The Ketogenic Diet

Popular holistic neurologist Dr. David Perlmutter, M.D., offers a nice summary and explanation of the ketogenic diet in the writing below, entitled “New to a Low-Carb Keto Diet? Avoid These Common Mistakes.” This article appeared on his website on 10-9-2018.

Because Dr. Perlmutter researches and writes so well I want to offer the reader a concise and well composed explanation of the keto diet from one of our best natural health experts. I first met Dr. Perlmutter in December, 2000, at the first board certifying examination for the American Holistic Medical Association, in Denver, Colorado.

At that conference he delivered a stunning video presentation on the use of the amino acid substrate N-acetyl cysteine in the treatment of Parkinson’s disease. I have followed his work since then, with great appreciation. He is a major thought leader in the field of using pure biochemistry to help people heal their maladies. You can read a short biography of his career and accomplishments on this page of his website. His published books on brain health are best sellers and are valuable resources.

Here is Dr. Perlmutter’s excellent summary article on the ketogenic diet, and how to avoid some common mistakes in its implementation:

New to a Low-Carb Keto Diet? Avoid These Common Mistakes

“The ketogenic diet is one of the most talked about and debated diet trends today. You’ve probably heard celebrities, athletes, and neighbors raving about the benefits of this dietary approach. Interestingly, the science backs up its rapid growth in popularity, as a ketogenic diet has been shown to have numerous health benefits for its adherents. The diet can reduce the risk of heart disease, improve glycemic control in both Type 1 and Type 2 diabetes, help individuals struggling with obesity lower their BMI, and even improve or control symptoms of debilitating neurodegenerative conditions like Parkinson’s and epilepsy. There is even some evidence to suggest that a ketogenic diet can play a role in the treatment of cancer! If it is implemented properly, adopting a ketogenic diet can be a very powerful tool in the fight against a variety of chronic diseases.

If you’ve recently made the decision to transition to a ketogenic diet or are exploring the possibility of a change, chances are you might currently find yourself in a world of confusion. What is ketosis? What are ketones? Can I really eat all the fatty foods I want? How can this possibly be good for me?

Allow me to address some of these questions.

While the ketogenic diet may sound “new,” it actually parallels the way many of our ancestors ate, before the advent of agriculture allowed for the domestication of staple crops like wheat and corn. Before the widespread emergence of these crops into the modern diet, which are high in carbohydrates and sugar (particularly in their most processed forms), our ancestors ate a wide variety of wild plants and animals and much less carbohydrate or sugar. This diet, naturally lower in carbohydrate, forced our ancestors’ bodies to burn fat for fuel as opposed to carbohydrates — the core goal of the ketogenic diet.

As a clinician, I have recommended the ketogenic diet both as a clinical intervention for patients suffering from a wide variety of ailments as well as a general suggestion for people looking to optimize their cognitive health. And while the diet is relatively easy to follow, there are a number of common misconceptions and lots of outright misinformation that one must be aware of. If you’re looking to incorporate a ketogenic diet into your lifestyle or just wanting to learn more, I’ve compiled a few tips for you here.

Ketosis Basics

The central aim of the ketogenic diet is to push the body into a state of ketosis, where metabolism shifts from burning carbohydrates as the primary energy source to fat, or “ketone bodies.” These ketones are a special type of fat that serve as cellular “superfuel.” In order to achieve ketosis, one must consume a diet high in healthy fats and dramatically lower in sugar and carbohydrates. This allows blood sugar to drop to the point that glucose is significantly less available to the body to burn as a source of fuel. In the absence of glucose, the body shifts its focus to ketones for energy production. Ketosis not only burns fat—which supports weight loss and BMI reduction if in a calorie deficit—it also transitions the body’s energy source to what clearly turns out to be a better fuel. In fact, energy derived from burning fat is associated with a remarkable reduction in the amount of damaging free radicals in the body, in comparison to burning sugar.

