Ketogenic Diet: Is The Ultimate Low-carb Diet Good For You?
Recently, many of my patients have been asking about a ketogenic diet. Is it safe? Would you recommend it? Despite the recent hype, a ketogenic diet is not something new. In medicine, we have been using it for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins popularized his very-low-carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. Over the years, other fad diets incorporated a similar approach for weight loss. What is a ketogenic diet? In essence, it is a diet that causes the body to release ketones into the bloodstream. Most cells prefer to use blood sugar, which comes from carbohydrates, as the body’s main source of energy. In the absence of circulating blood sugar from food, we start breaking down stored fat into molecules called ketone bodies (the process is called ketosis). Once you reach ketosis, most cells will use ketone bodies to generate energy until we start eating carbohydrates again. The shift, from using circulating glucose to breaking down stored fat as a source of energy, usually happens over two to four days of eating fewer than 20 to 50 grams of carbohydrates per day. Keep in mind that this is a highly individualized process, and some people need a more restricted diet to start producing enough ketones. Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical American diet. One of the main criticisms of this diet is that many people tend to eat too much protein and Continue reading >>
Dr. Tamsin Lewis: Dangers Of Ketogenic And Low-carb Diets, And Why Females Are Higher Risk
We are joined by Dr. Tamsin Lewis, who’s become a new mom since her last appearance on EP! Read Tamsin’s pregnancy blog, mentioned on the show. You can hire Tamsin for a health consultation at Curoseven.com. This episode investigates the risks and dangers of going to low carb, and advises athletes to assess their health via blood tests, consulting with professionals, etc, before taking on any extreme diets. 1. What are the risks of going too low carb or keto; problems you can create with these diets? 2. Who should avoid extreme low carb and ketosis (<50g/day)? 3. Take home: Finding health, finding balance Defining ketosis – similar to starvation mode – use mainly fat and protein for energy – eating <50 g CHO/day – exogenous forms of ketones What are the potential risks of going too low carb or keto; problems you can create with these diets? Gastrointestinal issues – constipation, diarrhea, pain, bloating, etc – disrupting the microbiota, epigenetics, and is keto the preferred diet for you? Female specific issues – problematic for supporting a healthy female hormone environment (disruption; depletion) – high cortisol & the pregnenalone steal – signal that body is in high stress state – can create thyroid problems – TSH increase; T3, T4 decrease – cortisol up, progesterone down; menstrual irregularities – potential loss of cycle or irregular period with too low carb – importance of diet during the luteal phase – psychological issues; anxiety and depression – caloric restriction/low-calorie mistakes – infertility and pregnancy complications – anecdotal evidence of: low-carb great at first, weight loss, etc, then you crash and hormones go crazy, get depleted, etc – Can males suffer from similar hormonal and health issues as females? Continue reading >>
The Beginners Guide To Ketosis: Investigating Low-carb, High-fat Eating
The only hard and fast rule of health is that health is personal and what works well for one person may not work for someone else. Aside from that rule, there are “frameworks” that seem to benefit large groups of people. One more level down from that are alternative strategies that benefit smaller groups. Ketosis is likely one of those alternative strategies that works well for certain, smaller groups of people. So, right off the bat I want you to understand that Ketosis might not be for everyone. I’m going to lay out the case for potential benefits of Ketosis. If it sounds interesting and beneficial to you, then consider trying it. (see our free cheat sheet to help you). What is Ketosis Ketosis occurs when liver glycogen gets depleted and the body burns fatty acids for fuel. The primary driver of this state is a very low carbohydrate intake. Often, it also requires a low protein, higher fat intake. You can also achieve a state of ketosis by not eating altogether. The creation of ketones is a byproduct of this metabolic state. Ketones are a source of fuel, just as glucose is a source of fuel. Ketones tend to have some added benefits, though. What role does Ketosis play in human health? Ketosis allows our bodies to function in the absence of carbohydrates, both physically and mentally. Instead of burning carbohydrates, or converting protein to glucose, the body burns ketones. This is pretty much a survival mechanism. It allows your body to function in a state of caloric deprivation. This is why ketosis often gets bad press (as it’s linked to “starvation”). Being a survival mechanism doesn’t make it invalid as a strategy, though. There can still be potential benefits to be had. Let’s cover a few of them… Ketosis and Accelerated Fat Loss Being in ketosis Continue reading >>
Why Dka & Nutritional Ketosis Are Not The Same
