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Like some automobiles, human beings are “hybrids'' when it comes to energy consumption. We can use sugar (glucose or simple carbohydrates) or fatty acids to meet our daily energy demands. However, we can’t simply decide to use one or the other—our bodies will first burn sugar if it's available and any sugar that is consumed but not burned will ultimately end up being stored as excess fat.
When our daily simple carbohydrate (breads, pasta, rice, sweets, some fruits, etc.) intake is reduced, our body will start to burn fat for energy. However, fat must first be broken down into ketones. This is the basis of what is called the ketogenic or keto diet.
Many have experienced significant weight loss by adopting this eating style. The main premise of the keto diet is that a person should consume 70 percent of their calories (not total food) from healthy fats, 25 percent of their calories from protein, and around 5 percent of their daily calories from simple carbohydrates—in other words, it is a dietary plan high in healthy fats, moderate in protein and low in simple carbohydrates. The keto diet recommends keeping simple carbohydrates (which turn into sugar) to less than 50 grams (or 20-25 net carbs) per day.
The keto diet has not always been used for weight loss. It was originally a treatment for drug-resistant seizures when it was observed as far back as the 1920s that some children with seizures who did not respond to the anti-seizure drugs responded favorably to a ketogenic diet. In many cases, seizures would disappear altogether as long as the diet was adhered to.
These days, the ketogenic diet has been adopted as a popular weight-loss strategy. Many who consume low-carb/high-fat (LCHF) diets report feeling more energized, especially as the excess weight begins to fall off. While this is promising for those who wish to slim down, as with any diet, consult with your physician prior to starting to make sure it’s the right choice for you.
The body’s cells use sugar (glucose), which comes in multiple forms, as their main energy source. Unneeded sugar is stored in the liver and muscles in the form of glycogen. Humans can store a 72-hour supply of glycogen, allowing sugar to be available in the event of hunger and when a quick source of energy is needed.
This storage provides an evolutionary advantage, allowing humans to survive starvation. However, when starvation doesn’t occur, and a person consumes more sugar than needed, fat storage will occur.
The ketogenic diet’s low carbohydrate and low sugar intake cause excess fat to break into free fatty acids. These fatty acids are then transformed into energy, generating ketones by the liver.
When a person minimizes their simple carbohydrate intake to less than 50 grams per day (20-30 net carbs) and stays physically active, ketosis will occur.
In my experience, once weight loss goals are achieved, it is important to choose one day per week when fruits (bananas, apples, etc.) and healthier carbs (brown rice, quinoa, pasta, lentil pasta, yams, etc.) are consumed — this helps maintain metabolic flexibility.
Avocados are popular among those who adhere to a ketogenic diet. However, few realize that avocado oil can also be consumed. It is a great oil to cook with as it has a high smoke point of 520 degrees Fahrenheit (271 Celsius), meaning it's stable up to this temperature.
Avocado oil consists of linoleic acid, oleic acid, and other monounsaturated fatty acids, which are healthy fats with anti-inflammatory properties. These fatty acids are believed to not only lower cholesterol and blood pressure but also stimulate weight loss. One tablespoon of avocado oil contains 124 calories, 14 grams of fat, and no carbohydrates. Avocado oil is not an MCT (medium-chain triglyceride) oil.
Coconut oil is one of the most popular MCTs and is frequently used for its brain-health benefits and to aid with weight loss. A 2009 study showed consumption for 12 weeks resulted in reduced weight around the waist. Coconut oil has a smoke point of 350 degrees Fahrenheit (177 degrees Celsius) and is an excellent option when cooking at low, medium, or high temperatures. One tablespoon of coconut oil contains 117 calories, 14 grams of fat, and no carbohydrates.
I know what you are thinking! There is no way there are keto cookies, keto cakes, keto brownies, and other keto snacks that are allowed when eating a ketogenic diet.
Fortunately, natural, no-calorie sweeteners and almond flour or coconut flour make this possible. While I do not recommend these be eaten daily, they are a satisfying alternative when you are on the verge of blowing your low-carbohydrate diet for a temporary sugar-filled delight.
Also known as clarified butter, ghee is popular with those on the ketogenic diet. It has played an important role in ayurvedic medicine and is used for its anti-inflammatory and digestive properties.
Ghee contains both short-chain and medium-chain triglycerides and is rich in omega-3s and butyric acid, which is why it likely has gut benefits. It also contains vitamins A, E, and K. Ghee can be added to any food recipe which normally uses butter. It is also added to coffee for those who want to increase their daily fat intake.
Medium-chain triglycerides (MCTs) can also play an important role for those trying to lose weight. Many on a ketogenic diet supplement with MCTs, which are used for energy and are less likely than regular long-chain triglycerides to be stored as fat.
A 2015 study showed that MCTs could modestly help reduce body weight in those who consume them. In addition, there was no elevation in blood cholesterol levels. They can be taken by the teaspoon or simply added to smoothies. Suggest dose: as directed on the label.
