In today’s episode of The Modern Vital Podcast, we’re going to talk about the ketogenic diet. Our Modern Vital Fact of the Day is that the ketogenic diet was first used by Russell Wilder to treat epilepsy in 1921. In 1911, starvation was used as an experiment to treat childhood epilepsy, which eventually led to trying a low-carb diet and then, later on, a high-fat diet. The ketogenic diet became the treatment of choice for childhood epilepsy before anti-epileptic agents came on the scene, starting in the 1930s.
One proposed mechanism by which the ketogenic diet improves seizure activity is that glutamate is reduced in the brain and GABA synthesis is enhanced. We know that glutamate is an excitatory neurotransmitter whose activity is highly associated with seizure activity, along with low GABA production, and GABA is a neurotransmitter or a compound that downregulates the nervous system.
Now, right before the coronavirus pandemic hit, the global ketogenic market was valued at around $10 billion. It’s probably worth quite a bit more today in light of inflation.
A ketogenic diet is a diet that consists of macronutrients in roughly these amounts: 55% to 60% fats, 30% to 35% protein and the remaining 5% to 10% in carbs.
The classic ketogenic diet was comprised of 1 gram protein per kilogram. Now, remember, there are about 2.2 kilograms per pound. So let’s say that I weigh 220 pounds. That means I weigh about 100 kilograms. So that would mean that according to the classic ketogenic diet, I should have about 100 grams of protein per day, along with 10 to 15 grams of carbs, and the rest should be in fat.
Now remember that carbs and protein provide 4 calories per gram, whereas fat provides 9 calories per gram. That’s over 2 times as many calories per gram of fat.
Now let’s talk a little bit about physiology and biochemistry. Basically, in the ketogenic diet, we deprive the body of carbs by reducing intake to less than 50 grams of carbs per day. This lowers insulin secretion, and so the body enters what is called a catabolic state, where it can break stuff down more readily.
Glycogen, which is a polysaccharide stored in our liver and muscles that forms glucose when it’s broken down with water, a process called hydrolysis, is our body’s preferred source of energy, and when glycogen begins to become depleted, then a couple of important metabolic processes in the body start, and this all is engendered by the ketogenic state.
So, these two metabolic processes are gluconeogenesis, that is, generating glucose in our bodies, and ketogenesis, that is generating ketone bodies in our bodies.
So, first, the liver starts to make glucose. It makes it from elements like lactic acid, which is mainly produced in the muscle cells and the red blood cells, and forms when the body breaks down carbs, and glycerol, which is an alcohol in our bodies that’s produced in our fat cells, and also when we break down triglycerides.
And then some amino acids like alanine and glutamine. Alanine, for example, produces glucose when our muscle cells are degrading, like in high-intensity exercise.
Once glucose production is not able to keep up with the body’s needs, then ketogenesis begins, so that ketone bodies can provide an alternative source of energy. They actually eventually replace glucose as our primary source of energy. Now insulin secretion also becomes lower.
Remember, insulin is made by the pancreas and it helps to push glucose into our cells. So now we no longer store fat and glucose like before, because insulin is not around to signal that, and in fact we begin to break down our fats into fatty acids. These are metabolized to things like acetoacetate in our mitochondria, and this happens mainly in our liver cells.
And these fatty acids get shuttled into our mitochondria with the help of enzymes, like a carnitine dependent enzyme called CPT1, and then they are beta oxidized into something called acetyl-CoA.
Eventually, after a couple more enzymatic reactions, acetyl-CoA becomes converted to acetoacetate And later on, the acetoacetate that we mentioned becomes betahydroxybutyrate and acetone. Now that’s a mouthful.
The moral of the story is these basic ketones accumulate in our bodies during ketosis, and this metabolic state was first called nutritional ketosis by, of all people, Dr. Robert Atkins, famous for The Atkins Diet in the 1970s.
