What does a Ketogenic diet mean?
What does it mean to you when someone tells you that they are on a Ketogenic diet? How do you picture their way of eating? Many people’s first impressions are that it is an “all you can eat” diet extremely high in saturated fat, pork bacon, red meat, deli meat, fat bombs, fatty bulletproof coffee and sugar alcohols. Some of the recent news articles highlight the ketogenic diet as a really high saturated fat diet and that it is a very restrictive diet and an extreme approach. Truth is, what many articles fail to mention is that for the first time in their lives, many people are finally breaking free from their sugar addictions, are losing weight, keeping their blood sugars stabilized, and are becoming fertile after periods of infertility (those struggling with PCOS), if following a well designed program that promotes eating WHOLE nutrient dense foods like green fibrous vegetables, low glycemic berries and moderate portions of healthy quality meats.
A ketogenic diet simply means that instead of primarily burning glucose as their fuel source, they are converting fat into ketones, which is an alternative fuel source for energy. The key to being in a state of ketosis for the average person is to simply consume less than 50g of total carbohydrates per day (or <25g NET carbs per day). NET carbs is simply taking the total amount of carbohydrates and subtracting the fiber and sugar alcohols that are present. Personally, I prefer to calculate the total carbs as I try to obtain my carb sources from whole food sources such as leafy green vegetables. For more athletic individuals who can easily burn off a lot of calories in a day, can likely eat less than 100g of carbohydrates a day and still be in a state of ketosis for most of the time, but this would not be the case for most individuals on a ketogenic diet. This is a rare exception.
You may be aware that the modern use of a ketogenic diet is for weight loss, but the ketogenic diet has many other benefits as well. The other benefits of a ketogenic diet include: decreased inflammation and joint pain, less free radical production and therefore less physical aging, improved cognitive function, reduced “brain fog”, better sleep, muscle “protein-sparing” effect, reduced symptoms of dementia, better control of one’s epilepsy, support and healing for traumatic brain injuries and better blood sugar outcomes for diabetics, pre-diabetics and women with PCOS.
Traditional or Therapeutic Ketogenic Diet
Traditionally, a high fat therapeutic ketogenic diet was used as a dietary means to control seizures in children with epilepsy by mimicking the metabolic effects of a state of extensive fasting to control seizures. The benefits of implementing a ketogenic diet is that while extended zero calorie fasts can degrade muscle, the ketogenic diet helps to preserve muscle mass as it is “protein-sparing” . For a traditional ketogenic diet, 75-90% of the macros consumed daily are derived from dietary fat, 20% of the macros consumed are derived from protein and 10-15% of the macros consumed are derived from carbohydrates. The high fat intake was advised in order to maintain healthy body fat in small children who did not need to lose weight. This higher fat approach is not always conducive for fat loss in individuals who need to lose a substantial amount of body fat and will most likely result in weight loss stalling.
Modified Ketogenic Diets
This modified ketogenic diet still suggests keeping carbohydrates less than 50g total daily, but advocates for optimal amounts of protein in order to maintain as much lean body mass as possible. In this modified ketogenic plan, you would use your fat intake as a lever specific to your goals whether or not you are trying to lose fat or maintain your current weight as part of your caloric maintenance. If you have fat to lose, you would rely on your own body storage of fat for energy instead of consuming a lot of dietary fat. If you do not have much fat to lose and you are relatively lean, then you can eat more fat as part of your maintenance calories. Keep this in mind, if you have 50 lbs of body fat or greater to lose, would you want to prioritise your body to burn its own storage of fat or would you want your body to burn mostly dietary fat? Regardless, you want to make sure that you are eating at least 50g of healthy fats daily to support healthy hormones and other processes in the body that requires a source of fat.
The Atkins diet
The Atkins diet is another diet that allows you to be in a state of ketosis, where it is burning fat as a fuel source. The Atkins diet is both high fat and high protein and has a series of phases that you go through to help put your body in a state of ketosis and eventually once you reach your goal weight, will help you slowly reintroduce carbohydrates to help prevent rebound weight gain. The Induction phase of the Atkins diet is what we would also refer to as a ketogenic diet.
Targeted Ketogenic Diet
Similar to the therapeutic or modified ketogenic diet, except that you can incorporate 25-50g of fast-digesting carbohydrates right before a workout if you feel like you need an extra energy source. Some sources recommend using a small amount of gummy bears, sweet tarts, or dextrose powder. This is usually only recommended for individuals that perform very intensive training, and is not an excuse to eat a “cheat meal” before working out. It is to support and sustain the intensive training only.
Cyclical Ketogenic Diet
Similar to the therapeutic or modified ketogenic diet, except that once every 7-14 days you include 1 day of high carbohydrates with a much lower fat intake to help replenish stored glycogen in the muscles and liver, to help aid in muscle building and some sources say that this may be ideal for helping support women’s hormones and to restore leptin levels, but may not be required. The reason for a lower fat intake is to help reduce as much fat gain as possible, since high carbohydrate and high fat diets (aka standard american diet) stores fat the easiest. You can expect to gain some weight after doing a carb-load but understand that most of the weight gained is simply “water weight” due to the stored glycogen in your muscles. The more muscle mass you have, the more weight you can be expected to gain especially if you consume a lot of fluids during this time. This approach seems to be the most ideal for bodybuilders. Usually after a carb-load or re-feed you can expect to return back into a state of ketosis within 3-4 days once you have ended your intake of carb-loading carbohydrates. You may expect to reach ketosis sooner by performing an intensive training session or by using some form of intermittent fasting, but these techniques are not necessary. Usually once the glycogen stores in the liver and muscles have been reduced, then the body will start producing ketones again in a carbohydrate restricted state.
Intermittent Fasting (Short-term ketosis)
If you perform some type of daily intermittent fasting or an extended fast, your body may be able to produce some ketones at least for the short -term until you start eating carbohydrates at your next planned meal.
Protein Sparing Modified Fasting (PSMF)
A low-fat (<20g), low-carbohydrate (<20g), and high protein intake (.8-1.5g per ideal body weight or current lean body mass), which is only meant to be done short-term and under the supervision of your physician. In the past, PSMF diets were used as a rapid weight loss intervention and in the past were considered dangerous due to the type of protein used (collagen) and not consuming enough protein, vitamins and minerals that were needed to maintain health. Today’s PSMF programs promote better quality sources of protein, instruct you to take a multivitamin, increased sodium intake, fish oil and mineral supplements (calcium, magnesium and potassium). You can typically find these programs at a specialized weight loss clinic or hospital such as The Cleveland Clinic. I must urge you to please consult with a physician before attempting to try this approach on your own. Intensive cardio or weight training are generally not advised under this plan as the goal is to easily lose weight but to also maintain or “spare” as much muscle mass as possible while eating at an extreme caloric deficit which is usually somewhere between 600-1200 calories depending on the individual. Some light lifting may be advised as a way to also help with muscle “protein-sparing”. Some side effects of this approach are hunger, increased biliary colic and gallstone formation, constipation, dry eyes, dry mouth, fatigue and insomnia.
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