There’s a very common misconception and general misunderstanding around ketones. Specifically, the misunderstandings lie in the areas of: ketones that are produced in low-carb diets of generally less than 50 grams of carbs per day, which is low enough to put a person in a state of “nutritional ketosis” ketones that are produced when a diabetic is in a state of “diabetic ketoacidosis” (DKA) and lastly, there are “starvation ketones” and “illness-induced ketones” The fact is they are very different. DKA is a dangerous state of ketosis that can easily land a diabetic in the hospital and is life-threatening. Meanwhile, “nutritional ketosis” is the result of a nutritional approach that both non-diabetics and diabetics can safely achieve through low-carb nutrition. Diabetic Ketoacidosis vs. Nutritional Ketosis Ryan Attar (soon to be Ryan Attar, ND) helps explain the science and actual human physiology behind these different types of ketone production. Ryan is currently studying to become a Doctor of Naturopathic Medicine in Connecticut and also pursuing a Masters Degree in Human Nutrition. He has interned under the supervision of the very well-known diabetes doc, Dr. Bernstein. Ryan explains: Diabetic Ketoacidosis: “Diabetic Ketoacidosis (DKA), is a very dangerous state where an individual with uncontrolled diabetes is effectively starving due to lack of insulin. Insulin brings glucose into our cells and without it the body switches to ketones. Our brain can function off either glucose or fat and ketones. Ketones are a breakdown of fat and amino acids that can travel through the blood to various tissues to be utilized for fuel.” “In normal individuals, or those with well controlled diabetes, insulin acts to cancel the feedback loop and slow and sto Continue reading >>
Is Ketosis Dangerous?
Duck Dodgers October 14, 2014 Peter, An article by Per Wikholm was published in this month’s LCHF Magasinet, where Per demonstrates that the Inuit could not have been in ketosis given that the scientific literature is abundantly clear, over and over again, that the Inuit consumed too much protein, and more importantly, Per debunks Stefansson’s claims for high fat with writing from his own books—Stef admitted in the pemmican recipes that Arctic caribou was too lean to make pemmican that supported ketosis. The most popular LCHF bloggers in Sweden, Andreas Eenfeldt/Diet Doctor and Annika Dahlquist have reluctantly agreed with Per’s findings—admitting that the Inuit were likely not ketogenic from their diet. I’ve put together a comprehensive review of the scientific literature regarding the Inuit, encompassing over two dozen studies, spanning 150 years, with references from explorers, including Stefansson. In the comments section of that post, Per gives a brief overview of how he was able to prove Stefansson’s observations on high fat intake were flawed. The post is a review of all the available literature that I could find (over two dozen studies). But, the literature certainly does not in any way support ketosis from the Inuit diet due to such high protein consumption. As Per (and Stefansson) points out, the caribou is too lean and as the many quotes show, the Inuit were saving their blubber and fat for the long dark Winter to power their oil lamps and heat their igloos. Again and again, we see that in the literature, as even Stefansson admits this. As far as glycogen is concerned, their glycogen intake is probably not worth scrutinizing given the well-documented high protein consumption in every published study. It really is besides the point. But, interest Continue reading >>
Adverse Reactions To Ketogenic Diets: Caution Advised
As the ketogenic diet gains popularity, it’s important to have a balanced discussion regarding the merits of this diet. Let me emphasize right out of the gate that this is not a diet without merits (excuse the double negative); in fact, it has significant therapeutic potential for some clinical pathologies. However, it is also a diet with inherent risk, as evidenced by the extensive list of adverse reactions reported in the scientific literature—and this has not yet been a thorough enough part of the public discussion on ketogenic diets. The AIP Lecture Series is a 6-week video-based, self-directed online course that will teach you the scientific foundation for the diet and lifestyle tenets of the Autoimmune Protocol. This is the first of a series of articles discussing various facets of a ketogenic diet with an inclination toward balancing the discussion of the pros and cons of this high-fat, low-carb, low/moderate-protein diet. My interest in this topic stems from concerns I have over its general applicability and safety, simultaneous with its growing popularity. I feel a moral and social obligation to share what I understand of these diets, from my perspective as a medical researcher. The dangers of a ketogenic diet was, in fact, the topic of my keynote presentation at Paleo F(x) this year (links to video will be provided once available). This series of articles will share the extensive research that I did in preparation for this presentation, including all of the topics covered during my talk as well as several topics that I didn’t have time to discuss (also see the free PDF Literature Review at the bottom of this post). For every anecdotal story of someone who has regained their health with a ketogenic diet, there’s a counterpoint story of someone who derai Continue reading >>
How Too Much Protein Is Bad For Ketosis
