Navigating Protein Intake on a Ketogenic Diet: Striking the Right Balance

The ketogenic diet, or "keto," a low-carbohydrate, high-fat eating plan, has gained considerable attention as a potential weight-loss strategy. It has been used for centuries to treat specific medical conditions, including controlling diabetes in the 19th century and as an effective treatment for epilepsy in children since 1920. The premise of the ketogenic diet for weight loss is that if you deprive the body of glucose-the main source of energy for all cells in the body, which is obtained by eating carbohydrate foods-an alternative fuel called ketones is produced from stored fat (thus, the term “keto”-genic).

Understanding Nutritional Ketosis

Nutritional ketosis is a powerful metabolic state in which your body primarily burns fat and ketones rather than glucose for fuel. This occurs when dietary carbohydrate intake is reduced below your personal threshold of carbohydrate tolerance. Once ketosis is achieved and maintained, the metabolic benefits are bountiful: safe and effective weight loss, reduced hunger and cravings, decreased inflammation, lower and more stable blood sugar, and beyond.

The length of time it takes a person to adapt to nutritional ketosis varies from one individual to the next, as each person has a unique biochemistry and varying degrees of metabolic damage needing repair. With very rare exceptions, it is possible for everyone to enter nutritional ketosis. In fact, all of us are exposed to nutritional ketosis as newborn infants if we are exclusively breastfed.

Common Mistakes Interfering with Ketosis

If weeks or even months have passed and you are still struggling, you may be falling prey to one of these common mistakes that can interfere with nutritional ketosis.

Mistake #1: Too Much Protein, Not Enough Fat

A well-formulated ketogenic diet is moderate, NOT HIGH, in protein. Protein has a moderate insulin-stimulating effect, and although it’s less than the impact from a similar amount of carbohydrates, it can interfere with ketone production by the liver when consumed in excess. Most healthy individuals require between 1.5 and 1.75 grams of protein per kg of ‘reference body weight’ to maintain lean body mass and function during a ketogenic diet. Intakes above 2.0 g/kg reference weight show no additional benefit.

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It is common for people consuming a ketogenic diet to think they are consuming protein in moderation when they are actually well above this in reality. When hunger strikes, it’s just easy to grab a protein source for a fix -- nuts and cheese are among the most satisfying low carbohydrate snacks, especially if your dietary fat intake is inadequate. Calories from FAT should make up the majority of your dietary intake in order to feel adequately satisfied. While dietary fat is typically associated with protein-rich foods (like those nuts and cheeses, as well as eggs and meats), ultimately, even the fattiest protein sources will fail to provide satiety while staying within your recommended personal protein goal. Adding fats like olive oil, butter, cream, coconut, or canola oils to meals without being accompanied by extra protein is critical to achieve both satiety and nutritional ketosis. If you remain fearful of adding dietary fat to your meals, now is the time to critically re-evaluate those fears.

Mistake #2: Choosing the Wrong Kinds of Fat

When it comes to consuming dietary fat, it’s not only about quantity, but quality, too. Fat is essential and two of its primary functions in humans are: 1) as a fuel source, particularly when “keto-adapted,” and 2) to build and maintain vital membranes for all the cells in the body.

On a ketogenic diet, monounsaturated and saturated fats should provide the majority of your dietary fat intake to supply the body with energy, as the body prefers to use these types of fats for fuel. Monounsaturated and saturated fat sources are both readily available and delicious. Monounsaturated fats are found in abundance in certain oils such as olive, avocado, and canola, as well as in some animal fats such as lard. Saturated fats are naturally concentrated in most animal fats such as dairy fat, beef (suet), and lamb, as well as “tropical oils” (e.g., coconut and palm oil). Dietary saturated fats are readily burned off to be used for fuel (i.e., they won’t accumulate in your blood) when a person is keto-adapted.

Polyunsaturated fats, on the other hand, are only required in small quantities and are not well-tolerated in large amounts. Therefore, highly concentrated sources such as most vegetable oils should be limited and avoided whenever possible. Common sources of polyunsaturated fat include soybean, corn, sunflower, safflower, cottonseed, and peanut oils. Note, however, that high monounsaturated versions (also called ‘high oleic’) of safflower, sunflower and even soybean oils are coming into the market; and this will make avoiding excess omega-6 fats both easier and more economical.

That being said, two sub-classes of polyunsaturated fats, omega-6 and omega-3, are essential to consume in small amounts for the purposes of membrane health, as our bodies cannot naturally make them. To consume the recommended amount of omega-3 fatty acid, eat 3 servings of cold-water ocean fish per week (even canned tuna is OK) or take at least 1 gram of fish oil daily (or flaxseed oil if you are vegetarian or vegan). In contrast, the absolute requirement for omega-6 is minor compared to what the average American eats, so even on a low fat diet it would be quite hard not to get enough. Consuming excess omega-6 fats, however, will lead to stomach and intestinal upset and possibly increase inflammation.

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Finally, avoid artificial trans fats all together, such as commercial shortening and margarine, as they are strongly linked to coronary artery disease.

