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Amy Berger

About Amy Berger

Amy Berger, MS, CNS, is a U.S. Air Force veteran and Certified Nutrition Specialist who specializes in helping people do “Keto Without the Crazy.”™ She has a master’s degree in human nutrition and writes about a wide range of health and nutrition-related topics, such as insulin, metabolism, weight loss, diabetes, thyroid function, and more. She has presented internationally on these issues and is the author of "The Alzheimer's Antidote: Using a Low-Carb, High-Fat Diet to Fight Alzheimer’s Disease, Memory Loss, and Cognitive Decline," and "The Stall Slayer: Seven Roadblocks to Keto Fat Loss and What to Do About Them."

What Happens When You Eat Too Much Fat on Keto?

Amy Berger

There are seemingly infinite ways to do a “keto” diet. Ask fifty different doctors and nutritionists and you’ll get fifty different pieces of advice. To some people, keto means keeping carbohydrate intake very low. To others, it means drowning their food in fats and oils. Fat, fat, fat—the more the merrier! And while fat is embraced on keto, there is such a thing as too much fat. So what happens if you eat too much fat on keto? 

What are your goals?

The best way to implement a ketogenic diet depends on your individual goals and where you’re starting from. If you’re carrying a hundred extra pounds or looking to reverse type 2 diabetes or metabolic syndrome, the approach to keto that will be most effective for you will be different from the approach that’s best for a competitive athlete or a child with epilepsy. Different goals, different strategies. 

This is why getting generalized information about keto from the internet can be a bit fraught. There’s no right or wrong way to do keto; it’s all about what you’re trying to accomplish. Following advice intended for someone whose situation is completely different from yours might not work so well for you. In fact, it might move you further from where you want to be. 

More “LC” than “HF”

It would be nice if fat were unlimited on keto and if calories didn’t matter, but unfortunately, that’s not the case. You’ve probably seen the abbreviation “LCHF” (low carb, high fat) used together with keto. But if losing body fat is your main goal in following a keto diet, thinking of it as “LCHF” can be misleading. 

Here’s how it works: what causes your body to shift from being fueled mostly by carbs to mostly by fat is cutting way back on carbs. When there’s very little carbohydrates coming into your body, your body has to find an alternative fuel source, and the one it will choose to use is fat. 

So that’s step 1: cut the carbs and get your body to burn fat. But if you want to burn your stored body fat, then step 2 is not overdoing the fat in your food. Once your body has switched over to fueling on fat rather than carbs, it has a choice between burning the fat that comes from your plate or the fat that’s stored in your hips, thighs, arms, and backside. Remember: having your metabolism primarily fueled by fat doesn’t automatically mean you’re going to lose body fat. “Burning fat” is not the same as losing fat.  

Don’t get confused here. Keto is a high-fat diet, but the thing to understand is that when your main goal is fat loss, not all of that fat should come from your food. You want some of it to come from your own body. That is, internally, your cells are eating a high-fat diet, but not all the fat is coming from your plate. This is one of the most common obstacles people run into when they’re struggling to lose fat on keto: they’re following advice to put butter and oil in their coffee or they’re adding lots of extra fat and oil to everything in order to “hit their fat macro.” With all that fat coming in from food and beverages, their body has no need to tap into their stored body fat for fuel. 

Where did fat loading come from?

It’s no secret that eating rich, fatty foods is one of the pleasures of following a keto diet. You no longer need to live in terror of egg yolks and crispy chicken skin, and while turkey bacon is handy if you don’t eat pork for religious or cultural reasons, if pork is part of your diet, you can have the real thing, guilt-free.

But adding fat and oil to everything for the sake of reaching an arbitrary fat macro or percentage of calories from fat in your diet is brand new. Low-carb diets have been around since at least 1825, long before there were smartphone apps, macro calculators, and MCT oil fat bombs. People were successful in losing weight and improving their health before these things even existed. 

Until recently, it was understood that a low-carb diet was just that: low in carbohydrate. Emphasizing a very high fat intake wasn’t part of the process. The first medically therapeutic ketogenic diets were very high in fat, but these weren’t intended as fat loss diets; they were treatments for children with epilepsy. The kind of diet that prevents or reduces seizures is not the same diet that’s best for weight loss.

Common culprits

So where does “too much” fat come from on keto? It depends on what someone typically eats, but it’s pretty rare for fatty meats to be the problem. Whole food animal proteins—fatty steaks or pork chops, salmon with the skin—are not usually the issue. More often it’s the concentrated or isolated fats and oils that we add to food: mayonnaise, butter, cream cheese, coconut oil, etc. 

Heavy cream is an especially common culprit. (Are you having a splash of cream with your coffee or a splash of coffee with your cream?) Are you one of the rare humans who can stick to 2 tablespoons of ranch dressing, or is your portion more like half a cup? 

Also be careful with nuts and nut butters: these are very common trigger foods. Consider using nuts and seeds as a garnish but not as a snack or staple food. Don’t sit down on the couch with a bag of nuts or a jar of nut butter. Use chopped or sliced nuts to add crunch to a salad or as a garnish on proteins or vegetables. The same goes for cheese. If you’re a cheese junkie, consider reserving cheese for use as a garnish and flavor enhancer rather than as a snack on its own. Sprinkle shredded cheese on a salad or low-carb tacos and fajitas. Top a burger patty with a slice. Don’t sit down with a whole block of cheddar or gouda and a knife. Thirty minutes later it’ll be gone and you’ll wonder where it went.

Keto treats can be problematic, too. Keto brownies, muffins, cookies—even if the net carbs are low (and net carbs can be a problem all on their own), extra fat adds up quickly from almond flour, coconut butter, cream cheese, etc. If you’re having a hard time losing excess body fat, these things aren’t totally off limits, but be aware of how much of them you’re having and how often. They can make keto easier and more enjoyable to stick to for the long term, but overdoing them can be a roadblock to easier fat loss.  

Don’t be afraid of fat

Don’t misunderstand what you’ve read here. You don’t need to fear fat. Just because fat isn’t unlimited on keto doesn’t mean you have to time travel back to 1987 and live on canned tuna, rice cakes, and egg white omelets cooked in nonstick spray. All it means is that if you know you have a heavy hand with added fats and oils, be aware of how much extra you’re adding and whether that might be standing in the way of you reaching your fat loss goals.  

And please, follow your appetite. Some days you’ll feel hungrier than on other days and it’s completely normal for your calorie intake—including from fat—to vary from day to day. What’s a little strange is expecting your hunger level to be exactly the same every day, every month, all year long, regardless of your activity level, sleep quality, and ladies, where you are in your cycle. Some days if someone were to look at your food, they might think you’re eating a low-fat diet, while other days, you’re gobbling up ALL THE FAT. And that’s fine. Things generally even out over time, as long as you’re not adding gobs of extra fat and oil to everything because an app told you to.   

Reaping the metabolic benefits 

If you’ve been overdoing dietary fat, don’t stress! First, it’s easy to course-correct. And second, even if your fat intake has prevented you from losing weight or you’ve lost only a little bit compared to the total you’re looking to lose, you are still likely getting the cardiometabolic benefits of a low-carb diet.1 Remember, keeping carbs low is what prompts the hormonal shift to keep your blood sugar and insulin lower. Research has shown that even if your weight doesn’t change much, you can reverse metabolic syndrome and have massive improvements in type 2 diabetes.2,3 So on the inside, you’re still benefiting from a low-carb way of eating even if you’re disappointed with changes in your weight. 

Shifting focus from “keto” to low-carb is a good start, and reframing LCHF to mean low-carb healthy fat is even better. So enjoy those delicious fats on your keto diet, but be mindful of whether you’re going overboard if you’re having trouble losing weight. 

Sources

  1. Feinman RD, Volek JS. Low carbohydrate diets improve atherogenic dyslipidemia even in the absence of weight loss. Nutr Metab (Lond). 2006;3:24.
  2. Hyde PN, Sapper TN, Crabtree CD, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. 2019;4(12):e128308.
  3. Gavidia K, Kalayjian T. Treating Diabetes Utilizing a Low Carbohydrate Ketogenic Diet and Intermittent Fasting Without Significant Weight Loss: A Case Report. Front Nutr. 2021 Jun 28;8:687081.
By |2021-09-20T15:05:29-06:00September 22nd, 2021|Categories: Uncategorized|0 Comments
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Is a keto diet safe for people with high blood pressure?

This entry is part 9 of 9 in the series Keto Basics

It’s no secret by now that ketogenic diets are excellent for weight loss and improving blood sugar control in people with diabetes (both type 2 and type 1). They’re also effective for reversing metabolic syndrome and helping to improve hormone balance in polycystic ovarian syndrome (PCOS). But keto diets also come with cautions about managing electrolytes—especially sodium. Can a diet that encourages a higher sodium intake be safe for people with high blood pressure? Let’s see what the science says. 

 

The Role of Insulin in Hypertension

Conventional thinking holds that a high sodium intake is a major contributor to high blood pressure (a.k.a. hypertension). The logic goes like this: in the human body, water follows sodium. If you eat more sodium, your body retains more water. Your blood is mostly water (almost 80%, in fact), so with more water in the body, your blood volume may increase. If you think about more water passing through the same amount of “pipe”—that is, your blood vessels—it makes sense that the pressure would go up. 

But the truth is, only a small percentage of people are sensitive to sodium in this way. Even when a large amount of sodium is consumed, properly functioning kidneys do an excellent job of holding onto just the right amount and excreting the rest with no impact on blood pressure. So what can get in the way of the kidneys being able to do this?

Insulin resistance (also called hyperinsulinemia) is a prime suspect. While insulin is most often associated with its role in lowering blood sugar, this is only one of several jobs this hormone is responsible for. Something else insulin does is cause the kidneys to hold on to sodium rather than letting go of the excess. In some people, chronically high insulin might be the primary cause of hypertension. One review article stated it in no uncertain terms: 

“Hypertensive patients have been shown to be insulin resistant, and because insulin can promote renal sodium reabsorption, several investigators have suggested that hyperinsulinemia may be involved in the pathogenesis of salt sensitivity of blood pressure.” 

A more recent review article echoed this perspective:

“Direct correlation between plasma insulin levels and blood pressure levels has been demonstrated and there is evidence to suggest a causal relationship between insulin resistance with resultant hyperinsulinemia and hypertension.”

The effect of high insulin (stimulated by a rising blood glucose level) on blood pressure is so powerful that two researchers even called salt “the wrong white crystals,” and suggested that refined sugar is a far more likely candidate compared to salt for causing high blood pressure.  

 

Insulin and Blood Vessels

In addition to affecting the blood, insulin also compromises healthy function of blood vessels. Think of your blood vessels as thin rubber tubes through which your blood flows. The vessels are supposed to be soft and pliant, and able to expand and contract to accommodate greater or lesser blood flow. Elevated insulin stimulates the sympathetic nervous system, which causes blood vessels to constrict. When blood flows through vessels that are constricted rather than soft and accommodating, the pressure goes up. Nitric oxide is a compound that helps blood vessels dilate and expand to let blood flow through smoothly. When insulin is high, though, this vasodilation is impaired, and it might be especially impaired in people with type 2 diabetes.       

Insulin also appears to stimulate cell growth within the blood vessels. Vessels that are thickened from excess growth may not function as well as healthier blood vessels, and they may be narrower too, both of which could result in higher blood pressure. 

 

What About Sodium? 

Sodium is an essential nutrient. The critical nature of sodium (from salt) is demonstrated by animals gathering around natural salt deposits and by traditional populations placing a high value on salt. It’s so highly valued, in fact, that it’s embedded in our everyday vocabulary: it’s a compliment to say someone is a “salt of the earth” person or is “worth his salt.” 

Despite the fearmongering about salt and the detrimental effects of a high sodium intake, diets that are too low in sodium might be more harmful for cardiovascular health compared to diets higher in sodium. A study published in the prestigious journal The Lancet in 2016 concluded that low sodium intake is associated with “increased risk of cardiovascular events and death” in individuals with or without hypertension—meaning even people with high blood pressure might not always benefit from reducing sodium intake, and low salt diets may also adversely affect those who are otherwise healthy. They concluded that reducing sodium intake would only benefit people with hypertension who had a high sodium intake: just 10% of the population. The remaining 90% would likely get no benefit from decreasing their sodium intake. 

What makes more sense, then? Reducing or addressing the underlying reason why the body isn’t able to properly balance its sodium level and maintain a healthy blood pressure? 

 

Keto and Insulin Resistance

Hypertension is included in the official diagnostic criteria for metabolic syndrome—a condition driven by chronically elevated insulin. So, researchers and medical professionals are well aware of the connection between a high insulin level and high blood pressure and have been since at least the 1980s.  

If elevated insulin is the major factor causing high blood pressure in most people, and if sodium is an essential nutrient, then rather than limiting intake of a critical electrolyte mineral, taking steps to bring insulin levels down might be more effective for improving blood pressure. And one thing we know is that ketogenic diets are highly effective for lowering insulin. 

A large body of clinical research shows that keto diets improve blood pressure in people with hypertension. The effect is powerful and may occur within a relatively short time after starting keto, so people taking medication for high blood pressure should be on the lookout for signs and symptoms of their blood pressure starting to get too low. This would be a signal that it’s time to talk to their doctor about reducing or stopping their medicine. 

