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Keto Approved Foods

I’ve been living and teaching patients about using a low-carb/ketogenic and carnivorous lifestyles for over 16 years.  I get thousands of questions each month about what to eat. People ask:

  • “What foods are ketogenic lifestyle approved?”
  • “Can you just give me a list of approved keto foods?”
  • “But, can’t I just have some oatmeal?”

In the past, I’ve given people seven day diets, and I’ve given them food lists.  But, you know the proverb, “give a man a fish . . .”  People still seem confused.  I’ve tried teaching people the simple ketogenic principles, “teach a man to fish . . .”  and this helps a few others.  However, there still seems to be great confusion about what foods can and should be used in a ketogenic lifestyle.  Today, I thought I would try to combine both approaches and discuss the basic macro-nutrients that make up a well formulated ketogenic diet.

Carbohydrates

Let’s start with carbohydrates.  The first principle that must be followed to enter and stay in ketosis is keep insulin from spiking.  This is done by keeping total carbohydrate intake less than 20 grams per day.  The liver produces a small amount of carbohydrate every day to protect the brain.  Therefore, a low baseline level of continuous insulin production is essential to maintain life.  However, it’s the large spikes of insulin after ingesting carbohydrate containing meals that cause the problems.  We talk about this at length in my book The Keto Cure.

Carbohydrates are the foods that most commonly cause insulin to spike.  It is the rapid rise or spike of insulin levels that drive weight gain, arterial plaque formation, heart disease, inflammation, neuropathy, kidney stones, gout and thyroid problems.  Simple and complex carbohydrates cause insulin to surge.  Those same simple and complex carbohydrates are the sugars (monosaccharides & disaccharides) and starches (polysaccharides) found in foods.

Fibers are also complex carbohydrates (polysaccharides) in the form of cellulose, lignin and pectin that are more difficult for human digestive enzymes to break down into simple digestible forms of carbohydrate.  However, juicing, blending or cooking fibers releases the carbohydrate from the complex form and makes them available to our bodies.

Carbohydrates in their various forms are present in varying amounts in foods like fruit, vegetables, grains, beans, legumes, milk, and processed foods like candy, soda & sweets. (These are the foods to limit or completely avoid).

In general, raw leafy greens contain cellulose and the carbohydrates in these vegetables when eaten raw do not need to be counted.  You are free to eat as much as you desire.  However, cooking, blending or juicing the leafy green (as noted below) does break the cellulose bonds and increases carbohydrate absorption (that is why cooked, blended, or juiced vegetables taste “sweeter”).

NOTE: I recommend 1-2 cups of raw leafy greens per day.  Leafy greens are one of the highest sources of folic acid (spinach, asparagus & okra) and without them in the diet, there is a potential risk of folate deficiency if it isn’t present in animal fat sourcesa.  This is especially problematic in pregnant and breast feeding mothers.  Yes, I hear you, eggs and meat are another source of folic acid; however, leafy greens like spinach contain four times the folic acid that eggs and meats do.  Even iceberg lettuce contains more folic acid than eggs (this is why I caution pure carnivore diets in women of child bearing age without folic acid supplementation).

Foods that are loaded with sugars and starches that should be AVOIDED or USED WITH GREAT PRUDENCE include:

Non-Leafy Green Vegetables (1 cup raw or 1/2 cup cooked) – 10 grams of carbohydrate

Asparagus
Bamboo Shoots
Beans (yellow or green)
Beets
Broccoli
Brussell sprouts
Cauliflower
Cabbage
Celery Leaves
Egg Plant
Leeks
Mushrooms
Okra
Onions
Green Onions
Scallions
Pea Pods
Peppers: Green, Red, Sweet, Hot
Sauerkraut
Spinach
Summer Squash
Turnips
Tomato
Zucchini
(Corn, Carrots and Potatoes are not listed here due to their higher carbohydrate content)

