Key Points:

• There is nothing magical about a ketogenic diet; 98% of what can be achieved through this strategy can be achieved with other eating strategies.
• I believe the ketogenic diet should be thought of as a tool to be used in certain applications – not a permanent lifestyle for most people. 
• Applications include training metabolic flexibility if you have eaten the SAD all your life, treatment-resistant epilepsy, and severe insulin resistance/metabolic syndrome. 
• A small subset of people see their inflammation rise and biomarkers get worse on keto – everyone is individual and needs to experiment to see what works best for them. 
• After training metabolic flexibility via a ketogenic strategy, one can still eat unprocessed carbohydrates and maintain it through intermittent fasting.

“Ancestral diets show a remarkable spread in macronutrient profiles. Some are rather low carb, while others may be as high as 70 per cent carbohydrate. This spread in macronutrients appears to have little if any impact on health so long as the foods are largely unprocessed and the carbohydrates come mainly from fruits, vegetables and tubers.” – Robb Wolf

If you haven’t been living under a rock, chances are you’ve heard of the ketogenic diet by now.  Walking into any grocery or convenience store, you’re assaulted with front page magazine covers touting the seemingly magic merits of the keto diet. “Lose 20 lb in 20 days!” and “Never have another sugar craving again!” amongst others.

But what gives? Can you trust the hype? Is the ketogenic diet just another fad diet doomed to be left behind in the ruins of nutritional history? Or is it truly the diet to end all diets? Will it give you that six pack, wipe all your stresses away, send your kids to college, and fix your marriage?

The answer, as with any nutritional strategy, lies somewhere in the middle. First off, no nutritional strategy is magic. There’s no such thing as one magic food or pill that’ll melt your fat away (that’s legal and safe, anyway).

Before getting into keto itself, I have to give a quick laymans physiology lesson on how your body uses its fuel (food) sources.

Whenever you eat a mixed meal (meaning a mixture of protein, fats, and carbs), your body has a certain hierarchy in which it burns the fuels you just ate. Carbohydrate or glucose comes first. Well, if you really want to drill down, alcohol comes first even before glucose if one consumes say, a glass of wine with your mixed meal.

But in the absence of alcohol, glucose is utilized first. Your bloodstream maintains a fairly tight range of sugar, and eating carbohydrate causes this sugar to go up post-meal. This causes a cascade of hormones, ultimately ending up in disposal of glucose from the blood into fat or muscle tissue to be burned. Or, in the event of extreme over-consumption of carbohydrate, breakdown products of carbohydrate are sent to the liver to be converted to fat.

Once the excess glucose is out of your bloodstream and you haven’t eaten for a while, a healthy body will slowly switch to using more of your stored body fat for fuel. It’s a sliding-scale process; your liver will release its stored glucose slowly to keep blood sugar in range, and you may be using a small amount of fatty acids as fuel in tandem.

As you prolong the period without food, your liver’s glycogen (glucose stores) will be all used up, and most of the fuel your body is utilizing is coming from stored bodyfat. If you continue to fast, your body will take some of those fatty acids and increasingly create ketones in the liver, so now you’re using both fatty acids and ketones for fuel.

So, this is the basic premise of the ketogenic diet. In the absence of your beloved pastas/breads/rice/cookies/cakes/potatoes and the increased presence of higher fat foods, your body has no excess glucose to use for fuel and thus goes straight to the dietary fat and subsequently your body’s own fat tissue. But why has it become so popular these days that even your grandma who never leaves the couch is privy to it? Let’s take a look at its actual values.

Slaves to Carbs

We first need to take a look at the standard American diet (SAD) and one of the consequences of a lifetime of eating in this way.

Think of a standard meal. A turkey sandwich with mayo. A few pieces of pepperoni pizza. Pasta in a cream sauce with chicken. A hamburger. Pork fried rice.

Now some snacks. Trail mix with dried fruit and chocolate pieces. Granola. Sugar-cured beef jerky.

What do all these things have in common? They all contain a mixture of carbohydrates, fats, and proteins. Some more processed than others. And remember, carbohydrates are going to be burned off first, fat will be stored, and proteins are used as building blocks for many things in the body.

