I’ve personally been following and prescribing ketogenic diets to my patients since 2005.   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 appropriate 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.

It’s Not Necessarily a High Protein Diet

Most people, when they hear you’re following a “Low-Carb” diet . . . respond with, “Oh, you are on that high protein, Adkins’ thing, . . . right?!”

Well, not really. A true ketogenic diet is NOT a “high protein diet.” However, you must be ingesting enough protein to maintain muscle, hair growth and energy levels.  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?!!)  However, remember that protein and fat usually come together in the sources that the Good Lord put them in.

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 that you race home to eat three large turkey legs and a pound of turkey bacon, the vegetarians gather their things to leave and the former home economics teachers begin to get chest pain at the mental picture in their heads.

How Are Ketones Made?

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)

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 like a futuristic car that can run on unleaded gasoline, oil, or diesel fuel.  It is able to recognize which fuel is present 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 . . .?

We have Two Fuel Systems

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.)

Nutritional Ketosis is Using Fat as Your Optimum Fuel

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?” I frequently get asked.

Honestly, No.

Protein and fat are both 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.  Because fat and protein come together in meats, eggs, fish, etc., satiation occurs with just minor increases in dietary intake real animal food.  I don’t recommend increase the fat alone.  I recommend increasing the amount of real animal protein until you are full.  This is even more satiating and many people find themselves eating only twice a day when they are hungry.

 Excessive protein in those who are morbidly obese with severe overproduction of insulin can experience a spike the insulin levels further with large amounts of protein. 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, in this group is ingested, it 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 sweeteners that raise insulin and consequently halts your weight loss – or even causing weight gain.