There have been longstanding concerns regarding the effect of keto diets on kidney function. It’s important to know that as long as you stay sufficiently hydrated, keto not only isn’t harmful for your kidneys, but it actually appears to be beneficial. The notion that a high protein intake is damaging to the kidneys is not backed up by evidence, and recent research showed that a diet low in carbohydrates led to improved markers of kidney function in people with type 2 diabetes—including the de-prescribing of several blood pressure medicines.

 

Summing Up

Contrary to what some believe, keto diets aren’t dangerous for people with high blood pressure. In fact, it’s just the opposite: they may be beneficial. People taking medication for hypertension need to be aware that they may need to adjust their dose(s) or stop the medicine altogether when their blood pressure starts improving. 

By |2021-09-01T14:37:46-06:00September 1st, 2021|Categories: Keto Basics|Tags: , , |0 Comments
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Keto and Intermittent Fasting: A Beginner’s Guide

Amy Berger

Scrolling through keto social media, it would be easy to think that intermittent fasting (IF) is required if you want to eat keto. It’s not! But since they do go hand-in-hand so much, let’s take a closer look at IF and how to incorporate it into your life if you choose to.

What is intermittent fasting? 

Intermittent fasting is just a fancy phrase for “going longer than usual without eating.” There’s nothing complicated about it. You just eat less often than you did before. People implement IF for different reasons, but it’s important to know that IF is different from extended, multi-day fasting or therapeutic fasting for medical reasons. 

Something people commonly report after adopting a ketogenic diet—sometimes within days of starting—is that they’re less hungry. They don’t need quite as much food to feel full, and they can go longer between meals than they’re accustomed to. They skip meals here and there not because they’re intentionally fasting, but because they’re just not hungry. So IF often happens naturally without someone even deliberately trying. And when hunger does come on, it’s a gentle feeling rather than an urgent sensation that comes out of nowhere and demands that you cram something down your piehole immediately.

It’s not an exaggeration to say this freedom from constant hunger is life changing for some people. Being able to go several hours without even thinking about food can be liberating if you were someone who needed to snack every few hours or had to have an “emergency” candy bar stashed in your purse or briefcase when you were on a higher carb diet. 

Why do you feel less hungry on keto?

Two main things are at work here. First, when you eat very few carbohydrates, your blood sugar stays steady and you don’t have wild fluctuations that cause you to feel irritable, shaky, light-headed, and hungry. (Some people call this “hangry”—the combination of hungry and angry. We’ve all felt it!) The signals that fat and protein send to your brain are very different from the signals carbs send—especially refined carbs. 

The second reason people tend to feel hungry less frequently on keto is lower insulin levels. You might be used to thinking of insulin as a “blood sugar hormone,” but insulin does a lot more than lower blood sugar. One of its other jobs is to keep fat tucked away in fat cells. That’s right: insulin inhibits fat burning. Eating keto keeps your insulin level lower throughout the day, so your body has easier access to its fat stores. This means that even when you’re not consuming food, you’re “eating” your stored body fat! Your cells still have plenty of fuel available to them. Nice, huh?

How do you intermittent fast?

However you want to!

There are no hard-and-fast rules and there’s no right and wrong when it comes to IF. There are as many different ways to do it as there are people doing it. If you’re brand new to keto, it’s best to not do any IF at all for a while. Give your body time to adjust to going without carbs. Once you’re accustomed to being off the blood sugar roller coaster, the easiest way to start IF is simply to wait a little longer between meals. However long you used to go between meals, push it out an extra 30 minutes. Do that for a few days, then wait a full hour. Stretch the time out a little further every few days and before you know it, you’ll be an IF ninja. 

Some people choose to implement a specific strategy for eating just one or two meals a day, sometimes based around an “eating window.” This is a window of time during which you have meals and you don’t eat outside that time frame. (You might choose to have coffee, tea, broth, sugar-free gum, or mints, but no food.)  

Many people do 16:8. This means consuming meals in an 8-hour window and staying in a fasted state the other 16 hours of the day. This strategy typically means having two meals per day. (For example, having breakfast around 10am and finishing dinner by 6pm, or having lunch at noon and finishing dinner by 8pm.) Some people have an even smaller window, like 20:4—a 4-hour window during which you eat and 20 hours during which you fast. Other people find hunger so well-controlled and their appetite so reduced that they feel best eating just one meal a day. (You’ll see this abbreviated as OMAD on social media. It’s fine to do OMAD as long as you’re getting enough protein and nutrients in that one meal.) 

Don’t let specific times of day or numbers of hours control you. If you intended to go 16 hours without eating but you’re ravenous at 14 hours, eat! It’s okay to have a shorter or longer eating window than you intended. 

Fit IF around your life; don’t fit your life around IF 

Should you skip breakfast or dinner? The morning meal or the evening meal? Do what works best with your schedule and your family dynamics. Some people find it easy to skip breakfast because they’re up and out of the house before the rest of the family is awake anyway. Or they can sit with their family and have a cup of coffee or tea while everyone else eats. Be flexible. If family dinner is important—the only time everyone gathers together on a daily basis—then you wouldn’t want to fast through dinner. 

Maybe eating dinner works best on weekdays but on weekends you like to have a leisurely breakfast. Or you like sharing breakfast with your spouse during the week and going out for dinner on Saturday nights. Intermittent fasting is entirely customizable. The way you implement it might look very different from the way someone else does it, and that’s totally fine.

Be flexible on a daily basis, too. If you normally eat a meal or two early in the day and skip nighttime eating, or you restrict food in the early part of the day and skew your food later, it’s okay to change this up now and then. What if something unexpected comes up and you’re not able to consume your meal at the usual time? Maybe an emergency at work pulls you away from your normal mealtime, or you get called for an unexpected social event where it’ll look odd if you don’t eat anything. It’s okay to do things earlier or later than you had planned. There is zero black and white to this. It’s 100% customizable and you can change it up at any time. 

IF in the real world

The custom of having three meals a day is completely artificial. Nothing about human physiology or metabolism suggests that you must eat breakfast, lunch, and dinner plus snacks in between. Don’t eat by the clock. Let your hunger—not the time of day—dictate when you eat. If keto controls your appetite so well that you’re only hungry for one or two meals a day, you don’t need to have three. 

Intermittent fasting may be easier to do if you’re single and live alone. If you live with your family, it can feel a bit awkward if everyone is sitting down to a meal and you’re fasting. But it doesn’t have to be uncomfortable. You can join your family at the table and enjoy their company and conversation. Sip on coffee, tea, or some other noncaloric beverage if you like. You don’t have to eat just because others around you are. 

And if you’re new to IF, don’t worry about whether it’s better to eat breakfast and lunch or lunch and dinner, or better to have two meals or one meal a day. The quantity and type of food you eat matters more than “when”. Intermittent fasting is really just a way to help your body flex its metabolic muscle and cruise along happily burning fat for a little longer between meals.

By |2021-06-23T10:58:28-06:00June 23rd, 2021|Categories: Keto Basics|Tags: , , |2 Comments
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Can a Keto Diet Cause Ketoacidosis?

One of the biggest misconceptions standing in the way of ketogenic diets being more widely recommended by medical professionals is confusion between nutritional ketosis and diabetic ketoacidosis. Let’s take a moment to discuss the differences between these, dispel common myths, and allay fears so that people can feel encouraged to try this powerful strategy for weight loss and improving health.  

 

What is ketosis?

Let’s start with the obvious: the word ketogenic is used to describe very low-carb diets because when you eat this way, your body generates ketones. When carbohydrates are restricted below a certain amount (50 grams per day for most people, although it can be closer to 20-30 grams per day for some people), your body switches from being fueled primarily by carbs (glucose) to being fueled primarily by fat. Ketones are generated as a byproduct of breaking down and burning fat.   

The presence of ketones is nothing to fear. They are a normal part of human physiology. Biochemistry textbooks are clear on this point: “Ketone bodies are a normal fuel for a variety of tissues and are part of a complex pattern of fuel metabolism. […] Many tissues prefer to use fatty acids and ketone bodies as oxidizable fuels in place of glucose. […] Acetoacetate and β-hydroxybutyrate produced by the liver are excellent fuels for many nonhepatic tissues [outside the liver], including cardiac muscle, skeletal muscle, and brain, particularly when glucose is in short supply.”1 

Dr. Stephen Phinney and Dr. Jeff Volek, two leading keto researchers, wrote in their book, The Art and Science of Low Carbohydrate Living, “Nutritional ketosis is by definition a benign metabolic state that gives human metabolism the flexibility to deal with famine or major shifts in available dietary fuels.”2  Dr. Robert Atkins, creator of the famous Atkins Diet, also used the word “benign” with regard to nutritional ketosis. But considering the numerous health conditions that may improve with adherence to a keto diet, it can be argued that ketosis isn’t just benign, it’s downright beneficial. 3 

 

Ketones sound great…so why are people afraid? 

The reason medical professionals may be concerned about people deliberately trying to achieve a state of ketosis is that ketone molecules are acidic. Your body aims to keep your blood very slightly alkaline, so if the concentration of ketones in your blood becomes too high, the fear is that your blood will become overly acidic, which is indeed a potentially life-threatening situation. But it’s important to know that this almost never happens solely as a result of carbohydrate restriction in the context of a keto diet.

Except for using ketogenic diets as a treatment for epilepsy, the only exposure to ketosis that many healthcare professionals had during education and training was this harmful, out-of-control ketoacidosis—when the blood ketone level is extremely high, the blood is dangerously acidic, and typically blood glucose is also very high. Only recently are they becoming more educated about the numerous benefits of safe, benign, nutritional ketosis. 

 

Nutritional ketosis versus ketoacidosis

There are three major differences between ketoacidosis and nutritional ketosis. 

1. In nutritional ketosis, your ketone level stays within a safe range. 

In the metabolic state induced by a keto diet, blood ketone levels generally stay below 4.0 or 5.0 mmol/L. In fact, most people rarely see levels that high unless they’re doing an extended or multi-day fast, in which case blood ketones can be as high as 6.0 or 7.0 mM.4,5  On a keto diet when someone is not fasting, ketone levels vary, but a typical range is 0.5 to 5.0 mM, although there is no formally agreed upon definition.2  (If your level is slightly lower—closer to 0.2 or 0.3 mM, you’re still in ketosis, just at a low level.) Contrast this with ketoacidosis, in which blood ketones may be as high as 15-25mM. This is five to ten times higher than the range commonly seen in nutritional ketosis.2 

Don’t confuse nutritional ketosis and ketoacidosis just because they both have “keto” in their name. The difference in ketone concentration in nutritional ketosis and ketoacidosis is like the difference between a gentle spring breeze and a hurricane. Both involve wind, but they’re worlds apart in magnitude of impact. You don’t want a hurricane blowing your house down, but a gentle spring breeze across the front porch is very nice.  

The reason blood ketones don’t continue rising ever higher on a keto diet is that they keep their own production in check. As your ketone level starts to rise, a very small amount of insulin is released. Not as much as if you were eating something sugary or starchy—just a tiny amount, which is enough to keep your ketones from reaching a dangerous level. The rising ketone level itself is what tells your body to slow down on producing more ketones. So unless you have difficult-to-control type 1 diabetes or are in another situation where you may not have adequate insulin, there is little danger of your blood having a pathological concentration of ketones on a keto diet.

2. In nutritional ketosis, blood does not become acidic.

At the ketone levels typically attained on a keto diet, your body has no problem engaging its built-in buffering system, so your blood pH remains within a perfectly normal, safe range. It’s only when the ketone level becomes excessive that it overwhelms this buffering capacity and your blood would become acidic. I’ll leave it to Drs. Phinney and Volek to explain again:

“There is a persistent myth that nutritional ketosis results in clinically significant acidosis, despite overwhelming evidence to the contrary. Yes, the modest rise in serum ketones will shift serum chemistries a bit toward the acid end, but blood pH and serum bicarbonate values almost always remain well within the normal range. […] Put another way, the buffering capacity of otherwise healthy humans is able to compensate across the full range of nutritional ketosis without any significant metabolic disturbance.”6 

“One of the many myths about ketogenic diets is that they cause the body to go into a state of acidosis. This stems from the unfortunate fact that many doctors and lay people alike confuse nutritional ketosis (blood ketones at 1-3 millimolar) with ketoacidosis (blood ketones greater than 20 millimolar). In nutritional ketosis, blood pH at rest stays normal … By contrast, in keto-acidosis, blood pH is driven abnormally low by the 10-fold greater buildup of ketones. Suggesting these two states or similar is like equating a gentle rain with a flood because they both involve water.”7 

3. In nutritional ketosis, blood glucose is normal.

In cases of diabetic ketoacidosis, it isn’t just ketones that are sky-high, but also typically blood glucose, too—in the range of 250–600 mg/dL (13.9–33.3 mM).8  In fact, some researchers posit that ketoacidosis is defined “by metabolic acidosis, high blood glucose, and the presence of ketone bodies in blood and urine.”8  In the nutritional ketosis that results from a keto diet, at least two of these don’t apply: acidosis and high blood glucose. Ketones will be present in the blood and urine, but at levels far lower than what is seen in ketoacidosis.