Mistake #3: Not Enough Salt

After decades of the media propagating low sodium diets, do you find yourself actively avoiding salt? If so, you may be susceptible to the common pitfall of not consuming enough of this critical mineral, putting you at risk for some pesky side effects.

Current US dietary guidelines recommend 2300 mg of sodium per day. However, recent research published in mainstream journals like the New England Journal of Medicine highlights that consuming 2300 mg or less of sodium daily actually increases mortality in the general healthy adult population; in fact, for optimal health, most of us need anywhere between 4000-5000 mg of sodium per day -- and that’s for people consuming standard diets containing appreciable amounts of carbohydrate.

On a ketogenic diet, consuming adequate sodium becomes all the more critical, as the rate of sodium excretion by the kidneys into the urine increases quite significantly while in nutritional ketosis. This means that most people on a ketogenic diet need to consume closer to 5000 mg (i.e., 5 grams) of sodium -- which equals 12 grams of salt -- per day in order to maintain an adequate balance. Starting in just the first few days of adapting to nutritional ketosis, neglecting to consume 5 grams of sodium can put your circulatory system into disarray and trigger the notorious “keto flu” symptoms: headaches, dizziness, lightheadedness, fatigue and constipation. And here’s an important point: this daily need for 5 grams of sodium continues as long as one remains in nutritional ketosis; it’s not just a temporary need during keto-adaptation as some bloggers would have you believe.

Fortunately, you can keep these symptoms at bay and improve your overall well-being and function by simply salting your food moderately and consuming 2 servings of broth or bouillon daily. For most people, this results in about 3 grams of sodium from regular food plus 2 grams from broth, totaling 5 grams per day. Keep in mind that salt and sodium are not the same -1 teaspoon of salt is the equivalent of 5 grams of salt but contains only 2.3 grams of sodium (the rest is chloride).

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Note: please consult a medical professional if you have high blood pressure or fluid retention due to congestive heart failure or kidney problems to determine the right dietary sodium intake for you.

Mistake #4: Stagnant "Macro Ratios”

There are three major macronutrients (or “macros”) that supply humans with energy (calories) from foods: carbohydrate, fat, and protein. On a well-formulated ketogenic diet, your daily energy needs should be satisfied by approximately 5-10% carbs, 70-80% fat, and 15-20% protein.

What people frequently overlook is the fact that when you initially begin a ketogenic diet and are losing weight, a significant portion of that 70-80% of energy from fat will actually come from burning your own body fat stores from adipose tissue-so it’s NOT entirely from dietary sources. Later down the road as you approach “weight maintenance” and are aiming to remain weight-stable while keeping your energy levels high and metabolic health at optimum, the fat needed to supply your daily energy will have to come from your food. After all, in this scenario you no longer have as much excess fat to lose!

Although your intake of dietary fat will need to increase, no matter if it’s Day 1 or Day 500, you will continue consuming approximately the same, moderate amount of protein in addition to non-starchy vegetables (your main source of carbohydrates plus essential vitamins and minerals). Depending on your personal health goals, and particularly how well your initial diabetes or prediabetes is held in reversal, some people may be able to increase their carbohydrate intake somewhat in maintenance.

So while it seems counterintuitive for someone wanting to stay slim, you will need to eat more fat as you approach and then achieve weight maintenance. This means that you can give yourself permission to increase your consumption of the tasty, “right” types of fats discussed above, which will become a cornerstone of your success.

Mistake #5: “Needing” to Fast

You may have noticed a recent frenzy of people advocating fasting as potent tool for rapid weight loss, enhancing ketone levels and increasing life span. But think twice before deliberately enduring calorie-free days. Much of the research supporting these benefits has been done in mice. Well-done human research on the long-term safety and efficacy of fasting raises important concerns, particularly if one chooses to fast longer than one day. Fasting for more than 2 days can lead to lean tissue loss and even a permanent reduction in reduction resting metabolism, among other significant health concerns.

Of particular concern to us is when periods of fasting, whether short or long, are performed by people taking medication for diabetes or high blood pressure.

The Role of Protein on Keto

The ketogenic diet typically reduces total carbohydrate intake to less than 50 grams a day-less than the amount found in a medium plain bagel-and can be as low as 20 grams a day. Generally, popular ketogenic resources suggest an average of 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. For a 2000-calorie diet, this translates to about 165 grams fat, 40 grams carbohydrate, and 75 grams protein. The protein amount on the ketogenic diet is kept moderate in comparison with other low-carb high-protein diets, because eating too much protein can prevent ketosis.

Gluconeogenesis: The Conversion of Protein to Glucose

If you eat too much protein while following a low carb diet, your body can actually start to produce glucose from the excess amino acids through a process called gluconeogenesis. Because your body prefers to use carbohydrates as its source of energy, it will do anything it can to get enough glucose.

Keto and low-carb experts recommend that the average person consume between 1.5 and 2.0 grams of protein per kilogram of body weight, or about 0.7 to 0.9 grams per pound of body weight. This amount of protein will give your body the protein it needs to maintain your muscle mass and improve body composition without causing weight gain.

