Ketogenic Diet

by Catherine M. Haug, June 18, 2013; updated Sept 2016;  and April 2019. (image, right, by Cat)

Ketogenic diet is a high fat, low carb and moderate protein eating plan. Once the body’s cells learn to burn fat instead of carbs as a primary fuel, profound positive effects can happen including weight loss and improvement in insulin sensitivity. The Atkins diet (that was very popular in the 1990s) is a type of ketogenic diet, but is designed for weight loss, rather than changing your metabolism.  It also spurned the popularity of Atkins-endorsed processed foods that, in the end, affected the health of people on the diet.

I started a ketogenic diet in 2014; within two days following the eating plan, I lost my cravings for sugar; I was totally amazed that I could look at the goodies I used to love, and acknowledge they look pretty, but had no desire to eat them. Over the years, it has not caused me to lose any weight, but my health and mood have definitely improved.

• Includes: 1. Ketogenic diet: What and Why; 2. Metabolic Mitochondrial Therapy (MMT); 3. Ketogenic Diet: Informational Links
• See also (this site): 1. Diet and Health Menu; 2. CKD: Cyclical Ketogenic Diet (CKD) and Metabolic Mitochondrial Therapy (MMT); 3. Carb/Protein/Fat (CPF) Counters (Charts/Tables) by food category (Protein, Veggies, Fruits, Fats, Dairy, Nuts & Seeds, Legumes, Grains & Starches, Condiments); 4. Keto Daily Outline
• See also (other sites): 1. Dr. Alan Christianson: The science behind the ketogenic diet (3); 2. Video with Dr. Dominic D’Angostino: Keto Nutrition (5); 3. Mercola: Beginner’s Guide to Ketogenic Diet (1A); 4. Mercola: Importance of ketogenic diet for avoiding/healing cancer (1C); 5. Mercola: Metabolic diet approaches for optimal health (1B); 6. Mercola: Metabolic Mitochondrial Therapy (MMT) (1F); 7. Mercola’s book:  Fat for Fuel (1J)

Ketogenic diet: What, When, and Why?

Dr. Mercola emphasizes a version of this diet for those with Protein nutritional type (P-type); especially for those who have gone astray with too many carbs so that they have insulin resistance (metabolic syndrome). People like me. The ketogenic diet is a low-carb diet that relies on fat and protein for energy, instead of carbs. If you have been a carb-eater for a long time, you need to retrain your body to burn fat for energy – fat in the form of ketones.

This diet is NOT a high-protein diet, but rather moderate in protein and high in fat. Dietary percentages: 5% carbs, 20% protein, 75% fat calories. I suspect that the type of fat is very important. Fats from pasture-raised livestock and dairy, wild fish, olives and coconuts are the best, and together include a good mix of saturated, mono-unsaturated and omega-3 polyunsaturate.

Not all people on a ketogenic diet will lose weight, but their health will improve.  If you want to lose weight on a ketogenic diet, you must reduce your dietary fat consumption enough that your body will burn stored fat. But remember that if you reduce dietary fat, you must also reduce dietary carbs and proteins to maintain the same keto dietary percentage (see above). Do not be tempted to eat Atkins-endorsed processed foods as this will likely make matters worse.

Intermittent fasting schedule 

Another important aspect of the Ketogenic diet has to do with “when you eat what you eat.” The following is from Dr. Loscalzo (4):

• There should be a 12-hour minimum break (or ‘fast’) between dinner and breakfast; then your breakfast is truly a ‘breaking of the fast;”
• Stop eating 3 or more hours before bed; e.g., if you go to bed at 11 PM, don’t eat/snack after 8 PM.
• Avoid high-carb foods (sugar, breads, cereal, porridge, etc) at breakfast. Instead, eat protein (e.g., eggs, green smoothie, protein powder, etc) balanced with fat (e.g., fatty bacon, butter, cream, full-fat cottage cheese, etc.) and a little whole fresh fruit (not juiced).

Following those three guidelines will help return your body to a normal leptin cycle (leptin governs when you are hungry; see my Insulin Resistance and Leptin article. Ideally, the leptin levels follow a wave pattern through the day that is low when you get up in the morning (so that you are hungry), and high after dinner (so that you are ready to fast). But when this cycle is out of balance – high in the morning, and low after dinner, for example – or flat all day long, your body stores fat and feels sluggish. This is an oversimplification, of course, but true nonetheless.

