. starches and sugars), whereas “net” includes only carbohydrates the body can fully digest into glucose. A good way to remember net carbs is to refer to them as “digestible carbs.” 

When counting net carbs, fiber and sugar alcohols are subtracted from the total carbohydrate amount to give you the new net carb number. Typically, naturally occurring fiber isn’t absorbed into the small intestine, and therefore passes very quickly into the colon, providing no caloric value (or glucose) to the body. Depending on the fiber type, soluble or insoluble, there may be an improvement in blood sugar, and insulin sensitivity, which is the reason that fiber is subtracted. Sugar alcohols are often added to keto-replacement foods such as chocolate, candy, ice cream, and granola. They are digested similarly to fiber, but vary widely when it comes to impact on blood glucose and insulin levels.  It’s important to make sure that if you’re counting net carbs instead of total carbs, the product has good quality fiber with limited sugar alcohols, or only uses stevia or monk fruit to sweeten [1, 2, 3, 4]. 

Most medical professionals recommend counting total carbs if following a ketogenic diet for therapeutic reasons such as treating epilepsy or cancer. However, the consensus for those simply looking to improve their insulin sensitivity and lose weight is that counting net carbs is sufficient. You can find which is best for you by monitoring blood ketone levels and making sure you’re entering nutritional ketosis. 

Common barriers of a ketogenic diet

The ketogenic diet is different from traditional dieting as its focus is not so much on caloric intake, but on consuming foods that are satiating, keep blood sugar/insulin low, and reduce inflammation. This impact on the body takes away a lot of the challenges traditional dieters face, like hunger and constant calorie counting [5, 6, 7, 8, 9, 10]. However, the ketogenic diet is not without some challenges: 

  • Restaurant Dining: Most restaurants serve hefty portions of carbohydrates (carbs are typically cheaper than protein). Some places even bring you a free appetizer of carbs in the form of chips or bread. When dining out, check the nutrition information online and decide what you’re going to order ahead of time. Instead of starchy carbs for a side, order double vegetables. You can always look for salads, or dishes that focus primarily on protein. Another option is non-breaded chicken wings or a lettuce “bun” burger. 
  • Social Pressure: We’re moving into the holiday season, and this time of year can be difficult for those in the middle of a health or weight loss journey. If you feel social pressure to eat certain foods during holiday gatherings, it’s great to have a quick response for tough situations. “I would love to have _____, but I feel really good with my current way of eating,” is an effective response that you can start using immediately. 
  • Cravings: These are difficult as there are so many reasons cravings are present. Sometimes cravings can be a sign of hormonal imbalances, unhealthy gut flora, high stress, high emotions, or even lack of sleep. If you struggle with cravings, you need to take some time to investigate why they are a problem and the circumstances around them. A good strategy for this is to analyze the day (or days) leading up to the craving. What happened the hours before? Did you sleep well the previous night? Are you hydrated? For ladies, are you pregnant or about to cycle?  [11, 12, 13, 14] 

Long term success on a Keto Diet

If you have met your health or weight loss goals, the next step is focusing on how you can remain successful in a maintenance phase. It is no secret that many people struggle with long-term weight loss success. Let’s look at some research-backed strategies to help you stay successful with your health journey long-term [15]:

  • Have a Marker to Measure: You could use a scale, an exercise tracker, or lab values. It’s just important that you have something you’re measuring success against. Several studies show that those who keep “track” have longer, more successful health changes [16].
  • Paying Attention at Meals: Make sure you’re aware of your plate and keep distractions to a minimum (Instagram, news, etc). Paying attention to everything about your meals (the flavor, the smells, the texture), will likely help you have better satiety and less calories [17]. 
  • Write it Down: Keep track of your meals, your body measurements, and even your mood! A large study from Kaiser Permanente found that those who tracked their food lose twice as much weight as those who didn’t [18]. 
  • Set Some Goals: Both short- and long-term goals are important to keep in the forefront of your mind. It’s also just as important to keep them written down somewhere where you can see them [19]. 
  • Prioritize Protein: Whether it’s at meals or snacks, protein is so crucial for body function and satiation throughout the day. Protein keeps you fuller for a longer period of time which could in turn help with cravings or the constant desire to eat [20]. 
  • Don’t Fear Fat: Dietary fat is essential for the body’s optimal functioning. There is no reason to fear consumption of dietary fat. Make sure to check out the several additional blog posts previously posted here.  
  • Don’t Bring Junk Home: “Out of sight, out of mind.” When highly palatable food is around, it’s difficult to ignore it. When food is visible or always around, people eat more of it [21].
  • Find Accountability and Support: We were not meant to do life alone, this includes staying active and healthy. Find a friend, build healthy habits with your family, or even join a community that has like-minded desires [22]. 

