The ketogenic diet: What is it?

The ketogenic diet is a low carbohydrate, adequate protein and high fat diet. Say good bye to most grains, breads, potatoes, fruits and pasta and think lots of meat, fish, nuts and seeds, butter, cream, oils and non-starchy vegetables.

Ketogenic history:

The ketogenic diet was first introduced in the 1920’s by Dr Russell Wilder who established that ketones in the blood could help treat people with epilepsy. This was because patients receiving this diet were monitored and their seizures were reported as being less frequent and less severe.

The Ketogenic diet is now used to treat a number of conditions including cancer, obesity, Alzheimer’s disease, Parkinson’s disease, Multiple Sclerosis, Diabetes, and Traumatic Brain Injury (Barry et al, 2018).

However, today many people are developing a trend towards a ketogenic diet from celebrities to celebrity chefs, as a potential weight loss strategy, due to the low carb diet craze like The Atkins Diet (low carb, high protein and moderate fat).

How the ketogenic diet works:

When a carbohydrate meal is consumed it contains enzymes that trigger our body to release insulin in order to store energy. However, when few carbohydrates are consumed, there is a decrease in insulin levels and so to a decrease in the amount of fat retained.

When the body is exposed to such a diet the brain gets hungry for glucose and so alerts the liver to release its stores of glucose. This temporarily breaks down muscle to release more glucose. However, if the glucose reserves from this method become exhausted the brain looks for another alternative to obtain the energy.

That energy comes from your fat, with the liver producing excessive Co enzyme A (acetyl CoA) resulting in higher outputs of beta-hydroxyl butyric acid and acetone and is known as ketone bodies. This mechanism, also known as ketogenesis, occurs in the mitochondria of the liver and thus replaces glucose as an energy source for the brain.

Healthy people naturally experience mild ketosis during periods of fasting, such as during sleep or very strenuous activity like exercise.

Ketone Bodies in Dieting.

With the amount of ketone bodies that build up during dieting it is no surprise that some fad diets like the ketogenic diet has come under scrutiny for causing ketoacidosis in people who follow them.  However, advocates of the ketogenic diet state that if the diet is followed carefully, ketones in the blood should not reach harmful levels (“ketoacidosis”) as the brain will use ketones for fuel, and healthy individuals will typically produce enough insulin to prevent excessive ketones from forming.

What is ketoacidosis?

An excessive amount of ketones in the blood can produce a dangerously toxic level of ketoacidosis. This is when the kidneys start to excrete ketone bodies in the urine along with body water, thereby unbalancing the body’s acid/ base buffering system.  This is a life threatening condition usually seen in cases of poorly controlled diabetes. 

Ketone Bodies in Diabetes.

Diabetes is a medical condition in which the body cannot or will not produce insulin, an enzyme in the glucose cycle. Insulins job is to message the cells in our body to uptake the glucose in the blood and use it for energy. People with diabetes do not have this signal and without artificial insulin, the glucose remains in the blood. Thus, the cells of the body do not get energy and many other cellular activities are paused.

In addition, the body begins to uptake fatty acids from the blood to provide the energy needed. And just like mentioned above, the lack of glucose triggers the liver to begin making glucose. This is when ketone bodies are released.

However, a person with diabetes has a compounded problem. That is, ketone bodies can be used for energy, but only if the proper channels are present and these come from the breakdown of glucose. But, in diabetes, only minimal glucose has been broken down. Therefore, this leads to the ketone bodies not being used as energy. And as such, they begin to build up relatively quickly causing a sudden and severe ketoacidosis.

Summary thus far:

The aim of the ketogenic diet is to swap the body’s predominant fuel source from glucose to fats and ketones. The body produces ketones when glucose is unavailable, therefore triggering the body to use its fat store for energy. This results in weight loss and low blood glucose levels.

The evidence:

Research suggests a ketogenic diet is beneficial as a medical treatment in extreme cases for people with epilepsy. There is also further evidence to support a wide range of health conditions including cancer, Alzheimer’s, Parkinson’s, polycystic ovary syndrome and brain injuries. In addition, conflicting information in regard to whether it is or is not good for cardiovascular disease was debated. Moreover, research has stated that overweight and obese dieters may lose weight faster in the short-term. Although, results have shown after one year, that little difference in weight loss was seen between a ketogenic diet and one where you are just cutting back on calories.

Are carbohydrates to be abstained?

In the short of it, NO!

Carbohydrates are the primary fuel source for our brains, muscles and vital organs.

In addition, carbohydrates such as brown rice, lentils, beans, wholegrains and quinoa are rich sources of vitamins, minerals, phytonutrients and fibre which reduces our risk of many chronic diseases, as well as some types of cancers. Furthermore, fibre keeps you feeling fuller for longer and combined with other macronutrients reduces transit time in our digestive system. It also helps us stay regular too. Our bodies are designed to eat carbohydrates, which is why we have sufficient enzymes in our stomach to take care of them.