The goal of the ketogenic diet is to achieve ketosis – a metabolic state in which the body burns segments of fats called ketones, instead of glucose (from carbs) for fuel. Your level of ketosis can be measured in your urine, using ketosis test strips. The graph below describes the different levels and the optimum ketone zone (from Mercola: Ketogenic Diet with Calorie Restriction for Improved Health (2)). He states the 1.0 – 3.0 millimolar (mM) range (peak of curve in illustration below)  is a good biomarker of nutritional ketosis. Note that above 5.0 mM, “starvation ketoacidosis” begins, which can cause serious problems.  My Ketostix measure mg/dl  ketone (acetoacetic acid); to convert, multiply mg/dl by 0.98 to get mM (0.98 * mg/dl = mM) for comparison with chart, right (14A). So the range is 0.98 – 2.94 mM, or 1 – 3 mM. (NOTE: mM means “millimolar” as used on chart, above). The color guide on the Ketostix container starts at 5 mg/dl, so that’s the best I can do unless I can find a better color chart. Color guide image, right, from LowCarbLuxury (14).  You want to be in the pink, not magenta or purple:

On the other hand, as long as it is NOT negative (beige color), your are in ketosis, and that’s all that matters (unless you are in a state of starvation or are a diabetic and you want to avoid ketoacidosis); Ketostix “do not accurately measure degree in all people”. (from Health & Beauty Blog)

Keto-diet test range includes 1 -4 mM

Feb 2016 update (Thanks to one of my readers for this information): The above color guide begins at 5 mM, which is too high for this diet – you want to be between 1 and 3 mM. Newer keto-sticks designed for ketogenic diet testing are now available that provide colors for that sensitivity range. (See Amazon search (7B)). Photo, left, from Amazon ASIN B01MUB7BUV, “Perfect KETO” brand test strips (14B); includes readings of 0.1, 1.5 and 4.0 mM. 

Or you can use blood glucose as a guide; per Mercola’s article, “if your blood glucose stays at 75 or below with carbohydrate restriction, there’s a good chance that you’ll be in nutritional ketosis, which is where you want to be.”

I decided to give this a try to reset my insulin levels, not cold turkey (on the advice of my acupuncturist/body talk practitioner). He advised I take 5 weeks to change my diet and then stick with if for several months. Eventually I hope to morph this into a version of the Paleo diet (similar to the ketogeneic diet except that it includes more ‘good’ carbs – fresh veggies and whole fruits). Sept 2016 update: I’ve been doing keto for almost 3 years and can’t imagine going back to the way I used to eat. After 2 days on this plan, the sugar cravings stopped, and I no longer missed bread. A year ago, I started adding whole grain bread, no more than a slice per day, or porridge (no more than a bowl a week) on the advice of my acupuncturist/body-talk practitioner, as I needed the fiber.

Paleo diet is not necessarily a ketogenic diet, but it can be.

1. It generally does not include high-carb foods like grains and legumes. Starchy tubers (potatoes, etc) are included in some paleo lists.
2. It includes meat from pasture-raised livestock, nuts and seeds (except grains, legumes), most veggies and fruit (no fruit juice), and may include eggs.
3. Some versions of the paleo diet do not include pasteurized dairy (but I find no references either way to raw dairy).

Mercola’s Metabolic Mitochondrial Therapy (MMT) and Cyclical Ketogenic Diet or CKD

See Mercola article on MMT (1F) for more about this interesting twist on the Ketogenic Diet that involves a feast/fast sequence:

1. 2 – 3 days per week increasing your carbs and protein (“feast”), and reduce your fats accordingly, then
2. Return to the low-carb, reduced protein ketogenic program (“fast”) for the remainder of the week (4 – 5 days).

This sequence should only be started after phase one of the ketogenic program, when your body has gotten used to burning fats instead of carbs for fuel.

Note: while there are many similarities between a keto plan and the Paleo diet, Mercola’s ketogenic and MMT program differs from the Paleo diet in several ways, especially restricting protein consumption to 1.2 gram protein for every pound (or 1 gram for every kilo) of lean body mass.

For more, see also my page on CKD: Cyclical Ketogenic Diet (CKD) and Metabolic Mitochondrial Therapy (MMT)

Ketogenic diet: Informational Links, notes

I’m working on my own carb/protein/fat (CPF) counter for various foods. In the meantime, see Ketogenic Diet Resource: carb, protein, fat counters (10B) for common foods which I have copied onto my article: Carb/Protein/Fat (CPF) Counters (Charts/Tables) by food category

Here are some other informational sources:

• Wellness.com: keto-nutrition, a summary of ketogenic diet and its benefits (8)
• Mercola: Beginner’s Guide to Ketogenic Diet (1A)
• Mercola: The Benefits of a Ketogenic diet and its Roll in Cancer Treatment. (1D)
• Mercola: [Ketogenic] diet may slow Alzheimers (1G)
• Mercola: D’Agostino Cancer Research on daily grams protein (1E)
  • Dr. D’Agostino believes 2 – 3 grams of protein for every kg of body weight is too much, but doesn’t suggest a better amount.
  • Dr. Rosedale recommends 1 gram protein/kg of body weight, especially for cancer treatment and prevention.
  • Based on these two opinions, I would say 1 – 1.5 grams protein/kg body weight. For example, if you weigh 150 lb (68 kg), that translates to 68-102 grams protein. If you weigh 200 lb (91 kg), that translates to 91-136 grams protein.
  • However, Broken Brain docu-series recommends 30 g protein for each meal, independent of body weight; If one meal is lower and others are higher than that, brain issues can result
• Scientific American blog post: Ketosis and the Brain: The Fat-Fueled Brain: Unnatural or Advantageous (9) explains what ketosis and ketone bodies are, and how they may help reverse neuro-degenerative damage in the brain
• Nutrition Info sites which I have used for my Carb/Protein/Fat (CPF) Counters (Charts/Tables) by food category:
  • Self Nutritional Data includes nutrient and  (15)
  • Fat Secret (16)
  • ImmuneWeb. com (17) (not a secure site at time of this writing, 5/2/19)
  • Ketogenic Diet Resource: Diet Plan (10A) includes:
    • Recipes, and sample menus,
    • Carb, protein, fat counters (10B) for common foods which I have copied onto my Carb/Protein/Fat (CPF) Counters (Charts/Tables) by food category.
    • Recommended books that explain the diet. For example, Dr. Atkins New diet Revolution, and New Atkins for  New You. See also atkins.com: Program Overview (11) and additional pages for the 4-phases, carb counter and more. The Atkins diet is a type of ketogenic diet, designed for weight loss; it gradually steps up the amount and kind of carbs you can eat.
    • Check with physician if you have heart or kidney problems before starting this diet. Note that the doctor may confuse ketosis with ketoacidosis.
    • The diet is 75% fat, 20% protein, and 5% carb (% of calories) – see image, above.  While fats have no impact on insulin, protein does have an impact; if you consume too much protein, the body will convert it to glucose. For this reason, the protein content should be 20-25% protein; if the protein is too lean, you may have malnourishment issues.
    • Based on above %’s, assuming by calories, for 2000 calories/day:
      • 5% carb = 100 calories (25 grams, at 4 calories per gram),
      • 20% protein = 400 calories (100 grams, at 4 calories per gram),
      • 75% Fat – 1500 calories (167 grams, at 9 calories per gram).
    • NOTE: When figuring calories, remember that fats have higher calorie count per gram than protein and carbs.  Fat: 9 cal/g; Protein: 4 cal/g; Carb: 4 cal/g
• Tips:
  • Clear your pantry and restock with low- or no-carb whole foods.
  • Ketostix will tell you when you are in a ketosis state. Optimal readings: 1 – 3 mM (millimoles) (from Mercola (1E))
  • Use coconut oil instead of cream/whole milk in my smoothie at least half the time (because of the lactose and its galactose component in one glass of milk can exceed the carb limit) per Mercola (1I). However, if you have good gut microbes, they will quickly turn the lactose into lactic acid, before it is broken down to galactose and glucose, keeping it from being burned as a carb.
  • Keep a daily food diary and track grams of Carbs, Protein, Fat  (CPF).
  • Learn how to stop sugar cravings (10C): special supplements such as 500 mg L-glutamine, B-complex, etc.; also exercise; 4-oz protein such as low-carb smoothie that include whey protein isolate (problematic for me so I will need a substitute; my rice protein is low in carbs so would probably work.. This is especially important at the beginning when your body has not re-learned how to live on fat.
  • See also Low-carb side-effects (10D). tiredness, dizziness, shakiness (hypoglycemia) will likely be what I experience, but possibly also others
• Three Fat Chicks: Ketogenic Diet Plan (12)
• eLow Carb Good List: Ketogenic diet Plan (13)
  • Stick to above-ground veggies (avoid root veggies). I love beets so I’m wondering if beet kvass would be OK (the fermentation should reduce the carbs in the beverage) According to Mike’s Calorie Counter: beets have CPF* =8/2/0 g for two 2” diameter cooked beets, or 2/0/0 for 1 oz (Mike’s Calorie Counter: caloriecountercharts.com/chart1a.htm no longer available, darn)
  • I eat only one-half of one 2” diameter beet at a meal, for CPF* = 2/0.5/0, which isn’t bad.
  • Compare that with  1 oz cooked, drained beet greens, with CPF* = 0/1/0; or 1 cup has CPF = 1/1/0; spinach is similar to beet greens: 1 cup cooked, drained CPF = 0/1/0.
  • ‘* CPF is Cat’s abbreviation for Carb, Protein, and Fat content.
• “Low Grain and Carb Diets Treat Hypoglycemia, Heart Disease, Diabetes, Cancer and Nearly All Chronic Illness”, by Dr. Joseph Brasco, MD (on Mercola’s website (iI)).
  • Includes a bit of anthropological history to support the ketogenic diet, glycemic index, epidemiological data, health risks. Also discussion of ketosis, increased saturated fats, dietary protein and cardiovascular disease, risk of osteoporosis, kidney and liver damage; all in relation to the ketogenic diet – whether each has positive or negative impact on health while on the diet.