 

Important Exception

There have been reports of ketoacidosis even when someone’s blood glucose is normal, and even among people who don’t have diabetes. This is called euglycemic ketoacidosis.9  However, it is important to note that this doesn’t happen spontaneously, and that keto diets by themselves don’t lead to this. There are some rare medical conditions that can result in euglycemic ketoacidosis, but one of the more common causes is use of medications called sodium glucose co-transporter-2 inhibitors. (SGLT-2i, used for both type 2 and type 1 diabetes.)10-15 It’s not known for certain what the mechanism is by which these drugs induce ketoacidosis, but it may be that they cause the kidneys to reabsorb ketone bodies, and they also increase glucagon secretion while decreasing insulin secretion, which would stimulate breaking down fat and raising ketones.14,15  There have been numerous reports of this in people using these drugs whose blood glucose was <200 mg/dL (11.1 mM). Most of the rare instances of ketoacidosis among people following low-carb or keto diets have occurred in people using these drugs for diabetes; acidosis was not brought on by the diet itself.16,17  As always, work with your doctor if you have concerns about any medications you may be taking. Never adjust or stop medications on your own.

 

Summing up

Is a keto diet likely to induce ketoacidosis in the absence of complicating factors? No. Your body has a complex network of checks and balances to keep your ketone level—and therefore, your blood acidity—within a safe range. So you know what to do: “Keep calm and keto on!”

  1. Devlin, T., ed. (2011). Textbook of Biochemistry with Clinical Correlations (7th edition). Hoboken, NJ: John Wiley & Sons, Inc. p.699-700.
  2. Volek, JS. & Phinney SD. (2011). The Art and Science of Low Carbohydrate Living. Beyond Obesity, LLC. p.5.
  3. Staverosky T. Ketogenic Weight Loss: The Lowering of Insulin Levels Is the Sleeping Giant in Patient Care. J Med Pract Manage. 2016 Sep;32(1):63-66.
  4. Cahill GF Jr, Veech RL. Ketoacids? Good medicine? Trans Am Clin Climatol Assoc. 2003;114:149-163.
  5. Hashim SA, VanItallie TB. Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester. J Lipid Res. 2014;55(9):1818-1826.
  6. Volek, JS. & Phinney SD. (2011). The Art and Science of Low Carbohydrate Living. Beyond Obesity, LLC. p.167.
  7. Volek, JS. & Phinney SD. (2012). The Art and Science of Low Carbohydrate Performance. Beyond Obesity, LLC. p.35.
  8. Hörber S, Hudak S, Kächele M, et al. Unusual high blood glucose in ketoacidosis as first presentation of type 1 diabetes mellitus. Endocrinol Diabetes Metab Case Rep. 2018;2018:18-0094.
  9. Bonora BM, Avogaro A, Fadini GP. Euglycemic Ketoacidosis. Curr Diab Rep. 2020 May 19;20(7):25.
  10. Ullah S, Khan N, Zeb H, Tahir H. Metabolic ketoacidosis with normal blood glucose: A rare complication of sodium-glucose cotransporter 2 inhibitors. SAGE Open Med Case Rep. 2016;4:2050313X16675259.
  11. Wolfsdorf JI, Ratner RE. SGLT Inhibitors for Type 1 Diabetes: Proceed With Extreme Caution. Diabetes Care. 2019 Jun;42(6):991-993.
  12. Palmer BF, Clegg DJ. Euglycemic Ketoacidosis as a Complication of SGLT2 Inhibitor Therapy. Clin J Am Soc Nephrol. 2021 Feb 9:CJN.17621120.
  13. Evans M, Hicks D, Patel D, Patel V, McEwan P, Dashora U. Optimising the Benefits of SGLT2 Inhibitors for Type 1 Diabetes. Diabetes Ther. 2020;11(1):37-52.
  14. Diaz-Ramos A, Eilbert W, Marquez D. Euglycemic diabetic ketoacidosis associated with sodium-glucose cotransporter-2 inhibitor use: a case report and review of the literature. Int J Emerg Med. 2019;12(1):27.
  15. Somagutta MR, Agadi K, Hange N, et al. Euglycemic Diabetic Ketoacidosis and Sodium-Glucose Cotransporter-2 Inhibitors: A Focused Review of Pathophysiology, Risk Factors, and Triggers. Cureus. 2021;13(3):e13665.
  16. Hayami T, Kato Y, Kamiya H, et al. Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet. J Diabetes Investig. 2015;6(5):587-590.
  17. Fukuyama Y, Numata K, Yoshino K, Santanda T, Funakoshi H. Euglycemic diabetic ketoacidosis due to a strict low-carbohydrate diet during treatment with sodium-glucose cotransporter 2 inhibitors. Acute Med Surg. 2020;7(1):e480.
By |2021-06-09T11:59:49-06:00June 9th, 2021|Categories: Keto Basics|0 Comments
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Added Fibers in Keto Foods

This entry is part 7 of 9 in the series Keto Basics

Let’s face it: for some people, following a low-carb or ketogenic diet is easy. They ditch the bread, pasta, potatoes, candy, and other starchy and sugary foods and never look back. They’re totally content sticking with fatty proteins, non-starchy vegetables, dairy foods, and nuts and seeds. For others, though, including keto-friendly sweet treats can make it easier to stick to a lower-carb way of eating for the long term. But can you trust the labels? What if some of the ingredients aren’t quite so keto-friendly? What about the added fibers used to lend sweetness and bulk to foods marketed as “keto”? Are these totally benign, or could they be interfering with you reaching your goals with this way of eating?

First Rule of Keto Club

The first rule of tweaking your diet is: “If it ain’t broke, don’t fix it.” So, however you’ve constructed your keto or low-carb diet so far, if you’re happy with the results you’re getting, keep on truckin’! If you’re satisfied with your physical and mental health, and your energy levels (or as ancestral health authority Robb Wolf often says, “How you look, feel, and perform”), then you don’t need to change anything. If you’ve got a few favorite go-to keto nutrition authorities and they’ve said something that makes you want to change something about your diet, there’s no harm in experimenting. But you are the ultimate authority on your body, and you know best how something affects you.

But what if something you’ve been eating isn’t working so well for you? If keto bars, cereals, cookies, and the like are a regular part of your diet, could the added fibers these typically contain be a problem for you?

Why Added Fibers?

There are a few different reasons why food products marketed as “keto” often contain added fibers. For starters, these various fibers contribute bulk and texture, so in some cases they’re a fundamental part of the physical structure of the product. Another reason is that some of them have a sweet taste, so they’re also used as sweetening agents. (For example, fructo-oligosaccharide, a prebiotic fiber, is about half as sweet as regular sugar.1) And third, food manufacturers have long since caught on that many people doing keto diets go by “net carbs” rather than total carbs when counting their carbs for the day. (Net carbs is the total grams of carbohydrate in a serving of food minus grams of fiber and sugar alcohol.) The higher the fiber in a food, the lower the net carb count—and the more attractive to the growing numbers of customers looking for just these kinds of things.

Okay, sounds good so far. But are there any drawbacks to cramming a bunch of extra fiber into a food product? Is there anything a savvy keto dieter should keep in mind before making these things a staple of their diet?

Two main concerns come to mind with regard to added fibers used in keto food products: effects on blood sugar, and effects on the gastrointestinal (GI) system. We’ll address both of these, but let’s start with some general info on fiber.

The US Food and Drug Administration (FDA) provided its first official definition of dietary fiber in 2016, in the rules and regulations regarding nutrition and supplement facts labels. They specified that dietary fiber is a nondigestible carbohydrate in both soluble and insoluble forms, and includes both the fibers intrinsic to whole, intact foods as well as isolated and synthetic fibers that are added during manufacturing. The FDA identified at least 15 of these isolated and synthetic nondigestible carbohydrates, many of which you’ve probably seen in ingredient lists on keto food products2:

  • cellulose
  • pectin
  • guar gum
  • locust bean gum
  • hydroxypropylmethylcellulose
  • β-glucan
  • psyllium husk
  • mixed plant cell wall fibers
  • arabinoxylan
  • alginate, inulin, and inulin-type fructans (fructooligosaccharides)
  • high-amylose starch/soluble corn fiber (resistant starch 2, RS2)
  • galactooligosaccharides
  • polydextrose
  • resistant maltodextrin/dextrin

Effects of Added Fiber on Blood Sugar

It’s important to realize that here we’re focusing specifically on fibers that are added as ingredients in food products, and not the fiber that’s intrinsic to whole food. For example, inulin or soluble corn fiber as opposed to the fiber that occurs naturally as part of the food matrix in things like broccoli, almonds, or blackberries. It’s possible that added fibers might not have the same effect as fibers that are intrinsic to a food. One of the beneficial effects of dietary fiber is that it slows the digestion of food, which may help lessen the glycemic impact of a high-carbohydrate meal (how much and how quickly it raises blood sugar). But think about it: flaxseeds are high in fiber, but how likely is it that taking a tablespoon of ground flaxseeds along with a glass of orange juice is going to make much of a difference in someone’s blood glucose?

Back to that in a bit. First, let’s take a closer look at fiber overall. Dietary fiber is a type of carbohydrate that is believed to have little to no impact on blood sugar and insulin because it’s not digestible and therefore doesn’t enter the bloodstream. The reason humans can’t digest fiber is because of the chemical bonds that make up the molecular structure of the different kinds of fiber. Our digestive enzymes are very selective and act only on certain kinds of food molecules or chemical bonds. For example, the enzyme sucrase splits apart sucrose (“table sugar”) into glucose and fructose. The lactase enzyme breaks apart lactose (“milk sugar”) into glucose and galactose. We don’t have digestive enzymes capable of breaking the bonds in most dietary fibers, so fiber passes through the GI tract to the large intestine.1,3

If fiber isn’t absorbed, then it should have zero impact whatsoever on blood glucose. Turns out this is a bit difficult to verify in humans. Research is surprisingly sparse on individual responses to these added fibers, and research on the effect of these fibers specifically in the context of a low-carb or ketogenic diet is practically nonexistent. Most studies involve adding fiber to high- and moderate-carb diets or individual meals, and they’re intended to see if the added fiber helps reduce the glycemic impact or improves biomarkers related to type 2 diabetes or insulin resistance.4-9 (They usually do on the whole, although findings are mixed.10,11) Results from those studies don’t tell us a whole lot about the effect of adding fiber to low-carb or ketogenic meals, where we’re more interested in seeing if blood glucose is raised.

To say this another way, research findings from people eating high-carb diets might not be equally applicable to people eating very low-carb diets. If fiber is filling/satiating and helps to slow the absorption of glucose, then some of the purported “benefits” of fiber—feeling full sooner, eating less food, and having a smaller blood glucose excursion after a meal—are not necessarily positive aspects of fiber, itself, but rather, the fact that these effects may be mitigating the negative effects of eating a higher carb diet! (Particularly among people who already have diabetes or pre-diabetes.)

The authors of a 2020 review looking at the effects of isolated and synthetic fibers on markers of metabolic diseases concluded that for these added fibers to have an impact powerful enough to be relevant, the doses would have to be relatively high over a long period of time, and most importantly, the best effect would come when these are used instead of, rather than in addition to, digestible carbohydrates.10 (Interestingly, in things like low-carb breads and bars, that’s precisely how these are used.)

The best way to see if added fibers are affecting your blood glucose is simply to test. You can use a glucometer to check your blood sugar before consuming something that contains these fibers, and then test again, maybe at 15 and 30 minutes after eating the test food, and then at the 1- and 2-hour marks. This is easier said than done, though. As mentioned earlier, these added fibers are consumed in things like keto bars, cookies, ice cream, cereal, chocolate, etc.—items that also typically contain sugar alcohols. So if you did see a significant change in blood sugar, it would be difficult to identify what the responsible factor was: the fibers or the sugar alcohols. With the exploding popularity of keto, though, there are food options available now that are rich in added fibers but have no sugar alcohols at all or are much lower in them, like keto breads, crackers, and wraps.

All Fibers are Not Created Equal

In theory, fiber is not broken down and absorbed at all. But the more food scientists tinker with things, the more variable people’s responses might be. For example, you might see “resistant tapioca starch” on an ingredient label. This is created by manipulating the starch molecule in order to make it “resistant” to digestion so that it has a much lower impact on blood sugar. Note that the impact is lower, not nonexistent. The many different types of fibers vary in the amount of digestible carbohydrates they contain.12 One study determined that resistant maltodextrin from tapioca starch was about 86% fiber but had a glycemic index of 59 in healthy subjects.13 (This is considered a “moderate” glycemic index.) Subjects were given a large dose of the resistant tapioca starch—larger than would typically be included in a food product—but even so, as much as 30-70% of “resistant” starch can be metabolized, so for some people, even a relatively small amount of this ingredient can affect blood sugar.13,14 Like other fibers, resistant starch might have its best effect on lowering post-meal glucose and insulin levels when it replaces conventional digestible starch, rather than being added to high-starch meals as a supplement.15

Plus, there’s a lot—a lot—of individual variability in glycemic responses to food, including resistant starch. In a 2015 study conducted in Israel, 800 subjects were observed for a week, during which they consumed nearly 47,000 meals in total.16 They wore continuous glucose monitors, which provided over 1.5 million glucose readings over a total of 130,000 hours. The results showed that the very same foods led to wildly different glycemic responses among individuals. This raises serious questions about the validity of glycemic index and glycemic load. Obviously, these are not fixed values if people have such different responses. How quickly and how high someone’s blood sugar rises after consuming a food apparently is not solely determined by the properties of the food, itself, but rather, by how an individual’s unique genetics and biochemistry prime them to handle that food.17 (Not to mention a host of lifestyle factors, such as sleep, that affect carbohydrate tolerance.18) One person’s low-glycemic high-fiber bran muffin could be another’s sugar-frosted breakfast cereal. So if someone else’s blood sugar barely moves in response to resistant starch or some other fiber, that doesn’t mean yours won’t.

