The ketogenic diet, often shortened to "keto," has gained immense popularity in recent years as a weight-loss strategy and potential therapy for various health conditions. It involves drastically reducing carbohydrate intake and replacing it with fat, shifting the body's metabolism away from carbs and toward fat and ketones. This article delves into the intricacies of the keto diet, exploring its principles, potential benefits, risks, and practical implementation for those seeking a healthier lifestyle.
Keto Basics: Understanding the Principles
The ketogenic diet is a very low-carb, high-fat diet that shares many similarities with the Atkins and low-carb diets. The standard ketogenic diet (SKD) typically contains 70% fat, 20% protein, and only 10% carbs. This reduction in carbs puts your body into a metabolic state called ketosis. When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain. Ketogenic diets can cause significant reductions in blood sugar and insulin levels. This, along with the increased ketones, has some health benefits.
Ketosis Explained
Ketosis is a metabolic state in which your body uses fat for fuel instead of carbs. It occurs when you significantly reduce your consumption of carbohydrates, limiting your body’s supply of glucose (sugar), which is the main source of energy for the cells. Following a ketogenic diet is the most effective way to enter ketosis. Generally, this involves limiting carb consumption to around 20 to 50 grams per day and filling up on fats, such as meat, fish, eggs, nuts, and healthy oils. It’s also important to moderate your protein consumption. This is because protein can be converted into glucose if consumed in high amounts, which may slow your transition into ketosis.
Variations of the Ketogenic Diet
There are several versions of the ketogenic diet, each with its own nuances:
Standard Ketogenic Diet (SKD): As mentioned earlier, this is a very low-carb, moderate-protein, and high-fat diet.
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Cyclical Ketogenic Diet (CKD): This diet involves periods of higher carb refeeds, such as 5 ketogenic days followed by 2 high carb days.
Targeted Ketogenic Diet (TKD): This diet allows you to add carbs around workouts.
High-Protein Ketogenic Diet: This is similar to a standard ketogenic diet but includes more protein. The ratio is often 60% fat, 35% protein, and 5% carbs.
However, only the standard and high-protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.
Achieving and Monitoring Ketosis
Following a ketogenic diet is the most effective way to enter ketosis, generally limiting carb consumption to around 20 to 50 grams per day and filling up on fats, such as meat, fish, eggs, nuts, and healthy oils. Practicing intermittent fasting could also help you enter ketosis faster. There are many different forms of intermittent fasting, but the most common method involves limiting food intake to around 8 hours per day and fasting for the remaining 16 hours. Blood, urine, and breath tests are available, which can help determine whether you’ve entered ketosis by measuring the amount of ketones produced by your body. Certain symptoms may also indicate that you’ve entered ketosis, including increased thirst, dry mouth, frequent urination, and decreased hunger or appetite.
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Potential Health Benefits of the Ketogenic Diet
A ketogenic diet is an effective way to lose weight and lower risk factors for disease. In fact, research shows that the ketogenic diet may be as effective for weight loss as a low-fat diet. What’s more, the diet is so filling that you can lose weight without counting calories or tracking your food intake.
Weight Loss and Body Composition
One review of 13 studies found that following a very low carb, ketogenic diet was slightly more effective for long-term weight loss than a low-fat diet. People who followed the keto diet lost an average of 2 pounds (0.9 kg) more than the group that followed a low-fat diet. Another study in 34 older adults found that those who followed a ketogenic diet for 8 weeks lost nearly five times as much total body fat as those who followed a low-fat diet. The increased ketones, lower blood sugar levels, and improved insulin sensitivity may also play a key role. There is evidence that the ketogenic diet is an effective weight loss therapy. However, the exact mechanisms behind this weight loss remain unclear. For example, in a review of thermodynamic principles of weight loss, Feinman and Fine explain that low-carbohydrate diets have decreased insulin fluxes causing an increased rate of lipolysis. In other words, insulin inhibits lipolysis, and decreased insulin in low-carb diets causes increased fat breakdown. Another proposed weight loss mechanism is with decreased carbohydrate intake, the body will have to undergo increased amounts of gluconeogenesis to provide glucose to the brain. Gluconeogenesis is an expensive metabolic process. Theoretically, restricting carbohydrates depletes glucose stores, and increases gluconeogenesis. Another mechanism of weight loss is theorized to be direct appetite suppression. While these mechanisms provide insight into how the ketogenic diet promotes decreased appetite and fat loss, it is important to note that evidence shows weight loss from the ketogenic diet can be partially attributed to water loss.
