15 July 2021 Sakiko Reuterskiold

A powerful health intervention, if done well.

Definition: the ketogenic diet is a high-fat, low carb, moderate protein diet that causes the body to use fats for energy and to produce ketones which the brain can use for energy. In order to ensure you are doing it, you must measure your ketones using ketone strips or finger-prick testing. Ketones should be between 0.5-3.00mmol/L.

Macronutrient Composition:

  • Classical Ketogenic Diet (therapeutic to treat epilepsy and has other medical applications): Energy Intake should be 4:1 Fats to Protein + Carbs, where the protein amount is 1-1.5g/kg body weight.
  • Modified Ketogenic Diet (helpful if resistance training to build muscle): 70% Fats, 25% Protein and 5% Carbohydrate by energy intake (kcal), NOT by weight (g).

Can Food Products be defined as “Keto”?

No. They can be keto-friendly, by being very low in carbs and high in fats. What defines “ketogenic” is that your body is generating ketones. You can be in ketosis by following a ketogenic diet, but a food product itself cannot be defined as keto. That is why “Keto” is not an approved claim.

Reasons to go on a Ketogenic Diet

  • Type I Diabetes: If you are on insulin and have type I diabetes, a ketogenic diet can significantly reduce blood glucose fluctuations and your insulin requirements. Reducing the amount of insulin you need has many positive health benefits.
  • Type II Diabetes: If you have prediabetes or type II diabetes, a ketogenic diet can enhance your insulin sensitivity and even prevent type II diabetes and all of its negative health consequences from developing.
  • Preventing & Treating Cancer: Although more research is needed, ketogenic diets and supplemental ketones (ketone esters) in animal studies have suppressed tumor growth and tumor burden and increased survival times. This may be due to ketones altering glucose metabolism, as cancer cells are highly glycolytic (use glucose for energy and proliferation). There is also research on how a ketogenic diet might enhance the efficacy standard-of-care cancer treatment, including chemotherapy and radiotherapy.
  • Enhanced and Stable Energy Levels: As a ketogenic diet causes your body to burn more fats (vs. carbs) for energy, it helps you to avoid the blood glucose fluctuations that make your energy levels fluctuate and make you feel ‘slumps’ during the day. Instead, having high, sustained energy levels will be more likely, especially when including all essential amino acids (protein) for your needs and all essential micronutrients.
  • Lose Body Fat: Eat fat and get fat, right? Wrong. The most effective dietary way to generate triglycerides (fat) and gain fat is to eat a high fructose diet. Fructose metabolism down-regulates fat-burning genes and up-regulates lipogenic (fat-generating) genes, provides building blocks for triglycerides, suppresses the fullness hormone’s (leptin) efficacy and increases the hunger hormone (ghrelin), usually resulting in you eating more than needed, further contributing to fat-gain. By shifting your diet to a very low-carb diet and keeping fructose to a minimum in particular, your metabolic flexibility increases and you increase the efficiency of your mitochondria (energy- generating organelles) burning fats for energy. Thus, when not eating, your body will easily burn fat for energy (incl. your own body fat), encouraging body fat loss.
  • Preventing and Treating Cognitive Decline: Research demonstrates that as we age, the brain’s ability to use glucose for energy declines, while its ability to use ketones is maintained. Alzheimer’s disease and cognitive decline can be mitigated and prevented by addressing the root causes for each individual and being on a ketogenic diet high in healthy fats.

What to DO when Implementing a Keto Diet:

  • MEASURE your KETONES to see if you are truly in ketosis! It is very easy to eat too many carbs when trying to go from a standard to a ketogenic diet. The amount of carbs you can have is VERY LOW. Based on a daily consumption of 2,000kcal, 5% carbs means only 100kcal allocated to carbohydrates.
  • ALLOCATE your CARBS CAREFULLY: As you only have c. 100kcal of carbs to allocate and all vegetables and fruit are carbs, you want to choose those carbs to maximise the essential vitamins and minerals that are found in fruit and vegetables. Avoid high- fructose fruit which can increase your hunger. Mostly choose a variety of micronutrient- dense, low-carb and high-fibre vegetables like dark leafy greens, cruciferous and colourful vegetables. Fibre is essential for your microbiome, gut and overall health, so be sure to eat enough high-fibre veg. Vitamins and minerals are ESSENTIAL, we must consume them from food and our health will suffer if we become deficient. Also choose super-foods and drinks that are high in longevity-pathway-activating polyphenols such as sugar-free dark chocolate, tea and fresh or dry herbs.
  • CONSUME COMPLETE PROTEIN: ensure you are getting all essential amino acids. Amino acids are the building blocks of protein, and there are 9 essential ones that must come from food and 6 that are conditionally essential. Eggs are a great protein source as they contain all essential amino acids. Although quinoa contains all essential amino acids, some of them are in such low quantity, quinoa alone will not cover the body’s needs, and it is also more of a carb than a protein.
  • CALIBRATE your PROTEIN AMOUNT: too high protein intake can tip you out of ketosis as the protein can be metabolised into glucose. On the other hand, ensure you eat sufficient protein, as protein is satiating (dampens hunger) and if you wish to gain or maintain muscle mass with resistance training.
  • CHOOSE FATS wisely: avoid vegetable seed oils (e.g. rapeseed, sunflower seed oils) and ensure you consume enough ESSENTIAL Omega-3 fats (DHA and EPA) in oily fish or through supplementation.
  • COMPLEMENT with TIME-RESTRICTED EATING and EXERCISE: fasting overnight for >14- 16hrs can speed up the process of getting into ketosis and has many other health benefits. Training fasted in the morning can also use up your glycogen (glucose stores) and enhance the initiation of ketosis as well.
  • CHECK with your DOCTOR: if you have a particular health condition, consult your doctor before implementing a ketogenic diet to check if there are no contraindications and make sure to adjust your protocol accordingly. For example, if you are taking insulin for Type I diabetes, you may have to reduce the amount.
  • ENJOY the experiment, measure, observe and adjust. You might find a new level of energy and wellbeing. You also might find that you want to evolve to a low-carb, not necessarily ketogenic diet. Figure out what is sustainable and optimal for you.

By Sakiko Reuterskiöld, MSc Personalised Nutrition, Functional Medicine, Founder of NOMOSU