Gastrointestinal Effects

Moving on from blood sugar, what about the GI effects of added fibers? It’s seen as a good thing that these fibers are not digested or are only partially absorbed in the small intestine, but for this very same reason, they can have negative effects lower down in the GI tract. The low digestibility of these fibers means they have little to no impact on blood glucose in most people. But because they’re not absorbed, they are passed along to the colon, where they serve as a food source for the bacteria that inhabit the gut. As mentioned earlier, humans lack the digestive enzymes to break apart these fibers, but our colonic bacteria break them down via fermentation. The result, for many people, is bloating, gas, and flatulence.19 Whether these are positives or negatives depends on your own level of discomfort, and whether you’re regularly in close proximity to other people!

Fibers also contribute to fecal bulking—that is, to a larger mass of stool.20 Conventional thinking says this is a good remedy for constipation, but larger, bulkier stools aren’t automatically a good thing. For example, if you have constipation, larger, bulkier stools are the last thing you want. (If your stool is already stagnating and not passing through your colon in a timely manner, why would you want there to be even more of it?) An intriguing study in subjects with constipation of unknown cause showed that following a zero-fiber diet led to increased frequency of bowel movements and complete resolution of several symptoms, like bloating and straining.21 A diet low in fiber might contribute to constipation for some people, but for others, increasing dietary fiber can make things worse.22

The news isn’t all bad, though. There might be some beneficial effects for colonic and overall health from consuming these fibers. The fermentation process generates short-chain fatty acids (SCFAs), which lowers the pH of the colon (makes it more acidic) and may help reduce the risk for colon cancer, improve mineral absorption, and reduce the growth of harmful bacterial strains in the colon.19,23 Plus, the SCFAs produced might have effects of their own, including being an energy source for colon cells, and having beneficial effects on the brain and central nervous system.23,24 Some of the supposed benefits of a higher fiber diet might be attributable to the butyrate rather than to the fiber, itself. (If “butyrate” reminds you of beta-hydroxybutyrate, one of the ketones your body produces on a ketogenic diet, pat yourself on the back! They are structurally similar and while they’re not the same molecule, they have some beneficial properties in common and there might be synergies that occur when the body has both.26,27 Small amounts of butyrate are also found in butter.)

Summary

If you’re concerned about the effect foods with a lot of added fiber are having on your blood sugar, get a glucometer (available at drugstores or online in the US), and test. This won’t give you any data on insulin, but it’s better than nothing, and it can give you helpful information to go on when deciding which kinds of fiber you’re comfortable including in your diet on a regular basis, and which ones you might prefer to avoid altogether or to have only once in a while.

And go with your gut, literally and figuratively. If fiber-fortified keto-friendly foods cause you physical discomfort, stay away from them! Don’t be bamboozled by slick marketing hype when your own body is giving you the clearest feedback you need.

References:

  1. Punit Kumar, Kashyap Kumar Dubey (2019). Chapter 10 – Current Perspectives and Future Strategies for Fructooligosaccharides Production Through Membrane Bioreactor. Editor(s): Pratyoosh Shukla. Applied Microbiology and Bioengineering, Academic Press. p.185-202. ISBN 9780128154076.
  2. Alexander C, Swanson KS, Fahey GC, Garleb KA. Perspective: Physiologic Importance of Short-Chain Fatty Acids from Nondigestible Carbohydrate Fermentation. Adv Nutr. 2019;10(4):576-589.
  3. Roberfroid M. Dietary fiber, inulin, and oligofructose: a review comparing their physiological effects. Crit Rev Food Sci Nutr. 1993;33(2):103-48. doi: 10.1080/10408399309527616. Erratum in: Crit Rev Food Sci Nutr 1993;33(6):553.
  4. de Carvalho CM, de Paula TP, Viana LV, Machado VM, de Almeida JC, Azevedo MJ. Plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients: a randomized crossover clinical trial. Am J Clin Nutr. 2017 Nov;106(5):1238-1245.
  5. Kamalpour M, Ghalandari H, Nasrollahzadeh J. Short-Term Supplementation of a Moderate Carbohydrate Diet with Psyllium Reduces Fasting Plasma Insulin and Tumor Necrosis Factor-α in Patients with Type 2 Diabetes Mellitus. J Diet Suppl. 2018 Jul 4;15(4):507-515.
  6. Thompson SV, Hannon BA, An R, Holscher HD. Effects of isolated soluble fiber supplementation on body weight, glycemia, and insulinemia in adults with overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2017 Dec;106(6):1514-1528.
  7. Abutair AS, Naser IA, Hamed AT. Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial). Nutr J. 2016;15(1):86.
  8. Tan WSK, Chia PFW, Ponnalagu S, Karnik K, Henry CJ. The Role of Soluble Corn Fiber on Glycemic and Insulin Response. Nutrients. 2020;12(4):961.
  9. O’Connor LE, Campbell WW. A novel fiber composite ingredient incorporated into a beverage and bar blunts postprandial serum glucose and insulin responses: a randomized controlled trial. Nutr Res. 2016 Mar;36(3):253-61.
  10. Armet AM, Deehan EC, Thöne JV, Hewko SJ, Walter J. The Effect of Isolated and Synthetic Dietary Fibers on Markers of Metabolic Diseases in Human Intervention Studies: A Systematic Review. Adv Nutr. 2020;11(2):420-438.
  11. Alexander C, Swanson KS, Fahey GC, Garleb KA. Perspective: Physiologic Importance of Short-Chain Fatty Acids from Nondigestible Carbohydrate Fermentation. Adv Nutr. 2019;10(4):576-589.
  12. Stewart ML, Nikhanj SD, Timm DA, Thomas W, Slavin JL. Evaluation of the effect of four fibers on laxation, gastrointestinal tolerance and serum markers in healthy humans. Ann Nutr Metab. 2010;56(2):91-98.
  13. Toraya-Avilés R, Segura-Campos M, Chel-Guerrero L, Betancur-Ancona D. Some Nutritional Characteristics of Enzymatically Resistant Maltodextrin from Cassava (Manihot esculenta Crantz) Starch. Plant Foods Hum Nutr. 2017 Jun;72(2):149-155.
  14. Kendall CW, Esfahani A, Hoffman AJ, Evans A, Sanders LM, Josse AR, Vidgen E, Potter SM. Effect of novel maize-based dietary fibers on postprandial glycemia and insulinemia. J Am Coll Nutr. 2008 Dec;27(6):711-8.
  15. Champ MM. Physiological aspects of resistant starch and in vivo measurements. J AOAC Int. 2004 May-Jun;87(3):749-55.
  16. Zeevi D, Korem T, Zmora N, Israeli D, Rothschild D, Weinberger A, Ben-Yacov O, Lador D, Avnit-Sagi T, Lotan-Pompan M, Suez J, Mahdi JA, Matot E, Malka G, Kosower N, Rein M, Zilberman-Schapira G, Dohnalová L, Pevsner-Fischer M, Bikovsky R, Halpern Z, Elinav E, Segal E. Personalized Nutrition by Prediction of Glycemic Responses. Cell. 2015 Nov 19;163(5):1079-1094.
  17. Doo M, Kim Y. Obesity: interactions of genome and nutrients intake. Prev Nutr Food Sci. 2015;20(1):1-7.
  18. Leproult R, Van Cauter E. Role of sleep and sleep loss in hormonal release and metabolism. Endocr Dev. 2010;17:11-21.
  19. Erickson JM, Carlson JL, Stewart ML, Slavin JL. Fermentability of Novel Type-4 Resistant Starches in In Vitro System. Foods. 2018;7(2):18.
  20. Flamm G, Glinsmann W, Kritchevsky D, Prosky L, Roberfroid M. Inulin and oligofructose as dietary fiber: a review of the evidence. Crit Rev Food Sci Nutr. 2001 Jul;41(5):353-62.
  21. Ho KS, Tan CY, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012;18(33):4593-4596.
  22. Scharlau D, Borowicki A, Habermann N, Hofmann T, Klenow S, Miene C, Munjal U, Stein K, Glei M. Mechanisms of primary cancer prevention by butyrate and other products formed during gut flora-mediated fermentation of dietary fibre. Mutat Res. 2009 Jul-Aug;682(1):39-53.
  23. Stilling RM, van de Wouw M, Clarke G, Stanton C, Dinan TG, Cryan JF. The neuropharmacology of butyrate: The bread and butter of the microbiota-gut-brain axis? Neurochem Int. 2016 Oct;99:110-132.
  24. Bourassa MW, Alim I, Bultman SJ, Ratan RR. Butyrate, neuroepigenetics and the gut microbiome: Can a high fiber diet improve brain health? Neurosci Lett. 2016;625:56-63.
  25. Newman JC, Verdin E. β-Hydroxybutyrate: A Signaling Metabolite. Annu Rev Nutr. 2017;37:51-76.
  26. Cavaleri F, Bashar E. Potential Synergies of β-Hydroxybutyrate and Butyrate on the Modulation of Metabolism, Inflammation, Cognition, and General Health. J Nutr Metab. 2018;2018:7195760.
  27. Emran B, Franco C. Butyric Acid Influences How β-Hydroxybutyrate Modulates Fatty Acid Oxidation and Ketogenesis To Support Ketosis. Curre Res Diabetes & Obes J. 2018; 8(5): 555746.
By |2021-05-03T10:30:41-06:00April 30th, 2021|Categories: Keto Basics|Tags: , , , , , , , |0 Comments
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New Year’s thoughts from a Nutritionist

The start of a new year is traditionally a popular time to adopt new health habits, or get back to ones that fell by the wayside during the holidays. It’s true of any year, but maybe this year more than ever. Did you find yourself reaching for high-carb foods during these unprecedented times? Seek solace in sugar? Comfort in cookies? That’s okay! Turn the page on the past and start 2021 on a better path.

KC 7 Day Reset E-book promo

Great things start happening for your health as soon as you cut the carbs. Blood sugar, insulin, and blood pressure begin to improve on day one of a keto diet1—not to mention the bloating and carb hangovers starting to subside. Plus, keto isn’t a gamble. It works. Mountains of scientific evidence are building all the time, showing that this way of eating is effective not only for weight loss, but for improving or reversing a long list of conditions typically thought of as progressive and irreversible–like type 2 diabetes and hypertension1, metabolic syndrome2, PCOS3,4, non-alcoholic fatty liver disease5,6, chronic migraines7,8, and more–get better and often completely disappear on ketogenic diets.

If you want some help jumpstarting your 2021, check out Keto Chow’s FREE 7-Day Reset! It’s got you covered with a meal plan and a workout schedule to take away the guesswork and questions. Download your FREE 7-Day Reset guide now.

  1. Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018 Sep;13(5):263-272. 
  2. Feinman RD, Volek JS. Carbohydrate restriction as the default treatment for type 2 diabetes and metabolic syndrome. Scand Cardiovasc J. 2008 Aug;42(4):256-63.
  3. Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J Transl Med. 2020;18(1):104.
  4. Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005;2:35. 
  5. Luukkonen PK, Dufour S, Lyu K, et al. Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease. Proc Natl Acad Sci U S A. 2020;117(13):7347-7354.
  6. Pérez-Guisado J, Muñoz-Serrano A. The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study. J Med Food. 2011 Jul-Aug;14(7-8):677-80.
  7. Di Lorenzo C, Currà A, Sirianni G, et al. Diet transiently improves migraine in two twin sisters: possible role of ketogenesis? Funct Neurol. 2013;28(4):305-308. 
  8. Barbanti P, Fofi L, Aurilia C, Egeo G, Caprio M. Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci. 2017 May;38(Suppl 1):111-115.

By |2021-01-07T00:06:25-07:00January 5th, 2021|Categories: Keto Basics|0 Comments
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5 Practical Tips for Starting Keto

This entry is part 6 of 9 in the series Keto Basics

My previous article walked you through a few things to know before starting a keto diet. But knowing what to do and actually doing it aren’t the same things. So now that you know the basics—what keto is, how it works, and what to focus on—here are some tips for getting started and setting yourself up for success.

As I mentioned last time, keto really isn’t that big a deal. It’s only as complicated, difficult, and expensive as you make it for yourself. The single most important thing is keeping your carbohydrate intake very low. If you have the financial means to consume solely organic produce and grass-fed or pasture-raised animal foods, that’s a great way to go. But if you’re on a tight budget and your go-to grocery shopping strategy is to get whatever’s on sale at your local supermarket or discount chain, you’ll do just fine. Keto isn’t about the provenance of your food; it’s about keeping carbs low.

