The ketogenic diet has gained immense popularity as a weight loss strategy, and many individuals are exploring its potential benefits. Tiffany, a health writer and registered nurse, has followed the ketogenic diet since 2019, experiencing weight loss, improved PCOS symptoms, and increased energy levels. This article delves into the relationship between the ketogenic diet and creatine, a natural compound that plays a crucial role in energy production.
Understanding the Ketogenic Diet
The ketogenic diet is characterized by a drastic reduction in carbohydrate intake and a high fat content. This dietary approach forces the body to burn fats and use an alternative metabolic fuel resource by stimulating endogenous ketone production. Typically, it consists of 70-80% fat, 15-25% protein, and less than 10% carbohydrates. When carbohydrate intake drops below 50 grams per day, insulin secretion decreases dramatically, and the body enters a state of breakdown. Various metabolic adjustments are compelled as the body's glycogen reserves are depleted.
Ketosis Explained
When the body's tissues are deficient in carbohydrates, two metabolic processes, gluconeogenesis and ketogenesis, come into play. Gluconeogenesis is the process by which the body produces glucose internally. If glucose levels in the body become too low, the body's natural glucose production cannot meet its energy needs, leading to the start of ketogenesis, which provides energy in the form of ketone bodies. The primary source of energy is switched to ketone. During ketosis, glucose and fat storage will decrease due to decreased insulin secretion. Acetoacetate, produced during the metabolism of fatty acids, is then changed into acetone and beta-hydroxybutyrate. Nutritional ketosis is the term used to refer to the state of the body where there is an increased level of ketone bodies. The body's metabolism remains in a state of ketosis for as long as it is denied carbohydrates. Ketone bodies are generated in low amounts without changing the blood's pH level.
Types of Ketogenic Diets
Various types of ketogenic diets exist, each with varying degrees of carbohydrate restriction and macronutrient ratios. These include the classic ketogenic diet, modified ketogenic diet, ketogenic diet with medium-chain triglycerides (MCT), modified Atkins diet, and low glycemic index diet.
Creatine: Fueling Muscle and Brain
Creatine is a natural compound found in your muscles and brain. You can also get creatine from red meat, fish, and poultry. Creatine helps regenerate ATP, your body’s energy currency. It works by increasing intracellular water content and enhancing protein synthesis.
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Creatine and ATP Regeneration
Your body uses three main energy systems. Creatine directly supports ATP regeneration through the phosphocreatine system. On keto, this system becomes even more important because you can’t rely on quick glucose for energy.
Creatine and Ketosis: A Compatible Combination
A common question among keto dieters is whether creatine supplementation can disrupt ketosis. The answer is no, creatine won’t break ketosis. A practical test showed that taking 5-10 grams of creatine resulted in minimal blood glucose changes. The key is choosing the right product, with creatine monohydrate being the gold standard form. Some creatine products include added ingredients like dextrose or maltodextrin, which should be avoided on a ketogenic diet.
Benefits of Creatine on Keto
Creatine supplementation offers several benefits for individuals following a ketogenic diet:
- Improved Exercise Performance: Ketogenic diets can limit performance during intense bursts of activity. Research shows that creatine supplementation during a low-carb diet helped “attenuate the decrement in high-intensity exercise performance.” Creatine is particularly valuable for maintaining power and strength during repeated high-intensity efforts.
- Muscle Preservation: Ketogenic diets may initially lead to some muscle loss, particularly in the first four weeks. Creatine helps maintain power output during heavy lifting sessions. You can absolutely build muscle on a ketogenic diet with adequate protein, and creatine supports muscle growth and strength gains.
- Enhanced Cognitive Function: Your brain needs ATP just like your muscles do. A 2024 systematic review found that adults on creatine had better memory and faster processing speed.
Creatine Supplementation: Dosage and Timing
The standard maintenance dose of creatine is 3-5 grams daily. Timing matters less than consistency. For keto dieters, taking creatine with a protein-rich meal can enhance absorption while maintaining ketosis. Even eating plenty of meat and fish, you’d struggle to get optimal amounts of creatine from food alone. Supplementation gives you precise control over your creatine intake.
Potential Considerations
While creatine is generally safe, there are a few potential considerations for individuals on a ketogenic diet:
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- Creatinine Levels: Ketogenic diets may increase serum creatinine levels in some people.