Focus on net carbs

Maintaining a state of ketosis is as simple as following the same dietary parameters that got the body into that state in the first place. If you limit carbohydrates and sugars in your diet, your body will opt to burn the healthy fats you consume for energy. However, when cutting carbs from your diet it is very important to focus on limiting net carbs, which is simply the number of grams of total carbohydrates in a portion of food minus the grams of fiber. Constipation is a very common issue for new adherents to the ketogenic diet, and it is caused by foregoing fiber in an attempt to limit total carbohydrates. So to prevent constipation from derailing your ketogenic diet, simply make sure you consume adequate levels of fiber!

What About Fasting?

One of the most powerful tools available to individuals on the ketogenic diet is fasting. Caloric restriction forces the body to burn through all of its available carbohydrates. Therefore fasting serves as an excellent kick start for getting the body into ketosis. Furthermore, periodic fasting while the body is in ketosis helps maintain that state because it keeps carbohydrate levels in the body negligible. Not to mention, fasting has been practiced by many cultures for thousands of years, and has numerous health benefits, generally, and is an incredibly powerful tool for improving brain health, specifically.

Before you fast, consult your health care provider to ensure it is a safe exercise for you. After confirming you can safely fast, I recommend kicking off a ketogenic diet with a 24-48 hour fast, during which time you consume nothing but water—but make sure you drink plenty of it. Once your body is in ketosis and you shift to maintenance mode, I suggest fasting once or twice a year for the same period of time and with the same, water-only restrictions. While fasting can be challenging, especially in the beginning, if you stick with it you can reap huge benefits.

Which Fats are Healthy?

One of the easiest traps to fall into when starting a ketogenic diet is the assumption that all fats are healthy. It is not uncommon to see new adherents loading up their plates with industrially harvested bacon, exclaiming, “I’m keto, so it’s healthy!” In reality, because ketosis repositions ketones as your primary fuel source, ensuring you consume healthy fats becomes even more important on the ketogenic diet.

Similar to the recommendations I make in Grain Brain, a ketogenic diet should derive a majority of its calories from fat. However, the optimal macronutrient ratio will vary from person to person. Some will thrive on roughly 80% of calories from healthy fats and 20% from carbohydrates and protein. Others may do better in the range of 60 – 75% of calories from fat and slightly more protein. I encourage you to experiment to find what works best for you. To meet this goal, you must consume plentiful amounts of healthy plant and animal fats. Some good examples of healthy fats include:

• Plant-based: Organic avocado, organic extra virgin olive and organic coconut oil, nuts—excluding peanuts, which are a legume, and seeds from chia, flax, hemp and pumpkin plants.
• Animal-based: Organic grass-fed and finished beef, pasture-raised chicken, wild-caught fish, organic grass-fed butter, and full-fat live culture yogurt.
• Supplements: MCT oil and fish oil, ensuring they are USDA-organic, hexane-free, and non-GMO. One important thing to note: MCT oil delivers beta-hydroxybutyric acid (BHB), which is the most important ketone body, and its benefits can be gained without fasting or even carbohydrate restriction. While the full benefits of a ketogenic diet will only be realized if you adhere to the diet in its entirety, incorporating MCT oil into your current diet and supplementation is a good way to benefit from ketone bodies on a smaller scale.

Ensuring that you consume adequate levels of healthy fats is vital to the success of any ketogenic diet. Avoiding bad fats, like industrially-farmed meat, hydrogenated oils, and processed vegetable oils, is just as important to ensure that you provide your body with a suitable source of energy in lieu of carbohydrates.

To Meat or Not to Meat?

One of the central questions new adherents to the ketogenic diet must answer is whether or not they want to incorporate meat into their new diet. It is entirely possible to consume adequate levels of healthy fats whether you approach the diet as an omnivore or a vegetarian, so this decision is largely a personal one. However, if you choose to incorporate meat into your version of the ketogenic diet, it is crucial to ensure it is grass-fed, organic, and free of antibiotics. Furthermore, it is important to focus primarily on above-ground leafy vegetables, with meat serving as a side dish. An example of the perfect plate for a keto omnivore would be a sizeable portion of colorful, above-ground leafy vegetables covered with a healthy fat like olive oil, paired with a 3-5 oz serving of high-quality meat.