But like I also said last time, even though keto is just regular ol’ food minus the sugar and starch, for many people, this is a pretty radical change. No more cereal or toast for breakfast, no more mid-afternoon latte and muffin. No more pasta dinners, no more post-workout fruit smoothies. Whether going keto will be just a mild shift from what you’re eating now, or it will be a massive overhaul of your entire diet, here’s some advice to make it easier, more convenient, and more delicious! After all, if a diet—keto or any other way of eating—is difficult, complicated, and forces you to eat things you don’t like, you’re not going to stick with it for long. So here’s to making keto simple and fun.

Give Your Kitchen a Makeover

A key factor in keto success is surrounding yourself with suitable foods, and only suitable foods. This is easy if you live alone, but more difficult if you live with family or housemates who aren’t jumping aboard the keto train with you. Let’s look at the former scenario first and tackle the latter one in a bit.

Clear out your kitchen! If you’re ready to start keto and you want to start now, get rid of everything that’s not appropriate for a ketogenic diet. Purge your pantry, cupboards, fridge, and freezer of all high-carb items. Don’t wait until you finish them all up. Ditch them now. If you’re starting keto to lose weight or improve a serious health issue, those foods aren’t doing you any favors, so why would you want to finish them? Toss ‘em! (Consider taking all sealed and non-perishable items to a local food bank or shelter.)

Depending on the style of keto you’re going for—there are lots of different ways to do it—get familiar with the foods that will become staples of your diet, and go stock up! The details will vary, but the core foods you can count on to work for any iteration of keto include fatty meats (beef, lamb, pork, poultry, bison, game meats), seafood, eggs, nuts and seeds, and non-starchy vegetables. High-fat dairy products, like cheese, butter, cream, and sour cream, are fine if you tolerate dairy.

Stock up when things are on sale. On a keto diet, your freezer is your friend. Fill the freezer with fatty meats—steaks, sausages, ground meats, pork chops, bacon, roasts, chicken thighs or drumsticks—whatever you like. Also, keep a few fatty protein options in the fridge. Having all that nice meat on hand doesn’t do you do any good if it’s frozen solid. Remember to always have a couple of options defrosted and ready to go. When the meat is defrosted, cooking may only take a few minutes depending on the cut.

Do the same with frozen vegetables. If you have space in your freezer, stock up on the ones you like. Broccoli florets, brussels sprouts, chopped spinach, blends of peppers, and mushrooms. Most supermarkets even have frozen riced cauliflower and spiralized zucchini noodles for convenient keto cooking. (When buying frozen veggies, make sure they’re plain and unseasoned, or watch out for the carb grams per serving if they do have sauce or seasoning.)

Eggs on sale? Keto jackpot! Buy several dozen. Use your own discretion, but the “expiration” or “sell by” date on an egg carton is really just a general guide. Properly refrigerated, eggs last a very long time, and they’re a gold mine of perfect fat, protein, and micronutrients for keto.

Prep Your Environment

Keto will be easier to stick to if you prepare large quantities of food ahead of time so there’s always something ready to go. Vegetables are great to have on hand, but what if you get home from work and you’re tired and hungry? You don’t want to start from scratch with peeling and chopping things when you’re exhausted after a long day. (Suddenly that pizza delivery menu will start looking really good…)

Whether you’re cooking for a crowd or just for one, never cook only enough for one meal. In most cases, it doesn’t take any longer to cook a large amount of food than it does a small one. If you’ve got the grill going anyway, don’t bother cooking just one or two steaks or chicken breasts. Grill five or six at a time—or more. You can have one for dinner and have another, cold, sliced into strips and dipped in blue cheese or ranch dressing for lunch the next day. Or use it as the protein on top of an entrée salad for dinner. Make steak & eggs later in the week for breakfast, or use pre-cooked steak and chicken in fajitas for dinner one night.

If you live in an apartment or some other arrangement where grilling isn’t feasible, use your oven in the same way. Invest in a large glass baking tray or rimmed metal baking sheet. Bake or roast eight or ten chicken legs or pork chops at a time. Most of it’s hands-off time, so while those are cooking, you can wash, peel, and chop vegetables for the week.

You can roast or steam a massive pile of broccoli or cauliflower all at once. Use it throughout the week with different seasonings each time. Using different herbs, spices, and even cooking fats, can make the same ingredients taste like an entirely new dish. Dice a mountain of onions, zucchini, and/or bell peppers. Sautee them with salt and pepper for a bit and store them in a container in the fridge. Since they’re already cooked, they’re an almost-instant side dish for any meat, or you can use them in an omelet. Just reheat and add whatever seasonings you like—curry powder, Italian seasoning, Tex-Mex, sesame ginger. The possibilities are endless, and it’s all entirely customizable to your own taste preferences.

Take advantage of the kitchen appliances and gadgets that make cooking quick and easy. Slow cookers, pressure cookers, and air fryers are good for making large pieces of meat that you can enjoy over the course of several days. (Keto pro-tip, for those who don’t want to cook every day: embrace leftovers!) Slow cookers and pressure cookers can help in the budget department, too: cuts of meat that are tough tend to be priced lower than tender, premium cuts, but when cooked using one of these tools, they end up melt-in-your-mouth soft.

Hard-boiled eggs are a common grab & go keto snack. If you’re boiling the water anyway, why bother with just a few eggs? Boil one or two dozen. You’ll thank yourself all week when hunger hits and all you have to do is open the fridge and snag one. The same goes for sausage links and bacon. Learn to enjoy certain foods cold. Cooking bacon? Don’t mess around with two or three strips. Cook the whole package; cold bacon is a dynamite keto snack. (Bake in the oven rather than frying on the stovetop for easier cleanup.) Sausage links are another ideal keto grab & go option. Fry or bake a few packages at once and fatty protein will always be handy.

What about non-perishables? This is easy since they require no preparation and no refrigeration. Keep a supply of keto-friendly foods to use as meals or snacks: canned seafood (tuna, salmon, sardines, mackerel), pork rinds, low- or zero-sugar beef jerky or meat sticks, nuts and seeds, cheese crisps, pepperoni, and salami. (These might call for refrigeration after they’re open.)

The name of the game here is, be prepared. Keto recipes abound online, and there are some incredibly creative and enticing keto cookbooks out there. Your cooking can be as intricate as you’d like. You can prepare a five-course gourmet meal every night if that’s your thing, but if keeping things simple will make it easier for you to stick to keto for the long term, all you really need to do is base your meals around a fatty protein and round out with low-carb vegetables if you choose to.

Doing Keto Alone in a Houseful of People

Getting rid of all high-carb foods is easy if you live alone. But what if you live with family or housemates, and you’re the only one doing keto? This definitely makes it harder. Your storage space will be limited if your fridge, freezer, and cupboards need to accommodate your keto-friendly foods in addition to the sugary and starchy fare the rest of your household prefers. One strategy is to have a designated cabinet, drawer, or pantry shelf that’s for you and only you. Keeping your keto goodies separate from other food might help limit your exposure to things that are off-limits.

Navigating the fridge will be more difficult. You can’t completely blind yourself from seeing others’ high-carb foods and beverages. You might just have to shore up your mental reserves and stay strong. Remind yourself often of the reasons why you’re doing keto. It’s pretty rare that anyone eats this way just for fun, so chances are you’re looking to lose a significant amount of weight or make a dent in a health problem. Whatever you’re trying to accomplish, are those foods going to help you get there, or will they only set you back?

Don’t assume it’s going to be difficult, though. Sure, you’ll be avoiding many of the foods you might have consumed daily for most of your life, but the good news is, for many people, sugar cravings disappear pretty quickly once they get carbs out of their diet. It doesn’t happen magically overnight for everyone, but many people are pleasantly surprised when they experience for themselves how much they don’t long for high-carb foods. There might, indeed, be times when you have to white knuckle it, but tell yourself that sugar cravings aren’t life-or-death emergencies. They’re not pleasant, but no actual physical harm will come to you if you power through and don’t give in to them. Remember: feeding the sugar beast doesn’t make it go away. It makes it hungrier for more. (A good way to satisfy a sweet craving, though, is to keep a Keto Chow shake in the fridge, and rather than drinking it all at once for a meal, take a swig once in a while to quench the sweet demon.)

Ketogenic diets are so good at regulating appetite that beyond weight loss and beyond better blood sugar control and other improvements in health, for some people, the best thing about keto is that—for the first time in their lives—they’re not hungry all the time. Not thinking about food constantly. Not planning lunch in the middle of breakfast, and not fantasizing about dinner before lunch is done. Intrusive thoughts of food no longer plague them 24/7. They’re freed from the shackles that kept them tethered to sugar all day. I can’t promise this will happen for you, but consider the possibility that sticking with keto will be easier than you think it will be.

As for cooking, don’t make this more complicated than it is. Family meals don’t need to change much. If you’re the “head chef” in your household, don’t become a short-order cook, making customized meals for everyone at the table. Household members who are doing keto can have fatty protein and vegetables; the others can have the same meal plus a starch or a sugary dessert. Don’t reinvent the wheel. It’s just food.

Have “The Talk” With Your Family

The physical logistics of making room for keto-friendly foods in a shared kitchen are easy compared to navigating the mental and emotional aspects of being a lone keto dieter in a home shared with carb eaters. If you have a spouse, significant other, and/or children in your home who won’t be joining you in eating keto, it’s a good idea to set some boundaries.

Ideally, your loved ones will be supportive of you implementing a lifestyle change to improve your health. They don’t have to eat the same foods you do, but they should respect you enough to understand that you have reasons for changing your diet, and they can be positive and encouraging around you.

That’s the ideal scenario, though. More likely, there’ll be someone or perhaps multiple people in your life who will feel threatened by the changes they’ll see in you and they’ll end up sabotaging you, intentionally or unintentionally. Sabotage may come in the form of “food pushing” – “Oh, you can have just this one taste,” or, “Aren’t you going to have any dessert? I made this just for you!” It can even present as passive aggression—eating your favorite high-carb foods right in front of you, on purpose.

Food triggers powerful feelings in people. Sometimes this is because those around you who are not making changes may feel like you’re judging them (even if you don’t give a hoot about what anyone else eats), and significant others may be worried that if your physique or health changes substantially, they might not be “good enough” for you anymore. These feelings have nothing to do with you and everything to do with the person expressing them. Their fears. Their insecurity. They don’t genuinely want to sabotage you; they’re just scared. They might not even be able to recognize that this is what’s going on, but you know, and now you can navigate those relationships with tact and grace.

People get awfully worked up when people close to them make changes in their life. A new job, a new diet: anything that threatens to change the status quo and alter relationship dynamics can make people uncomfortable. It’s simply human nature and none of us is immune. Spouses and significant others can feel especially threatened when their partner makes a major change—especially one that might result in significant weight loss.

If people close to you express negativity about you doing keto, consider having a polite and calm conversation about this. Let them know you understand their perspective but make it clear that you’re making these changes because you want to live a better life. If obesity or a major health issue is compromising your quality of life, then improving these things can only make you a better spouse, parent, friend, sibling, or coworker. Having a frank and honest discussion about how your health or your weight is affecting you—physically and mentally or emotionally—and sharing openly with them can provide them an opportunity to do the same. Perhaps they know their own life is limited because of similar issues but they were afraid to be honest about it. Opening the conversation can help both of you.

In other situations, it’s best to keep your mouth closed. The quickest way to turn others off to this way of eating is to proselytize about it. Don’t be “that person”—the one who can’t eat anything without commenting about how many carbs it does or doesn’t have. You don’t want people judging you or commenting on your low-carb food selections, so give them the same respect with regard to the foods they eat.

If someone expresses curiosity or specifically asks you for information, then sure, point them in the direction of some good resources. But whether it’s about diet or pretty much any other topic, one thing most people don’t like is unsolicited advice. So don’t give any. Even when you feel moved to. Even when you think keto could really help someone in your family or circle of friends. The best way to get someone interested in keto is to serve as a silent example of the incredible things this diet is capable of doing. Let your results speak for themselves and you won’t have to convince anyone to try it. They’ll come around on their own.

Be Prepared for it to be Difficult – or Not!

I explained a little about the “keto flu” in my previous article. Keto flu is the nickname for the unpleasant things some people experience as their body transitions from being fueled mostly by carbohydrates to being fueled mostly by fat. I said “some people” experience it, because despite the alarming warnings in keto circles, most people don’t go through a rocky adjustment period. Most people sail through and feel great pretty quickly on keto, but you do need to be aware of what to expect in case you’re someone who has a few hiccups.

If you ditch the carbs and have more energy, clearer thinking, and a well-controlled appetite right from the start, great. But be prepared with plenty of salt and magnesium supplements if you have headaches, muscle cramps, or feel dizzy or lightheaded. (If you’re taking medication for diabetes or high blood pressure, work with a doctor who’s on board with you trying keto, because your medications might need adjusting very quickly after starting keto. Some of what you think is keto flu might be effects of being overmedicated.)

So What Are You Waiting For? Get Started!

Now you have no more excuses. You know what to be aware of before starting keto, and you have practical tips to jump in and do it. So get going. You can radically transform your health, and all you have to do is eat delicious food! That’s right: just regular food. What you don’t need to start keto is MCT oil, bone broth and collagen powders, ketone pills, gadgets, apps, and meters. It’s fine if you want to play around with all that later on, but when you’re just starting out, use your money where it will serve you best: on your food.

