Ketogenic Blog Series Part I

Part I - Overview of the Ketogenic Diet

If you're like me, 'diet' isn't the most comfortable word.  Past failures, unwelcome foods and rebounds can make diets seem like a lot of work...quite honestly, work that I don't feel like putting in most days.  But, despite my experience with diets in the past; whenever I make the decision to eat something unhealthy, or a portion that's meant for two...or three, I still end up telling myself: "I need to go on a diet..."

That's where today's blog comes in.  It's the first part of our three-part blog series about the ketogenic diet.  While this isn't meant to advise you to go on any specific diet -recommending a diet without understanding a person's health and needs is irresponsible- at Naturopathic Specialists we have a ketogenic diet program that we've been able to use to help patients with cancer, obesity, diabetes, and many other illnesses.  

If you're familiar with the ketogenic diet, great!  You'll probably appreciate getting our perspective on how it can be used safely.  And if you haven't heard of it before, then read on to see why we've found success in using this diet to help our patients improve their health.  The ketogenic diet has some incredible benefits that most diets can't boast.  Sure, it can help you lose weight, but it also has some promising studies to support its role in fighting cancer.

Here's an outline of what the keto blog series is going to look like:

Part One will give an overview of the ketogenic diet, and what it is.
Part Two will cover the ketogenic diet and its role in cancer treatment.
Part Three will cover the ketogenic diet and its role in treating other illnesses.

If you have questions or want to get started on the ketogenic diet through Naturopathic Specialists, contact our clinic at 480-990-1111.

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What Is the Ketogenic Diet?

Simply put: A ketogenic diet is:

  • Low in carbohydrates (5 – 10% of calories)

  • High in fat (60 - 80 % of calories)

  • Low to moderate in protein (15 – 25% of calories)

The goal of a ketogenic diet is to lower the body's blood glucose level so that your body switches to using ketone bodies as a fuel source. You are in a state of ketosis when your blood ketone levels are between 0.5 – 7 mmol/L.  The body needs to have both a low blood glucose level and reduced glycogen stores (glycogen is the storage form of glucose found in your liver and muscles) to enter a state of ketosis.  Additionally, the body also needs a decreased level of insulin which is controlled by carbohydrate intake.  Insulin’s role is to uptake glucose from the bloodstream and push it into cells.  Additionally, it prevents fat from being used as a fuel source.

There are three major ketones produced by the body they are: acetone, acetoacetate, and beta-hydroxybutyrate.  These ketones are either produced by the breakdown of our bodies own fat stores or by the breakdown of dietary fats.

Typically, your body has around 2,000 calories worth of glucose stored in your muscles and liver in the form of glycogen.  If you fast for extended periods or do an exhaustive workout these calories are depleted and need to be restored.  Therefore, you need to constantly eat to keep your blood glucose at a constant level and replenish your glycogen stores.

Comparatively, a pound of fat contains 3,500 calories.  Which means that someone with 10 pounds of body fat has over 35,000 calories stored that (given the right metabolic environment) can be used as a source of energy.

The goal of ketosis is to tap into these fat stores to fuel your body.

Most of us have been in some degree of ketosis at some point in our lives without even knowing it.  If you eat an early dinner and don’t eat again until the morning you most likely have ketone bodies in your bloodstream.  Additionally, if you have ever done a prolonged fast then you have been in a state of ketosis.  The idea of using fasting as a therapeutic modality has existed since ancient times.  It is believed that the production of ketones is the reason prolonged fasting is so beneficial.


Is the Ketogenic Diet the New 'Fad' Diet?

