Benefits and Cautions of a Ketogenic Diet (LC/HF) info for anyone curious...

[BadHare]

I know quite a few HE members eat a ketogenic diet already, so I'm posting for the benefit of those who don't know what it entails.

Benefits and Cautions of a Ketogenic Diet

High fat, ketogenic diets are being used therapeutically for a number of health conditions including Alzheimer’s, epilepsy, cancer and obesity. Low in carbohydrate and high in fat – a ketogenic diet might sound like a new idea, but in fact it was the way our ancestors predominantly ate and some would argue it is how we are designed to eat. Ketosis is where the body burns ketones – derived from fats. For most people, glucose from carbohydrates is the main energy or fuel source for the body.

Our ancestors had little access to sources of sugar – just some fruit and wild honey occasionally. In the autumn, they would have eaten large quantities of fruit, gaining fat to see them through the lean winter months. In the winter, this stored fat supplemented their meagre food intake. When the body switches to using fat as its main form of energy, ketones are created, mainly in the liver.

Using fat as the main fuel is called ketosis and our ancestors would have spent a large proportion of time in ketosis. Today, some populations in the world still consume a largely ketogenic diet. For example, the Inuit’s traditional diet is ketogenic – including nutrient-dense foods obtained from the local environment and comprising largely wild game, marine mammals and fish.

What is a ketogenic diet?

A ketogenic diet is high in fat, moderate in protein and very low in carbohydrate which causes the body to behave in a similar way to periods of limited food availability. The diet is composed of around 65% – 80% fat with carbohydrate and protein constituting the remainder of the intake.

Ketones explained

Between meals, as well as during fasting, starvation and strenuous exercise, when blood glucose levels fall, fatty acids are released from adipose tissue and can be used by most cells as a fuel source (except brain cells which are unable to uptake fatty acids). In the liver some fatty acids are formed into ‘ketone bodies’ – acetoacetate which is then further metabolised to beta-hydroxybutyrate and acetone. Ketone bodies can be used by tissues, including the brain, as a source of fuel.

How much fat, protein and carbohydrate to eat

In order for the body to switch to ketosis, carbohydrate intake needs to be low eg below 50 g per day of net carbs. Some people may achieve mild ketosis at a higher level of carbohydrate than this, others may need to go lower initially, for example, people who are overweight or with metabolic syndrome may need to reduce to below 20 g per day. Net carbs is the amount of carbohydrate minus the fibre.

In Europe food labels generally show net carbs, while in the US labels show total carbs. Net carbs can be calculated by subtracting fibre from total carbs. Carbohydrates should come mainly from vegetables, nuts/seeds, with small portions of fruit such as berries. At 50 g of carbs per day it is still possible to eat 7+ portions of non-starchy vegetables.

There is no restriction on the amount of healthy fats that can be eaten, however once ketosis has been achieved appetite should decrease. It is important to eat plenty of fat to stay in ketosis. So foods such as avocado, olive oil, coconut oil, MCT oil can be eaten liberally. Nuts, seeds, wild oily fish and eggs provide other sources of healthy fats.

Fat phobia may cause people to reduce carbohydrates without increasing fat in the diet, however, a low carb / low fat diet will not achieve sustainable ketosis. On the other hand, beware – eating a high fat diet without restricting carbohydrate sufficiently may lead to weight gain and other health problems.

Medium chain triglyceride (MCT) oil is often used in ketogenic diets. MCTs are a type of fat that can be rapidly and easily converted to ketone bodies in the liver. Coconut oil is a good source of medium chain triglcycerides, eg caprylic acid, but MCT oil is also available and this contains higher concentrations. It can be eaten off the spoon or added to food/smoothies. When adding MCT oil to the diet it is best to start slowly eg one teaspoon per day to avoid any unwanted gastrointestinal side effects.

Protein in foods can be converted by the body to carbohydrates so excessive protein needs to be avoided. Between 0.8 to 1.2 g of protein per kg body weight depending on the level of activity (ie higher level for those who are very active / undertaking strenuous exercise and weight training on most days of the week).

