The ketogenic diet, or keto diet, is a low-carb, high-fat diet that offers many health benefits. It involves drastically reducing carbohydrate intake and replacing it with fat, which 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. Many studies show that this type of diet can help you lose weight and improve your health. Ketogenic diets may even have benefits against diabetes, cancer, epilepsy, and Alzheimer’s disease. This article explores the use of creatine supplementation while following a ketogenic diet, considering its safety, efficacy, and potential benefits.
Understanding the Ketogenic Diet
The ketogenic diet is a very low carb, high fat diet that shares many similarities with the Atkins and low carb diets. It involves drastically reducing carbohydrate intake and replacing it with fat. 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.
Types of Ketogenic Diets
There are several versions of the ketogenic diet, and what you eat depends on the type. They include:
- Standard ketogenic diet (SKD): This is a very low carb, moderate protein and high fat diet. It typically contains 70% fat, 20% protein, and only 10% carbs.
- 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. The information in this article mostly applies to the standard ketogenic diet (SKD), although many of the same principles also apply to the other versions.
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. 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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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. 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.
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. The ketogenic diet can boost insulin sensitivity and cause fat loss, leading to significant health benefits for people with type 2 diabetes or prediabetes.
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.
- 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.
- 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.
However, keep in mind that research into many of these areas is far from conclusive.
Foods to Eat and Avoid on Keto
Here’s a list of foods that need to be reduced or eliminated on a ketogenic diet:
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- 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.
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.
Creatine: An Overview
Creatine, derived from “kreas,” which is the Greek word for “meat,” is an amino acid available in high concentrations in skeletal muscle. About 95% of it is stored in your muscle while the rest is found in your heart, brain, and testes. Research shows that people who eat animal-based foods have more muscle creatine stores than vegetarians. A normal-sized person would have to consume around 2-3 grams of creatine per day to maintain their normal creatine stores, although this also depends on their activity level and muscle mass. Creatine in supplement form (meaning that it is laboratory-synthesized), is available as a powder, tablet, capsule, liquid, or cream. Creatine phosphate, also known as phosphocreatine (PCr), is the phosphate-storage molecule of muscle. In the brain, creatine is also synthesized in a two-step reaction, although most of this synthesis happens in the kidney, liver, and pancreas. Despite what some people believe, creatine is generally safe at recommended doses. It is widely researched. Based on protocols, a person would have to consume about 3 grams of creatine per day in their diet, especially as they age. There’s also research showing that athletes who did heavy training took 15-25 grams of creatine monohydrate (the most common form of creatine supplement) for 4 - 12 weeks. They didn’t report any side effect.
Benefits of Creatine Supplementation
Taking creatine as a dietary supplement - particularly creatine monohydrate - has potential benefits for athletes and those engaging in short-duration but high-intensity exercises. These benefits range from better performance and muscle size to brain health.
- Helps increase muscle size: Creatine builds muscle mass by increasing the formation of new proteins. Creatine supports your goals of increasing muscle in a short period when you combine it with resistance training workouts. Creatine itself draws water into muscle cells, leading to growth.
- Gain strength: Muscle strength declines with age, in addition to the loss of muscle. A review that paid special attention to creatine for diseases related to brain aging found that it may have positive effects on muscle strength.
- Improves exercise tolerance in heat: Exercising in hot environments can decrease your performance.
- May slow the progression of neurological diseases: These conditions include Amyotrophic Lateral sclerosis (ALS), Duchenne Muscular Dystrophy (DMD), and Parkinson’s Disease.
- Cognitive Function: Effects of Creatine Supplementation on Brain Function and Health.
Creatine Loading and Maintenance
A “creatine loading phase” means consuming a high dose of creatine in a short period for up to one week, followed by a lower maintenance dose. The purpose of a loading phase is to rapidly fill your muscles with creatine to maximize your performance. Many fitness enthusiasts follow a loading phase, although note that this is not necessary. The loading phase is then followed by a maintenance phase, with a daily dose of 3-5 grams to maintain optimal creatine levels. The final phase is the pause phase, which means you stop taking creatine supplements for 2-4 weeks.
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Potential Side Effects
For those who take creatine, the most commonly reported side effect is weight gain due to water being drawn into your muscles. A weight gain of 2-4.5 pounds is especially noticeable during a creatine loading phase wherein you take higher dosages. Digestive issues may also occur. Yes, studies reveal that creatine supplements lead to water retention, which is only temporary. This bloating is more noticeable during the first few days of taking creatine.