Avoiding the “Low-Carb Flu”

Arguably the most challenging period of transitioning to a ketogenic diet is the first few days as your body adjusts to the dramatic decrease in carbohydrate intake and your metabolism begins its shift to fat as its primary fuel source. It is not uncommon during this period to experience a lack of energy, irritability, ravenous hunger, and brain fog, symptoms commonly referred to as the “low-carb flu.” These uncomfortable symptoms arise because a ketogenic diet eliminates the spikes in blood sugar that follow carb-heavy meals, keeping insulin levels low (because it is no longer needed in response to said blood sugar spikes) and triggering the kidneys to excrete high levels of electrolytes—think sodium, potassium, and magnesium. Additionally, many people transition to a ketogenic diet from a standard, modern diet, which was likely rich in processed foods packed with sodium, so electrolyte levels drop simply because you aren’t getting enough sodium to replace that which you previously took in from processed foods. In the end, if you do not replace these excreted and/or missing electrolytes in your new ketogenic diet, it can ultimately lead to a drop in blood pressure and bring about the symptoms of “low-carb flu.”

Rest assured, not everyone experiences this side effect of the ketogenic diet and, if you do, it will abate on its own; furthermore, there are some simple preventative steps you can take to lower your likelihood of “catching” this flu. As you adopt a ketogenic diet, make sure you replace electrolytes, eat enough fat to meet your total caloric needs, drink plenty of water, and exercise as you are able. It’s very important, however, to ensure that you aren’t relying on sugary sports drinks to replace electrolytes, as all that added sugar will prevent your metabolism from entering ketosis. Ultimately, electrolytes play a crucial role in our health and many Americans do not consume them at adequate levels, so it is very important to monitor your intake of these nutrients regardless of whether or not you are an adherent of the ketogenic diet.

In the end, the “low-carb flu” should be viewed as a testament to the power of the ketogenic diet. After all, eliminating the pressure on your body to regulate the blood sugar spikes that follow “normal” meals is ultimately what leads to these symptoms!

The ketogenic diet is an incredibly powerful tool that can be wonderfully effective in treating a variety of health issues facing modern society. By allowing the body to burn fat for fuel, the ketogenic diet can not only lead to sustainable weight loss, but it actually pushes the body to use an alternative and potentially superior fuel source. If you are just starting a ketogenic diet, use the tips outlined above and stick with it; it can be a challenging transition, but there are many, many benefits of long-term adherence to this diet.”

This completes the article. Dr. Perlmutter offers an e-guide book if you want to learn more in-depth information about the ketogenic diet.

Crestone and Beyond Journals

I recommend the ketogenic diet for anyone who has diabetes, obesity, dementia, and cancer. The basic common abnormality in these conditions is mitochondrial dysfunction. Ketosis chemistry helps improve mitochondrial function. Mitochondrial health and efficiency is the basis of physical health.

I have written about the keto diet in a number of past Journals which contain additional helpful information:

• Minding your Mitochondria
• Cancer Therapy Today
• Preventing and Reversing Dementia
• Detoxification

Dr. Perlmutter’s article is a good consolidation of helpful information on the subject.

The Low Carbohydrate Diet

Ketogenic diets usually involve getting fat intake up to about 70-75% of total daily calories. Protein is limited to about 20-25% of calories, and carbohydrates are reduced to about 5-10% of daily calories. When eating like this our body shifts into burning ketones which is a more efficient fuel for the brain and other organs. Food cravings diminish and weight loss ensues.

 

In order to initiate a ketogenic state it may be necessary to reduce grams of sugar to 20-25 grams per day! You have to become familiar with carbohydrate and sugar content in your common foods (see link in next paragraph), and you will have to become adept at reading food labels. The major balance of daily calories will come from high quality fats, up to 70-75% of daily calories.

Some good fats to use in a ketogenic diet are: olive oil, coconut oil, coconut butter, butter, ghee, avocados, nuts and seeds, omega 3 fats from deep cold water fish, grass fed meat, eggs from free range chickens, MCT oil (medium chain triglycerides), and other fats as is seen on this website…A Keto Diet for Beginners.

The following list from Dr. Cate Shanahan, author of Deep Nutrition: Why Your Genes Need Traditional Food, also details some of the best and worst fats found in our modern diet.

The keto food resource page linked above is from the Ketogenic Diet Resource website which offers many other helpful recommendations. On this page you will see the amount of grams of carbohydrate which are present in common serving sizes of almost all of the commonly consumed foods in the various food types except for fruits. Here is a page which shows carbohydrate content for some common fruit varieties.

