Are you new to the ketogenic diet or are unsure what this latest diet trend is all about? Are your clients curious about ketosis and whether it can help them achieve their health and weight goals? Here’s your ketosis 101.

What is the Ketogenic Diet?

The ketogenic diet is a very low-carbohydrate, high-fat diet that is gaining in popularity for its use in weight loss, insulin sensitivity, brain health and athletic performance, in addition to its original use for treating epilepsy. Following a ketogenic diet forces the body to use up all of its stored carbohydrates and turn to its alternative fuel source—fat (body fat and dietary fat)—which it converts to ketones and uses for energy.

On a ketogenic diet, the macronutrient composition looks like this:

• 70-80% fat
• 10-20% protein
• 5-10% carbohydrates

Given those numbers, you may wonder how eating like this could be healthy. After all, fat has been the dietary bad guy for years. However, numerous studies have been conducted comparing ketogenic diets to traditional low-fat/high-carb diets and the results suggest that ketogenic diets can be effective. Keeping total carbohydrates low (usually less than 50 grams a day) by cutting out all starches, sugars and fruit keeps insulin production low. Insulin is the hormone that is produced by the pancreas to shuttle glucose from the bloodstream to the cell where it is burned for energy. When carbohydrate intake is continuously high (high-carb meals, frequent meals and snacks), insulin is constantly being produced and a state of insulin sensitivity develops. Instead of moving glucose into the cells for fuel, much of the glucose is converted to body fat. This leads to weight gain and an increased risk for diabetes and heart disease.

What to Eat on a Ketogenic Diet

A ketogenic diet is filled with fresh, whole, clean foods including pastured eggs, wild-caught salmon, organic poultry, grass-fed/finished beef, organic and fermented dairy products, non-starchy vegetables, raw nuts, seeds, avocado, as well as anti-inflammatory oils and fats such as virgin coconut oil, extra virgin olive oil, avocado oil, grass-fed butter, grass-fed ghee, and MCT oil. Absent are fruit, grains, sweets, refined and processed grain-based foods (crackers, cereal, bread products)—pretty much anything that raises blood glucose and insulin levels.

Cutting out the processed carbs is highly beneficial for your gut microbiome. The bad bacteria that reside in your gut thrive on sugars and refined starches. By eliminating their food source, you are able to starve them out. The good gut bacteria love to eat the fiber found in vegetables and fermented dairy products. Eating ketogenically helps shift the composition of your gut microbiome to a healthier, more anti-inflammatory place. Many people note that their digestive issues clear up when they eat a ketogenic diet.

How to Tell if You are in Ketosis

It takes a few days of following a ketogenic diet to get into ketosis—this is the amount of time it takes to use up all of your glycogen stores. During this time, you are shifting over to burning fat, or ketones, for fuel. Three types of ketones are produced, each one at a different phase of ketosis. Acetoacetate is produced in the early stages of ketosis and can be measured in your urine by testing with ketosticks. After a few days in ketosis, beta-hydroxybuterate—the main form of ketones—is produced, which won’t be detected in your urine, but rather in your blood. The best way to test this is by using a blood ketone monitor. Unfortunately, this method is very costly and quite uncomfortable. A third way to measure ketones is with a breath analyzer, which detects acetone, the third type of ketone. This way of measuring ketones is both affordable and easy.

You don’t have to go out and buy anything to see if you are in ketosis. You’ll know it. That’s because most people experience something known as the “keto flu.” The first few days of eating a ketogenic diet can be quite difficult on the body. As you are using up your stored carbs, your body is desperately searching out for more carbs because that’s what it’s used to consuming. You’ll feel tired, achy, irritable, weak and sleepy, and experience poor workouts, lowered libido and constipation. It’s just like having a case of the flu. You can ease the discomfort of the keto flu by increasing hydration, pumping in extra electrolytes (sodium, magnesium, potassium) and supplementing with MCT oil, which is a source of exogenous ketones. Use these few days as rest days. Once the keto flu passes, you will likely feel an increase in energy, mental clarity and reduced hunger.

Health Benefits of Ketosis

Weight Loss

Numerous studies have demonstrated that following a ketogenic diet promotes weight loss, body fat loss, improvement in insulin sensitivity, reduction in metabolic syndrome and improved blood lipid markers. In addition, studies confirm that being in a state of ketosis reduces appetite even when following a very-low-calorie diet. Reduction in appetite leads to fewer calories being consumed, which results in weight loss.

Diabetes

Reducing carbohydrate intake with a ketogenic diet helps to restore insulin sensitivity, blood sugar control and hemoglobin A1c. Ketogenic diets have proven to be very successful in people with type 2 diabetes and are now being studied as a possible treatment for people with type 1 diabetes.

Cancer Prevention

As cancer cells prefer glucose as a fuel source, it would make sense that reducing carbohydrate intake would prevent cancer growth. There have been limited human studies on using a ketogenic diet as a therapeutic treatment for cancer, and results have been mixed as different types of cancer behave differently. Here are some reviews of research to date. More human studies are needed, but there is no harm in trying a ketogenic diet as part of cancer treatment. We suggest working with a functional and integrative medicine doctor or registered dietitian nutritionist for the best guidance.

Reversing Neurodegenerative Diseases

Emerging data on the use of ketogenic diets for therapeutic treatment of multiple neurological diseases and disorders including epilepsy, headaches, Parkinson’s, Alzheimer’s migraines, autism and multiple sclerosis is promising. Although these diseases are different from each other, it seems that the use of a ketogenic diet may be helpful as they all share abnormalities in cellular energy utilization. The exact mechanism for which ketogenic diets could be effective is still not clearly understood, but they do show a neuroprotective effect.

Athletic Performance

There is a plethora of studies that support the use of carbohydrates for optimal performance, especially for endurance athletes. Unfortunately, the limited research on ketogenic and athletic performance makes it difficult to support any conclusions about its efficacy and for which type of athlete it would best be used. Some sports researchers believe that it would benefit athletes or events involving prolonged submaximal effort where there is no benefit or requirement for higher-intensity, or for individuals who find it difficult to consume adequate carbs to meet goals for optimal carbohydrate availability.

Downsides of Ketosis

Other than experiencing the keto flu, there’s not much downside to following a ketogenic diet. In fact, reports of increased mental clarity and energy, reductions in hunger and carbohydrate cravings, and better blood-sugar control and lipid profiles are reasons to see if following this type of a diet will work for your clients. After a few weeks following a ketogenic diet, it is recommended to liberalize the diet by increasing carbohydrates with the inclusion of some low-sugar fruits, starchy vegetables and whole grains.

Who Should Avoid Following a Keto Diet

Individuals with liver disease, gallbladder obstruction or missing a gallbladder, those who take steroids (which increase blood glucose), lactating women and some athletes should not follow a ketogenic diet. In these cases, a higher-fat intake may not be well tolerated and a balance of macronutrients would provide a better nutritional outcome.

Is a Ketogenic Diet Healthy Over the Long-term?

Ultimately, the best diet is one that you will stick to. We find that carb cycling or diet phasing is a more effective strategy to help you and your clients achieve their weight and health goals. There is a lot of good data suggesting that low-carbohydrate diets are effective for weight loss and improvements in insulin sensitivity. However, that doesn’t mean your clients have to adhere to a strict low-carb (<50 gram) diet. Many people do equally well with reduced carbs, low-to-moderate protein and high fat. There is no single diet that will work for everyone; rather, many dietary strategies can be used with great success.

Looking to expand your nutrition knowledge and learn how to translate that information into actionable lifestyle changes for clients and patients? Learn more with ACE’s Fitness Nutrition Specialist program.