I feel like I’m about to beat a dead horse, ya’ll
… and I really don’t want to. Like I really, really don’t want to. For you guys, I would do anything, though. So here goes with the quick and dirty of it!
There are two main energy pathways within our bodies. We can utilize glucose metabolism where our bodies take carbohydrates from our diet and convert them to energy. With this method, you get 4 kcal (units of energy) for every 1 gram of carbohydrate. The other option is to use fat for energy (ketosis) through the process of beta-oxidation. With beta-oxidation you get 9 kcal/units of energy for every 1 gram of fat.
Obviously, if you could get more energy for less work, your body would prefer that method, right?
The nay-sayers would point out that the brain cannot use fat for energy. Every other part of the body, like our muscles, can utilize fat for energy, but our brains cannot. Does that mean that people eating low-carb/ketogenic aren’t getting any energy to their brains? Of course not. We’d be dead.
The full story on that is that the brain can utilize carbohydrates for energy (which is what happens when you eat more than 20 g of carbohydrate/daily – give or take), but the brain can also use ketone bodies/ketones. When you limit your carbohydrate intake and increase your fat intake, the beta-oxidation pathway kicks in and turns fat into ketone bodies/ketones, which is where the name ketosis comes from.
Your brain then uses ketones for energy.
Your brain also uses ketones for energy when you fast, which is interesting because that means that there are inherent similarities between fasting and eating a ketogenic diet. That also means that fasting and the ketogenic diet share many of the same benefits. Getting your energy from carbohydrate sources, however, does not provide those benefits.
Benefits of the ketogenic diet
Being in ketosis, just like fasting, has been shown to have many benefits.
Weight-loss – It is a widely-accepted and scientifically proven fact that the ketogenic diet is conducive to weight-loss. Many studies have shown that a ketogenic diet and calorie-restricted diet provides more weight-loss than a calorie-restricted diet, alone. Some research even suggests that ketogenic provides weight-loss benefits, regardless of calorie intake.
The issue with some of the science in this space is that researchers do not always use high-quality fats for their “ketogenic” intervention. Also, some of the earlier research used either no or faulty methods for testing ketosis, and were utilizing fat sources that do not actually produce ketones; therefore, some studies on the ketogenic diet were reporting results based on participants who were not actually in ketosis.
To enjoy any of the weight-loss benefits of ketosis you have to eat a diet low in carbohydrates and high in healthy fats, not soybean oil (the cheapest, least healthiest kind of fat that actually prevents your body from entering ketosis).
Improved Energy Utilization – Through the mechanism of bioenergetics, scientists have discovered that using ketones for energy is more efficient than using carbohydrates. Not only because fat contains more than double the energy units per gram than carbohydrates, but also because many people do not process glucose very well.
This is a highly individualized area, but many people do not tolerate carbohydrates as well as they should (insulin resistance, type I diabetes, type II diabetes). If your body is working harder to process the negative effects of a high carbohydrate diet, then you’re not only receiving less initial energy from your diet, but your body is then expending even more energy to process your food.
Stay Satiated Longer – Who doesn’t want to stay full longer after their meals? I don’t think anyone enjoys eating breakfast then feeling like you’re going to die if you don’t get a mid-morning snack in your system.
Because being in ketosis is so similar to fasting, and provides your body is so much more energy than carbohydrates, you stay full longer. Not just that, but it’s easier for you to fast when you’re used to being in ketosis, because your body is already using the same form of energy as it would be if you were fasting.
It’s not uncommon for people in dietary ketosis to go 4 – 5 hours between meals. In fact, once you’re fat-adapted (used to being in ketosis) you may find that it’s a natural progression to experiment with intermittent fasting where you skip one or more meals per day.
When you’re using carbohydrates for your main source of energy, not only is it hard to skip meals, but it’s also not really advisable. One of the things I enjoy most about ketosis is having some freedom and flexibility in my meal timing. I don’t often feel like I have to eat. I certainly never get that mid-morning life or death snack craving.
Neurological Health – There are many benefits of ketosis involving neurological health. It has been used in the treatment of early stage Alzheimer’s disease, epilepsy, autism, and to prevent the negative effects of prolonged deep-sea diving in Navy Seals. All of the mechanisms are not fully elucidated, yet, but the research is very promising.
Perhaps the most well-researched of all is the effect of the ketogenic diet on reducing epileptic seizures. The genes that predispose someone to epilepsy often overlap with the genes that are associated with autism.
While the body of research on ketogenic diet and autism is not as robust as with epilepsy, it is probably my favorite area in which the ketogenic diet can be used to improve health.