By |2020-10-06T09:24:50-06:00October 7th, 2020|Categories: Keto Basics|Tags: , , , , , , , , |0 Comments
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8 Things to Know Before Starting Keto

This entry is part 1 of 9 in the series Keto Basics

You’ve watched a bunch of videos, listened to some podcasts, lurked on a few forums, and you’ve decided you’re gonna do it: you’re gonna try this keto thing. Great! Come on in, the water’s fine! And guess what? It’s as simple as cutting sugar and starch out of your diet and keeping all other carbohydrates to a minimum. Do that, and congratulations—you’re doing keto!

But wait a minute…

Not so fast.

While it’s true that all you really need to do to get started is to eliminate the majority of carbohydrates from your diet, there are a few things to be aware of before you jump into this. Let’s take a look at what you need to know before starting keto.

  1. Make sure you understand what keto really is.

Contrary to what you might see on social media, keto isn’t about adding butter and coconut oil to everything you eat, and it’s not about eating piles of bacon covered with bacon, with a bit of bacon on the side. (Not that there’s anything wrong with that bacon part!) Rather than “keto,” think of this way of eating as very-low-carb. When you frame it that way, you put the emphasis where it belongs: on keeping your carbohydrate intake very low. This is the single most important part of a ketogenic diet. What makes a diet “keto” is not the presence of mountains of fat and oil, but the absence of the carbs.

You don’t need any special gadgets or gizmos to be successful on keto. This is a way of eating, not an erector set for a Mars excavator robot. You might’ve seen videos of people checking their blood sugar or ketone levels with special meters, and pictures of people’s kitchen counters decked out with bottles of MCT oil, keto bone broth protein powder, and keto coffee creamers. If you’re a data lover—and you have a couple of thousand extra dollars floating around—you’re welcome to use these kinds of things. But if you want to keep things low-tech and simple, know this: keto is about one thing: keeping your carbohydrate intake very low.

Your body isn’t a computer. You don’t have to have a Ph.D. in math to figure out your “macros” or how many calories you should be eating. Keto doesn’t work by magical percentages of fat, protein, and carbs in your diet. You don’t need to calculate your diet down to the last microgram so that you “hit your fat macro” or “don’t eat too much protein.” What you need to do is keep your carbohydrate intake very low. Period.

  1. Have realistic expectations.

Keto is a very powerful way of eating that can radically transform your health and physique. But keep in mind that your transformation might not be as fast as you’d like it to be. Don’t compare your results to anyone else’s. We are all unique individuals, with our own genetics, dietary and medical histories, and lifestyle habits. Use other people’s successes as motivation and inspiration, but don’t “compare and despair.” Start where you are, and follow your own path. If you do the right things, you’ll get to your goals; the journey might just take a little longer than you wish it would.

If you’re specifically in this for fat loss, heed these words and save yourself a mountain of frustration and disappointment: women, don’t compare your rate of fat loss to a man’s. Men tend to lose weight more quickly on keto, even when they’re not as strict with the diet. It’s unfair, it’s infuriating, but it’s just the way it is. You can’t fight biology. Your fat loss will come; it’ll just come more slowly than it does for the men in your life. And older folks, don’t compare your fat loss to that of someone younger. There are always exceptions, but as a general rule, younger people lose fat more quickly than older people. Younger people have faster metabolisms. You can envy them that, but look on the bright side: you probably have more than ten dollars in your checking account.

Another note about fat loss: the more you’re looking to lose, the more quickly it’ll come off—at first. If you have a substantial amount of weight to lose, a good rate of loss is about 1-2 pounds per week. People who have less to lose will probably lose more slowly. If you’re new to this way of eating, you might lose several pounds in the first week or two but then things will slow down. This is normal and to be expected, so be ready for it. If you find things going slower a few weeks into keto, don’t worry that you’re doing something wrong.

Whatever you’re looking to achieve with keto—fat loss, relief from migraines, more energy, clearer skin, lower blood sugar—some of it might happen right away, but other things will take longer. Play the long game and be patient. Be on the lookout for beneficial things keto is doing for you even if you haven’t gotten to your main goal. (See point 8).

  1. Be prepared for keto flu.

Ah yes, the dreaded “keto flu.” The truth is, most people make the transition to keto with no problems. But some people experience a few hiccups as their body adjusts to life without sugar and starch, so it’s important for you to know about these in case they happen to you. The first thing to know is, these issues will be mild and temporary. They’ll pass quickly and they’re a small price to pay to feeling great and experiencing all the benefits of keto once your body adapts.

The most common issue is headaches. You may also feel dizzy, lightheaded, nauseated, or fatigued. Most of these can be prevented by taking in more salt. As I mentioned in a previous article, ketogenic diets increase your body’s need for sodium. Skimping on salt is usually the cause of headaches, lightheadedness, and feeling sluggish on keto. Be generous with salt and sodium in your diet: either sprinkle it liberally on your foods or add it to your beverages, or be sure to incorporate salty foods into your diet—things like bacon, olives, pickles, or pepperoni. Not a fan of those? Make a cup of broth using a bouillon cube for an easy sodium boost.

If you experience muscle cramps (especially in the legs) that you can’t attribute to overexertion, extra magnesium usually helps. Magnesium also helps with constipation, which some people experience on keto. If sodium alone doesn’t help with headaches, add magnesium; it’s helpful for headaches, too. (Check out the electrolytes from Keto Chow for convenient ways to get sodium and other important minerals.)

  1. Get professional guidance on medication.

If you take medication for diabetes (either type 1 or type 2) or for high blood pressure, you must have medical supervision when you start keto. This is not negotiable! Ketogenic diets are so powerful for normalizing blood sugar and blood pressure that you may need to adjust your medication doses with days of starting. For people with type 2 diabetes, insulin injections sometimes need to be stopped on the first day of starting the diet.1 (And people with type 1 might need to adjust their dose on day one.) If you take the same amount of medication you needed when you were eating a high-carb diet, but now you’re on a very low-carb diet, you might end up overmedicated, and this comes with effects ranging from dizziness and fatigue to more dangerous things, such as passing out.

Don’t adjust medication on your own. Work with a physician or other qualified medical professional who can advise you on changing your medication safely, as needed.

  1. Get baseline blood tests.

You don’t have to have any blood tests done before starting keto, but I recommend it—you’ll want to have something to compare to after a few months so you can see how much things have improved! Your body will give you loud and clear signals about how keto’s working for you—more energy, less joint pain, no more brain fog or heartburn—but it can be rewarding to also see objective proof that eating delicious food has had a positive impact on your health. Plus, if weight loss is a bit slow or you’re not getting closer to another goal you have, seeing certain measurements go in a favorable direction can help keep you motivated to stay on plan.

For a good baseline before starting, I recommend a comprehensive metabolic panel (CMP, which includes fasting glucose and liver enzymes), complete blood count (CBC), hemoglobin A1c, fasting insulin, C-reactive protein (CRP), and a lipid panel (cholesterol & triglycerides). Most of these are pretty standard tests, but you might have to specifically request fasting insulin. It’s not a routine test, but it’s important. For the lipid panel, ask your doctor if they can order a particle size test. (This isn’t essential, but it’s nice to have if you can get it.) If you suspect you might have a thyroid problem, ask for a comprehensive thyroid panel. (It’s important to ask for a comprehensive panel. If you ask for a “thyroid test,” many doctors test just one or two things, but a comprehensive panel provides much more information about thyroid function. See here for details.) If you’ve been taking antacid medication for a while—either by prescription or over-the-counter—consider asking for a vitamin B12 test. Antacids interfere with the absorption of vitamin B12, which is critical for energy levels and healthy neurological and cognitive function.

  1. Know how to order in restaurants.

In an ideal world, everyone would cook all their meals at home from scratch. But over here in the real world, where you and I live, dining out is one of life’s small pleasures. Whether you do it because you don’t like to cook, because it’s convenient, or because it’s a kind of treat and doesn’t have to cost a fortune, chances are you’ll find yourself in a sit-down restaurant or at a fast food drive-thru sometime after starting keto. Now that bread, pasta, rice, potatoes, beans, and noodles are off-limits, what can you order?!

Dining out or grabbing food on the go is easy. Just ask to swap out starchy sides in favor of non-starchy vegetables or a salad. Most restaurants will have no problem substituting steamed broccoli or roasted brussels sprouts for a baked potato or scoop of rice. At fast food places, bun-less burgers or grilled chicken are good ways to go. (Pro tip: ask for burger patties or grilled chicken patties a la carte if you don’t want the lettuce, tomato, and other toppings. It’s cheaper to just get the meat.) Tex-Mex places will serve you meat, veggies, and cheese in a lettuce bowl instead of wrapped in a tortilla. Just skip the rice and beans.

If you’re on the road and need to grab something quick from a convenience store, you’ll have no problem finding suitable items. With string cheese, nuts, pork rinds, pepperoni, and low-sugar beef jerky, there’s practically a smorgasbord of keto-friendly foods at these places now. If you’re passing by a grocery store, it’s even easier: grab some deli counter lunchmeat, a rotisserie chicken, canned fish (with a pop-top for easy opening), and/or pre-cut vegetables from the produce department. Many supermarkets have fresh salad bars now. These are perfect for a quick keto meal: lettuce, spinach, bell peppers, cucumber, radishes, mushrooms, turkey, ham, hard-boiled egg, shredded cheese. Being in a hurry or being on the road doesn’t mean you have to sacrifice your low-carb ways. (See here for more tips on staying keto while dining out.)

  1. Go easy on yourself.

Some people sail right through transitioning to keto. What? I can eat ribeye steaks, macadamia nuts, and Gruyere cheese and lose weight? Where do I sign?! But for others, this way of eating is a struggle to get used to. When you’ve spent your entire life eating cereal, granola, bread, pasta, rice, potatoes, ice cream, fruit smoothies, and other sweet and starchy things, it can be difficult to let go of them.

When you think about it, keto really isn’t that big a deal. It’s just no sugar or starch. Other than that, you’re eating the same meat, poultry, seafood, eggs, dairy, and low-carb vegetables you’ve always eaten. However, for some people, this is a really big deal! Be patient with yourself if you don’t master keto right away. (I sure didn’t!) Do the best you can, and if you find yourself faceplanting into a cupcake six days in, make sure you faceplant into just one cupcake, and not the whole box. Get back on the plan right at your next meal. Not tomorrow, not Monday, but immediately.

If you have trouble sticking to keto, it’s okay to ease into it gradually, rather than giving up carbs cold-turkey. The best way to experience the full effect of keto is to do it full-on right from the start, but if that all-or-nothing mindset has tripped you up in the past, then make a slower transition to this way of eating. A good way to approach this is to eliminate one high-carb food category each week. For example, week one: no fruit. You can still have bread, pasta, rice, beans, etc., just no fruit. Week two: no fruit and no pasta. You can still have bread, rice, beans, potatoes, etc., just no fruit or pasta. Each week (or even every two weeks), remove a high-carb food from your diet, and eventually, you’ll be on keto. It’ll take you longer to get there this way, but if doing it slowly helps you actually do it, that’s all that matters. Better to make a gradual transition and stay with it than to jump in overnight but have to restart every two weeks.

  1. Give yourself non-weight milestones.

Weight loss is just one of many reasons people adopt a keto diet, but since it’s probably the most common one, here’s something to keep in mind if you’re doing keto to lose weight. Look beyond the scale to assess whether keto is doing anything good for you. A lower body weight is only one thing on a long list of what keto can help you achieve. Looking for positive effects unrelated to your weight can keep you motivated to stay on plan if a weight loss stall or plateau has you feeling frustrated. Do you have brain fog? Acne? Acid reflux? What about migraines, hypoglycemia, hypertension, or low energy? Keto is good for all of these, and more. Research shows that metabolic health can improve substantially—including metabolic syndrome being reversed—even when you don’t lose a significant amount of weight.2,3 Here’s a list of 14 ways to tell if keto is working for you besides weight loss.

So, yes, if you want to start keto right now, all you have to do is stop eating sugar and starch. But keeping these 8 points in mind will set you up for success and give you a boost if your enthusiasm for this way of eating starts to wane in the early days. In a future article, I’ll give you some real-world strategies for making keto simpler and easier to stick with for the long term.

References:

  1. Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018;13(5):263-272.
  2. Hyde PN, Sapper TN, Crabtree CD, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight. 2019;4(12):e128308.
  3. Feinman RD, Volek JS. Low carbohydrate diets improve atherogenic dyslipidemia even in the absence of weight loss. Nutr Metab (Lond). 2006;3:24.
By |2020-09-23T11:26:04-06:00September 23rd, 2020|Categories: Keto Basics|Tags: , , , , , , , |4 Comments
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How Keto Affects the Brain

This entry is part 4 of 9 in the series Keto Basics

Apart from the well-documented benefits ketogenic diets provide—like weight loss1, lower blood sugar and blood pressure2, and improved cardiovascular risk factors3—people commonly report sharper thinking. Brain fog disappears, and it’s smooth sailing for cognitive function. Is this—no pun intended—all in people’s heads, or is keto genuinely good for the brain?

