I recently found out that a former colleague of mine in the fitness industry is marketing themselves as a “keto guru,” which I found interesting because ketogenic (or “keto”) diets are probably the least complex of all the recent diet fads. However, “simple” doesn’t necessarily mean ineffective. I am progressively becoming more convinced that the path to weight management and optimum health is unique to each individual and conceptually easy for most people (well, easy in theory, difficult in practice). So what’s the deal with this latest designation of the low-carb craze?
Ketosis is a totally normal metabolic process and something that occurs in your body inadvertently all the time. The human body is a machine fueled by sugar. Our body breaks down consumed carbohydrates into glucose, which is either used immediately for energy or stored in our muscles, liver, or as adipose for future use. In times when energy, in its conventional form, isn’t readily available, the amazing human body will find another way to fuel itself. When we have used up all the glucose stored in our muscles and liver, our body burns stored fat instead (in a process known as gluconeogenesis), with a byproduct of this beta-oxidation process being the formation and usage (by the body and brain) of ketone bodies. The primary purpose of these ketone bodies is to fuel the vital organs during times of glucose famine, and it is especially important for continued cognitive function during these extended sugar fasts, as the brain is not capable of using stored fat as fuel. Thanks to the breakdown of consumed amino acids, stored adipose, and (unfortunately) lean tissue, physiologically normal levels of blood glucose can be maintained while our body’s command center subsists on nail-polish-remover-scented acetoacetate, acetone, and beta-hydroxybutyrate.
Ketosis isn’t some newly discovered metabolic phenomenon, its effects have been widely known and understood by the scientific community for ages. And it certainly isn’t a new idea in the health and fitness world. Ketogenic diets have been prescribed for those suffering from a variety of health conditions for nearly a century, and the research that the Atkins Diet is based on is six decades old. Heck, certain cultures that exist in harsh environments where it is difficult for vegetation to thrive for extended periods of time (e.g., the Inuit) survive being forced into ketogenesis for entire calendar seasons—and have done so for millennia. If you are looking for some of the researched benefits of ketosis: ketone bodies can have anti-inflammatory activity and have a wide spectrum of physical and mental benefits for those suffering from diabetes and epilepsy. Longitudinal studies have also shown that ketosis may be effective in positively influencing various biochemical parameters of cardiovascular health, especially blood cholesterol levels, and possibly have some short term cognitive benefits. Recent research has shown that ketogenic diets may also be beneficial for addressing everything from amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) to metabolic syndrome. The greatest body of research involves how ketogenic diets may influence weight management, and that’s probably why you are all reading.
The greatest issue with any exclusionary diet is the increased threat of nutrient deficiency, but recent studies suggest that ketogenic diets are likely no worse than the average modern diet (which, in all honesty, isn’t saying much) and may be superior to a vegan diet in this regard. Another regularly noted side effect of ketogenic diets is lethargy and an inability to maintain or increase strength and muscle mass. However, a recently published study suggests that may not actually be the case. In an eight-week study examining the effects of different macronutrient compositions on strength performance and lean muscle tissue, Brazilian researchers found that participants on a ketogenic diet experienced equal strength and muscle gains as those on higher carbohydrate diets. It’s doubtful that a medical professional will recommend going keto (or any other exclusionary diets) other than in extreme situations, but other than the difficulty of adherence, there is actually a surprisingly low number of long-term contraindications.
So time to start serving your bacon with a side of bacon, right? Before you ditch your oatmeal and start your day with eggs and a handful of nuts, there are a few things to consider.
1. Yes, research suggests that ketogenic diets are no worse than “average” diets when it comes to risk for nutrient deficiency, but we’re looking to improve health right? A close examination of some common ketogenic diets suggests a high likelihood of deficiencies, specifically in vitamin C and calcium. Possibly more concerning is a lack of fiber. There’s a simple solution, a multivitamin/mineral complex, but it may not be the best one for you. Keep in mind that ketogenesis does not mean “no carb”. Meat, cheese, and butter should not dominate your plate; several leafy greens and non-starchy vegetables are actually pretty good sources of vitamin C and calcium and can be eaten while staying below the ketogenic threshold. Likewise, not only is fiber intake in and of itself not that important for overall health (it is more an indicator of a healthy diet, rather than a component), but it doesn’t have to be an issue in a keto diet. Load up on the red and green peppers, spinach, cabbage, broccoli, and don’t forget the fatty fish and almonds for calcium.