Fasting can be useful to help achieve and maintain ketosis. For example, a 16 hour overnight fast ie skipping breakfast. This would also include avoiding milk etc in drinks and caffeine which stimulates a blood sugar response.

Benefits of a ketogenic diet

The ketogenic diet, if done correctly, can be an ‘anti-inflammatory’ way of eating. When we eat carbohydrate our blood sugar increases and this creates some level of inflammation in the body. Ketogenic diets can:

Lower blood sugar (and thus lower inflammation) and reduce the risk of metabolic syndrome and diseases associated with it

Control appetite – ketosis affects ‘hunger’ hormones and allows us to feel full for longer. In contrast, eating a lot of carbohydrates can have the opposite effect

Help with weight loss

Support memory – research is showing the benefit of ketogenic diets in symptomatic relief from Alzheimer’s and ketosis may have disease-modifying activity through a number of different mechanisms. Increased mental focus can be gained from the diet as ketosis provides a steady flow of ketones to the brain which avoids large spikes in blood sugar levels. The brain’s preferred fuel source is glucose, however, in cognitive decline the brain may struggle to use glucose; this has a dual consequence – the brain is starved of the fuel it needs to function well AND glucose levels in the brain remain high which can cause damage to brain cells. Switching to using ketones as the main source of energy bypasses both these problems and is the therapeutic diet being used by Professor Bredesen in the USA to reverse cognitive decline

Improve physical stamina – ketogenic diets are used by some sportsmen for endurance events

Improve sleep, immunity, anxiety, mood and overall feeling of wellbeing

Epilepsy – The ketogenic diet has long been associated with helping to manage epilepsy. It was discovered to help control symptoms back in the 1920s and was mainly used to help treat children with uncontrolled epilepsy. Controlled trials have shown that the diet can control seizures and more recent results have shown adults as well as children can benefit from it. It can also reduce the need to take anti-epileptic drugs. Specialist dieticians are available to guide patients on the use of this diet.

Is it safe to go on a ketogenic diet?

Some diets which are ketogenic are not recommended, ie diets which are high fat but place little emphasis on the types of fats included (ie they allow processed and inflammatory fats) and diets which encourage protein and fat intake at the expense of vegetables.

The majority of people can safely go on a well-planned ketogenic diet, however, those with serious medical conditions should only undertake this diet under the supervision of a health professional. The diet may not be suitable for those with diabetes, thyroid and liver disease. For example, people with diabetes are at risk of developing a condition called diabetic ketoacidosis which can be fatal. [However, a low carbohydrate diet is recommended for those with diabetes and some people with diabetes may be advised to follow a ketogenic diet with appropriate monitoring and supervision].

For anyone embarking on a ketogenic diet it is recommended that blood monitoring is undertaken at the start and after 2 to 3 months to monitor and check for any adverse changes. Tests to include: Complete blood count, fasting blood sugar, HbA1c, fasting lipid panel, thyroid panel, liver function, kidney function and electrolytes.

Some people can feel unwell in the first few days of changing to this diet – referred to as Keto Flu. This can be helped by eating some salt daily and staying hydrated (urination may increase for a few days).

Increasing fat in the diet and the addition of MCT oil can lead to intestinal symptoms (including diarrhoea), so transition to this new way of eating may be best done slowly, starting with 1 teaspoon of MCT oil per day with food and increasing gradually. If symptoms occur reduce to a lower dose.

Long periods of ketosis can result in loss of muscle and increased fat. Whether this occurs, and how quickly, depends on the person, some endurance athletes use a ketogenic diet very successfully. For the rest of us it may lead to loss of muscle if carried out long-term due to the very low insulin levels. Although in general reducing insulin is one of the benefits of ketosis, one of the actions of insulin is to inhibit gluconeogenesis by the liver (gluconeogenesis is the conversion of protein to glucose); low insulin results in increased gluconeogenesis and muscle breakdown to provide the protein.