Your Brain on Glucose & Insulin

There isn’t much published scientific research specifically studying the effects of ketogenic diets on brain function in healthy humans outside the epilepsy world, so we can’t say for certain that keto is “good” for the brain. However, we do have a pretty good idea of what’s not good for the brain: chronically high blood sugar and insulin.

Type 2 diabetes and high blood pressure—two conditions rooted in high blood sugar and/or insulin—are among the risk factors for Alzheimer’s disease (AD). In fact, researchers now regularly call AD “type 3 diabetes,” and you might also come across the term “brain insulin resistance.”4,5 The links between metabolic syndrome (driven by chronically elevated insulin) and cognitive impairment are so strong that researchers also use the phrase “metabolic-cognitive syndrome.”6

The reason AD is called “type 3 diabetes” is that the primary problem in the brain of someone with AD is that neurons in affected regions of the brain are no longer metabolizing glucose properly—that is, they cannot convert glucose into energy, so they’re basically starving for fuel. Calling AD “a brain form of diabetes”4 is helpful because it immediately makes a connection to problems with glucose, but it misses what might be an even more important factor in this energy shortage in the brain: chronically high insulin.

Millions of people have normal blood glucose (a.k.a. blood sugar) levels, but very high insulin, and having chronically high insulin—even when blood sugar is normal—is a major risk factor for AD. This is independent of family history or genetics: if you have high insulin most of the time, you have an increased risk for developing AD. According to one study, compared to people with normal insulin levels, those who had high insulin but who were not diabetic had double the risk of developing AD.7

What about when your blood sugar is just a little bit higher than normal? What if it’s slightly elevated but not so high that you’ve been diagnosed with diabetes? Here we also see some frightening data. One paper said it pretty clearly: “… even in the absence of manifest type 2 diabetes mellitus or impaired glucose tolerance, chronically higher blood glucose levels exert a negative influence on cognition, possibly mediated by structural changes in learning-relevant brain areas.”8 In plain English: people with higher blood glucose had worse cognition than people with lower glucose, and this was probably due to changes in the physical structure of the brain. This echoed earlier research which had similar findings—elevated average blood glucose may be a risk for dementia even at levels lower than the diabetic range.9

Alzheimer’s is only the most severe manifestation of the adverse effects of chronically high blood sugar and insulin on the brain. What about when things are in a much milder state? Could this be what we casually call brain fog? When your blood sugar fluctuates wildly throughout the day, it’ll reach some big highs and drop to some precipitous lows. Nervousness, anxiety, confusion, and difficulty speaking are some of the brain-related effects of acute hypoglycemia (low blood sugar).10

So if chronically high blood sugar has a negative influence on cognition11, then it’s possible that keeping blood sugar within a healthy range could have a protective influence. We can’t say this for certain, but it’s a pretty safe bet that you’re better off having normal levels of blood sugar and insulin compared to chronically high levels of either.

Fueling the Brain

Well-meaning friends and family who tried to steer you away from keto may have peppered you with arguments about the brain “needing carbs,” or perhaps a medical or nutrition professional even warned you that your brain would starve on a low-carb diet because the brain needs 120 grams of glucose every day. Let’s set the record straight on this.

It’s true that your brain needs glucose. There’s no denying that. But a need for glucose doesn’t equate to a need for lots of sweet and starchy carbohydrates in your diet—or any carbs, for that matter. The human body is the ultimate reuse and recycle machine. It’s great at converting things into other things—moving and changing things here and there like some kind of wondrous biochemical Jenga game or Rubik’s cube. (Remember those?!) One of the things your body is great at making out of many different raw materials is glucose. You can make glucose from amino acids (from protein), glycerol (from fats), and from a few other starting points—no bagels, pasta, bread, rice, or cookies required!

One thing is clear: the brain is an energy hog. Sources differ, but as a general ballpark, your brain represents only about 2% of your body weight, but it sucks up nearly 20% of your body’s energy.12 But does all this energy have to come from glucose, or can the brain use some other fuel instead?

According to researchers, the brain metabolizes about 120 grams of glucose per day “under conditions of normal glucose availability.”12 But what about under other conditions? What about in someone eating a very low-carb or ketogenic diet?

Well, as I mentioned, your body can make all the glucose it needs in-house. If your brain absolutely required a certain amount of glucose every day and your body couldn’t supply it, no one would ever survive more than a day or two of fasting. So either your body has no problem generating 120 grams of glucose in the total absence of dietary carbohydrate, or maybe your brain doesn’t need quite that much glucose if it’s being fueled by something else.

In addition to being great at recycling, your body—and brain—are like hybrid cars. They adapt to running on whatever fuel you give them. Most cells in your body can use glucose, fats, or ketones. Your brain can use glucose and just a small amount of fat, but it’s a champ at using ketones. Look at this breakdown of how much of your brain’s energy supply comes from ketones at different blood levels of beta-hydroxybutyrate (βOHB).

Blood ketone level
(βOHB)		 Proportion of Brain
Energy Supplied
0.3–0.5 mM 3–5%
1.5 mM 18%
5 mM 60%
7 mM >60%

Data from reference 12.

Even people not on ketogenic diets could achieve a blood ketone level of 0.3–0.5 mM or higher if they do a hard workout and it’s been a few hours since their last meal. 1.5 mM is easily achievable when carbs are very low. The higher numbers in this table would likely only be seen in someone doing an extended fast, but levels in between—2.0–4.0 mM, for example—could provide a substantial amount of fuel for the brain and are not unheard of in people doing strict ketogenic diets.

Is it essential to be in ketosis, then? No. A few billion people all over the world who have a healthy cognitive function but who are not on ketogenic diets show us this implicitly. But based on the research we explored earlier, what probably is needed for healthy cognition throughout life is maintaining healthy blood sugar and insulin levels. Keto is certainly one way to do that, but everyone’s carb tolerance varies. Some people will have to stay ultra-low-carb most of the time; others can be more generous.

Exciting Research in Alzheimer’s and Traumatic Brain Injury

Getting back to the association between diabetes, metabolic syndrome (MetSyn), and cognitive impairment, some small-scale research suggests that ketogenic diets and other lifestyle interventions that help correct MetSyn may also improve cognitive function. Ketogenic diets combined with exercise, intermittent fasting, or brain training games were shown to reverse mild cognitive impairment (MCI, the precursor to Alzheimer’s) in three subjects, one with type 2 diabetes and two with MetSyn.13,14,15 The diabetes and MetSyn were also greatly improved, and while we can’t say for certain that those improvements caused the reversal of cognitive impairment, it’s a plausible hypothesis.

Most of the research looking at ketones as an alternative brain fuel to glucose in Alzheimer’s disease have used exogenous ketones or MCT oil rather than ketogenic diets. This is disappointing but understandable. It can be difficult even for young, healthy, able-bodied people to adhere to strict ketogenic diets. Now imagine someone with cognitive impairment, who might also have limited mobility and capacity to cook. Caregivers already face heavy burdens in looking after their loved ones; trying to force them to make dietary changes they’re opposed to only makes things harder. Plus, by using exogenous ketones or MCT oil without changing someone’s diet, researchers narrow down confounding issues that might cloud the results. If a subject’s cognition improves when their ketone levels are elevated from MCT oil or exogenous ketones, then it’s more likely that it’s a direct result of the ketones and not something else, like weight loss, better blood sugar control, less inflammation, or other things we know keto typically leads to.

Elevated ketones, by themselves, aren’t a slam dunk for radically improving Alzheimer’s or cognitive impairment. But let’s not dismiss even minor beneficial effects, especially considering that right now, there are no effective treatments for AD. Generally speaking, these studies show that at least some people have improved cognition when their ketone levels are elevated.16-19 In MCI, the brain energy deficit is specific to glucose, and “at least partially correcting this deficit with ketones results in cognitive improvements.”16

Ketogenic diets and exogenous ketones also show potential in improving recovery from traumatic brain injury (TBI). Almost all the research in this area has been done in animals, but it’s encouraging and holds promise for people affected by these devastating injuries. TBI and AD have a surprising amount of overlap, first and foremost, a reduced capacity of the brain to convert glucose into energy.20-22 TBI also results in increased free radicals, mitochondrial damage, an increased need for antioxidants, increased susceptibility to neuronal death, and other issues that ketones themselves or the collective effects of ketogenic diets can address.23

Using ketogenic diets or exogenous ketones as therapy in TBI is in its infancy, but one thing that has been well known for a while is that higher blood sugar is associated with worse outcomes in TBI patients. So why not adopt a nutritional strategy that keeps blood sugar in a healthy range and gives neurons an alternative fuel to glucose? Research in animals and humans suggests that a switch to a ketogenic state might help to protect damaged neurons.20,24

Spotlight on Vitamin B12 and Choline

Vitamin B12 is a crucial factor for anyone concerned about brain health and cognitive function. Outright B12 deficiency and milder subclinical insufficiency are common, particularly among older people who may be consuming fewer foods rich in B12, and whose digestive capacity may be waning, making them less able to absorb B12 from the foods they do consume. Inadequacy of this critical nutrient comes with a long list of signs and symptoms, including confusion, memory loss, dementia, dizziness, altered mental status, depression, apathy, paranoia, mania, delusions, psychosis, and hallucinations.25 So yes, it’s fair to say that suboptimal B12 status could have a major impact on the brain.

With this in mind, it’s possible that raising B12 levels is another way keto may be beneficial for the brain, entirely separate from its influence on blood glucose, insulin, and ketones. An omnivorous ketogenic diet that includes red meat, eggs, pork, seafood or shellfish, provides plenty of B12. People may have been eating these foods all along, even before keto, but when sugary and starchy carbs are off the menu, replaced by fats and proteins, it’s possible people get more B12 than they did before.

Consuming foods rich in B12 doesn’t guarantee your blood levels will increase or be maintained at healthy levels, though. As we mentioned in a previous article, eating certain foods doesn’t automatically mean you’ll digest them effectively and absorb the nutrients they contain. So if you know you have compromised digestive function, consider getting your B12 level checked (it’s a simple blood test), and take supplements if warranted. B12 is found only in foods from the animal kingdom, so lacto-ovo vegetarians can get B12 from eggs and dairy products, but strict vegans must supplement.

Choline is another nutrient critical for brain health and neurological function. It’s an essential part of all cell membranes, and is a precursor to acetylcholine, a neurotransmitter that affects “memory, mood, muscle control, and other brain and nervous system functions.”26 Patients with Alzheimer’s may have lower levels of acetylcholine compared to healthy people, and one class of drugs used to treat AD is designed to reduce the breakdown of this critical compound.27

Your body synthesizes choline, but only in small amounts—not enough to meet the full demands, so you need to get some from your diet. Some of the richest sources of choline are the foods commonly consumed on ketogenic diets: eggs, red meat, pork, seafood, plus nuts and seeds, broccoli, and Brussels sprouts. Plant foods contain choline, but animal foods are more concentrated sources. To the extent that increased dietary choline may be providing more raw material for acetylcholine, this might be another way low-carb or ketogenic diets may be beneficial for the brain.

Conclusion

Ketogenic diets are impressive for helping people lose weight, banish acid reflux28, reverse non-alcoholic fatty liver29, improve hormone balance in PCOS30,31, and for many other health issues. It stands to reason that this very low-carb way of eating would also be beneficial for the brain. So if you’re doing keto and you’ve noticed improved mental clarity and cognitive sharpness, it is in your head—and in the rest of your body, too.

Wondering how keto affects mental health? Stay tuned. We’ll cover that in a future article.

