The Ketogenic Diet

There’s a lot of hype around ketosis and the ketogenic diet, which can sometimes make the entire subject feel like either one big hoax or an out-of-control fad.

The basic truth is that the ketogenic diet has a large number of benefits, some clearly known, measured and proven, and others with evidence, anecdotal or statistical, but which is today insufficient to say those benefits are proven.

While there’s lots of good science behind the benefits of a ketogenic diet, it’s still a relatively new field, which means three things:

  1. The benefits haven’t been completely accepted by everyone.
  2. The benefits and risks are insufficiently understood to speak with absolute certainty about all the long-term effects of the diet.
  3. Because it’s new and trendy, everyone’s jumping on the advice bandwagon (points to self) and so there’s a mess of information out there.

Ketosis Information

This article is the summary page for a series on ketosis. It contains brief and simplified information from each of the other articles. The links below will guide you to each article for more in-depth information.

  1. What is Ketosis?
  2. What are the benefits of Ketosis?
  3. How do I get into Ketosis?
  4. Why does Ketosis feel so awful?
  5. How do I stay in Ketosis?
  6. Further reading on Ketosis.

You may also want to find information on meal plans, hacks and recipes that can support your efforts to get into and stay in ketosis.

What Is Ketosis?

Ketosis is a state your body enters when it is starved of carbohydrates.

In the absence of carbs, which can easily and readily be converted into energy through glycolysis, the body changes the mechanism through which it generates its own energy and begins to burn fatty acids.

When you’re in ketosis, the liver breaks down fatty acids into acetoacetate and beta-hydroxybutyate, which most cells in the body can use for fuel. The liver only does this when it lacks glucose.

In a state of glycolysis, insulin levels in the body will block the release, and promote the storage of fat. Ketosis reverses this, causing the release of fat from adipose tissue (fat cells) so that they can be broken down for fuel.

The Benefits of Ketosis

The list of likely benefits is fairly well known, with different levels of understanding and certainty for each benefit. We can state with at least some evidence to support it that:

  • The Ketogenic diet has a measurable positive effect on epileptics, resulting in a reduction in the frequency and severity of seizures.1
  • Nutritional ketosis has been shown to help people with type 1 and 2 diabetes keep their blood sugar levels under control and, in some cases, reduce insulin resistance.2
  • There is emerging evidence that ketosis – especially when combined with other treatments, can be effective in treating cancerous tumors.3
  • It may help reduce the symptoms in, and increase the fertility of, women with polycystic ovary syndrome.4
  • A ketogenic diet may improve cognitive function, and may be effective in treating age-related cognitive decline and early-stage Alzheimer’s disease.5
  • It appears that Ketogenic diets are, over the long term (paradoxically, and controversially) good for your levels of LDL cholesterol, and therefore advantageous for patients with heart disease.6
  • Ketogenic diets are effective for weight loss.

The first two points in the list above are broadly accepted by the medical community. Ketogenic diets are prescribed to patients with epilepsy and insulin-resistant diabetes as treatments.

In addition, there are numerous very serious medical studies being carried out on the effects of ketosis in managing autism, cancerous tumors, the symptoms of polycystic ovary syndrome and the early stages of Alzheimers. These are not studies carried out randomly – early signs are very encouraging and the studies are seeking to deepen our understanding of the mechanisms in play.

Following a Ketogenic Diet

This is the subject of much of this blog, and I suggest you read through the relevant articles to understand what it is and how you do it.

It takes discipline and a pretty significant shift in your habits.

The short version of the advice is that you reduce your carbohydrate intake to (initially) below 20 to 50 grams per day to starve your body of fast sugars. After a reasonably unpleasant transition period your body will begin to consume fat for much of its fuel, and this is what we call ketosis.

The diet you follow needs to be carefully thought through because if you replace all your carbs with chicken and steak you’ll be eating too much protein, for example.

When you change such a big part of your lifestyle, it’s worth making sure you don’t replace your previous habits with new, equally bad habits. There are therefore two areas of additional constraints that are worth mentioning.

  1. Many foods that are not carbs are not good for you. Processed vegetable oils, for example, are not good for you. Read up on the difference between a healthy fat and an unhealthy fat because you didn’t decide on a new diet to just poison yourself in a new and different way.
  2. Think about the impact of your food and drink choices on the environment. We don’t improve ourselves at a cost imposed on everyone else. Drink lots of water? Sure, but don’t buy it in plastic bottles. Eat healthy fish? Yes, but don’t contribute to the depopulation of damaged fish stocks.

