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#WTFWEDNESDAY: Keto Diet

March 11, 2019

My goal is #WTFWednesday is to provide information + guidance regarding health + wellness topics of interest, so that you can then do more research for yourself. For most of these topics, I wouldn’t consider myself a full-on “expert” - but I have familiarized myself enough with the basics to talk intelligently about the topic and to know where to look (or to look at all!) for more information. I’m always interested in hearing your personal experience or opinions based on your own research.

 

 

Beef (and avocado)... it's what's for dinner.


Or it may be, in the event that you are following the uber-trendy Keto Diet.

 

The latest diet du jour prominently features fat, with 70% or more of your daily food intake coming from this controversial + misunderstood macronutrient.

 

The second most important tenet of the diet requires that you eat an extremely limited amount of carbohydrates per day: 50 grams or less. (For reference, there are about 25 grams of carbs in an apple, 20 grams in 1/2 cup cooked quinoa, and 27 grams in a medium sweet potato).

 

Finally, the remainder of what you eat comes from protein, making the diet low to moderate in the muscle-building macro.

 

But people who have been prosthelytized into believing that dietary fat is the devil and that low-fat is the way to go are probably more confused than ever. Doesn't fat make you fat? How does the Keto diet work?

 

 

WHAT IS THE KETO DIET?


According to Harvard Health:

"In essence, it is a diet that causes the body to release ketones into the bloodstream. Most cells prefer to use blood sugar, which comes from carbohydrates, as the body’s main source of energy. In the absence of circulating blood sugar from food, we start breaking down stored fat into molecules called ketone bodies (the process is called ketosis). Once you reach ketosis, most cells will use ketone bodies to generate energy until we start eating carbohydrates again. The shift, from using circulating glucose to breaking down stored fat as a source of energy, usually happens over two to four days of eating fewer than 20 to 50 grams of carbohydrates per day. Keep in mind that this is a highly individualized process, and some people need a more restricted diet to start producing enough ketones."

 

More from Harvard Health on the Keto Diet

Dr. Mark Hyman, M.D. of The Cleveland Clinic gives his take on Keto
Well+Good shares what's in store for the Keto Diet in 2019 according to experts

Dr. Dominic D'Agostino, the Keto Diet Doctor

 

The general idea is to train the body to rely on fat for fuel - both from your diet AND your waistline. Your brain, which generally uses glucose (aka sugar) for energy, will then run on KETONES (a byproduct of being in ketosis). Avoiding carbs is essential for maintaining ketosis; if you mess up the ratio, you'll quickly kick yourself out of the fat-burning state, and your body will start burning carbohydrates again, and storing more of the fat you eat as reserves.

 

As far as weight loss and cravings go, a calorie is NOT a calorie. Yes, calories matter in the context of an overall diet. If you chronically over consume significantly more calories than your body requires to function, you will gain body fat.

 

But 100 calories of avocado vs. 100 calories of eggs vs. 100 calories of kale vs. 100 calories from a cheese burger look different, make you feel different, and affect the body differently. Fat is naturally satiating (especially when combined with some protein), so it's likely that overall, you will eat less while on a strictly keto diet. 

 

There is also less variety to “choose” from. The brain loves variety; that's part of why you want something sweet after a savory meal. If you're entire diet revolves around a handful of high-fat foods - and foods that are typically difficult to overeat due to satiety - you have less opportunity to stimulate your appetite with variety. You may even get “sick” of eating the same foods, and naturally decrease how much you eat. (I haven’t tried it, but I would venture to guess that even I would get sick of cheese if I ate it all the time… especially when it's not melted on pizza crust.)

 


WHAT CAN KETO BE HELPFUL FOR?


Typically, the purported benefits of the keto diet include:

  • weight loss (initially from less water retention due to lower carbohydrate stores, eventually from body fat if executed properly)

  • reduction in cravings/hunger (very satiating)

  • less brain fog + better mental focus (as a result of less blood sugar fluctuations + as a byproduct of ketones)

  • general inflammation

While all of that sounds great for the average person, did you know that Keto has been used as a medical diet to tread epilepsy (especially in children) for over 100 years? There is also evidence it can have profound effects on Type-2 Diabetes and even as part of treating certain cancers.