Now think of how often the average American actually eats. Wake up? Bagel and cream cheese with an egg. Get to the office, take one or two fun-sized pieces of candy from the front desk and munch on them as the pre-snack snack to the granola you have sitting in your desk. Lunch time? Sandwich and some carrot sticks. A few hours later comes dinner; some frozen pre-packaged concoction or, if you’re lucky, a home cooked meal of say, spaghetti and meatballs. Then it’s time to relax on the couch and have your nightly ice cream before bed. Sleep for 8 hours (except it’s more like 5-6 in this day and age), wake up, rinse and repeat.

Now let’s examine what I’ve described here. The SAD contains mostly processed carbohydrates in every meal and the average American is eating just every couple of hours across a span of about 14-16 hours.

Then during sleep, the body will slowly liberate its glucose stores from the liver to keep blood glucose in range, and those stores may or may not run out during sleep. And when you wake up, its back to shoving food down the gullet.

So, in simplified terms:

• Processed carbohydrate or carbohydrate at every meal
• Meals/snacks spaced 3 hours apart for 14-16 hours

We see a dangerous combination of high frequency of eating, a long eating window, with carbohydrates at every meal.

Repeat for years, and as a consequence, the body’s fat burning machinery is like that old, rusty pickup truck that hasn’t been started in 10 years and you’re not sure if it will. You just can’t effectively switch between burning sugar for fuel and burning fat for fuel. This is termed metabolic inflexibility.

This creates the “hangry” effect. I’m sure you’ve all felt it; you haven’t eaten in a few hours and you’re assaulted by hunger pangs, irritability, and you might even get a little bit shaky. The body is looking for more glucose because that’s what it’s used to using, and is ignoring the humongous goldmine of energy that are your body fat stores.

This is not normal. We should be able to go the whole day with no food if we need to and feel great. In fact, evolutionarily, periods of fasting were much more common than periods of feeding. So, having spent hundreds of thousands of years evolving with intermittent food availability and a relatively low-food environment compared to today, our bodies greatly benefit from short periods of fasting (which is what ketosis simulates) from a health perspective.

This is also why when someone eating the SAD all of their life attempts a ketogenic diet, they can experience what’s known as the “keto flu”. Brain fog, lethargy, headaches, sleepiness. The body is looking for that glucose while its slowly dusting off and revving up its fat burning machinery again. For some, this lasts as little as 24 hours; for others, 5-7 days. I’ll include some tips in part 2 to mitigate the effects of the keto flu should you want to try a ketogenic diet.

So, let’s get into some further benefits of the ketogenic diet.

Reduction of Inflammation

A recent buzzword being thrown around in the health and wellness industry, and for good reason. Inflammation is thought to be the root cause of many chronic illnesses. A ketogenic diet has been shown to reduce systemic inflammation through the following mechanisms:

• • Reduction of reactive oxygen species (ROS), which include dangerous free radicals which trigger inflammation responses
  • Inhibition of the NLRP3 inflammasome, which prevents downstream inflammatory responses
  • Reduction of inflammatory cytokines such as TNF-α

This all sounds wonderful, right? Reducing inflammation has powerful benefits to health. Vastly reduced chances of chronic disease, weight loss will occur easier, you’ll have more energy, better mental clarity, and an overall better sense of well-being.

But a ketogenic diet isn’t the only way to reduce inflammation. If you follow a whole-foods diet high in anti-oxidants, don’t overeat, eliminate vegetable oils (more on that in part 2) and refined sugars, you can get the same effect of inflammation reduction.

To further throw a wrench in the spokes, there seems to be a small(er) population of individuals whose inflammation markers go up on a ketogenic diet. According to in-the-trenches practitioners, this number seems to be about 10-15% of people who attempt a ketogenic diet. This just further illustrates that everyone responds individually.

Reduction of Cravings

To reiterate, the ketogenic diet is not a magical diet. There are no magical fat loss properties. Calories still matter. However, what most people experience when they try a ketogenic diet is that they spontaneously eat less calories because of less cravings, and thus weight loss occurs.

A large reason this occurs is that your insulin levels are much more stable; blood glucose spikes and therefor insulin spikes can lead to blood sugar crashes, which in turn lead to more cravings.

The brain’s reward system is also implicated in this. When simple carbohydrates are consumed, especially sugar, the brain’s reward system lights up like a Christmas tree. This stimulates the urge to keep eating even though we may be bordering on stuffed. However, it’s been shown that the reward system doesn’t activate near as much when on a ketogenic diet; everything is much more stable.