Whilst the brain can run on ketones it does require a small amount of glucose. So after a few weeks of being in ketosis, it may be preferable to eat a larger amount of carbohydrates on 1 or 2 days per week (eg a sweet potato and couple of portions of fruit).

There has also been concern raised that ketogenic diets raise cortisol and so some advise that a ketogenic diet should not be undertaken by people under a lot of stress or continued long-term. A 2012 study compared 3 diferent diets (low fat, low carb, low glycaemic index). The study showed the low carbohydrate diet produced the best effects overall but also raised cortisol levels, which can lead to insulin resistance etc. However ketogenic diets have also been shown to reverse symptoms of metabolic syndrome – so this is an area that would warrant further research.

Finally, the intake of certain micronutrients may be lower on a ketogenic diet – this can be minimised by carefully planning the diet. We would also recommend taking an all-round multivitamin / mineral daily.

A ketogenic diet is not advised for people with certain health conditions. Therefore, we recommend only embarking on a ketogenic diet with advice and guidance from a suitably qualified health practitioner.

Key Takeaways

A ketogenic diet is high in fat, moderate in protein and very low in carbohydrate. Fat intake is between 65 – 80% of total energy intake.

Foods eaten include olive oil, butter, coconut oil, MCT oil (medium chain triglycerides), wild oily fish, avocado, nuts/seeds and non-starchy vegetables.

Ketones are made in the liver and can be used by tissues, including the brain, as fuel.

Reported benefits include reduced hunger, improved mental clarity and weight loss. The diet is being used therapeutically for a number of conditions including Alzheimer’s, cancer and epilepsy.

The diet may be best used short or medium term. If planned for long-term use then it may be beneficial to have one or two days per week with a higher carbohydrate intake (eg a sweet potato and couple of portions of fruit).

Intake of certain micronutrients may be low on a ketogenic diet, we would recommend an all-round multivitamin / mineral daily.

Due to the restrictions of the diet, advice of a suitably qualified health practitioner is recommended. It is not suitable for people with certain health conditions.

blog.cytoplan.co.uk/benefit...

[TheAwfulToad]

That's a good summary. There's a lot of misunderstanding about what LCHF actually is, including a lot of intentional FUD put out there by vested interests.

Especially interesting to see a 'natural' diet described as cyclical. I came to that conclusion myself - it's obvious when you look at seasonal availability of certain foods - but I've not seen it elucidated before in a LCHF article. There's still an ongoing argument about whether humans 'naturally' ate high-carb or high-fat, but basically both camps are correct ... at different times of year. Because I train a lot, I intentionally crank my carbs up and down (slightly) during the year to avoid the catabolic effects of prolonged low insulin mentioned in the article. I've noticed if I stay low-carb for more than about 8 months at a time, my strength training performance starts to tail off.

I really dislike the idea that there is One True Way - a single diet that's "best" for everyone, to be eaten every day, all the time, day in, day out. If that were true, we'd all be desperately unhealthy without a massive international network of trade in foodstuffs. Observing that nature provides food in cycles neatly resolves the argument between the pro-carb and the pro-fat groups, and also indicates a way forward for sustainable, healthy food production.

[BadHare in reply to TheAwfulToad]

Humans, like animals, would have eaten anything we could get hold of that provided energy & wasn't poisonous in small quantities. People have adapted to live in so many different environments from desert to tundra, there can't be any single diet that wouldn't change at least seasonally.

[andyswarbs]

I always think when there is an appeal to ancestry people choose which bit of ancestry they want to highlight to suit their needs. For tens if not hundreds of millennia before humankind was eventually able to catch, kill and cook animals the body lived and thrived on nuts, seeds, fruit and plants. Why do ketogenic advocates limit their horizons to relatively recent history?

Whatever is it right for the body to adopt a diet that is not easily maintained as a steady state? I am not saying some people, indeed many people do not thrive on keto, at least in the short and medium terms. That would be absurd.