Fruits (portions below) – 15 grams of carbohydrate

Apple (1 small)
Apple Juice (1/2 cup)
Apple Sauce (1/2 cup)
Apricots (2 fresh) Page | 5
Banana (1/2)
Berries (blueberries, black berries, strawberries, loganberries, raspberries – 1 cup)
Cantaloupe (1/4 of a 6 inch melon)
Cherries (12)
Cranberries (1 cup)
Dates (3)
Figs (Fres
Grapefruit Juice (1/3rd cup)
Grapes (17 small)
Honeydew melon (1/8th of a 7inch melon)
Kiwi (1)
Lemons (2)
Mango (1/2)
Nectar (1/3rd cup canned)
Nectarine (1)
Orange (1 small orange)
Orange Juice (1/2 cup)
Peach (1 medium)
Pear (1 small)
Pineapple (1/2 cup chopped)
Plumbs (2)
Prune Juice (1/3 cup)
Prunes (2 fresh or dried)
Raisins (2 Tbsp)
Rhubarb (1 cup cooked)
Tangerine (1)
Watermelon (4 inch x 1 ½ inch thick wedge)

Breads (portions below) – 20 grams of carbohydrate

Bread: white, wheat, French, rye, pumpernickel (1 slice)
Bagel (1/3rd)
Biscuit or Roll (1 small)
Breadcrumbs (1/4th cup dry, grated)
Bread-stick (1)
Buns: hamburger, hot dog (1/2 bun)
Cereal – cooked (1/2 cup)
Cereal – puffed (1 cup)
Cereal – flakes (1/2 cup)
Corn (1/3rd cup or 1 small cob)
Crackers:
Graham (three 2 ½ inch squares)
Oyster (1/2 cup)
Saltines (5)
Soda (3)
Zwieback (2)

Macaroni noodles (1/2 cup cooked)
Matzo (one 5 inch square)
Muffin – English (1/2 plain)
Muffin – bran (1 small) Page | 6
Toast – Melba (4 rectangles)
Pasta (1/2 cup) Peas – green (1/2 cup)
Pita bread (1 small)
Popcorn – air popped, dry (3 cups)
Potato – New, Russet or sweet (1/2 cup)
Pretzels (3/4th oz)
Rice – cooked (1/3rd cup)
Rice Cakes (2 plain)
Tortilla (1 small)

Dairy (portions below) – 25 grams of carbohydrate

Milk – whole, 1%, 2% and skim (1 cup)
Powdered Skim Milk – dry (1/3rd cup)
Yogurt:
Plain (1 cup)
Light – sweetened with NutraSweet (1 cup)
Regular – fruit filled (1/2 cup)
Cottage Cheese (2 cups)
American Cheese (12 slices)

You may use hard cheeses, cream cheese, sour cream, and mascarpone as great options on a ketogenic diet because they contain very little carbohydrate and are high in fats.

Proteins

Proteins are large molecules made of of long chains of amino acids and are essential for a vast array of functions within the human being including structural formation, enzymatic reactions, immune response, cell adhesion, DNA replication, and molecular transport to name just a few.  There are 22 amino acids that make up the protein molecules used in the human body.  Interestingly, microorganisms and plants can make all 22 of these amino acids on their own.  However, humans (and a number of other mammals) can’t make 15 of these amino acids on our own and we must obtain them from our diets.

How much protein do you actually need? Understanding your individual needs baseline protein needs can be calculated from your ideal body weight (IBW).  IBW can be very easily calculated from your height and your level of activity.  I give you this calculation because many female patients I see do not eat enough protein.  Lack of protein will halt weight loss (as the body thinks it is starving.)

Your daily protein need can be calculated by the following:

Males: IBW =  50 kg + 2.3 kg for each inch over 5 feet.  Males need 1.2 g protein per kg of IBW.

Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. Females need 1.0 g protein per kg of IBW.

If you are exercising more than 30 minutes 3 days per week then those values increase to 1.4 grams per kg for females and 1.6 grams per kg for males.

Example:

A 6 foot male’s IBW would be 50 kg + (2.3kg x 12 inches) = 77.6 kg  x 1.2g/kg if sedentary or 1.6g/kg if exercising 4-5 days per week. 

A 5 foot 4 inch females IBW would be 45.5 kg + (2.3kg x 4 inches) = 54.7 kg x 1.0g/kg if sedentary or 1.4g/kg if exercising 4-5 times per week.