The Myth of Excess Protein and Ketone Levels

Many low-carb, high-fat advocates believe excess protein can turn into sugar in your bloodstream through a process called gluconeogenesis and knock down your ketone levels. After all, the body produces ketones from fat, so you should keep carbs and protein down to a minimum, right? On the other hand, eating protein won’t affect your ketone levels. GNG is a real and necessary process that is already happening in your body. It’s not the enemy of ketosis.

Think about GNG this way: It’s how your body creates new sweet wine for your body. GNG is an extremely stable process. When you eat extra protein, your blood glucose doesn’t spike the same way. Eating adequate amounts of protein is beneficial on the ketogenic diet.

Benefits of Adequate Protein Intake

• Preventing hypoglycemia: Your glucose levels can never drop to zero, even in ketosis.
• Fueling tissues that can’t use ketones: There are a handful of cells in your body that can only use glucose to survive, including red blood cells, kidney medulla (inner part of the kidney), testicles, and some portions of your brain. Ketones can cover up to 70% of your brain’s energy needs, while the glucose from GNG covers the rest. The other organs can’t metabolize ketones at all.
• Resupplying glycogen stores: You can replenish muscle glycogen through the GNG that happens during ketosis - at least if you’re not a professional athlete or participate in competitions.
• Neuron atrophy: Your brain needs amino acids to function optimally.

Determining Your Optimal Protein Intake

Each one of these variables will affect how much insulin and glucagon you secrete in response to protein consumption. With that being said, you don’t have to plug all of these factors into a complex algorithm to figure out how much protein can get away with eating. However, using either one of these methods will not tell you your maximum keto protein limit.

1. Eat less than 35 grams of carbs a day for a week, following the protein intake recommendations that you get from the previous section or our keto calculator.
2. If your ketone levels are at 1.5 mmol/L or above (this is considered as being optimal for keto dieters), increase your protein intake gradually (i.e., have an extra serving or two of high-protein foods per day) over the next week. How many grams of protein can you eat per day before your ketone levels drop below 1.5 mmol/L?
3. On the other hand, if your blood ketone levels are below 1.5 mmol/L, make sure you are eating fewer than 35 grams of carbs. Keep measuring your ketones for a few days, and if you’re always in optimal ketosis, you have found your ketosis protein limit.

As you can see, this process is pretty intricate and requires a great deal of awareness and experimentation.

Signs of Excessive Protein Intake on Keto

1. When we first start producing ketones, many of us exhale acetone until our body gets more efficient at ketone production. Though this usually happens when we first start keto, it can also occur when we eat so much protein or carbs that it kicks us out of ketosis. Another clue that your protein intake is too high is if your breath starts to smell like ammonia. This compound is a natural by-product of protein metabolism that is typically released in your urine.

2. Another sign that your body is restarting its journey to ketosis is if you are experiencing keto flu symptoms again.

High-Protein, Low-Carb Foods

Some examples of high-protein, low-carb foods include:

• Meats, including poultry, fish, and red meat (heart-healthy options such as salmon, mackerel, anchovies, sardines, and herring).
• Eggs
• Healthy fats and oils such as avocados and olive oil
• Low-carb vegetables such as broccoli, kale, spinach, and cucumbers
• Cheese
• Nuts
• Cauliflower rice
• Beans, legumes, and lentils
• Greek yogurt
• Tofu and tempeh
• Lower-carb fruits such as raspberries and blackberries

Potential Benefits of High-Protein, Low-Carb Diets

• Weight loss. High-protein diets can help you stay full after eating and lower cravings, which can help you lose weight. But some of the short-term weight loss is often due to losing water from cutting out carbs.
• Blood sugar control. Low-carb diets can help you control your blood sugar levels and manage diabetes and prediabetes.
• Maintaining and building muscle. While some diets can lead to reduced muscle mass, you can maintain and build muscle while losing weight by increasing your protein intake.

Potential Risks of High-Protein, Low-Carb Diets

• High cholesterol. Some protein sources - such as fatty cuts of meat, whole dairy products, and other high-fat foods - can raise cholesterol, increasing your chance of heart disease.
• Nutrient gaps. Because carbohydrates include many food groups (like fruits and vegetables), you face a higher risk of missing out on certain nutrients when you cut carbs.
• Kidney problems. If you have any kidney problems, eating too much protein puts added strain on your kidneys. This could worsen kidney function.
• Osteoporosis and kidney stones. When you’re on a high-protein diet, you may urinate more calcium than normal. There are conflicting reports, but some experts think this could make osteoporosis and kidney stones more likely.
• Constipation concerns, as a low-carb, high-protein diet can lower your fiber intake and lead to constipation

Who Should Avoid High-Protein, Low-Carb Diets?

Certain groups should avoid high-protein, low-carb diets due to related health risks. She suggests avoiding a high-protein, low-carb diet if you have certain conditions and health issues, such as:

• Kidney disease or kidney issues, as too much protein strains your kidneys
• History of disordered eating or eating disorders, as low-carb diets promote restrictive eating
• Pregnancy or breastfeeding, as nutrient-dense diets are critical during these stages

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