So, What is this Ketogenic Thing Again . . . ?
I’ve personally been following and prescribing ketogenic diets to my patients for the last nine years. When I started on my ketogenic journey, it was called a “Low Carbohydrate Diet.” Over the last 5-10 years, we’ve learned a thing or two about how the body processes carbohydrate, protein and fat. Specifically, it’s not just the restriction of the carbohydrates that leads to metabolic health, but controlled protein intake and significant emphasis on the level and type of fat intake as well. The majority of people who cut out carbohydrates will initially see successful weight loss, but to maintain that weight loss and see significant metabolic changes that reverse the diseases of civilization, an understanding of protein and fat needs are essential.
Well, not really. A true ketogenic diet is NOT a “high protein diet.” Most people, having been brainwashed in grade school and middle school about the horrors of fat in the diet, assume that if you’re not eating carbohydrates, then you must be eating extra protein to stay satiated. (No one would ever intentionally increase the fat in their diet, right?!!) That’s the impression that most people in my office get when I mention the words “Low-Carb” or “Adkins,” and, before I have a chance to explain that I’m not recommending you race home to eat three large turkey legs and a pound of turkey bacon, the vegetarians begin to gather their things to leave and the former home economics teachers begin to get chest pain at the mental picture in their heads.
A ketogenic diet is one which allows your body to use ketones as it’s primary fuel source. Ketones are produced from the breakdown of triglyceride and free fatty acids. Ketones are essentially produced by two distinctly different events: 1) starvation caused by prolonged periods without food (which is essentially what happens to type I diabetics when they have no insulin at all in their systems), or 2) when fat is ingested as the primary fuel, and very low levels of insulin are concurrently produced, primarily when the diet has minimal to no carbohydrate present (allowing the body to activate its free fatty acid reserves found within in the adipose cells).
The body is an amazing machine. It was designed to take any of the three main macro-nutrients (carbohydrate, protein or fat) as fuel and function quite well. It’s kind of like a futuristic car that could run on unleaded gasoline, oil, or diesel fuel and it would be able to recognize which fuel it is and run quite well off of any of the three. The amazing thing about the body is that we mix up all three fuel types and just pour them into the tank. Impressively, the body can separate them out and run very well in the short term on any combination of mixes. We don’t have cars or trucks that do that today . . . maybe in the future . . .?
I like to equate carbohydrates to unleaded fuel. These are clean burning, easy to access and cheap. However, the body requires the production of insulin to use this “unleaded” type of fuel. When carbohydrates are identified to be present in the liver and pancreas, insulin is released so that the rest of the cells throughout the body can “open the tank” and let the carbohydrate into the cell to be used as fuel. The challenge is that carbohydrates don’t store very well in the form they are supplied in, so, as a protective mechanism against starvation and famine, if excess carbohydrate is found in the system, it is converted into triglyceride. Insulin is required for this. Interestingly, when your insulin levels rise, the signal to the body is that “unleaded fuel” is in the system, so it stores any fats and excess carbohydrates in the form of free fatty acid and triglyceride. Carbohydrate stimulate an insulin response and cause fat storage. It is the same reason we give corn to cattle — to plump them up before taking them to market.
Fat then is the “diesel fuel” of macro-nutrients. It burns well, can be stored very easily, and provides over twice the energy to the body when measured in the form of k-cal per gram. Fat is used preferentially when there is limited or no insulin floating around the blood stream and is quickly and efficiency stored when other forms of fuel are available. (Insulin being the key hormone signaling that other fuel is around.)
So what is this “ketosis thing?” It is a method of dietary change (a lifestyle) that intentionally focuses the body’s metabolism to use fat (in the form of triglyceride & free fatty acid) as its primary fuel. Leading to weight loss, dramatically improved blood sugars, significantly improved cholesterol and triglyceride levels, and notably improved inflammatory markers.
But don’t you end up eating a lot more protein on your weight loss program? Honestly, No. Protein and fat are very filling, and most people find that limiting the carbohydrates actually causes less hunger and diminishes the rebound carbohydrate cravings often stimulated by the two or three slices of bread, pasta or that potato often occurring 2-3 hours later. Interestingly, most people don’t eat that much more and the protein levels remain fairly constant. The key is to increase the fat intake. This is even more satiating and many people find themselves eating only twice a day when they are hungry.
Excessive protein will be converted into glucose and/or glycogen and spike the insulin levels. Protein can be equated to the oil you put in your car. Protein is a building block used for muscle, connective tissue and some essential metabolic functions. When too much protein is ingested, it is converted into carbohydrate and spikes the insulin. (See my article on Why Your Chicken Salad is Making you Fat)
Most people have problems when they start supplementing with protein shakes. These often contain more than needed amounts of protein and sweeteners, both of which stimulate increased insulin levels and consequently halts your weight loss – or even causing weight gain.