A keto or ketogenic diet, characterized by its low-carb, moderate protein, and higher-fat composition, can be a valuable tool for individuals undergoing testosterone replacement therapy (TRT) who are aiming to manage or reduce weight. Research indicates that ketogenic diets have an indirect impact on testosterone levels. However, a diet prioritizing fat intake can contribute to overall well-being for men on TRT by promoting healthy cholesterol levels, weight management, and inflammation reduction.
Understanding the Ketogenic Diet
When following a low-carb diet, the body primarily uses fat as its main energy source instead of carbohydrates. The liver breaks down fatty acids into ketones, which serve as the fatty equivalent of energy. While carbohydrates provide glucose to fuel the body and brain, fat provides ketones to fuel these functions in the absence of glucose.
In recent years, keto or low-carb diets have gained popularity among doctors due to their observed positive effects on patients, including reversing diabetes, correcting hypertension, reducing inflammation and chronic pain, improving cognitive scores, and improving HDL/LDL cholesterol scores.
Contrary to initial assumptions, consuming fatty foods does not necessarily lead to increased "bad" cholesterol levels or clogged arteries. The body naturally regulates cholesterol levels, flushing out excess LDL as more HDL enters the bloodstream.
Keto for Weight Loss
The ketogenic diet has emerged as a prominent weight loss strategy in the health and fitness domain. Losing weight can contribute to elevating the body's testosterone levels, making keto a potentially beneficial approach for individuals with low testosterone.
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Some individuals may find it challenging to maintain keto as a long-term lifestyle diet. However, committing to keto for a shorter period, such as 1-2 months, can be an effective strategy for weight loss and maintenance. This approach can also help mitigate common keto side effects associated with rapid weight loss, such as dizziness, headaches, irritability, and insomnia, collectively known as the "keto flu." These symptoms arise from glycogen loss, low insulin levels, dehydration, and impaired metabolic flexibility.
Chronic low-carb, high-fat diets may lead to the release of toxic lipophile fats throughout the body, but proper management and adjusting fat-to-carb ratios can minimize these risks.
Managing Keto Flu
Like any dietary change, keto flu can be managed through adequate hydration and electrolyte intake, such as consuming waters with high pH levels.
It may take several weeks for the body to adapt to using ketones for fuel, but once this adaptation occurs, the body enters full keto-adaptation.
Cholesterol and Testosterone Production
Hormone-producing glands rely on cholesterol to produce hormones like estrogen, testosterone, and cortisol. Cholesterol is a vital chemical that supports various bodily functions, including maintaining cell structure and fluidity.
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The liver converts cholesterol into bile acids, which aid in processing fat and absorbing essential vitamins like A, D, E, and K.
Testosterone production begins in the testicles, with cholesterol serving as the fuel. Through brain signals that release stimulating hormones (LH and FSH), Leydig cells in the testicles convert cholesterol into testosterone. These cells obtain the necessary cholesterol from the bloodstream.
As men age, Leydig cells may experience impaired conversion, leading to decreased testosterone production, a condition known as hypogonadism. Medical researchers believe that imbalances or changes in chemical reactions within cells contribute to this impaired conversion, resulting in DNA, protein, or lipid damage and subsequent functional changes.
Keto and TRT: Synergistic Effects
When combined with TRT, adopting a keto or hybrid keto diet can enhance overall well-being by stabilizing the body's BMI and improving athletic performance. A low-carb diet can also indirectly improve TRT outcomes by mitigating potential side effects from conditions like prediabetes, high blood pressure, or high cholesterol.
A well-formulated ketogenic diet is generally safe for the heart, and research suggests that dietary cholesterol does not raise blood cholesterol or clog arteries. While elevated LDL (bad cholesterol) is a concern, studies indicate that keto does not interfere with statins or other medications.
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If LDL levels are elevated while on keto, adjustments to the keto plan can help reduce LDL and promote HDL. Strategies include intermittent fasting, reducing saturated fat intake, switching from saturated to unsaturated fats, and increasing fiber consumption.
Impact on Blood Sugar and Cortisol Levels
A ketogenic diet can benefit individuals with type 2 diabetes or blood sugar issues by maintaining glucose levels at a low but manageable range.
A low-carb diet can minimize large blood sugar spikes, reducing the need for insulin and allowing the body to "reset." High blood sugar contributes to chronic inflammation due to increased stress on the body.