One of the well-known mantras of the ketogenic diet is very low carb intake and high fat intake. But there’s another nutrient that’s important to monitor when going keto—and a lot of people make the mistake of not considering its importance. That would be protein. Although protein is a critical element in the diet we need for optimal health, it’s important to not eat TOO much protein on the ketogenic diet. Why? Well, there are a couple reasons that we’ll be discussing below. How Too Much Protein is Bad for Ketosis The biggest energy source on the ketogenic diet is fat. In fact, around 75% of your diet should come from healthy fat sources. The key here is that, unlike the traditional idea of low-carb diets where protein is higher, protein intake should bemoderate, not high, on keto. Not following this advice will never allow your body to enter ketosis, which is the main point of going keto and reaping all of the amazing benefits. The reason too much protein is bad for ketosis is because our bodies have a fundamental energy process called gluconeogenesis. For a deeper dive into the topic, see our post on fixing the biggest ketosis mistakes. For now we shoud know the basics. Let’s break it down this mouthful of a term. The word gluconeogenesis has three parts to it, Gluco – coming from the greek root glukos – literally meaning “sweet wine.” Neo – “new” Genesis – “creation” So a great way to think about it is this is how your body creates new sweet wine for your body. Some people tout that “you don’t need carbohydrates to survive,” which is only partially true. To clarify, you don’t need to eat any carbs to survive, but make no mistake, your body needs carbs in the form of glucose and glycogen, and it will get this via survival mechan Continue reading >>
Is A Ketogenic Diet Good Or Bad For You?
A ketogenic diet is well known for being a low-carb diet, where the body produces ketones, which are byproducts or the result of using fat for fuel instead of carbs (or glucose/sugar). These ketones or byproducts are produced in the liver to be used as energy. How It Works Glucose (sugar) is the easiest molecule for your body to convert and use as energy so it will always be chosen over any other energy source. When we consume glucose, insulin is produced to process and circulate it. When glucose (carbs or sugar) is being used as a primary source energy, fats are not needed as much and therefore can be stored, when we might want to be burning those instead. When there isn't sufficient glucose, glycogen levels become depleted, blood sugar and insulin are lowered in the body, and now your body starts looking for an alternative fuel source, in this case, fat. The body, in its infinite wisdom and resourcefulness, now uses ketones as fuel for both the body and the brain. This puts you in a state of fat burning called ketosis. You can also achieve this state with fasting or prolonged exercise. If you were out in the wild starving, your body would go into ketosis pretty quickly – here we're doing it with food, but starving it of carbs. This diet has many different names – the ketogenic diet, low carb diet, low carb high fat (LCHF), etc. When you eat something high in carbs, your body will produce glucose and insulin. Most people who have experienced ketosis claim to have reached that state at about 20-50 grams of net carbs per day. The grams of carbs you should consume daily depend on your weight. Ultimately, if your goal is to achieve ketosis, then you'll want to keep your carb intake to 5% or less of total calories. When considering which carbs to consume, keep in mind t Continue reading >>
Is Ketosis Really Bad For You?
A patient recently asked me how bad being in nutritional ketosis was for her. I responded that the worse problem I’ve seen recently is the patient that broke his toe when he slipped on bacon grease. Are there risks with a ketogenic diet? Yes, but these usually only occur when you cheat or fall off the wagon. What problems can arise? Lets talk about them individually. First, as I stated above, make sure you don’t slip on bacon the grease. It really can be an issue if you’re not used to using increased amounts of fat in your kitchen. So, be prepared for how to cook and use fat. Grandma understood this well, we could learn a great deal from her if you ask her about using bacon grease. Second, let’s define the difference between ketosis and keto-acidosis and try to clarify the misinformation that is being spread around the blogosphere. A ketone is a molecule the body produces from the breakdown of fat (specifically triglycerides) and some proteins (amino acids). There are specifically three types of ketones: beta-hydroxybutyric acid, acetoacetic acid and acetone. If ketosis was “bad,” then why would our bodies produce these molecules? They are not bad, and in fact, multiple studies show that the body is often more efficient in weight loss, inflammatory reduction, bowel function, epigenetic influence and maintenance of lean body mass more effectivly when it functions on ketones rather than glucose as its primary fuel source. You can see these studies here, here, here and here. The body can only supply a limited amount of sugar or glucose for fuel. If you talk to runners, marathoners or triathletes, they will tell you that after about 45-90 minutes of continuous endurance exercise the glucose supply runs out and they will experience what is termed a “bonk” (ha Continue reading >>
Is Ketosis Dangerous?