 

This will give you a starting point for your daily protein needs and you can divide this number by the number of meals per day to get the protein needs at each meal.  However, many of my patients after three months of ketogenic living need more protein to continue seeing weight loss.

What if I eat too much protein? There is still significant controversy over exactly how much protein is necessary on a daily basis.  The reason is that many amino acids when ingested in significant amounts stimulate an insulin surge by themselves. These include arginine, lysine and tryptophan.  Eating proteins that are high in these three amino acids in my very insulin resistant patients will raise insulin enough to halt weight loss, cause worsening inflammation, raise blood pressure and cholesterol.

Do you have to avoid these foods on a ketogenic diet? No, however, when you are using them more than 2-3 times a week, weight loss is inhibited and one’s ability to maintain ketosis is blunted.

However, two recent studies(1, 2) demonstrate that when protein intake is increased beyond a certain threshold, growth hormone counterbalances the insulin response and stimulates muscle growth instead of weight gain. That threshold seems to be around 90 grams of protein per day as women and 150 grams of protein as men.

Yes, this is much higher protein in take than the calculation for baseline protein needs we’ve used for years outlined above.  We are learning a great deal about protein.  For years, we’ve been missing the mark on protein needs.  This revolves around the need of leucine to stimulate muscle growth.

What proteins can you use?  The following list should be helpful.  Remember that protein and fat often come packaged together in nature.  As we discuss below, to maintain adequate ketosis, total fat intake should between 70-90% of your total calories.  In order to maintain fat contents greater than 70%, you’ll want to use proteins sources that are the highest in fat (like red meat and pork) or add fat (like cooking in butter or coconut oil) to those that are lower in fat content.

Food:                                                                       Protein Content:                           Fat Content:

Ground Beef (75% Lean) –                                    16 grams per 4 oz.                                  78%

Steak (Ribeye) –                                                      39 grams per 8 oz.                                  74%

Steak (Top or Bottom Round) –                         33 grams per 6 oz.                                  53%

Bacon (pan fried) –                                                 3 grams per 1 slice                                 69%

Sausage (beef) –                                                      14 grams per 3.5 oz.                               79%

Sausage (pork) –                                                      17 grams per 3.5 oz.                               75%

Pork Chop (boneless) –                                         18 grams per 3 oz.                                  31%

Ham (cured whole boneless) –                           19 grams per 3.5 oz.                               28%

Sockeye Salmon –                                                  23 grams per 3 oz.                                  22%

Halibut –                                                                    23 grams per 3 oz.                                  19%

Chicken Breast (boneless, skinless) –                24 grams per 3 oz.                                  18%

Turkey Breast –                                                        24 grams per 3 oz.                                  15%

Tilapia –                                                                      21 grams per 3 oz.                                  13%

Yellowfin Tuna –                                                      25 grams per 3 oz.                                  10%

Light Tuna –                                                             22 grams per 3 oz.                                  8%

Deli Meats:

Pepperoni –                                                              18 grams per 3 oz.                                  83%

Roast Beef –                                                             21 grams per 3 oz.                                  48%

Canadian bacon –                                                   17 grams per 3 oz.                                  42%

Roast Turkey Breast –                                            18 grams per 3 oz.                                  15%

Snacks:

Beef Jerky (Jack Links) –                                          13 grams per 1 oz.                                  9%

Peanut Butter (Peter Pan Crunchy) –                 8 grams per 2 tbsp.                              76%

Macadamia nuts, raw                                             2.2 grams per 12 nuts                           89%

Mixed Nuts –                                                               6 grams per 2 oz.                                  79%

Almonds, raw –                                                          6 grams per 1 oz.                                   66%

Walnuts, raw –                                                           4 grams per 1 oz.                                    85%

Sunflower seeds, raw –                                            6 grams per 1 oz.                                    76%

Tofu –                                                                          12 grams per 3 oz.                                   30%

Greek Yogurt –                                                        23 grams per 8 oz.                                  0%

Cheeses:

Cream Cheese –                                                       11 grams per 3.5 oz.                               79%

Cheddar Cheese –                                                   24.6 grams per 3.5 oz.                           74%

Swiss Cheese –                                                         24 grams per 3 oz.                                 66%

Ricotta cheese –                                                      10 grams per 3.5 oz.                               63%

Eggs –                                                                        6 grams per 1 large egg                        70%

Look for foods who’s ratio of protein to fat is close to or greater than 1:1.  For example, eggs are 6 grams of protein and 6 grams of fat.