There are now a number of very good ketogenic diet books available which you can discover with a simple web search.

Supplements to Assist Ketogenesis

In addition to food and lifestyle recommendations, such as the ones explained above, I often recommend targeted nutritional supplements from Designs for Health to assist clients in reestablishing a healthier biochemistry as the fertile ground from which a new life can grow.

Some of the supplements I recommend to assist ketosis are seen below. This listing contains nutrients which support mitochondrial health, and there are newer supplement toward the end of this listing which specifically support ketosis.

Search the following nutritional supplements at my Designs for Health Virtual Dispensary store link.

• Mitochondrial NRG…an advanced formula containing the ingredients needed by the mitochondria to produce the cellular energy molecule of life, which is ATP. Please see the website writing Minding your Mitochondria which explains mitochondrial chemistry in more detail, as well as other important supplements to assist mitochondrial health.
• Metabolic Synergy…this multivitamin/multimineral/antioxidant/antiglycation formula is a potent and very important formulation for those who are dealing with any feature of metabolic syndrome. The formula helps maintain healthy glucose and insulin levels while supporting mitochondrial conversion of carbohydrates into ATP.
• Carnitine Synergy…a blending of L-carnitine and acetyl L-carnitine. Carnitine is essential for fat burning in the mitochondria. Acetyl L-carnitine has noted brain enhancing effects, and is one of the essential precursors of the neurotransmitter acetylcholine.
• CoQnol 100 and CoQnol 200…the reduced ubiquinol form of coenzyme Q10 which is an important substrate in mitochondrial production of ATP. The reduced ubiquinol form of CoQ10 is needed because the body’s ability to transform the oxidized form of CoQ10 known as ubiquinone has declined with aging. Both ubiquinol and ubiquinone are necessary to assist mitochondrial production of ATP.
• Q-Evail 100 and Q-Evail 200…the oxidized form of CoQ10, known as ubiquinone, which is needed by the mitochondria, and is also needed to cycle into the formation of the reduced form, ubiquinol.
• An impressive array of OmegAvail fish oil supplements…omega 3 fatty acids correctly formulated for maximum absorption arranged in an impressive array of choices and styles. Omega fats decrease inflammation, increase blood flow, decrease brain atrophy, increase working memory, executive function, and mood. Designs for Health’s impressive suite of fish oil supplements can be viewed in the link above.
• PaleoFiber…a unique blend of 12 different forms of fiber which provide insoluble fiber for stool bulk and cleansing and also has forms of insoluble fiber which support healthy gut microbial growth and diversity.
• PaleoFiber RS…this more advanced fiber supplement benefits GI health through its ability to support microbial balance and proper intestinal permeability and integrity. Additionally, this formula may help support optimal blood sugar and insulin levels, appetite control, and cardiovascular health.
• MCT Colada…an emulsified form of medium chain triglycerides (MCTs) in a pleasant pineapple flavored liquid. The MCTs will be readily converted into ketones by the liver to assist fueling brain cells which are under duress.

Other important nutritional supplements to assist in the health of the central nervous system can be viewed in the more extensive Journal writing entitled Brain Health Nutrients.

This writing will be followed by a growing list of Associated Reading References as I discover them.

Thank you for reading.

I want to thank Dr. Perlmutter for his informative article.

Signing off from Crestone and Beyond

How to Measure your Level of Ketosis

1. Am I in Ketosis? Four Simple Steps to Find Out!…Dr. Perlmutter demonstrates a test kit method
2. Keto Mojo–The Most Accurate and Inexpensive Way to Determine if You’re in Nutritional Ketosis…a new test kit is showcased on the Mercola website.

Ketogenic Cookbooks

There is now quite an array of cookbooks for learning how to implement the keto diet.

One of my favorites is The Ketogenic Kitchen written by Domini Kemp and Patricia Daly who successfully used this type of eating to deal with their own breast cancer and melanoma processes.

Another one which is often used in my home is Quick and Easy Ketogenic Cooking by Maria Emmerich.

Joseph Mercola published his KetoFast Cookbook in the spring of 2019.