It really is a sad fact that some experts add more to the confusion surrounding health and nutrition then they do to clear things up. One such area is that of ketosis vs ketoacidosis. While you may be unfamiliar with these terms, you will most certainly know about low carb and very low carb diets, and it is likely you’ve heard health professionals warning against the dangerous side-efffects of low-carbing. Well, ketosis and ketoacidosis are often quoted as two of those dangerous side-effects. This advice, however, is partly misinformed, partly overcautious. I read about Jimmy’s (Livin’ La Vida Low-Carb) experience recently when he went to give blood. He struck up a conversation with the type 2 diabetic nurse, and talk turned to eating a low carb diet. Her immediate response was that ketosis is a dangerous condition to be avoided. This is a pretty common opinion echoed by many health professionals. Here is what WebMD say on the subject of ketosis; Unhealthy metabolic state (ketosis). Low-carb diets can cause your body to go into a dangerous metabolic state called ketosis since your body burns fat instead of glucose for energy. During ketosis, the body forms substances known as ketones, which can cause organs to fail and result in gout, kidney stones, or kidney failure. Ketones can also dull a person’s appetite, cause nausea and bad breath. Ketosis can be prevented by eating at least 100 grams of carbohydrates a day. It is hardly surprising that the general public are confused, when health professionals and mainstream websites like WebMD make statements like this. And that’s only two examples. If this is all starting to sound a bit worrying, let me clarify things for you by firstly defining the difference between ketosis and ketoacidosis. Ketosis vs Ketoacidosis Continue reading >>
What Is Ketosis?
"Ketosis" is a word you'll probably see when you're looking for information on diabetes or weight loss. Is it a good thing or a bad thing? That depends. Ketosis is a normal metabolic process, something your body does to keep working. When it doesn't have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones. If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. It can also happen after exercising for a long time and during pregnancy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin. Ketosis can become dangerous when ketones build up. High levels lead to dehydration and change the chemical balance of your blood. Ketosis is a popular weight loss strategy. Low-carb eating plans include the first part of the Atkins diet and the Paleo diet, which stress proteins for fueling your body. In addition to helping you burn fat, ketosis can make you feel less hungry. It also helps you maintain muscle. For healthy people who don't have diabetes and aren't pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That's about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too. Doctors may put children who have epilepsy on a ketogenic diet, a special high-fat, very low-carb and protein plan, because it might help prevent seizures. Adults with epilepsy sometimes eat modified Atkins diets. Some research suggests that ketogenic diets might help lower your risk of heart disease. Other studies show sp Continue reading >>
Why Is Ketosis Is Important For Our Bodies
A lot of people are confused by the term "ketosis." You may read that it is a "dangerous state" for the body, and it does sound abnormal to be "in ketosis." But ketosis merely means that our bodies are using fat for energy. How Ketones Are Made in Our Bodies Ketones (also called ketone bodies) are molecules generated during fat metabolism, whether they are from the fat in the guacamole you just ate or fat you were carrying around your middle. When our bodies are breaking down fat for energy, most of it gets converted more or less directly to ATP. (Remember high school biology? This is the "energy molecule.") But ketones are also produced as part of the process. When people eat less carbohydrate, their bodies turn to fat for energy, so it makes sense that more ketones are generated. Some of those ketones (acetoacetate and ß-hydroxybutyrate) are used for energy; the heart muscle and kidneys, for example, prefer ketones to glucose. Most cells, including the brain cells, are able to use ketones for at least part of their energy. But there is one type of ketone molecule, called acetone, that cannot be used and is excreted as waste, mostly in the urine and breath (sometimes causing a distinct breath odor). If enough acetone is in your urine, it can be detected using a dipstick commonly called by the brand name Ketostix (though there are other brands, they are still often called Ketostix). Even though everyone is generating ketones continuously, this detection in the urine is what is commonly called "ketosis." (Less commonly but more accurately blood ketones can also be measured). The higher the concentration of ketones in the urine, the more purple the sticks will turn. The Atkins Diet, in particular, advises people to monitor ketosis as an indication of fat burning. Other r Continue reading >>
Is Keto Bad For The Thyroid?