Palate fatigue also occurs. The food choices on a ketogenic diet are fairly limited. Well, not so much anymore actually, given the popularity and a bunch of companies popping up making packaged keto snacks.

I actually think these can be a bit dangerous, because they are super palatable when compared to whole-food ketogenic food choices, at least. Eating those packaged snacks frequently can desensitize the reward system, which we just talked about being one of the benefits of the ketogenic diet. I would advocate only eating those types of things sparingly. Okay, tangent over.

We’ve all been there. It’s Thanksgiving – we’ve just had our heaping portions of turkey, stuffing, mashed potatoes, etc, and are so stuffed we couldn’t eat another bite. But when the pumpkin and pecan pie roll out, that’s when the second stomach shows up. The stimulation of the sweet sense rekindles our appetite, since what we just had was mostly savory.

Robb Wolf uses a great example is his book Wired to Eat. On a particular food challenge TV show, a man was tasked with eating a kitchen sink full of ice cream. We’re talking multiple gallons of ice cream, here. He gets about ¾ of the way through and its clear it’s getting to him: we see the picture of a sweaty, hunched-over, pale man only able to get a spoonful in every other minute.

So, what does he do? Give up? Nope. He orders a full, 1000 calorie plate of French fries and ketchup, proceeds to eat the whole thing, and then goes back to the ice cream and finishes it. This illustrates the power that palate fatigue and food choice has on our ability to stop eating.

Should You Do the Ketogenic Diet?

The ketogenic diet is a tool in the toolbox. I don’t think anyone should spend all year-round in a ketogenic state, just as I don’t think everyone should spend all year-round in a carbohydrate burning state. What we’re trying to train the body for here is metabolic flexibility – the ability to effortlessly switch between glucose for fuel and fat for fuel without having any adverse symptoms.

If you’re coming from the SAD, regardless of whether you’re overweight or not, I highly recommend doing a period of 1-2 months in a ketogenic state to train up your metabolic flexibility.

Even quite lean individuals can have carbohydrate dependency/rusty fat burning machinery if they’ve been eating that way all their life. I’d still recommend a period of ketosis, or low carbohydrate at the very least, to train up metabolic flexibility.

From there, it depends on how you’re feeling. If you feel the absolute best you’ve ever felt in your life and your blood/biomarkers are looking beautiful, then by all means, continue.

Most people, however, find that the limited food choices of a ketogenic diet aren’t sustainable. And that’s perfectly fine! Great, even. As long as you keep processed carbohydrate/food lower in general, exercise regularly, eat lots of vegetables and well-sourced proteins, you’ll be good to go.  This strategy will also reduce hyperpalatable foods that trigger us to overeat.

If you suffer from debilitating cravings that keep you eating, going into a ketogenic diet for a period of time can help reset the brain’s reward system; as long as hyperpalatable foods are highly limited after you come off the diet.

Another good application of the ketogenic diet would be in obesity and severe insulin resistance/metabolic syndrome. Most studies show that, calories equal (both groups eating in the same calorie deficit), a high carbohydrate, low fat and low carbohydrate, high fat approach have roughly the same fat loss.

However, in cases of severe insulin resistance, studies show that people tend to fare better on a low carbohydrate, even ketogenic approach. So, if you know you’re severely insulin resistant through high fasting blood glucose measurements, a borderline OGTT, and perhaps a pre-diabetic A1C value, then you will probably fare better on a ketogenic or low carb approach for weight loss purposes.

But the bottom line is, beyond the applications of severe insulin resistance, training up your metabolic flexibility, and treatment-resistant epilepsy, a ketogenic approach is just as good as any. You need to find the right eating strategy that you can maintain in a healthy fashion for the rest of your life.

If you go through your ketogenic period and decide that you don’t ever want to do it again, you can still maintain the metabolic flexibility you’ve built through intermittent fasting. Whether it be 16 hours of fasting and 8 hours of feeding, alternate day fasting, or any other protocol. You can eat your carbohydrates during your feeding window, and then if you have a bit of an extended fast, your body has a chance to liberate and use its stored fatty acids for fuel.

To conclude this part, the main message is that keto is a tool. I don’t believe it should be a permanent lifestyle (for a few it seems to work), but it does wonders for the applications I’ve laid out above.

In part 2 I’ll address the in’s and out’s of successfully embarking on a ketogenic diet. Stay tuned.

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