Conclusion:

Simple lifestyle changes can help you not only lose weight but keep it off in the long term.

Here are my 6 tips for sustainable weight loss.

1.       Slow and steady wins the race.

Aim to lose 0.5kg a week, anything more than that and you are possibly losing muscle and water not fat.

2.       Reach for Low Glycaemic Index (GI) Foods.

Carbohydrates in foods and how they affect your blood glucose levels as it's digested, absorbed and metabolised can be measured using a glycaemic index.

These measures are as follows:

There are three ratings for GI:

Low GI = value 55 or less

Medium GI = value of 56 – 69 inclusive

High GI = 70 or more

The reason for choosing a low GI food is it doesn’t spike blood sugar levels and gives you longer-lasting energy. Thus, a slower and gentler rise and fall in blood glucose.

This helps when you are trying to lose weight, as after a meal you will feel satisfied and not be thinking of your next meal any time soon. In contrast, when a high GI meal is consumed there's a rush of glucose into the bloodstream followed by a quick fall.

GI values of everyday foods can be found by searching the University of Sydney's GI database for exact GI values of foods.

3.       Filling up on Free Vegetables  (Click on the link to find my cookbook on Free Veg)

Free of carbohydrates, having less than 20 calories in a serve and don’t affect your blood sugar.

Like salad and vegetables.

Alfalfa, artichoke, asparagus, bamboo shoots, beans (green), bean sprouts, broccoli, Brussel sprouts, cabbage, capsicum, carrots, cauliflower, celery, choko, cucumber, eggplant, leek, lemon, lettuce, marrow, mushrooms, onions, radish, rhubarb, rocket, shallots, silverbeet, spinach, spring onion, squash, swede, tomatoes, turnips, watercress, water chestnut, zucchini.

The vegetables are bursting with phytonutrients, minerals and vitamins that are not only beneficial for your health but also help you to lose weight.

4.       Drink water.

Keeping a bottle of water with you at all times helps you stay hydrated whilst also monitoring how much you have drunk throughout the day. Since water is free in calories, it is also linked with reduced calorie intake. Therefore, when you then drink water instead of other beverages, which are often high in calories and sugar, you are more likely to lose weight.

5.       Portion sizes.

Eating from a side plate can help you keep portion sizes in check and dividing your plate into segments of protein, ¼ of the plate, carbohydrate another ¼ of the plate and free vegetables that make up ½ the other side of the plate. You can find the plate here

Watch out for hidden dressings and sauces that contain high amount of sugars and fats and can contribute to your overall calorie intake. You are looking for low fat sauces or dressing but no more than a tablespoon.

6.       Exercise:

All kinds of physical activity are of benefit to your general health and wellbeing. This can be as simple as taking a power walk, cleaning the house, washing the car or taking the stairs at work. Just as long as you can get your heart rate up. Exercise is beneficial for helping you lose some weight but regular physical activity increases your chances of maintaining weight loss.

If you are new to physical activity or you need to do is start off small, with just a few minutes of physical exercise at a time. As any exercise is better than none, and this slowly gets you being used to being active. In addition, if it's more convenient for you, you can do short spurts of activity like 10 minutes here, 15 minutes there, such as during your lunch hour, before work or in the afternoons. Every action by itself may not seem like much, but they all add up. Your mission is to work up to at least 30 minutes on most days of the week to get the full benefits from exercise.

If you are wanting to improve your health and well being you can send me an email or give me a call. I am only to happy to help by offering simple suggestions on food and giving simple swap ideas. 

If you are wanting a nutritional consult or meal plan written up or would like to do a workshop on MACROS do not hesitate to send me a message and I can arrange this for you today. I can also do Skype calls and am mobile to come and see you. 

My eating philosophy is all about balance and creating long term healthy habits focusing on practical strategies for modern, busy people that encompasses variety and moderation.

References:

Barry, D.; Ellul, S.; Walters, L.; Lee, D.; Haluska, R., & White, R. (2018). The ketogenic diet in disease and development. International Journal of Developmental Neuroscience. Volume 68, August 2018 pages 53-58

Better Health Channel. (2013). Carbohydrates and the glycaemic index. Retrieved from https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index

Biology Dictionary (n.d). What are ketone bodies? Retrieved from https://biologydictionary.net/ketone-bodies/

Clemons, R. (2014). Eating at a food label buffet. Retrieved from https://www.choice.com.au/food-and-drink/diet-foods/health-and-weight-loss/articles/low-gi

Feren, J. (2018). What this dietitian wants you to know about the keto diet. Retrieved from https://www.bodyandsoul.com.au/nutrition/nutrition-tips/what-this-dietitian-wants-you-to-know-about-the-keto-diet/news-story/6bff440190dd01c3314c9af6a5874556

Gildea, M. (2017). The Ketogenic Diet: A Summary. Nutritional Perspectives: Journal of the Council on Nutrition, 40(4), 5-9.