Cortisol, another hormone, is physiologically linked to stress and testosterone. As cortisol levels rise, testosterone levels tend to decrease. Elevated glucose and cortisol levels can inflame organs, potentially leading to cardiovascular, kidney, and periodontal diseases.
A low-carb keto diet can alleviate the physical and emotional stress associated with blood sugar fluctuations. By normalizing blood sugar levels, less cortisol is released, reducing stress on the adrenal glands and promoting testosterone production.
In essence, reducing sugar intake can lower cortisol production, which in turn supports the body's ability to produce more testosterone.
Keto and Fatty Liver Disease
While concerns exist regarding the amount of fatty acids keto sends through the liver, a high-fat, low-carb diet has demonstrated the potential to reverse fatty liver disease. As the body enters ketosis, it transitions from burning glycogen to burning fat, naturally reducing the volume of fatty acids. However, consulting with a healthcare provider is crucial before starting keto for individuals with liver disease.
Low testosterone is strongly linked to inflammation and insulin resistance. Researchers have found that normalizing testosterone through TRT can help balance metabolism disorders and liver function. Studies have confirmed the impact of androgen (T) on liver function and the higher prevalence of low T in men with NAFLD.
Historical Context and Variations of Keto
Dr. Russell Wilder at the Mayo Clinic originally designed the ketogenic diet in 1923 for treating epilepsy. All keto diets are variations of the classic keto diet, which is characterized by a strict ratio of fat to protein and carbs, known as the macronutrient ratio.
Key Steps to Achieving Ketosis
To reach ketosis, it's essential to consume low-carb foods such as meat, fish, eggs, vegetables, and natural fats like butter or olive oil. Unprocessed meats are generally low in carbs and nutrient-rich. Fish and seafood, particularly fatty fish like salmon, tuna, sardines, mackerel, and herring, are excellent choices. Eggs are versatile and can be prepared in various ways.
Vegetables, especially those that grow above ground like leafy greens, cauliflower, cabbage, avocado, broccoli, and zucchini, are crucial for their fiber content. High-fat sauces and oils like olive oil or coconut oil are encouraged for cooking.
Butter and high-fat cheeses are acceptable in moderation, but milk should be limited due to its sugar content. Nuts like macadamia or pecan nuts are preferable to cashews due to their lower carb content. Berries can be consumed in moderation.
Potential Negative Effects and Management
During the keto adaptation period, individuals may experience side effects like headache, tiredness, muscle fatigue, cramping, and heart palpitations as the body adjusts to using fat and ketones for fuel.
These side effects are typically short-term and can be managed by staying hydrated and consuming enough electrolytes. Adjusting carb intake slightly, from 5-10% to 10-20%, may improve comfort without significantly impacting ketosis and testosterone levels.
Completely eliminating sugar and starches is crucial for initiating ketosis. While initial rapid weight loss may be primarily water weight, it's an important first step.
Keto for Endurance Athletes
Contrary to the belief that high-protein, high-carb diets are necessary for high-level training, studies have shown promising results for endurance athletes using a keto diet. Performance and nutritional profiles were not negatively impacted, and lipid profiles actually improved, indicating that the body can effectively use fat ketone energy to fuel high-intensity training.
Debunking Myths and Misconceptions
Claims that eating more meat, meat-only diets, or raw meat can boost men's health, increase testosterone naturally, or improve fertility are not supported by evidence. While carnivore and keto diets may aid weight loss, concerns exist regarding their ability to provide sufficient nutrients for overall health. Fruits, vegetables, and whole grains, essential sources of vitamins and fiber, are limited in the keto diet and absent in the carnivore diet.
Studies suggest that consuming unprocessed meat does not negatively impact sperm health, while fish, shellfish, fruit, and vegetables have been consistently associated with improved sperm counts and quality.
Cooking meat is essential for eliminating pathogens, despite potential impacts on some nutrients.
Variations of the Ketogenic Diet
- Cyclical Keto: This involves following the keto diet for 3-6 days, then deviating with a higher carb intake on "off" days. However, it may take 2-3 days to return to ketosis after a high-carb day, which can be expedited through intense workouts.
- Dirty Keto: This involves consuming processed meat and pre-packaged convenience foods with unhealthy levels of sodium and additives, which should be avoided.