References

The numbers in parenthesis, like (9), were the reference numbers before I reorganized the reference list and updated them in the text above. You can ignore them.

1. Mercola:
   1. (9) Beginner’s Guide to Ketogenic Diet: articles.mercola.com/ketogenic-diet.aspx
   2. (7) Ketogenic Diet for Optimal Health (Basic Intro to nutritional ketosis): articles.mercola.com/sites/articles/archive/2016/09/04/ketogenic-nutritional-ketosis.aspx; see also 1H, below
   3. (6) Elevated Blood Sugar Sets the Stage for Cancer Growth: articles.mercola.com/sites/articles/archive/2016/07/27/elevated-blood-sugar.aspx)
   4. (10)  The Benefits of a Ketogenic diet and its Roll in Cancer Treatment (articles.mercola.com/sites/articles/archive/2013/06/16/ketogenic-diet-benefits.aspx)
   5. (2) Ketogenic Diet in Combination with Calorie Restriction and Hyperbaric Treatment Offer New Hope in Quest for Non-Toxic Cancer Treatment:
       articles.mercola.com/sites/articles/archive/2013/06/30/dagostino-cancer-research.aspx
   6. (8) Basic Intro to Metabolic Mitochondrial Therapy (MMT): articles.mercola.com/sites/articles/archive/2017/05/21/metabolic-mitochondrial-therapy-introduction.aspx
   7. (11) [Ketogenic] diet may slow Alzheimers: (articles.mercola.com/sites/articles/archive/2013/03/31/diet-may-slow-alzheimers.aspx)
   8. Benefits of Nutritional Ketosis: articles.mercola.com/sites/articles/archive/2016/09/26/nutritional-ketosis-benefits.aspx; see also 1B, above
   9. Low Grain and Carb Diets Treat Hypoglycemia, Heart Disease, Diabetes, Cancer and Nearly All Chronic Illness: mercola.com/article/carbohydrates/scientific_evidence_low_grains.htm
   10. (H) Mercola’s “Fat for Fuel” book: shop.mercola.com/product/2096/1/fat-for-fuel-by-dr-mercola
2. (12) Wikipedia: Cyclic Ketogenic Diet (Mercola suggests this link)
3. (13) Dr Christianson: drchristianson.com/keto-curious-understanding-the-science-behind-ketogenic-diets/
4. (1) ketogenic-diet-resource.com/ketogenic-diet-plan.html
5. (3) Video with Dr. Dominic D’Angostino: Keto Nutrition (wellness.com/ketonutrition)
6. (4) Dr Ritamarie Loscalzo: drritamarie.clickfunnels.com/delivery-12hrbreakthatburnsbellyfat
7. (5) Ketosis test strips:
   1. Original link is not longer valid: amazon.com/Smackfat-Ketone-Strips-Measurement-Adaptation/dp/B00SODYZQK/
   2. Instead, try this search on Amazon for ‘ketosis test strips (amazon.com/s?k=ketosis+test+strips+urine&crid=3MI98DLLC5WJY&sprefix=ketosis+test+%2Caps%2C214&ref=nb_sb_ss_i_3_13)
8. Keto Nutrition: wellness.com/ketonutrition
9. Scientific American: Ketosis and the Brain: The Fat-Fueled Brain: Unnatural or Advantageous (blogs.scientificamerican.com/mind-guest-blog/the-fat-fueled-brain-unnatural-or-advantageous)
10. Ketogenic Diet Resource:
    1. Diet Plan: ketogenic-diet-resource.com/ketogenic-diet-plan.html
    2. Carb, protein, fat counters: ketogenic-diet-resource.com/carb-counter.html
    3. How to stop sugar cravings: ketogenic-diet-resource.com/how-to-stop-sugar-cravings.html
    4. Low carb side-effects: ketogenic-diet-resource.com/low-carb-diet-side-effects.html
11. Atkins Program Overview: atkins.com/Program/Overview.aspx
12. Three Fat Chicks: 3fatchicks.com/the-ketogenic-diet-sample-meal-plan
13. eLow: Good Carb List: elowcarbfoodlist.org/ketogenic-diet-plan/
14. Keto Stix Color Guide:
    1. LowCarbLuxury.com/ketostix.html (starts at 5 mg/dl, too high for keto diet)
    2. Amazon ASIN B01MUB7BUV, “Perfect KETO” brand test strips incl 0.1, 1.5 and 4.0 mM, more appropriate for keto diet.
15. Self Nutritional Data: nutritiondata.self.com
16. Fat Secret: fatsecret.com/calories-nutrition