It is essential to understand that not all sources of protein are equal in their absorption in the human gut.

  • Egg protein utilization – 50%
  • Meat protein utilization – 40%
  • Cheese protein utilization – 40%
  • Whey protein utilization – 18%
  • Vegetable protein utilization – 14%

Therefore, the two most important things you can do to optimize your ketogenic lifestyle is lower the carbohydrate intake to less than 20 grams per day, and use adequate high quality protein. Muscle gain and fat loss are most effectively achieved when high quality protein is used.

If you are struggling or just getting started, get a copy of Dr. Nally’s Ketogenic Diet here.

What You MUST Know about Total Cholesterol & LDL-C on a Ketogenic Diet

Is following your Total Cholesterol and LDL-C really that important?

You may be quite surprised.

Watch as we discuss the important markers of heart disease and vascular disease risk.  We will talk about how these markers can help you understand what your body is doing in the process of making or reversing atherosclerosis (plaque in the vessels).  And, should you really be taking that STATIN (cholesterol lowering) drug?  Get the scoop here as Dr. Nally very simply points out how the right diet can and will lower your cholesterol without the use of medications.

Research in the last 10 years points to the small-dense LDL particle as the atherogenic component of cholesterol (Hoogeveen RC et al., Arterioscler Thoromb Vasc Biol, 2014 May; Ivanova EA et al., Oxidative Med Cell Longevity, 2017 Apr). Studies in the last five years have identified that elevated small-dense LDL cholesterol correlates much more closely with risk for inflammation, heart disease and vascular disease (Williams PT, et al. Atherosclerosis. 2014 April; 233(2): 713-720.)

Recent research in the last three years demonstrates that small dense LDL cholesterol is a better marker for prediction of cardiovascular disease than total LDL-C (Hoogeveen RC et al., Arterioscler Thromb Vasc Biol. May 2014, 34(5): 1069-1077l; Ivanova EA et al., Oxidative Med Cell Longev. 2017).

Additionally, higher LDL-C is actually predictive of longer life and has been demonstrated to correlate with longevity (Ravnskov U et al., BMJ Open, 2016 Jun 12;6(6): e010401).  And, a low LDL-C actually increases risk of early mortality (Schwartz I et al., Lancet 2001, 358: 351-55).

It is commonly understood that LDL-C will rise with increased saturated fat intake on a ketogenic diet. This has been know and reported in the scientific literature for over twenty years. This is to be expected, because LDL-C is really a measurement of three different LDL sub-particles (“big fluffy, medium, and small dense”). Increased saturated fat intake, while at the same time lowering carbohydrate intake, actually causes a shift in these low density particles to a bigger “fluffier” particle conformation (Griffin BA et al., Clin Sci (Lond), 1999 Sep).
The 2015 British Medical Journal, referenced above, analyzed the relevant 19 peer reviewed medical articles that included over 68,000 participants. This review showed that there is no association of high LDL-C with mortality (meaning that an elevated LDL-C does not lead to an increased risk of death from heart or vascular disease). I realize that, in stark opposition to the landmark review above, The American Heart Association’s Presidential Advisory published their position in the June 20, 2017 issue of Circulation. They stated that saturated fat is the cause of increased LDL-C and they further extrapolated that elevated LDL-C is associated with an increase in death by cardiovascular disease. This boldfaced claim is only based on one single small four year (2009-2013) literature review completed by the World Health Organization with a total of only 2353 participants, most of these studies only lasting 3-5 weeks (not nearly long enough to see fully effective cholesterol changes) and none of which had any focus on carbohydrate intake, insulin levels or LDL sub-particle measurement (Mensink RP, Geneva: WHO Library Cataloguing-in-Publication Data, 2016).