- Hydration: Both creatine and ketogenic diets affect hydration status. You’ll need to increase your water intake when combining both approaches.
Optimizing Cellular Energy
Jinfiniti’s Creatine + ATP offers a unique advantage for keto dieters. This formulation is particularly beneficial because it addresses both the phosphocreatine system (through creatine) and direct ATP availability. For those looking to optimize their overall cellular energy production, Jinfiniti’s Vitality↑® NAD+ Booster can complement your creatine supplementation.
Ketogenic Diets in Nephrology
In nephrology, two main applications of ketogenic diet are currently identified: weight loss, with different objectives according to the stage of chronic kidney disease (CKD), namely in the early stages of CKD to stabilize kidney function and control proteinuria, in the late stages of CKD mainly to allow access to kidney transplantation, and, more recently, the treatment of autosomal dominant polycystic kidney disease (ADPKD).
Concerns and Considerations for CKD Patients
Obesity and diabetes are major risk factors for kidney disease, and obese patients with chronic kidney disease (CKD) are potential candidates for weight reducing diets, among them ketogenic diets. However, concerns remain about safety in patients with CKD, particularly in the long term and in those with poor residual kidney function. Although further studies are needed to identify the profile of CKD patients who may benefit from the implementation of ketogenic diets to treat obesity or slow the progression of ADPKD, and to assess short- and long-term safety and adherence, the available data appear promising.
Potential Cardiovascular Benefits
The 2014-2016 guidelines for the management of obesity of different societies, namely the American Heart Association, the American College of Cardiology, the Task Force on Practice Guidelines and The Obesity Society, the National Institute of Health and the UK Nice suggest using a very low-calorie ketogenic diet in patients who f…
Potential Risks and Side Effects of Ketogenic Diets
While ketogenic diets offer potential benefits, it's crucial to be aware of potential risks and side effects:
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- Common Side Effects: Constipation, low-grade acidosis, hypoglycemia, kidney stones, and increased lipid in the blood are among the most common and easily reversible consequences of this diet.
- Kidney Dysfunction: Renal dysfunction associated with the ketogenic diet has been reported in individuals with underlying kidney disease exposed to high protein. Studies show that people with chronic kidney disease and those without prior kidney problems are experiencing a decline in kidney function.
- High Protein Intake: The proposed mechanisms of high protein dietary intake for kidney damage include mediators including acid load, high phosphate content, gut microbiome dysbiosis, and inflammation. A diet high in protein can cause intraglomerular hypertension, leading to glomerular hyperfiltration, injury, and proteinuria. Studies show that the source of the dietary protein also matters; it is noted that animal protein has a higher incidence of kidney injury compared to plant-based protein.
A Case Study: Acute Kidney Injury and Keto
A 36-year-old female patient presented with acute kidney injury induced by a ketogenic diet. She was on a ketogenic diet for the past two months and lost more than 30 pounds. Her diet primarily consisted of three meals a day: mainly composed of eggs, beef, avocado, chicken, and peanuts. Laboratory investigation showed elevated creatinine of 4.3 meq/L, hypokalemia of 3.3 meq/L, FeNa was 4% and positive urine ketone. She was given IV fluids and supportive care and showed improvement in symptoms by the second day, and her creatinine level started to drop.
Historical Context: Ketogenic Diets
The ketogenic diet has a rich history, initially utilized to treat epilepsy. The term "ketogenic diet" was created by Russell Wilder in 1921 and was initially utilized to treat epilepsy. It was popular for about 10 years as a treatment for pediatric epilepsy but lost favor when antiepileptic drugs came on the market. Notably, interest in ketogenic diet in epilepsy was revived in the early 1990s by a television program and subsequent film (“First Do No Harm”, starring Merryl Streep) based on the true story of Charlie, a 2-year-old boy with intractable generalized seizures, who was seen by Dr Freeman and Ms Millicent Kelly, a nutritionist with specific experience with the ketogenic diet, and rapidly became seizure-free on the diet. Since then, there have been several trials looking at ketogenic diet. In line with the resurgence of ketogenic diet in epilepsy, several studies are currently underway to evaluate its applications in various diseases, including neurodegenerative diseases such as amyotrophic lateral sclerosis, Parkinson’s disease, Alzheimer’s disease, and in various types of cancer as well as in post-traumatic brain injury.
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