Diabetes Management
The ketogenic diet can boost insulin sensitivity and cause fat loss, leading to significant health benefits for people with type 2 diabetes or prediabetes. Diabetes is characterized by changes in metabolism, high blood sugar, and impaired insulin function. One older study found that the ketogenic diet improved insulin sensitivity by a whopping 75%. A small study in women with type 2 diabetes also found that following a ketogenic diet for 90 days significantly reduced levels of hemoglobin A1C, which is a measure of long-term blood sugar management. Another study in 349 people with type 2 diabetes found that those who followed a ketogenic diet lost an average of 26.2 pounds (11.9 kg) over a 2-year period. This is an important benefit when considering the link between weight and type 2 diabetes. What’s more, they also experienced improved blood sugar management, and the use of certain blood sugar medications decreased among participants throughout the course of the study.
Other Potential Health Benefits
Studies have now shown that the diet can have benefits for a wide variety of different health conditions:
Heart disease: The ketogenic diet can help improve risk factors like body fat, HDL (good) cholesterol levels, blood pressure, and blood sugar.
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Cancer: The diet is currently being explored as an additional treatment for cancer, because it may help slow tumor growth.
Alzheimer’s disease: The keto diet may help reduce symptoms of Alzheimer’s disease and slow its progression.
Epilepsy: Research has shown that the ketogenic diet can cause significant reductions in seizures in epileptic children. The keto diet was first used as a treatment for pediatric drug-resistant epilepsy to reduce seizures in the 1920s when medications alone aren't enough.
Parkinson’s disease: Although more research is needed, one study found that the diet helped improve symptoms of Parkinson’s disease.
Polycystic ovary syndrome: The ketogenic diet can help reduce insulin levels, which may play a key role in polycystic ovary syndrome.
Brain injuries: Some research suggests that the diet could improve outcomes of traumatic brain injuries. Researchers are looking to see if the keto diet can help treat age-related brain decline and potentially Alzheimer's disease. There are many different theories as to why the keto diet may be beneficial for brain health. These include the direct benefit from the presence of ketone bodies, especially one called beta hydroxybutyrate.
However, keep in mind that research into many of these areas is far from conclusive.
Foods to Eat and Avoid on a Ketogenic Diet
Navigating the ketogenic diet requires a clear understanding of which foods to embrace and which to avoid.
Foods to Avoid
Here’s a list of foods that need to be reduced or eliminated on a ketogenic diet:
Sugary foods: Soda, fruit juice, smoothies, cake, ice cream, candy, etc.
Grains or starches: Wheat-based products, rice, pasta, cereal, etc.
Fruit: All fruit, except small portions of berries or strawberries
Beans or legumes: Peas, kidney beans, lentils, chickpeas, etc.
Root vegetables and tubers: Potatoes, sweet potatoes, carrots, parsnips, etc.
Low fat or diet products: Low fat mayonnaise, salad dressings, and condiments
Some condiments or sauces: Barbecue sauce, honey mustard, teriyaki sauce, ketchup, etc.
Unhealthy fats: Processed vegetable oils, mayonnaise, etc.
Alcohol: Beer, wine, liquor, mixed drinks
Sugar-free diet foods: Sugar-free candies, syrups, puddings, sweeteners, desserts, etc.
The keto diet excludes carb-rich foods like grains, beans, fruits and starchy vegetables.
Foods to Embrace
You should base the majority of your meals around these foods:
Meat: Red meat, steak, ham, sausage, bacon, chicken, and turkey
Fatty fish: Salmon, trout, tuna, and mackerel
Eggs: Pastured or omega-3 whole eggs
Butter and cream: Grass-fed butter and heavy cream
Cheese: Unprocessed cheeses like cheddar, goat, cream, blue, or mozzarella
Nuts and seeds: Almonds, walnuts, flaxseeds, pumpkin seeds, chia seeds, etc.
Healthy oils: Extra virgin olive oil, and avocado oil
Avocados: Whole avocados or freshly made guacamole
Low carb veggies: Green veggies, tomatoes, onions, peppers, etc.
Condiments: Salt, pepper, herbs, and spices
It’s best to base your diet mostly on whole, single-ingredient foods. Some healthy unsaturated fats are allowed on the keto diet - like nuts (almonds, walnuts), seeds, avocados, tofu, and olive oil. Vegetables (also rich in carbs) are restricted to leafy greens (such as kale, Swiss chard, spinach), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber, celery, and summer squashes.
Sample Keto Meal Plan
Here’s a sample ketogenic diet meal plan for one week:
Monday
- Breakfast: Veggie and egg muffins with tomatoes
- Lunch: Chicken salad with olive oil, feta cheese, olives, and a side salad
- Dinner: Salmon with asparagus cooked in butter
Tuesday
- Breakfast: Egg, tomato, basil, and spinach omelet
- Lunch: Almond milk, peanut butter, spinach, cocoa powder, and stevia milkshake with a side of sliced strawberries
- Dinner: Cheese-shell tacos with salsa
Wednesday