Once you’re on a ketogenic diet, you’ll need a certain number of recipes you can deploy rapidly for when things go sideways. That means having stocks at home and a strong understanding of the diet in your own head. When you end up in a restaurant, you want to see the menu and be able to order rapidly and with a minimum of adjustment to the menu items. Don’t be that person who makes it painful for everyone by asking for everything on the side and every dish to be radically altered.

A Note on the Risks and Unknowns

The ketogenic diet has a large community of detractors, who will list any number of reasons why adherence to it is dangerous.

It’s worth reading about the effects of ketosis on the body so you understand what is happening, but it’s also important to distinguish between a known risk and a theoretical possibility.

There’s a double standard applied to recent or emerging information regarding health. Benefits are incessantly questioned and challenged, accepted only when solid, incontrovertible proof is presented. Risks, on the other hand, are not subjected to any tests at all. A writer will say, “People on the diet will eat more protein, which causes an increase in acidity as it is processed by the body. This is a risk of the diet.”, and they will quote that as a risk without having done any research to test whether this risk actually occurs in dieting patients.

So bear in mind the double standard that is sometimes applied. Anything bad that could happen is named as a risk, but a benefit is only valid if we can prove it exists.

Two examples:

  • There’s controversy around the effect of ketogenic diets on cholesterol. This comes from the fact that it’s accepted knowledge that lots of fat in the diet leads to cholesterol, which leads to heart disease. This is the basis of the food pyramids communicated by governments across the western world. But long-term ketosis appears to lower LDL (bad) cholesterol in test subjects.
  • The possibility of kidney stones is frequently mentioned as a risk on a ketogenic diet. Nobody has carried out a comparative analysis between the risk caused by the diet and the risk caused (for example) by not drinking enough water. Perhaps the right advice isn’t “Don’t go keto, you’ll get stones”, but instead, “Drink lots of water (on keto or off it), or you’ll increase your risk of kidney stones.”

Take the risks on board. Think about your own health and where those risks apply to you. Monitor yourself carefully when you make big changes to your diet and apply those changes gradually. That’s just common sense. But don’t let a single bad anecdote or a scientist hypothesizing about possible negative effects scare you off.

Also remember, risks should be examined as probabilities. We take a risk every time we take a train or a plane, cross the road or turn on the gas to cook a meal. Those risks are small, and we take them every day. Some people take much bigger risks – walking while wearing headphones or reading their cellphones, for example. Just because something has a risk associated to it (expressed as a probability of something undesirable happening) doesn’t stop us from taking an educated and informed decision to go ahead and do it anyway, because in our analysis the benefits outweigh the risks.

So learn the risks and make your decision.

But don’t read a specific risk and think, “Oh dear, that’s not for me”, before you’ve understood it, how it applies to you and whether it’s a real risk or just someone hypothesizing.

Footnotes

  1. Great Ormond Street Hospital Website – Ketogenic Diet: https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/ketogenic-diet
  2. WebMD, “The Keto Diet for Diabetes”: https://www.webmd.com/diabetes/keto-diet-for-diabetes
  3. Federal Practitioner, February 2017, “Ketogenic Diets and Cancer: Emerging Evidence”, by Jocelyn Shalamby: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/
  4. Nutrition and Metabolism, December 16th, 2005. “The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study”, John C Mavropoulos, William S Yancy, Juanita Hepburn, and Eric C Westman: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/
  5. Frontiers in Aging Neuroscience, December 3rd, 2018. “A Ketogenic Diet Improves Cognition and Has Biochemical Effects in Prefrontal Cortex That Are Dissociable From Hippocampus”, Abbi R. Hernandez,1 Caesar M. Hernandez,1 Keila Campos,1 Leah Truckenbrod,1 Quinten Federico,1 Brianna Moon,1 Joseph A. McQuail,1 Andrew P. Maurer,1 Jennifer L. Bizon,1 and Sara N. Burke. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286979/
  6. There is significant controversy around this point, and any article I could provide as a reference would be on one side or the other of that debate – I prefer you do to your own research, or read one of my articles on the subject, by going into more depth, can be more balanced on this topic.