Actually, fasting as a therapeutic modality has existed for thousands of years.  In 400 BC Hippocrates wrote about how dietary interventions, namely fasting, can treat epilepsy.  The first study looking at fasting as way to treat epilepsy was performed in France in 1911 (1).  Meanwhile in America a man named Bernarr Macfadden was becoming one of the first health gurus.  Macfadden believed in clean eating, exercise, nature, and fasting.  He published a magazine named Physical Culture that, by the end of WWI, reached over 500,000 people (2).  Macfadden opened a sanitorium in Battle Creek Michigan, where one of his employees and students, Dr. Hugh W. Conklin, used fasting to treat people with epilepsy.  This caught the attention of many physicians, and by 1920 many doctors were studying the anti-epileptic effects of a ketogenic diet.  Throughout the 1920’s and 1930’s thousands of patients with epilepsy were placed on a ketogenic diet.  Textbooks had entire chapters dedicated to how to implement a ketogenic diet in patients.

in the past five years, over 1,000 studies have been published on...the ketogenic diet

This all changed in 1938 with the discovery of diphenylhydantoin also known as phenytoin.  Over time the ketogenic diet was forgotten about as doctors preferred the use of pharmaceuticals.  In 1958, scientist Ancel Keys published the seven countries study which showed that levels of saturated fat intake were correlated with heart disease (10).  This was the start of the low-fat craze and the use of ketogenic diets fell out of favor.  However, there were distinct flaws in Ancel Keys research, and recent studies have indicated that eating a diet rich in fat may be healthy (3).  Recently, interest in the ketogenic has skyrocketed and in the past 5 years almost 1000 studies have been published on pubmed looking at the ketogenic diet.


What Can I Eat on a Ketogenic Diet?

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When it comes to starting a ketogenic diet a lot of people have trouble figuring out what to eat the first few weeks.  (Probably because most of us we have been taught that eating fat is bad and we need to eat whole grains every day to be healthy).  

A good starting point is limiting carbohydrate intake to <25 grams/ day.  This means that the only source of carbohydrates will be via non-starchy vegetables.  

The next step is to increase intake of healthy fats.  As previously stated most people have been trained their entire life to cut down on fat consumption. Healthy fats include avocado oil, coconut oil, olive oil, butter and heavy cream.  

When it comes to protein, most people can consume 1g/ kg of protein per day.  While on a ketogenic diet, consumption of fatty cuts of meat is encouraged.

Because of the popularity of the ketogenic diet, there's a ton of cookbooks and websites offering ketogenic recipes, meal plans, shopping lists, and budgets.  It might not be as hard as you'd expect to find a ketogenic version of your favorite meals!


Pros and Cons of a Ketogenic Diet

We're going to dive into the benefits of a ketogenic diet in parts II and III of this series, but here's a quick taste of some of the potential pros and cons that we'll discuss.

Potential Drawbacks of a Ketogenic Diet

  • Adaptation period which may last weeks to months

  • Flu like symptoms for the first few weeks of the diet

  • Restrictive way of eating

  • Very easy to exit a state of ketosis

  • Decreased athletic performance at first

  • Can lead to micronutrient deficiencies

  • Gastrointestinal disturbances

  • Kidney stones

Potential Benefits of a Ketogenic Diet:

  • Weight loss

  • Improved memory, cognition, mental clarity

  • Anti-cancer effects

  • Prevents heart disease

  • Decreases inflammation

  • Improves sleep

  • Reverses neurological and metabolic diseases

  • Helps stabilize hormone levels

  • Improves athletic performance


Common Questions About the Ketogenic Diet

What about ketoacidosis?
It is important to understand the difference between ketosis and ketoacidosis.  Ketoacidosis usually occurs in the context of uncontrolled type I diabetes and in some instance type II diabetes.  In type I diabetes the pancreas does not produce insulin.  In the case of type II diabetes the body’s cells can become resistant to insulin and so more is needed to provide a normal response.  This can overwork the pancreas and cause it to fail leading to the development of the disease.  In both scenarios cells think they are starving even though there is enough glucose in the bloodstream.  