A Complete Guide to the Keto Diet

Popular natural health advocate Chris Kresser published this excellent writing on the subject on April 2, 2019. This writing summarizes everything thing one would need and want to know when considering a ketogenic diet. This writing is highly recommended.

5 Signs a Ketogenic Diet Isn’t Right for You

This is a January, 2021 writing by John O’Connor who is the founder of MyGeneFood; a service that analyses 23andMe data to determine your best diet type from a selection of 20 different diet types. I have been pleased with this service and their science. Please see this brief writing about the signs that you are not suited for this type of diet. “If you’re thriving on keto, great, but if you are seeing lab results that make your physician nervous, are tired all the time, and have seen a downturn in your digestion, your body might be trying to tell you something.”

Associated Reading and References

1. Tripping Over The Truth, by Travis Christofferson…published in 2014, this book details the story of “the return of the metabolic theory of cancer and illuminates a new and hopeful path to a cure.” This book is a well written scientific investigative journalism narrative for anyone who has any of the diseases which can be helped by assisting one’s mitochondrial health, and that would be most diseases, not just cancer. The historical trail supporting the keto diet is based on the work of 1931 Nobel Prize winning German biochemist Otto Warburg who discovered that cancer cells are dependent on sugar as their main fuel.
2. Cancer as a Metabolic Disease, by Thomas Seyfried, Ph.D….published in 2012. This 400 page text is written by a professor of biology at Boston College and covers the subject of cancer’s true origins in technical detail. Chapter 11 is entitled “Mitochondria: The Ultimate Tumor Suppressor.” The keto diet is explored in depth via mitochondrial chemistry.
3. Eat Fat, Get Thin…Dr. Mark Hyman, M.D., plunges into the fat for fuel subject and why this is the best way to fuel the body.
4. Cereal Killers 2…this is an excellent video documentary about 2 elite athletes who switched from carbohydrates to fats for fuel…and then performed an amazing endurance feat. This is a wonderful documentary.
5. Revolution Health Radio: The Ketogenic Diet and Cancer…holistic and functional medicine researcher and commentator Chris Kresser posts a nice summary of considerations involving the use of ketogenic dieting in cancer therapy.
6. How Many Carbs Can You Have on Keto?…a nice and brief presentation of recommended keto diet carb amount and types of good keto diet carb foods.
7. A ketogenic diet for beginners…this page is a wealth of keto information rendered in a visual picture format. The information presented here is very easy to grasp.
8. Ketones–Understanding These Precious Molecules…an excellent brief summation of ketones which includes a reference to the exogenous ketone supplement…Keto-Nootropic, from Designs for Health.
9. What Is the Optimal Human Diet?…Chris Kresser poses this excellent summary article on 9-27-18. This is a very good summary of the variables and considerations.
10. Dr. Will Cole: Keto-tarian…Dr. Perlmutter interviews Will Cole on how to marry the keto diet with the vegetarian/vegan diets.
11. The Effect of Medium Chain Triglycerides on Time to Nutritional Ketosis and Symptoms of Keto-Induction in Healthy Adults…this study, published in the Journal of Nutrition and Metabolism, looks at whether MCT supplementation improves the time to nutritional ketosis, and how MCTs affect commonly reported mood disturbances and other symptoms of keto-induction.
12. The Fasting Cure…a book published over 100 years ago, written by Pulitzer Prize winner Upton Sinclair, who used fasting in his own life, and lived to age 90.
13. Plenty of Room for Fiber on Ketogenic Diets…a look at fiber intake on ketogenic diets.
14. Primer on Dietary Fats…the different types of fats, where they’re found, and their effects in the body.
15. What is mTOR?…a 2.5 minute video synopsis of the answer to this question (skip the ad).
16. Best Ways to Activate Autophagy and mTOR…the video of the people conducting this interview are not so great, but the information is very good.
17. Intermittent Fasting and Autophagy…Annette Bosworth, M.D. explains the concepts in a 12 minute video.
18. New study demonstrates improvement in sleep with ketogenic diet in patients with insulin resistance…according to a new study published last month in Sleep Medicine, researchers demonstrated that nutritional ketosis improves sleep quality and quantity in patients with type 2 diabetes.