, everyone says. It’s a great way to lose weight, improve cognition, and stave off degenerative disease. It may help your performance in the gym and on the track. It could even give Grandpa some respite from Alzheimer’s. But it’s hell on your thyroid. Right? Keto detractors and proponents alike often warn that remaining in ketosis will tank your thyroid. The thyroid’s an important gland, exerting major influence over essential systems like fertility, energy, metabolism, body temperature regulation, blood lipids, and general wellness. It controls the metabolic rate of every organ in the body. We want it working well, so this is a major blow to keto—if the criticism holds true. Fortunately, there’s much more to this story. The Problem with Keto—Thyroid Research Up till now, the vast majority of studies on the effects of low-carb, high-fat diets on thyroid health have used high-PUFA high-fat diets. Could this confound the results? Yes. It turns out that linoleic acid suppresses thyroid signaling. See the impact for yourself…. Rats on a corn oil diet convert less T4 to active T3 than rats on a lard diet. Rats on a safflower oil diet have a more greatly reduced metabolic response to T3 than rats on a beef fat diet. Rats on a high-PUFA diet have brown fat that’s less responsive to thyroid hormone. Remember, brown fat is the type that generates heat to keep us warm. Rats on a long-term diet high in soybean oil have terrible body temperature regulation, which thyroid function in large part controls. The more rapeseed meal (from which PUFA-rich canola oil is derived) you feed turkeys, the worse their thyroid signaling gets and the less meat/eggs they produce. Heck, back in the 70s, researchers proposed using vegetable oil as a treatment for hyperthyroidism. Thi Continue reading >>
Are Ketones Dangerous?
Are ketones dangerous? The answer to that question is it depends. I think it’s important to note that ketones still may pose a risk for those of us on a ketogenic diet, pursuing nutritional ketosis. I have blogged a lot over the years about the benefits of a ketogenic (low carb, high fat) diet for type 1 diabetes. I even wrote an eBook about it. I began my dietary experimentation after 15 years of living with diabetes so my discussion of this topic often assumes that readers are also aware of their own limits and responsibility to establish their limits before inviting complex experimentation. As exciting as the results of a ketogenic diet are, risks must be understood in order to proceed safely. Ketones can indicate diabetic keto-acidosis or DKA, which is life-threatening insulin deficiency, for someone with type 1 diabetes. Sadly, far too many people with type 1 diabetes die from DKA every year. Although the risk is pretty low on an annual basis, there are large numbers of people who actually die from DKA. So, you can easily see why the medical system believes that ketones (or the condition it is associated with) can absolutely can be dangerous.We all enter into experimentation with ketosis having had the “ketones are dangerous” doctrine drilled into our heads from the time of diagnosis. When you have type 1 diabetes, assuming a standard carbohydrate driven diet, the appearance of ketones in any concentration suggests DKA (diabetic keto acidosis) which is life threatening! DKA occurs as a result of insulin deficiency and correlates with elevated blood glucose. In response, usually over a period of hours, the liver dumps ketones which accumulate in the bloodstream at levels approaching 20 mmol/l . At this level of concentration the blood acidifies and the symptom Continue reading >>
Diabetes & Ketogenic Diet: Can You Manage Your Diabetes On A Ketogenic Diet?
In this article we will cover what a Ketogenic diet is and if you can manage your diabetes while on this diet. Ketogenic diet for diabetics is a highly controversial topic, but we will break down everything here for you! As a Certified Diabetes Educator (CDE), I have to tell you from the start I will have a biased view here. Sorry, but I feel that I need to be completely honest right up front! I will however, present all the evidence that is available currently on the subject. As a CDE, I have been taught to follow the American Diabetes Association Dietary Guidelines for Americans which is low in carbohydrates, high in fiber, with fresh vegetables, fruits and whole grains. The Ketogenic Diet this article will be discussing is much lower in carbohydrates, in order to promote the state of nutritional ketosis, or the fat burning state for weight loss. What is a Ketogenic Diet? The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up? Your body uses the carbohydrates you eat for energy, so if we restrict how many carbohydrates we eat, the body has to get its fuel source from fat. A byproduct of this fat burning state are ketones which are produced; this is called nutritional ketosis. You can determine if you are in this fat burning state by purchasing urine ketone testing strips from your local pharmacy. The Ketogenic Diet with Diabetes Some precautions must be made clear; this diet is not appropriate for people with any Continue reading >>