Nutritional ketosis has been shown to be quite safe, and we’ve seen a lot of low carb diets over the years. We had like The South Beach diet, we had Paleo. Even certain aspects of The Mediterranean Diet are more on the low carb side, and these have all gained popularity.
The ketogenic diet is clearly the breadwinner, but that bread is a brick of fat.
It’s interesting to note that it is the deprivation of carbs that keeps the body in a ketotic state.
Being in ketosis, by the way, is way different than a life-threatening condition like ketoacidosis, where we produce large concentrations, rather than small amounts, of ketone bodies And our blood pH becomes altered and it can become more acidic, or the technical term is acidotic.
Our heart, our skeletal muscle, our kidneys, they all need to produce a lot of energy, a lot of ATP, and so they can utilize these ketone bodies, which also, fascinatingly, cross the blood-brain barrier, also known as the BBB, and provide an alternative source of energy to the brain.
Interestingly, our red blood cells and liver cells do not use ketones. We don’t have time to go into that here.
So how much more adenosine triphosphate, or ATP, that is, the currency of our cells, the energy of our cells…How much more of it is produced by ketone bodies than by glucose? This is a really interesting question.
A hundred grams of acetoacetate generates about 9,400 grams of ATP, and a hundred grams of betahydroxybutyrate yields about 10,500 grams of ATP.
Now, a hundred grams of glucose by itself is only going to produce about 8700 grams of ATP, as opposed to 9400 with acetoacetate and 10500 with betahydroxybutyrate. So what this means is that our ketone bodies, gram per gram, when compared with glucose, produce 8 to 21% more energy. That’s pretty fascinating. I kind of want to be in on that investment, don’t you?
Also, in spite of a caloric deficit, efficient fuel production is still maintained in the body during ketosis, and antioxidant capacity is also enhanced, which is neuroprotective and limits the potential damage that free radicals can generate under oxidative stress.
So what are the side effects of going keto? Well, for the short term, there’s something known as keto flu. You’ve probably heard of it, if you haven’t experienced it yourself. It usually lasts about a week, but it can last longer in some people, up to three or four weeks. It’s a collection of symptoms like nausea, vomiting, headache, fatigue, poor sleep, even maybe dizziness.
Oftentimes making sure that electrolytes are balanced can offset these symptoms.
And when it comes to long-term effects, well, the literature is pretty spare. It’s possible that there could be liver congestion, also hepatic steatosis, kidney stones, some vitamin and mineral deficiencies often can occur.
It’s also important to monitor lipids. We know that LDL cholesterol, the so-called bad cholesterol, does usually go up when on a ketogenic diet, and the HDL cholesterol, the so-called good cholesterol, is enhanced and higher, like it’s supposed to be, and then triglycerides are lower, which is good.
Now it’s a popular belief that high-fat diets cause obesity and cardiovascular disease and diabetes and even cancer, but this has not been observed in recent epidemiological studies.
According to CDC statistics from 2018, 42% of Americans are considered to be obese, and we could extrapolate this to the global population of 8 billion, which is certainly not that high in terms of 42%, but the 42% that I mentioned is also probably even higher.
Now, quite to the contrary, low-carb and high-fat diets have been shown in recent studies to cause weight loss.
Now, did you know that the average American typical caloric intake for carbs is around 55% carbs? It’s just mind-blowing. And this basically is a range from 200 to 350 grams of carbs per day.
Now just remember that the ketogenic diet, when talking about like a modified version of it, we’re talking about 50 grams or less of carbs, and then classically, we’re talking about 10 or 15 grams of carbs in a 24-hour period. So here we are mentioning that the typical daily intake is 200 to 350, which is like 20-fold of what’s required on the ketogenic diet.
The idea here I think that’s important to mention is that when we’re taking in this many carbs, we’re going to displace otherwise healthy things. We’re not going to be eating very many vegetables, nuts, seeds. We’re not going to be getting much lean animal protein perhaps, and certainly not a lot of healthy fats. Now what is interesting about the ketogenic diet is that insulin production lowers and because insulin inhibits the breakdown of fat, then the breakdown of fat occurs. This is also called lipolysis. This is why people lose fat pretty quickly and rapidly on the ketogenic diet.