*There is much controversy within the autism community regarding whether or not autism should be referred to as a disorder. Those who are care-givers to autistic individuals prefer autism to be viewed a disability, but individuals with autism prefer that it be considered a difference, not a disorder. Autistic brains work differently than neurotypical brains, and that’s part of autism’s beauty. However, our world was designed by and for neurotypical individuals. Therefore, many daily events are traumatic for autistic individuals. I see the ketogenic diet as a means to lessen the daily trauma associated with living in a neurotypical world so that autistic individuals can thrive and contribute their gifts as freely as neurotypicals.
A little off topic, I know, but I can’t mention autism without advocating in a way that does service to the wishes of the actually autistic community. In the past I have spoken of autism in the context of research and referred to it as a disorder, but going forward I will be bringing awareness to this issue. If that rubs you the wrong way, hold on to your hats, because I’m not one to shy away from controversy, especially as it relates to autism and women’s health.
Fertility – One of my favorite topics in women’s health is fertility. Not just fertility in the sense of trying to conceive, but fertility in the sense of having healthy menstrual cycles.
Certain conditions like polycystic ovarian syndrome (PCOS) can cause your menstrual cycle to be disrupted. A low-carb, high-healthy-fat diet has been shown to improve the fertility outcomes of women with PCOS. I highly recommend all women track their cycle through basal body temperature, cervical position, cervical mucus, and urinary luteinizing hormone (LH) detection, even if you don’t plan on having children any time soon.
I restored my own fertility, in large part, through the use of the ketogenic diet. Within a couple of months of going keto I was ovulating again, and have had regular periods ever since.
“I’m sold! How do I go keto?” You ask…
Everyone’s carbohydrate tolerance is different, so I won’t give you some regurgitated nonsense about macronutrient amounts (ie. less than 20 g carbs/daily). I even struggle with the percentages of macronutrients given in the scientific literature.
Not everyone needs to restrict carbohydrates down to nothing, and not everyone needs to eat 70-85% of their calories from fat to be in ketosis. Of course, for the first 2 – 3 weeks, most people do need to be at that level of strictness to achieve fat-adaptation. Fat adaptation is the amount of time it takes your body to up-regulate the enzymes utilized in the beta-oxidation pathway. After becoming fat-adapted, you can be more lenient and experiment a little with the right macronutrient ratios to keep you in ketosis.
The main thing to consider is that you’re eating healthy fats. Like I said earlier, if you are eating the type of high-fat diet you can order through a drive-through window, you’re probably not ketosis. Not only will low-quality fats like soybean oil prevent ketosis, but high levels of systemic inflammation will do the same, and low-quality fats are inflammatory.
Eating whole foods, not heating certain types of fat, and eating enough fat are the most important parts of the ketogenic diet, in my opinion.
Check out this quick guide to different kinds of fats to help you achieve the most clean-burning energy!
You’ll notice that some fats have more saturated fat than others, some more monounsaturated fats, and others more polyunsaturated fats. You’ll also notice different smoke points. The smoke point is the temperature at which oxidation occurs for that oil. Once an oil is oxidated, it’s essentially rancid, like a trans fat. You want to avoid oxidizing your fats by overheating them at all costs.
Fats like olive oil and macadamia nut oil are better off only used cold like in salads.
Peep my favorite macadamia nut oil salad dressing:
- 2 tbsp macadamia nut oil
- 1 tsp dried parsley
- ¼ tsp dried onion powder
- Salt & pepper to taste
You’re going to thank me for that one… it’s effing amazing.
The other thing I want you to know about the different types of fatty acids in these oils is that saturated fat (SCF) is good! Saturated fat gets a bad reputation, but studies have proven that saturated fat is perfectly healthy, especially when eaten as part of a ketogenic diet.
The problem fats are the ones highest in polyunsaturated fat (PUFA), and to some extent the monounsaturated fat (MUFA). MUFAs and PUFAs are only an issue because they are easily oxidized. MUFAs are actually really great for you (think avocado), but they have one unsaturated carbon in their structure. Since that carbon is not saturated with a hydrogen, it is left susceptible to changing its confirmation into the trans position and become a trans fat when exposed to high heat. Just think, PUFAs are poly unsaturated, and have multiple points at which their carbons can be corrupted by heat and other environmental overexposure.
Keep these things in mind when you’re choosing a type of fat. MUFAs and PUFAs are all fun and games until someone roasts, cooks, fries, bakes, grills them or leaves them on the shelf past their prime.
One last point I’d like to make is about cycling in and out of ketosis. Ketosis is a bioenergetic shift that your body is making, and once you are fat adapted it becomes easier to shift into ketosis. That, to me, is the first of many signs that our bodies want us to be able to shift out of it, occasionally.