19. Applications for the Ketogenic Diet and Exogenous Ketones…a brief writing on the evolution of the ketogenic diet.
20. Rebooting the System: The Benefits of a Fasting Mimicking Diet…Chris Kresser explains this effective and well researched dieting style.
21. Influence of Ketogenic Diets on Blood Glucose and Insulin…an excellent and short article on the subject of elevated insulin and comorbid conditions caused by elevated insulin.
22. Weight Loss and Thyroid Testing: Beyond Just TSH…considerations here about thyroid testing in the face of weight loss, such as can occur on ketogenic diets.
23. Influence of Ketones and Ketogenic Diet on the Brain and Central Nervous System…KD is good for mitochondria, which is one of the important bottom lines in any cell.
24. A New Application of Ketones–Muscle Regeneration…skeletal muscle has a high affinity for ketone bodies.
25. Is Fasting Right for Everyone?…this article advises on which groups of people should be supervised while fasting.
26. Low-carb Diets Improve Metabolic Health Even in the Absence of Weight Loss…Metabolic syndrome and cardiometabolic disease in general occur in people of any body weight, not exclusively those who are overweight or obese. Low-carb diets are the healthy choice.
27. The Evolutionary Diet…the paleo diet revisited. Posted here on 8-9-19.
28. When a High-Carb Diet is the Answer Instead…high carb diets are indicated in cases of amyotrophic lateral sclerosis.
29. New Research on Why We Gain Weight as We Age…biochemical mechanism of adipose cell turnover in an article from 10-22-19.
30. How to Limit Restrictive Eating and Develop a Healthy Food Mindset…nutritionist Lindsey Christiansen posts a nice article about developing a healthy relationship with food on Chris Kresser’s website.
31. Ketone Supplement Drinks Mimics Ketogenic Diet…15 people were tested with a ketone drink containing beta-hydroxybutyrate. “It demonstrates that these supplements may have real potential as a valuable tool for those with Type 2 diabetes.”
32. Effects of Intermittent Fasting on Health, Aging, and Disease…a December, 2019, article from the New England Journal of Medicine. Being in a fasted state activates cellular pathways that remove or repair damaged molecules and improve our defense against oxidative and metabolic stress. Intermittent fasting can improve: 1) blood sugar regulation, heart rate, and blood pressure, 2) stress resistance 3) the effects of aging, 4) inflammation, and 5) cognitive function. There are several different approaches to IF, including alternate-day fasting (eating only every other day), 5:2 fasting (eating five days per week, and fasting two days), and time-restricted eating (typically eating only during a six- to eight-hour window each day). It is best to start slowly to give your metabolic machinery a chance to more easily adapt from using glucose to using ketones.
33. Richard (Bud) Veech, the Unknown Scientist Behing the Ketogenic Diet Craze Dies at 84…Travis Christofferson has penned a nice tribute here to the great Richard Veech, M.D., Ph.D. Dr. Veech attended Harvard and then went on to Oxford University to study and work under Sir Hans Krebs with whom he developed beta hydroxybutyrate as a nutritional dietary supplement for use in ketosis applications. Upon remembering a time he shared with Dr. Veetch, Christofferson states, “I knew I was in the presence of greatness. Not today’s brand of greatness: celebrities, athletes or YouTube stars, but rather greatness of a different era.” Oh, how true this statement is.
34. Ketones: The Fourth Fuel…Travis Christofferson discusses his fourth book and expounds on a lot of good information about ketones for health.
35. How To Lose Weight…posted here on 1-16-21. This is a very good article and is highly recommended…”Health is the best investment you can make in 2021.”
36. 10 Facts About Cholesterol and Why a Personalized Approach is Best…posted here on 2-11-21. This article is based on the evolving science of nutrigenomics. This one comes from the people at mygenefood.com, which is a service that analyses genetic information to determine one’s best diet type from a selection of 20 diet types. This article is informative about 10 key points about cholesterol.
37. Ketosis and the Heart…posted here on 11-22-21. Dr. David Perlmutter, MD, reviews new evidence that the keto diet is good for the heart and the cardiovascular system. this is very interesting information and I encourage you to review what Dr. Perlmutter has written here.