References:

  1. Staverosky T. Ketogenic Weight Loss: The Lowering of Insulin Levels Is the Sleeping Giant in Patient Care. J Med Pract Manage. 2016;32(1):63-66.
  2. Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018;13(5):263-272. doi:10.1080/17446651.2018.1523713.
  3. Bhanpuri NH, Hallberg SJ, Williams PT, et al. Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovasc Diabetol. 2018;17(1):56. doi:10.1186/s12933-018-0698-8.
  4. de la Monte SM. The Full Spectrum of Alzheimer’s Disease Is Rooted in Metabolic Derangements That Drive Type 3 Diabetes. Adv Exp Med Biol. 2019;1128:45-83. doi:10.1007/978-981-13-3540-2_4.
  5. Frazier HN, Ghoweri AO, Anderson KL, Lin RL, Porter NM, Thibault O. Broadening the definition of brain insulin resistance in aging and Alzheimer’s disease. Exp Neurol. 2019;313:79-87. doi:10.1016/j.expneurol.2018.12.007.
  6. Frisardi V, Solfrizzi V, Seripa D, et al. Metabolic-cognitive syndrome: a cross-talk between metabolic syndrome and Alzheimer’s disease. Ageing Res Rev. 2010;9(4):399-417. doi:10.1016/j.arr.2010.04.007.
  7. Luchsinger JA, Tang MX, Shea S, Mayeux R. Hyperinsulinemia and risk of Alzheimer disease. Neurology. 2004;63(7):1187-1192. doi:10.1212/01.wnl.0000140292.04932.87.
  8. Kerti L, Witte AV, Winkler A, Grittner U, Rujescu D, Flöel A. Higher glucose levels associated with lower memory and reduced hippocampal microstructure. Neurology. 2013;81(20):1746-1752. doi:10.1212/01.wnl.0000435561.00234.ee.
  9. Crane PK, Walker R, Hubbard RA, et al. Glucose levels and risk of dementia. N Engl J Med. 2013;369(6):540-548. doi:10.1056/NEJMoa1215740.
  10. Mayo Clinic. Diabetic Coma. Accessed Aug 31, 2020 from https://www.mayoclinic.org/diseases-conditions/diabetic-coma/symptoms-causes/syc-20371475.
  11. Saedi E, Gheini MR, Faiz F, Arami MA. Diabetes mellitus and cognitive impairments. World J Diabetes. 2016;7(17):412-422. doi:10.4239/wjd.v7.i17.412.
  12. Hashim SA, VanItallie TB. Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester. J Lipid Res. 2014;55(9):1818-1826. doi:10.1194/jlr.R046599.
  13. Stoykovich S, Gibas K. APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case study. Alzheimers Dement (Amst). 2019;11:264-269. doi:10.1016/j.dadm.2019.01.009.
  14. Dahlgren K, Gibas KJ. Ketogenic diet, high intensity interval training (HIIT) and memory training in the treatment of mild cognitive impairment: A case study. Diabetes Metab Syndr. 2018;12(5):819-822. doi:10.1016/j.dsx.2018.04.031.
  15. Brown D, Gibas KJ. Metabolic syndrome marks early risk for cognitive decline with APOE4 gene variation: A case study. Diabetes Metab Syndr. 2018;12(5):823-827. doi:10.1016/j.dsx.2018.04.030.
  16. Croteau E et al. A cross-sectional comparison of brain glucose and ketone metabolism in cognitively healthy older adults, mild cognitive impairment and early Alzheimer’s disease. Exp Gerontol. 2018 Jul 1;107:18-26.
  17. Fortier M, Castellano CA, Croteau E et al. A ketogenic drink improves brain energy and some measures of cognition in mild cognitive impairment. Alzheimers Dement. 2019 May;15(5):625-634.
  18. Cunnane SC, Courchesne-Loyer A, Vandenberghe C, et al. Can Ketones Help Rescue Brain Fuel Supply in Later Life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer’s Disease. Front Mol Neurosci. 2016;9:53. doi:10.3389/fnmol.2016.00053.
  19. Cunnane SC, Courchesne-Loyer A, St-Pierre V, et al. Can ketones compensate for deteriorating brain glucose uptake during aging? Implications for the risk and treatment of Alzheimer’s disease. Ann N Y Acad Sci. 2016;1367(1):12-20. doi:10.1111/nyas.12999.
  20. Prins M. Diet, ketones, and neurotrauma. Epilepsia. 2008;49 Suppl 8(Suppl 8):111-113. doi:10.1111/j.1528-1167.2008.01852.x
  21. Bernini A, Masoodi M, Solari D, et al. Modulation of cerebral ketone metabolism following traumatic brain injury in humans. J Cereb Blood Flow Metab. 2020;40(1):177-186. doi:10.1177/0271678X18808947.
  22. Prins ML, Matsumoto JH. The collective therapeutic potential of cerebral ketone metabolism in traumatic brain injury. J Lipid Res. 2014;55(12):2450-2457. doi:10.1194/jlr.R046706.
  23. Greco T, Glenn TC, Hovda DA, Prins ML. Ketogenic diet decreases oxidative stress and improves mitochondrial respiratory complex activity. J Cereb Blood Flow Metab. 2016;36(9):1603-1613. doi:10.1177/0271678X15610584.
  24. Miller VJ, Villamena FA, Volek JS. Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health. J Nutr Metab. 2018;2018:5157645. doi:10.1155/2018/5157645.
  25. Pacholok, S and Stuart J. Could It Be B12? An Epidemic of Misdiagnoses. Quill Driver Books, Linden Publishing, Inc. Fresno, CA, 2011.
  26. S. Department of Health and Human Services. National Institutes of Health, Office of Dietary Supplements. Choline Fact Sheet for Health Professionals. Updated July 2020. Accessed Aug 31, 2020 from https://ods.od.nih.gov/factsheets/Choline-HealthProfessional/.
  27. Oregon State University. Linus Pauling Institute Micronutrient Information Center. Choline. Updated Jan 2015, accessed Aug 31, 2020 from https://lpi.oregonstate.edu/mic/other-nutrients/choline.
  28. Pointer SD, Rickstrew J, Slaughter JC, Vaezi MF, Silver HJ. Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: a pilot study in European- and African-American obese women. Aliment Pharmacol Ther. 2016;44(9):976-988. doi:10.1111/apt.13784.
  29. Luukkonen PK, Dufour S, Lyu K, et al. Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease. Proc Natl Acad Sci U S A. 2020;117(13):7347-7354. doi:10.1073/pnas.1922344117.
  30. Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005;2:35. doi:10.1186/1743-7075-2-35.
  31. Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J Transl Med. 2020;18(1):104. doi:10.1186/s12967-020-02277-0.

 

By |2020-09-14T21:08:14-06:00September 14th, 2020|Categories: Keto Basics, Ketogenic Diet|Tags: , , , , , , , , |0 Comments
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Is Keto Dairy Free?

This entry is part 3 of 9 in the series Keto Basics

Look at pictures of food on keto social media and no one could blame you for thinking that dairy is required when you’re eating this way. Bowls are filled with cheese covered in rivers of melted cheese, with cheese sprinkled on top for good measure. People put butter in their coffee, and keto dessert cookbooks would be pretty empty if you took out all the recipes calling for cream cheese and heavy cream. But what if you’re allergic or sensitive to dairy, or you just plain don’t like the stuff? Is it possible to do dairy-free keto?

What Makes Keto Ketogenic?

Can you do dairy-free keto Yes! Ketogenic diets have more to do with what you don’t eat than what you do eat. Diets are ketogenic not based on what they include, but rather, on what they exclude. Don’t eat sugar or starch. Beyond that, what you choose to consume is up to you. The single most important thing about keto is keeping your carb intake low. Period. There are no specific foods that you need to include to make your diet “more keto” or to make it work better.

Based again on those alluring food pics, it would be easy to think that you have to eat bacon, or ribeye steak, coconut oil, almond flour cookies, or cauliflower rice to belong to the keto club. But that’s not how it works. The beauty of keto is that it’s entirely customizable. Keep your carbs very low, and get your protein and fat from whichever foods you like. Dairy certainly fits in well, but it’s not required.

Keto Without Dairy

Since keto is defined more by what’s not in your diet than by what is, you can definitely do keto without dairy—and many people do. Dairy has two main roles on ketogenic diets: first, it’s delicious, and second, it’s a great source of fat. But there’s a world of other foods that fulfill both those criteria, depending on your personal taste preferences. Guacamole, anyone? If you’re an avocado fan, you’ll have no problem getting plenty of good fats in your keto diet. Coconut more your thing? Coconut milk, coconut oil, and coconut butter provide flavor along with a big dose of healthy fat. And of course, there’s lard, tallow, schmaltz, and other traditional animal fats.

Dairy is also a protein source—one that plays a big role in lacto- or lacto-ovo-vegetarian keto diets. Meat eaters don’t have to worry about getting enough protein on keto, but those who avoid animal products except eggs and dairy might need to be a bit more careful. Cottage cheese, Greek yogurt, and whey protein shakes are all low-carb sources of protein. (Yes, cottage cheese and Greek yogurt. These might not work if you need to stay ultra-strict keto for medical reasons, but everyone’s carb threshold differs. Some people can have more carbs than others and still stay in a ketogenic state.)

But what if dairy is off-limits? If you need to avoid dairy but you’re not a vegetarian, the rest of the protein world is still open to you: beef, pork, lamb, chicken, turkey, seafood, venison, duck … there’s no shortage of protein options. If you choose to avoid these animal foods, however, getting adequate protein will be a bit tougher. If eggs are on your menu, eat them liberally. They’re phenomenal sources of protein, fat, and micronutrients.

If you’re a dairy-free vegetarian, then beyond eggs, you can use vegetarian protein sources, like pea, hemp, or rice proteins. (Always read labels and look at the carb counts. Most protein powders are low in carbs, but never assume.) If your diet can be slightly more liberal with regard to carbs, you may be able to incorporate tofu, lentils, and other lower-carb beans and pulses as protein sources. Not everyone needs to be in ketosis all the time to reap the benefits of lower-carb eating.

After all this talk about doing keto without dairy, it’s worth pointing out that some people with lactose intolerance do well-eating dairy foods that are very low in lactose, like butter, ghee, or long-aged cheeses, all of which are perfect for keto. The longer a dairy product has been aged or fermented, the more lactose the culturing bacteria consume, and the less remaining in the final product. So if you have lactose intolerance but love dairy, stick to dairy foods that are almost all fat (butter, ghee, heavy cream), and those that have been aged for a long period of time.

Does Dairy Affect Insulin?

Whether to include dairy in your diet is a personal decision. It may be true that, technically, milk is the only food specifically intended to help small mammals grow larger, and that this could potentially be a problem if you’re specifically looking to lose weight. It’s also true that dairy stimulates insulin and a similar hormone, insulin-like growth factor 1 (IGF-1)1,2,3, but neither of these means that including dairy foods in a ketogenic or low-carb diet is harmful.

A small effect on these hormones in the context of a very low-carb diet is likely different from the effect that results when dairy is included in the diet of someone with chronically high blood sugar or insulin. It must be noted that most research connecting dairy consumption to chronic cardio-metabolic disease is epidemiological in nature (meaning it can’t establish cause-and-effect), and has been conducted in populations consuming mixed—i.e. high-carb—diets. Very little research has been done investigating dairy specifically in the context of ketogenic diets.

Some people notice that dairy foods (particularly cow dairy) cause or exacerbate acne. Research looking at the evidence for the acne-promoting effects of milk and other dairy products known to stimulate insulin concluded that “restriction of milk consumption or generation of less insulinotropic milk will have an enormous impact on the prevention of epidemic western diseases like obesity, diabetes mellitus, cancer, neurodegenerative diseases, and acne.”4

The key here is to limit the consumption of fluid milk and other dairy foods that stimulate insulin more than items that are very low in carbs, like butter and cream. The work of nutrition research pioneer Weston A. Price tells us that many populations whose diets included liberal amounts of dairy foods were healthy, robust, long-lived, and free of the chronic diseases that plague us now. So it’s not dairy, per se, that’s driving these modern illnesses. It’s more likely dairy in the context of a diet that already over-stimulates insulin.5 Including cheese, butter, ghee, cream, sour cream or cream cheese in a very low-carb diet is likely fine—the evidence being many thousands of people who are doing exactly this, and whose health has improved dramatically just by cutting carbs.

A 2019 review presented evidence that consuming full-fat and fermented dairy is not associated with increased risk for cardiovascular disease or type 2 diabetes.6 Earlier research noted, “Data from RCTs [randomized controlled trials] suggest that dairy consumption has no impact on insulin resistance and glucose and insulin homeostasis in the short term, but may be beneficial in the long term.”7 (Emphasis added.) So if you’ve been including dairy regularly on your keto diet and you’re happy with your health, body size, and skin appearance, keep calm and dairy on.

Bottom Line

Do what works for you. Dairy can be a delicious and convenient part of ketogenic diets, but it’s not required. Your results won’t be compromised if you skip the butter and cheese and get your fat from meats and seafood, olive oil, avocado, nuts and seeds, and other sources. If you’re doing dairy-free keto and could use some recipe inspiration, the book Dairy-Free Keto Cooking can help breathe new life into your kitchen routine.

References:

  1. Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp Dermatol. 2009;18(10):833-841. doi:10.1111/j.1600-0625.2009.00924.x.
  2. Melnik BC, John SM, Schmitz G. Over-stimulation of insulin/IGF-1 signaling by western diet may promote diseases of civilization: lessons learnt from laron syndrome. Nutr Metab (Lond). 2011;8:41. doi:10.1186/1743-7075-8-41
  3. Clatici VG, Voicu C, Voaides C, Roseanu A, Icriverzi M, Jurcoane S. Diseases of Civilization – Cancer, Diabetes, Obesity and Acne – the Implication of Milk, IGF-1 and mTORC1. Maedica (Buchar). 2018;13(4):273-281. doi:10.26574/maedica.2018.13.4.273.
  4. Melnik BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program. 2011;67:131-145. doi:10.1159/000325580.
  5. Cordain L, Eades MR, Eades MD. Hyperinsulinemic diseases of civilization: more than just Syndrome X. Comp Biochem Physiol A Mol Integr Physiol. 2003;136(1):95-112. doi:10.1016/s1095-6433(03)00011-4.
  6. Astrup A, Geiker NRW, Magkos F. Effects of Full-Fat and Fermented Dairy Products on Cardiometabolic Disease: Food Is More Than the Sum of Its Parts. Adv Nutr. 2019;10(5):924S-930S. doi:10.1093/advances/nmz069.
  7. Drouin-Chartier JP, Côté JA, Labonté MÈ, et al. Comprehensive Review of the Impact of Dairy Foods and Dairy Fat on Cardiometabolic Risk. Adv Nutr. 2016;7(6):1041-1051. doi:10.3945/an.115.011619.
By |2020-09-01T09:35:40-06:00August 26th, 2020|Categories: Keto Basics|Tags: , , , , , |0 Comments
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