 

My professional opinion is that the Keto diet might be worth exploring if:

  • you have a significant amount of weight to lose

  • you are sedentary (and don't require as much carbohydrate anyway)

  • you have tried calorie counting + it hasn’t worked

  • you feel mentally + logistically prepared to eat high fat/low carb

  • you have a neurological issue and are working with a doctor or healthcare practitioner

HOWEVER: you MUST LIMIT CARBS, otherwise CARBS + FAT = FAT STORAGE

 

Sadly, this is not keto. :(

 

 

KETO VS. ATKINS

 

There are some comparisons being drawn to the Keto diet and formerly famous Atkins diet; in fact, the first "stage" of Atkins is essentially Keto, before higher levels of protein and eventually carbohydrates are optionally added back in.

 

In my opinion, both the Atkins + Keto diets can be effective for weight loss for a fairly simply reason: when you eat carbs, your body continues to require carbs to run efficiently (especially your brain + muscles for certain types of exercise). That can cause fluctuations in glucose, which lead to more insulin being secreted to manage blood glucose levels, which leads to body fat storage, hunger, and fluctuating energy levels. By removing carbohydrates, you remove that burden. 

Protein, a major component of the Atkins diet, while also essential on Keto, has a caveat: if you consume more than your body needs, it gets converted to glucose via gluconeogenesis - literally, “making new glucose." Hence the need to consume so much fat, so little carbohydrate, and such a modest amount of protein.

 

By limiting both proteins + more drastically carbs, what’s left for your body to use?: fat.

 

 

WHO SHOULD AVOID KETO? WHAT SHOULD YOU WATCH OUT FOR?

 

Note that although Keto can have incredible benefits, it is an extreme diet and therefore, a STRESS on the body. If you are already under stress (whether from daily life, lack of sleep, too much intense exercise, or contraindicated chronic health conditions), keto may not be for you.

 

Additional considerations:

  • history of kidney problems/kidney stones (too much protein, not enough water, genetic predisposition)

  • history of liver issues (ketones made by liver)

  • pregnancy (not the time to be trying extreme diets)

  • history of disordered eating

  • rare genetic disorders that make it difficult to metabolize ketones

Some people hear "ketosis" and think "ketoacidosis," something they vaguely remember from medical dramas as being very, very bad. Is this something you need to worry about when going keto?

 

According to Healthline:

"Ketoacidosis or diabetic ketoacidosis (DKA) is a life-threatening condition that results as a complication of type one diabetes. It occurs when there are dangerously high levels of ketones and blood sugar present at the same time."


Hypothetically, if you are following the keto diet correctly, your blood sugar levels should be stable, and this shouldn't be a concern.

 

 

KETO + NUTRIENT DEFICIENCIES

 

Of course, any time you are removing a major food group or macronutrient from your diet, you need to watch out for deficiencies (or toxicities from too much of something else). With strategic planning, there is plenty of room on the Keto diet for low carbohydrate, nutrient-dense vegetables, like leafy greens; broccoli, cauliflower, cabbage + other crucifers; "others" like mushrooms + eggplant; and even occasional low sugar fruit, like berries.

 

If not planned for correctly, however, the Keto diet can ver very low in various vitamins + minerals, and well as cause digestive issues from lack of fiber intake. From my perspective as a health coach, in addition to the more obvious considerations listed above, there are 3 major deficiencies to pay attention to while on the Keto diet:

  • Magnesium: most people are already low in magnesium, and it is further depleted by stress. Keto-approved sources of magnesium include hemp, chia, and pumpkin seeds; swiss chard, spinach, and other leafy greens; almonds and dark chocolate (no sugar).

  • Sodium: if you are eating a whole foods-based Keto diet without a lot of processed food, there is a chance you may need to increase your sodium intake. Adding some sea salt to your cooking (or over avocado with some fresh lemon juice) is an easy way to maintain electrolyte balances. 

  • Gut health + the microbiome: this is a much more broad topic than there is time or space for in this blog post, but in short, gut health + microbial diversity is dependent, among other things, on fiber intake. With practically no grains, legumes or other carbohydrates-rich foods and limited produce, fiber intake can suffer on the Keto diet. Be sure to get as much low-carbohydrate vegetables as you can, drink tons of water, and consider a fiber supplement.

More simply, as mentioned before, the Keto diet can be difficult to follow, mentally + logistically. If you have a history of disordered eating, if you are under a lot of stress, if you don’t have time/access to cook or prepare a lot of your own food, if your roommate/significant other/family eats differently, etc. it’s  going to be a challenge. If you're not ready to take on that challenge, that's ok! There are smaller actions you can take that will still make a big difference

 
 

MY BOTTOM LINE

 

It's essential to keep in mind that everyone is biologically unique, and what will work best for you will be a combination of genetics, gender, lifestyle, environment, diet, exercise, and stress management.