To remedy this the body tries to produce more glucose, through a process known as gluconeogenesis, from lactate, amino acids or fatty acids.  During this the body also starts to produce ketones to try and fuel itself.  Elevated blood glucose also leads to increased urination to try and remove some glucose from the bloodstream.  This decreases blood volume which in turn increases the concentration of ketones in the bloodstream leading to increased blood acidity (ketoacidosis).  Blood ketone levels can raise as high a 25 mmol/L and blood glucose levels can be as high as 300 mg/dl, (4) which can lead to many adverse health outcomes.  

This scenario is physiologically unlikely to occur in healthy individuals.  However, there are case reports of non-diabetic individuals going into ketoacidosis under very certain conditions (5).  That is why it is important to be medically supervised while undergoing a ketogenic diet.

Wait...doesn’t eating fat make you fat?
The rate of obesity of America it has increased exponentially since the 1980’s.  Scientists at the time were saying that saturated fat caused heart disease and encouraged people to consume a low-fat diet.  However, once fat was removed from foods, these foods became highly unpalatable.  In order to make foods taste better and be considered “heart healthy” food scientists found that they could replace the removed fat with sugar.  Food scientists also started replacing saturated fat with hydrogenated and polyunsaturated fats.  These forms of fat are high in omega 6 fatty acid’s which are highly inflammatory.

The combination of high sugar and high polyunsaturated fat content in foods is a contributing factor to the obesity epidemic.

Recent studies have shown that healthy fat consumption is linked to decreased obesity and improved cardiovascular parameters, metabolic parameters and decreases overall mortality when compared with a diet high in carbohydrates (3).

Is the ketogenic diet just a version of the atkins diet?
While the ketogenic diet and the atkins diet share many similarities, there are key differences.

Both diets limit the amount of carbohydrates you can consume to <30 grams/ day.  However, the atkins diet does not limit the amount of protein you can consume (6).  It has been found that under certain conditions protein can be converted into glucose to maintain blood sugar levels (7).  Furthermore, the atkins diet consists of different phases and once you are past the initial phase, you can gradually increase your carbohydrate intake which may prevent you from entering ketosis.

How will a 'high-fat' diet affect my cholesterol?
You might wonder,  "If I'm consuming fats, won’t that increase the level of fats in my blood and lead to heart disease?"  

Actually, research shows that the opposite may be true.  A meta-analysis published in the British journal of nutrition looked at 1,415 subjects who ate a low carbohydrate diet (<50 grams/day) (8).  The results of that analysis showed that those who ate a low carbohydrate diet had increased HDL (the good cholesterol) when compared with those eating a low fat diet (8).

A study looking at obese men put on a low carbohydrate diet (10% of calories from carbohydrate) found that LDL concentration decreased by 9.6% and LDL particle size increased by 5.2% (9).  Decreased LDL concentration and increased LDL particle size is associated with decreased risk of heart disease.  Additionally, the same study found that VLDL particles were decreased by 19% (9).  Greater VLDL levels are associated with increased risk of heart disease.

As seen from the above studies it has been found that the ketogenic diet has a positive impact on cardiovascular health.


Contraindications to the Ketogenic Diet

As we stated at the beginning of this article, while our doctors have found many applications for the ketogenic diet, we don't believe that it's a diet for everyone.  There are some definite contraindications to a ketogenic diet.  

Before you start any diet, it's best to speak with your doctor to determine how it might affect you.  Our doctor's would be happy to see if a ketogenic diet could benefit you, but here's a short list of contraindications to the ketogenic diet:

Absolute contraindications

  • Carnitine deficiency (primary)

  • Carnitinepalmitoyltransferase (CPT) I or II deficiency

  • Carnitinetranslocase deficiency b-oxidation defects

  • Medium-chain acyl dehydrogenase deficiency (MCAD)

  • Long-chain acyl dehydrogenase deficiency (LCAD)

  • Short-chain acyl dehydrogenase deficiency (SCAD)

  • Long-chain 3-hydroxyacyl-CoA deficiency

  • Medium-chain 3-hydroxyacyl-CoA deficiency

  • Pyruvate carboxylase deficiency

  • Porphyria

Relative Contraindications
(Again, speak to your doctor if you have one of these conditions so that your doctor can assess whether it would be safe to begin a ketogenic diet with one of these conditions).