Conclusion

The ketogenic diet is a widely used health and weight loss diet. It’s prescribed for a variety of medical conditions with outstanding results, and the research continues to support its use. Understanding how to properly follow a well-formulated ketogenic diet, the common barriers that come alongside it, and steps to making it a long-term dietary change are all key aspects for success. Not only is it fully sustainable for the long-term, but changing to a ketogenic diet will make a significant impact on your health and weight status! 

 

References

  1. Brennan MA, Derbyshire E, Tiwari BK, Brennan CS. Enrichment of extruded snack products with coproducts from chestnut mushroom (Agrocybe aegerita) production: interactions between dietary fiber, physicochemical characteristics, and glycemic load. J Agric Food Chem. 2012 May 2;60(17):4396-401. doi: 10.1021/jf3008635. Epub 2012 Apr 17. PMID: 22458938.
  2. Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, Waters V, Williams CL. Health benefits of dietary fiber. Nutr Rev. 2009 Apr;67(4):188-205. doi: 10.1111/j.1753-4887.2009.00189.x. PMID: 19335713.
  3. Weickert MO, Pfeiffer AF. Metabolic effects of dietary fiber consumption and prevention of diabetes. J Nutr. 2008 Mar;138(3):439-42. doi: 10.1093/jn/138.3.439. PMID: 18287346.
  4. Livesey G. Health potential of polyols as sugar replacers, with emphasis on low glycaemic properties. Nutr Res Rev. 2003 Dec;16(2):163-91. doi: 10.1079/NRR200371. PMID: 19087388.
  5. Doucet E., Imbeault P., St-Pierre S., et al. Appetite after weight loss by energy restriction and a low-fat diet-exercise follow-up. Int J Obes Relat Metab Disord. 2000;24(7):906-914.
  6. Gibson, AA., Seimon, RV., Lee, CMY., et al. Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obesity Reviews. 2015; 6: 64–76.
  7. Boden, Guenther, et al. “Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes.” Annals of internal medicine 142.6 (2005): 403-411
  8. Volek, Jeff S., et al. “Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet.” Lipids 44.4 (2009): 297-309
  9. Clamp, Hume, et al. “Enhanced insulin sensitivity in successful, long-term weight loss maintainers compared with matched controls with no weight loss history.” Nutrition & Diabetes 7 (2017): 282
  10. Forsythe, CE., Phinney, SD., Fernandez, ML., et al. Lipids. 2008; 43:65–77 Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation. Lipids. 2008; 43:65–77
  11. Chao, A. M., Jastreboff, A. M., White, M. A., Grilo, C. M., & Sinha, R. (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring, Md.), 25(4), 713–720. https://doi.org/10.1002/oby.21790
  12. Alcock, J., Maley, C. C., & Aktipis, C. A. (2014). Is eating behavior manipulated by the gastrointestinal microbiota? Evolutionary pressures and potential mechanisms. BioEssays : news and reviews in molecular, cellular and developmental biology, 36(10), 940–949. https://doi.org/10.1002/bies.201400071
  13. Chao, A. M., Jastreboff, A. M., White, M. A., Grilo, C. M., & Sinha, R. (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring, Md.), 25(4), 713–720. https://doi.org/10.1002/oby.21790
  14. Markwald, R. R., Melanson, E. L., Smith, M. R., Higgins, J., Perreault, L., Eckel, R. H., & Wright, K. P., Jr (2013). Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proceedings of the National Academy of Sciences of the United States of America, 110(14), 5695–5700. https://doi.org/10.1073/pnas.1216951110
  15. https://www.huffpost.com/entry/long-term-weight-loss_b_7502026
  16. Steinberg DM, et al. Weighing every day matters: daily weighing improves weight loss and adoption of weight control behaviors. J Acad Nutr Diet. 2015 Apr;115(4):511-8. doi: 10.1016/j.jand.2014.12.011.
  17. Andrade AM, et al. Eating slowly led to decreases in energy intake within meals in healthy women. J Am Diet Assoc. 2008 Jul;108(7):1186-91. doi: 10.1016/j.jada.2008.04.026.
  18. Dunham, W. (2021). Study shows value of food diary in losing weight. Retrieved 13 October 2021, from https://www.reuters.com/article/us-diet-diary/study-shows-value-of-food-diary-in-losing-weight-idUSN0741885020080708
  19. How to set weight-loss goals that actually work. (2021). Retrieved 13 October 2021, from https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20048224#:~:text=Weight%2Dloss%20goals%20can%20mean,transition%20to%20a%20healthier%20lifestyle.
  20. Blom WA, et al. Effect of a high-protein breakfast on the postprandial ghrelin response. Am J Clin Nutr. 2006 Feb;83(2):211-20.
  21. Wansink B, et al. The office candy dish: proximity’s influence on estimated and actual consumption. Int J Obes (Lond). 2006 May;30(5):871-5.
  22. Gorin A, Phelan S, Tate D, Sherwood N, Jeffery R, Wing R. Involving support partners in obesity treatment. J Consult Clin Psychol. 2005 Apr;73(2):341-3