Instead let me just ask, if keto was such a natural diet why is it such a modern phenomenon?

[BadHare in reply to andyswarbs]

I don't think it's modern. It seems to me to be another way of cutting out processed food. I'm sure Inuits & Bedouin ate ketogenic diets until recently. Farming & growing crops is fairly new in evolutionary terms, & prior to that, people ate anything they could find growing or catch.

[TheAwfulToad in reply to andyswarbs]

andyswarbs : I think you seriously underestimate how incredibly skilled our stone-age ancestors were at killing things.

Necessity is the mother of invention, and we know simply by observing "primitive" tribes still in existence that an expert hunter can easily kill enough meat for at least a family-sized meal, if not the whole tribe, at least once a week. In fact most hunter-gatherer societies spend a lot of time doing nothing, because hunting and gathering takes up half a day at most.

We also have archaeological evidence that people were able to hunt populations of animals literally to extinction (at least locally), with only "primitive" techniques. Humans came, they saw, they stuffed their faces. Some olde-worlde weapons were pretty impressive: for example the Chinese (IIRC) invented laminar composites for making recurve bows centuries before carbon fibre was invented. Performance would have been within spitting distance of 21st-century models.

>> is it right for the body to adopt a diet that is not easily maintained as a steady state?

Can you think of any good reason why it should not be? Why do you believe we should eat the same things all the time? Do you think it's right and proper that tomatoes should be available in the UK in December?

Apart from anything else, it gets kinda boring, surely?

>> many people do not thrive on keto

Leaving aside the issue of what is and is not "keto", do you have any evidence for this? Unless someone has some serious metabolic malfunction - say, a missing gallbladder - I can't think of any logical reason why "many people" would fail to thrive on keto.

I've found that the most common reason people DO fail to thrive on a low-carb diet is that they attempt to "improve" it by doing low-fat at the same time, which rather misses the point. They'd do better to just stop eating. A well-formulated LCHF diet is varied, interesting, tasty, and healthful.

>> the body lived and thrived on nuts, seeds, fruit and plants.

Yeah, try doing that in an arid climate (or a semi-arid climate during the dry season). That's roughly 40% of the earth's land area, depending on your definitions. Seeds happen at a very specific time of year - often at the end of the dry season. Seeds are the plant's entire raison d'etre; an annual plant will put so much energy into them that it dies. They are, in other words, scarce. The idea that people would have ever eaten a lot of "whole grains" is just laughable.

[andyswarbs in reply to TheAwfulToad]

Humans eating grains for a at least 100,000 years? blogs.scientificamerican.co...

As well as people doing low fat low carb problems I think people attempting high fat vegan an incredible challenge. For a while I was in one FB group and found it too painful to stay around.

I have no doubt our ancestors were skilled. Did they develop a brain sufficient to gain those skills to kill animals and thence eat meat. Or did their brains develop because of eating plentiful carbs first?

I have no statistics for people not surviving on keto. However googling a phrase such as "why I gave up keto" yields lots of insights into that community. I have no doubt that similar stats can be had for people giving up veganism. And you are right that a lot of it is down to people doing things wrong in the first place - in both camps.

By maintaining a steady state I do not mean eating the same things day in day out. I am rather talking about the effect of foods on the metabolism.

[TheAwfulToad in reply to andyswarbs]

>> I think people attempting high fat vegan an incredible challenge. For a while I was in one FB group and found it too painful to stay around.

I agree with that. Personally I don't think it's even possible. It's just my personal opinion, but IF you want to do a plants-only diet, then your best bet is what the nutritionists call "balanced" : moderate carbs + moderate fat. I would also put it the other way around: IF you want to eat a "balanced" diet, then a plant-based diet is a good way of doing it, because it keeps your appetite under control for much the same reasons a LCHF diet does (ie., they're both full of bulky plant material).

>>Did they develop a brain sufficient to gain those skills to kill animals and thence eat meat. Or did their brains develop because of eating plentiful carbs first?