 

Everyone can benefit from eating less processed carbs + sugar. Sugar is omnipresent in our food system; it used to be available only seasonally. Bananas aren’t the worst food ever, but if you are from/live in the northeastern United States, this is not a food you are likely evolved to tolerate a lot of!

 

Everyone can benefit from eating more water + fiber + nutrient rich low starch veggies, like leafy greens, cruciferous veggies, and “other” (mushrooms, asparagus, cucumber, tomatoes).

 

Everyone needs to include more healthy fats in diet. Dietary fat is essential to hormone production/regulation, brain function, managing inflammation, and promoting satiety, among other things.

 

If you are sedentary, you could probably benefit from eating less carbs overall. You don't exert as much energy, so you don't need to consume as much energy. It's also likely your blood sugar regulation isn't working great, so consuming less carbs can help mitigate that. (So can exercise.)

 

If you are active, you likely need to maintain a moderate-higher intake of carbs. Although not impossible to be a low carb athlete, it's definitely tricky and takes a lot of planning, observation, experimentation, and patience. Glucose is the preferred fuel sort for intense activity. (While fat is the preferred energy source for long, slow, steady, endurance-based exercise.) Check out Mark Sisson's The Keto Reset Diet or Primal Endurance for more on being a low-carb athlete.

 

If you are a woman (especially depending on your point in your cycle and if you are under stress), you like need more carbs. My suggestion is to focus on what I call "smart" carbs: minimally processed; fiber + nutrient-dense; and not in the form of fries/chips/crackers/cookies/bread/pasta.

 

This is outside of the scope of this topic, but for more information on nutrition + training for women, I highly recommend Dr. Stacy Tims' book Roar." For example, according to Dr. Tims: "when estrogen rises (starting in ovulatory phase and peaking during luteal phase), it reduces the body’s ability to access glycogen and “spares” carbs, making more free fatty acids available. This sounds good, but if you’re an athlete, this means your intensity and capacity are impeded. More cortisol (stress hormone) is released (also impeding recovery). More carbs are needing to hit intensity, reduce cortisol production, and keep the immune system from becoming depressed."

 

 

IF YOU'RE GOING KETO

I do have some suggestions if you are going to give the Keto diet a go. As with any major lifestyle change, however, first make sure you are consulting a qualified healthcare practitioner or health coach.

  • Vary your sources of fat: avocado, olives/olive oil, coconut, nuts/seeds (note they also contain protein + some carbs), butter/ghee/dairy if you can tolerate. Keep in mind animal protein naturally contains fat (unless you are eating low fat cheese or boneless, skinless chicken breasts).

  • Get your protein from well-sourced animals: pastured/free range eggs + chicken, grass-fed beef, sustainable seafood. (“Organic” generally just refers to the feed they are given, which isn’t even necessarily what they have evolved to eat).

  • Avoid processed animal protein + fats as much as possible. Although they can be helpful from a convenience perspective, many brands of deli meats, charcuterie, sausages, hot dogs, or pre-made burgers or patties don't come from high-quality meat and often contain fillers + preservatives.

  • Load up on non-starchy veggies for nutrients + fiber.

  • Limit “Keto treats”. A no-sugar brownie is still a brownie; it likely doesn't have much nutritional value outside of fat content, and may even promote an unhealthy mindset.

  • Consider a multivitamin as insurance; magnesium + a pro/prebiotic blend might also be a good idea.

  • Drink lots of water (and perhaps add electrolytes to help with mineral balance).

Keep in mind there’s an acclimation period and you really do need to be “strict” to see benefits. You may want to lay off intense exercise in the meantime.

 

Overall, the best diet is one you can stick to in the long run. If you are someone who likes a short term challenge or jumpstart, Keto  might give you the focus, energy, and quick weight loss results to motivate you to keep going. If you are someone who “has a problem” with carbs (craves them, can’t stop, can’t say no), it also may be worth exploring to help change that relationship.

 

And remember - we are all biologically so very different. I strongly feel that the future of dieting will depend on genetics + personal testing (nutrient levels, gut biome, hormones, etc.), but in the meantime, you won't know unless you give something a try.

 

If you want to hear me chat about Keto, check out my #WTFWednesday discussion here:

 

 

I want to know - have you gone Keto? What benefits have you experienced? What obstacles have you faced? Let me know in the comments, and feel free to leave questions.

 

 

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