There are many types of nuts, each containing a variety of vitamins and minerals. Due to their high concentration of essential fatty acids, nuts are an excellent source of healthy fats and protein. Along with their cardiovascular and brain benefits, they’re also an excellent keto snack to help ward off cravings.
High intake of table sugar, or sucrose, is a major reason why more and more people around the world suffer from obesity, diabetes, and high blood pressure. Sucrose is what scientists call a disaccharide, meaning it’s a combination of glucose and fructose.
Prior to the 1600s, daily sugar intake was essentially unheard of. However, in the last few hundred years, sugar has become ubiquitous and leads to chronic disease. Fortunately, there are safer alternatives such as monk fruit, allulose, erythritol, or stevia.
For some, a low-carb diet can cause constipation. As a result, it is important to stay well hydrated. I often tell my patients to consider a fiber supplement if constipation occurs. Take as directed.
Protein bars are an excellent snack or meal replacement for those on a keto diet. Ensuring they are low in net carbs is important to make sure you stay below your daily carbohydrate goal. I often take protein bars with me when traveling.
The following supplements may help support health for those on the ketogenic diet.
This protein is also known as connective tissue and is responsible for stabilizing our skin and maintaining joint movement and flexibility. Collagen supplementation has many benefits, which include reduced facial wrinkles and helping to minimize cellulite. Those who are losing weight on a keto diet may consider taking extra collagen to make sure skin health is optimized. I recommend at least 3,000 to 5,000 mg daily.
Taking an additional 1,000 to 2,000 mg of vitamin C should also be considered to help optimize collagen strength and production.
A common problem for some on a ketogenic diet is electrolyte abnormalities. Early on, if sufficient fluid isn’t taken in, dehydration can occur, resulting in magnesium and potassium abnormalities. Staying well-hydrated is key. Those who workout and sweat regularly are most at risk for electrolyte abnormalities. As a result, many consume electrolyte powders to help ensure repletion.
These supplements (beta-hydroxybutyrate) and sports drinks have become popular over the last few years. A 2017 study concluded that “exogenous ketone drinks are a practical, efficacious way to achieve ketosis”. Studies also show they can suppress appetite, and lower triglyceride and glucose levels. Note: taking this supplement does not eliminate the need to limit consumption of simple carbohydrates when on a ketogenic diet.
Contrary to what many believe, a ketogenic diet should be rich in green leafy vegetables, which are complex carbohydrates and high in fiber. Consuming adequate amounts of phytonutrients and fiber is important. However, this is not always easy for some people to accomplish through diet alone, so adding green powders may be of additional benefit. Many green drinks contain wheatgrass, chlorella, and many other vegetables.
Magnesium is involved in over 350 biochemical reactions. During times of physical and mental stress, this mineral is utilized more by the body, which likely explains the relationship between tension headaches, spasms, and heart palpitations during life’s more stressful times. Further, this macro-mineral is commonly taken to help prevent muscle cramps, which sometimes occur in those who are on a ketogenic diet or those with an active lifestyle.
Magnesium chelate (magnesium aspartate, magnesium citrate, magnesium malate) is a preferred formulation for cramps and headaches at a daily dose of 125 mg to 500 mg. Since constipation is common for those on a keto diet, magnesium use can help keep bowel movements regular. For those who have more constipation than cramps, magnesium citrate or magnesium oxide should be considered.
On June 19, 2002, a study in the Journal of the American Medical Association recommended that all adults take a multivitamin. Additional assurance that the body is getting what it needs, a quality multivitamin provides extra nutrients when eaten with a low carbohydrate or ketogenic diet. Recommended dose: As recommended on the label
The ketogenic diet is a high-fat diet, and consuming high amounts of healthy fats is crucial. Omega-3 fatty acids and/or fish oils can play an important role in ensuring adequate healthy fats in the diet. Most supplement with a dose of 1,000 to 4,000 mg per day. Flaxseed is a good alternative for those who are vegan.
A pea protein meal replacement shake or vegetable protein powder should be considered by those following a ketogenic diet. Pea protein is advised for those who avoid dairy, especially those who follow a vegan diet. One serving has less than one gram of carbohydrates. Recommended dose: As recommended on the label.
Vitamin D deficiency is one of the most common vitamin deficiencies worldwide. Those who are on a ketogenic diet are also susceptible. Low blood levels of vitamin D are associated with an increased risk of osteoporosis, heart attacks, strokes, and many cancers. Most adults who are vitamin D deficient supplement with 2,000 to 5,000 IU daily for life.
A common supplement used by those who exercise routinely, whey protein is frequently used as a meal replacement by those trying to maintain or lose weight. Derived from cow's milk, it is also a popular source of protein among individuals attempting to build muscle. A whey protein shake can be used as a meal replacement for those on the keto diet. Recommended dose: As recommended on the label.
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By Dr. Eric Madrid, M.D.