The main reason I do cyclical ketosis (shifting in and out of ketosis every now and then) is to keep my metabolism flexible and to make sure my hormones are optimized. Metabolic flexibility is the same reason that I switch up my fasting protocols almost daily. You don’t want your body to get used to any particular state or forget how to operate optimally in a different state.
Gut bacteria change based on what you eat, among other factors. You may find that your gut bacteria seem to change in a beneficial way after being in ketosis for a while, but you don’t want to lose the gut microbes that help you process certain carbohydrates effectively.
That doesn’t mean that you should eat cookies every 3 days, but research has shown that if you restrict carbohydrates below 20 g/daily for longer than 2-3 days in row, your body will increase production of reverse T3, effectively blocking the action of thyroid hormones. You will actually gain weight if you produce too much reverse T3.
Keeping that in mind, there may be other hormonal changes that take place, especially in women, during periods of prolonged carbohydrate restriction. Instead of eating cookies or Wonder Bread every 3 days, though, try baking something with cassava flour and a natural sweetener like stevia, erythritol, monk fruit, or xylitol. This blog is actually a great resource for sugar-free and grain-free recipes. Speaking of cookies, you can go to the search bar of this blog and type in any particular baked good and you should find a version or two made using grain-free and sugar-free ingredients!
You can also eat yuca root (the plant cassava flour is made from) as a carbohydrate. It can be made into fries or mashed into something resembling mashed potatoes. Some folks recommend sweet potatoes, but I try to avoid lectins, and if you have autoimmune issues sweet potatoes may or may not work for you. Cassava and yuca are low-lectin foods. White rice is relatively low-lectin, too.
How do you know if you’re in ketosis?
The best way to measure ketosis is in the blood through beta-hydroxy butyrate (BHB) testing. BHB is not an actual ketone body, but it is the direct precursor of a ketone body and the most accurate indicator of whether or not you’re in ketosis.
You can also use ketone sticks that test your urinary levels of a different ketone (acetoacetate), but it is not an accurate indication of whether or not you’re in ketosis. The longer you’ve been fat adapted, the less sensitive this measure is at actually determining ketosis.
Another way to check for ketosis is through breath acetone levels. This is, again, less accurate than the blood, and even less accurate than urine. Concentrations of ketones in the breath are even lower than those in the urine.
Researchers, now, mostly use blood BHB to determine ketosis in their studies, and that’s enough reason for me to use it. It’s basically like checking your blood glucose with a glucose meter, but instead of using glucose strips you use ketone strips. They’re expensive and you, often times, need an entirely new meter for BHB testing than the one you use for glucose testing.
However, you can buy one that does both, if that’s what you’re into. Mine, theoretically does both, but no stores carry the glucose strips. No stores carry the ketone strips, either though. You have to order them online. I typically use ebay.
Technically, to be considered in ketosis, you need a blood BHB level of 0.5 – 1.5 mmol/dL. Mild ketosis can be observed starting at 0.3 mmol/dL. If you take exogenous ketone supplements don’t be surprised to see your blood BHB levels soar to over 6.0 mmol/dL. No one really knows if that’s healthy or not, but once your body gets used to exogenous ketones, that number usually gets back to the normal range.
The meter I use is Precision Xtra Blood Ketone Monitoring meter Kit Bundle 10 Abbott Ketone Strips + 30 Alcohol Wipes + 30 Lancets + Abbott Ketone Test Meter Ketogenic Diet Keto Diet Monitor, and it costs about half of what I paid for it a couple of years ago when it first came out.
Most of time, now, my blood BHB is between 0.5 and 1.5 mmol/dL, no matter what I eat. Even when I cycle out of ketosis I’m still in mild ketosis. The only time I have trouble getting up to the 0.5 mmol/dL mark is when my inflammation is out of control. Even then, I’m usually around 0.3 mmol/dL.
The take away
There are many other considerations for ketosis and eating a ketogenic diet that I won’t really get into in this post. Just to give you an idea, though, I will include this nice little infographic that highlights the basics. I’m available for distance coaching appointments (phone, text, email, and video chat) if you want an experienced Keto coach to help you adapt this lifestyle to your own personal goals.
For a free ketogenic + low-lectin cross-referenced grocery list, leave your email address in the sign-up box (to the right of this post if you’re on a computer; at the bottom of this page if you’re using a mobile device).
As always, references are available upon request.
If you have any questions about anything in this post, just drop me a line either in comments, below, on my Instagram @Experimental_Betty, or through email at ElizabethClarkHealthCoach@gmail.com