Who Can Benefit from Creatine?
Older adults who do resistance training or need help improving their cognition may benefit from taking a creatine supplement. Yes, creatine can also benefit females. Creatine is a safe way to increase your exercise performance, build muscle, and even boost brain function.
Combining Creatine and Keto
Yes, you can use creatine with a ketogenic diet. Supplementing with creatine provides numerous benefits for health and performance, especially when combining a ketogenic diet with exercise.
Benefits of Creatine on Keto
- Enhanced Athletic Performance: Creatine helps improve athletic performance and muscle building ability. When there is more creatine in the body, more phosphocreatine (PCr) becomes available for high-intensity, short burst muscle contractions.
- Muscle Maintenance: Our bodies naturally create creatine, but as we age these levels can naturally decline. Creatine helps maintain muscle mass, which can be particularly important when on a ketogenic diet.
- Brain Health: Creatine plays a role in brain function and health.
Types of Creatine to Consider
Different creatine supplements exist on the market, but creatine monohydrate is the most popular among users and the one that’s commonly mentioned in research studies. Kre-Alkalyn, a patented pH-corrected form of creatine, is another option. Like creatine, Kre-Alkalyn improves athletic performance and muscle building ability. Studies show that Kre-Alkalyn is the best form of creatine.
Potential Considerations
- Water Retention: Creatine supplements lead to water retention, which is only temporary. This bloating is more noticeable during the first few days of taking creatine.
- Purity of Supplement: As long as your creatine supplement does not contain prohibited substances, it will not result in a failed drug test. That being said, it’s important that you carefully choose a creatine product.
Additional Supplements for Keto
While supplements are not required when you’re on a ketogenic diet, supplements can greatly enhance the quality of your ketogenic diet while contributing to positive overall health. As you’ve now learned, whole foods are the first source of nutrients for your keto lifestyle, while supplements should aim to bridge the gaps in your nutrition and optimize your diet.
- Krill Oil: Krill Oil gives the body the essential nutrients found in omega-3 fats, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), that it needs. Krill oil helps to decrease inflammation within the body, fight off the keto flu, lower LDL (bad cholesterol) levels, and increase overall body health.
- L-Glutamine: L-Glutamine is clinically proven to improve digestive health, reduce inflammation, enhance muscle recovery, boost endurance, and reduce soreness from exercise.
- Vitamin D: Vitamin D is an integral component of overall health and wellness. Studies have proven that individuals with low vitamin D concentrations have a direct correlation with obesity.
- Electrolytes: When you’re on a ketogenic diet, electrolyte imbalances can occur due to the depletion of glycogen from the consumption of more fat for energy. One of the best supplements for the keto diet is Magnesium. Being deficient in magnesium can also mean that you’re deficient in potassium.
- Probiotics: Several have shown that probiotics can enhance weight loss, improve brain function, and boost your immune system.
- MCT Oil: Medium-chain triglycerides, or MCT, is the kind of fat that is most abundant in MCT oil. Keto dieters often use MCT oil because of its ability to boost your natural ketone production.
Potential Side Effects of Keto
Although the ketogenic diet is usually safe for most healthy people, there may be some initial side effects while your body adapts. There’s some anecdotal evidence of these effects often referred to as the keto flu. Based on reports from some on the eating plan, it’s usually over within a few days. Reported keto flu symptoms include diarrhea, constipation, and vomiting. Other less common symptoms include:
- Poor energy and mental function
- Increased hunger
- Sleep issues
- Nausea
- Digestive discomfort
- Decreased exercise performance
To minimize this, you can try a regular low carb diet for the first few weeks. This may teach your body to burn more fat before you completely eliminate carbs. A ketogenic diet can also change the water and mineral balance of your body, so adding extra salt to your meals or taking mineral supplements may help. Talk to your doctor about your nutritional needs. At least in the beginning, it’s important to eat until you’re full and avoid restricting calories too much. Usually, a ketogenic diet causes weight loss without intentional calorie restriction.
While the keto diet has its benefits, staying on it in the long term may have some negative effects, including risks of the following:
- Low protein in the blood
- Extra fat in the liver
- Kidney stones
- Micronutrient deficiencies
A type of medication called sodium-glucose cotransporter 2 (SGLT2) inhibitors for type 2 diabetes can increase the risk for diabetic ketoacidosis, a dangerous condition that increases blood acidity. Anyone taking this medication should avoid the keto diet. More research is being done to determine the safety of the keto diet in the long term. Keep your doctor informed of your eating plan to guide your choices.