  • Pregnancy

  • Lactation

  • History of or current pancreatitis

  • History of or current disease

  • History of or current liver disease

  • History of or current kidney disease

  • Gastric bypass surgery

  • Decreased GI motility

  • Poor nutritional status

  • Abdominal or liver tumors

Conclusion

Diet isn't a dirty word.  What and how much we eat has an incredible amount of power to impact our overall health.

Even though most of the time people hear of diets before swim-suit season, or as new-years resolutions, the best reason to consider dietary changes isn't for vanity.  If our health can be improved by changes in diet, then it's worth the effort to see how it can do so.  Especially in specific, doctor mandated situations, diet changes or plans, like the ketogenic diet can have amazing effects that go far beyond weight loss.

Part two of our ketogenic diet series will discuss the beneficial effects that a ketogenic diet has on cancer.

 Written by Adam Kozin, ND.

Written by Adam Kozin, ND.

 

(Our blog isn't designed to provide specific medical advice or replace a medical professional.  If you have any specific questions about your health, how to make changes responsibly, or would like to set up an appointment with our clinic, head to our Contact Us page and let us know)!

 

 

 

References
1.  Guelpa G, Marie A. (1911) La lutte contre l‘e’pilepsie par la de’ sintoxication et par la re’e’ducation alimentaire. Rev Ther Medico-Chirurgicale 78:8–13.

2.  Wheless, J. W. (2008). History of the ketogenic diet. Epilepsia, 49, 3–5. https://doi.org/10.1111/j.1528-1167.2008.01821.x

3.  Dehghan, M., Mente, A., Zhang, X., Swaminathan, S., Li, W., Mohan, V., … Mapanga, R. (2017). Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet (London, England), 390(10107), 2050–2062. https://doi.org/10.1016/S0140-6736(17)32252-3

4.  Cartwright, M. M., Hajja, W., Al-Khatib, S., Hazeghazam, M., Sreedhar, D., Li, R. N., … Carlson, R. W. (2012). Toxigenic and Metabolic Causes of Ketosis and Ketoacidotic Syndromes. Critical Care Clinics, 28(4), 601–631. https://doi.org/10.1016/j.ccc.2012.07.001

5.  Von Geijer, L., & Ekelund, M. (2015). Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report. Journal of Medical Case Reports, 9, 224. https://doi.org/10.1186/s13256-015-0709-2

6.  Westman, E. C., Volek, J. S., & Phinney, S. D. (2011). New atkins for a new you: the ultimate diet for shedding weight and feeling great. Random House.

7.  Veldhorst, M. A. B., Westerterp-Plantenga, M. S., & Westerterp, K. R. (2009). Gluconeogenesis and energy expenditure after a high-protein, carbohydrate-free diet. The American Journal of Clinical Nutrition, 90(3), 519–26. https://doi.org/10.3945/ajcn.2009.27834

8.  Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(7), 1178–1187. https://doi.org/10.1017/S0007114513000548

9.  Wood, R. J., Volek, J. S., Liu, Y., Shachter, N. S., Contois, J. H., & Fernandez, M. L. (2006). Carbohydrate restriction alters lipoprotein metabolism by modifying VLDL, LDL, and HDL subfraction distribution and size in overweight men. The Journal of Nutrition, 136(2), 384–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16424116

10.  Keys, A., Menotti, A., Aravanis, C., Blackburn, H., Djordevič, B. S., Buzina, R., … Toshima, H. (1984). The seven countries study: 2,289 deaths in 15 years. Preventive Medicine, 13(2), 141–154. https://doi.org/10.1016/0091-7435(84)90047-1

Michael Nelson