2. Using your body’s stored adipose for fuel is the ultimate goal, not ketosis in and of itself, and there are a variety of ways to get there. As research has shown, the threshold for going into ketosis is highly individual. For some it may require staying under 20 grams of carbohydrates per day; the average tends to be around 50 grams, but others may be able to get away with as much as 100 grams and still exhibit accepted indicators of being in a ketogenic state. As with anything else nutrition, exercise, or health-related, every body is unique and responds differently to specific input and stressors. The easiest way to stay keto is to actually not eat at all (not that I am necessarily advocating fasting), and it also makes it quite a bit easier when you are simply eating less. Again, don’t think you need to eat no carbohydrates or be reliant on ketone urine testing strips to experience the benefits of ketosis. In fact, some research suggests that carbohydrate cycling may be the most effective method for weight management (for some people, of course). If you have a particularly intense workout planned, beginning (or ending it) with a sweet potato or even something higher glycemic like a banana isn’t going to derail your goals. It might expedite your journey towards them by allowing you to work harder and longer and push the energy balance equation even further into the negative. And again, load your plates with as much kale, broccoli, mushrooms, celery, etc. as your heart (and gut) desires.
3. Low carb doesn’t necessarily mean high fat. By now, we should all have accepted that dietary fat doesn’t necessarily make us fat, but all the peer-reviewed research in the world about “healthy fats” isn’t going to invalidate the first law of thermodynamics. High carb, low carb, no carb . . . regardless of macronutrient composition, if weight management is a concern, energy balance is still the bottom line and dietary fat is still a really dense source of energy. Give me a spoon and a jar of natural peanut butter and I can easily eat through my recommended daily caloric needs before my mechanical satiety cues even begin to register. Being in a state of ketosis isn’t a “get out of obesity free card” and increasing your intake of low-quality fats (especially from processed meat products) isn’t going to improve your health even if it means you remain in a perpetually ketogenic state. You still have to find a way to fuel your body with the stores of energy surrounding your vital organs and not what you just put in your mouth. Staying ketogenic does inherently mean you’ll likely increase your intake of dietary fat as your energy has to come from somewhere, but creating an energy deficit is still the bottom line. Be mindful of how much coconut oil you are using in your cooking. Almonds can go from being a healthy snack to a problem real fast if the portion is not a handful, but the entire bag. Regardless of what your ketogenic guru says, calories and energy density matter.
I always advocate lifestyle changes over temporary diets and I have a very difficult time recommending excluding entire categories of whole, nutritiously-dense foods (such as fruits, beans, and unprocessed grains) because they tend to increase the risk for nutritional deficiencies (among other side effects) and are generally unsustainable long-term. But what really matters is finding out what feeding patterns and foods work best for you. Ultimately, what every weight management “diet” comes down to is finding the best way for you to intake less fuel than you use. Ketosis may be an option worth exploring on your own journey to find your path to health, but as always, consult a healthcare professional before making any drastic lifestyle changes. Otherwise, move more, eat less, get better rest; think of every decision as an opportunity to build a healthier and better you.
Dr. Damian Rodriguez is the health and exercise scientist for doTERRA International, LLC. He holds a doctorate in health science, a master’s degree in exercise physiology, and countless professional certifications. He has spent most of his life researching nutrition, exercise, and the lifestyle behaviors associated with optimal health. Along with his passion for health, as someone who lives with Asperger’s Syndrome, he is also involved in bringing awareness to autism spectrum disorders. There are varying opinions about many health and fitness topics. His opinions are his own and not necessarily that of doTERRA International, LLC. Consult your healthcare provider before making any changes to diet and exercise.