Now, we’re not going to get much into this, but a lot of water loss does take place in the first week or two of going keto. It’s often the case that fat loss is exaggerated because a lot of water loss also happens, and so it can be a little bit tricky to tease that out in the early days of going keto.
Overall, though, what I’ve been talking about explains why low-carb diets increase fat breakdown, mainly because there is less insulin needed by the body, and so fat gets broken down because insulin inhibits the breakdown of fat, and since it’s not around, then the breakdown of fat occurs more rapidly and readily.
So let’s say you’re thinking of trying keto, that is, consuming a high-fat, moderate protein or high protein and very low-carb diet. Well, it certainly has its challenges, and it definitely should be done under the supervision of a medical provider. This is not medical advice.
However, here are some practical tips to getting started that are readily available in the public sphere, and remember, you can always take your time with it and modify your own journey as you go.
Now. Number one, understand the basics. Familiarize yourself with the principles of the ketogenic diet, with macronutrient ratios and so on. Remember we’re talking about approximately 70% fat, 25%, 30% protein and 5% carbs.
Two, plan your meals ahead of time. That’s pretty explanatory.
Three, know your own body.
In my opinion, as a naturopathic physician, it’s essential that you limit the things that wreck you. You have to not be consuming your kryptonite, your so-called food sensitivities, your food intolerances, while you’re going keto, or it’s going to probably keep you from getting the results that you’re hoping for.
If you don’t know what your food sensitivities and food intolerances are, I recommend working with a naturopathic or functional medicine doctor to help you determine what they might be.
For example, for dairy intolerance or dairy sensitive individuals, it might be important to use products like non-dairy creamers. My personal favorite is from Keto Brains. I have no personal financial ties to this company. They are incredible. They make the most exquisite non-dairy nootropic creamer made with Alpha-GPC, C8 MCT, l-theanine, lion’s mane. It’s incredible. We don’t have time to get into it here, but I love it.
Four, track your macros. You can use a food tracking app or a journal to monitor your daily macronutrient intake, ensuring that you’re maintaining required ratios for ketosis.
Five, track your biometrics. You can get some ketone test strips. You can also use an Oura Ring or other wireless wearable that tracks biomarkers such as body temp, heart rate variability and so on. You can have your routine and specialty blood work run at least once a year by a naturopathic physician. You can routinely check your heart rate, your pulse oximetry and your blood pressure. You can even go as far as to get a continuous glucose monitor, or CGM, if you wanted to.
Six, gradually transition into keto. Ease into it if you can handle that. I know some people just need to jump right in. Slowly reduce your carbon take over a period of weeks. Take your time with it. This can minimize the side effects of the keto flu.
Seven, stay hydrated. This will help provide your body with plenty of fluid for detoxification, metabolism and so on.
Eight, manage your electrolytes. We already talked about this. Make sure you replenish your electrolytes daily…potassium, sodium, magnesium. Also, it’s important to get plenty of trace minerals, as they act as cofactors in all metabolic processes.
Nine, quality over quantity. Eat healthy fats, that is, fats that are not processed. No trans fats. You don’t want poor quality saturated fats. Things like avocados, olive oil, coconut oil, nuts, seeds, sustainably raised and harvested animal fats, etc.
Ten, find support by participating in a keto community. Make sure to have a good healthcare team.
I recommend consulting a naturopathic physician. Remember, none of this is health advice, so please consult your doctor before starting a new diet.
And that concludes today’s episode of The Modern Vital Podcast. We would love to hear from you. We value your feedback. If you have any questions or suggestions, please reach out to me at firstname.lastname@example.org. Also, please leave us a review if you enjoyed this episode. We look forward to having you join us next week for an exciting episode of The Modern Vital Podcast.