Who knows? As BadHare said, they most likely ate whatever was around, and that would have varied seasonally. The point here is that they would have had very little choice in the matter.

There were no stone-age nutritionists telling everyone "you're all going to die of cancer!" while they were trying to eat their goat curry. That's because they all died of malnutrition, being unable to find seeds and greens in the middle of March on the Mongolian steppe. Those who didn't were probably quietly done away with.

>> I am rather talking about the effect of foods on the metabolism.

OK, but what effects specifically? You seem to be implying that not eating carbs is inherently harmful, even if only seasonally.

>> googling a phrase such as "why I gave up keto" yields lots of insights into that community.

Well, "keto" is not the same thing as LCHF. Keto has specific applications and personally I don't think it's desirable or necessary for extended periods.

Anyway, I did google that, and I came up with the usual list of facepalms:

1) "Bacon and sausages 'cause cancer - and are as bad for us as smoking'"

That's just beyond stupid. There is some tiny association between cancer and processed meat, but we don't know if it's precisely those foods that are the problem, or just the general bad diet that processed-meat diets are associated with. And we don't know because the scientists didn't bother to control for that.

The effect itself is so tiny you have to apply sensitive statistical tests to tease it out: it's something like 1000x smaller than the effect associated with cigarette-smoking, and 20x smaller than the risk associated with not exercising. It really winds me up when the press come out with blatant untruths like this and don't get hauled up for it.

Anyway, let's assume it's true: just don't eat sausages and bacon then. Good grief.

2) "Keto is a great way to lose weight fast, but I have my doubts about how healthy it is long-term to eat massive amounts of meat."

Um yeah. Except keto has nothing to do with eating massive amounts of meat. As BadHare 's article above points out.

3) "I had some pretty terrible issues with my diarrhea even after trying to sort out electrolytes."

It turns out the poster is subsisting on some bizarre packaged meal replacement, instead of eating proper food.

4) "I'm tired of cooking meats and a limited selection of vegetables. I hate fat. I'm tired of trying to get my calories by adding butter and cream (if I don't, I'm at a 60% deficit because I just don't like the food)."

You're only supposed to do this for about a week. Yes it's boring, but after that you start introducing other things until you're eating 50-100g net carbs per day. My diet is extremely varied and includes quite a lot of carbs, but 90% of the time my meals would be classed as "LCHF". There's no need to punish yourself, which seems to be a common mindset among dieters.

I simply don't understand how people can label LCHF as "boring" when the only things that have been eliminated are tasteless pap: potatoes, rice, pasta, bread. The irony is that we slather these things with sauces and fat and sugar to make them taste nice - because if you don't, they wouldn't be worth eating.

[andyswarbs in reply to TheAwfulToad]

>>> I simply don't understand how people can label LCHF as "boring" when the only things that have been eliminated are tasteless pap: potatoes, rice, pasta, bread. The irony is that we slather these things with sauces and fat and sugar to make them taste nice - because if you don't, they wouldn't be worth eating.

The very interesting experience of many vegans is how their taste buds change. I can eat a potato with nothing on it, nothing at all and thoroughly enjoy it. (Well I used to do but now try to avoid pots, being a nightshade and the arthritis reaction I can get.)

So what was considered tasteless begins to explode with flavour, and texture. I will happily munch on a slice of dry wholewheat bread or toast.

Last night I had pizza at Pizza Hut, no tomato, no cheese, just a range of veg. It was very moist and flavourful. (Yes it wasn't wholewheat sadly.) The waiter looked at me when ordering as if I was mad and said he wasn't sure if the cooks could do this. I replied I had had this several times, each with success.

It is very interesting in how there are things people say are stupid / impossible, and yet they are neither.

A good question is how and why do the taste buds change. The answer is they are driven by the microbiome, which I consider takes three months to properly change. Though some people report changes within two weeks, and yet others it may take a year.

But once the microbiome adaptation is made oils, cheese, meats, fish increasingly smell repugnant.