Based upon the most current scientific evidence above and my clinical experience, the large body of evidence above demonstrates the use of total cholesterol and LDL-C to determine vascular disease risk to be ineffective tools. A low carbohydrate/ketogenic diet lowers small dense LDL cholesterol, triglycerides and blood sugar and in many cases, the use of cholesterol drug (STATIN) therapy is not needed and ineffective in comparison with a ketogenic/carbohydrate restricted lifestyle.

 

The Shovel will Fail You in Obesity, Finances & Life

A few years ago, my family and I set out to build a pond.

I have always loved Koi and the serenity of a Koi pond in my own back yard was very enticing. I spent about a year planning my design and the location.  I dreamed of a serene evening after a very long, hectic day seeing patients relaxing beside the pond.  The sound of trickling water, the occasional splash from fish, the cool breeze passing over the mist from a water-fall would sooth my soul after a busy day in the office.

I envisioned the perfect area.  An unused access path, previously worn by the previous owner with truck and trailer traffic, beside my now expanded patio. Twenty feet wide, thirty feet long and four feet deep. . . that seems just perfect.

I pulled out my shovel and set about digging. Eager to begin and filled with the energy of the final product, I set to digging.  What could be so hard about digging my own pond?  Think of the exercise I will be getting.  Thoughts spurred me on.

Minutes later, chest heaving, face glistening with sweat, I stared in dismay at the ground. All I had to show for my wild digging was a small 1/2 inch dent in the dusty Arizona top soil.

Sonoran Clay

Over time, calcium-carbonate, along with other minerals, accumulates and dissolves into the topsoil of the very arid regions of Arizona Sonoran Desert.  It forms a two to three-foot layer of soil called “caliche.” Periodic rains carry the calcium as far as three feet down into the soil, then the water rapidly evaporates in the blistering Arizona heat.  This often forms two to three feet of soil that is “literally” harder than concrete.

With tremendous zeal, a great deal of sweat and a round of painful blisters, I broke my third shovel on this impenetrable ground.  I realized this was much more difficult than I thought.  I pulled out the back-hoe attachment for my small farm tractor.  After a few hours and few gallons of diesel fuel later, still very little progress occurred.

Multiple weekends and evenings of digging in the Arizona caliche left me with three broken shovels, a ruptured hydrolic line in my tractor, anger that my expensive back-hoe attachment didn’t work, and only a small dent in the ground near my patio.  Even the brute force from the tractor would not budge the clay.  I wondered if dynamite would be effective?  (My wife would have none of this idea).

With my exuberance quashed, I concluded that this would require much more measured exhuming.

Escape From the Prison

We often imagine, with great delight, the removal or destruction of that which enslaves or imprisons us.  We dream that just a little sweat, exertion of a few shovel scoops of dirt and the foundation to our prison of obesity, addiction, debt, and depression are exposed.  A few extra scoops and we imagine freedom from that prison cell.

If only I had a jack hammer and a bigger, more powerful scoop, I imagine . . . I could make short work of these manacles that bind me.

But, our manacles and prison cells do not so easily give way.

The failings of our sharpened spades and powerful back-hoes form a new, even stronger fetter – the belief that our prison cell is unbreakable, that our challenge is just too great. These failings usually leave a person cured of any further desire to break free.  It quashs the dream and solidifying the depression of stagnation.

The in-fecundity of my shovel, no matter the strength and effort put behind it, was not cause to quit.  It was life’s lesson that prisons and shackles often only need a simple tool.

Enter the pick-axe.  During this process my wife said, “Honey, why don’t you use the pick in the garage?”

“If my shovel and the back-hoe didn’t work, there was no way I was going to break through this clay with a pick axe.” That was absurd, I thought.

Yet when I humbled myself to try, it was simple.  The pick-axe was unpretentious.  This simple tool allowed for an almost effortless stroke to a small area of weakness in the caliche.  A large flake of soil would pop free with each stroke. The process was repeated.

Scale by scale, the dragon’s flank was exposed. Careful work of the pick-axe began to loosen layer after layer, section after section, pellicle after pellicle.  Yes, it was slow work. But, each swing was a small victory.

At each little victory, my heart would leap, the dream would become ever clearer.

Working this magic again and again until finally the specter was weakened enough to pull out the shovel.  And, further work, allowed for bringing back the powerful back-hoe, in gratifying scoops.

The excavation that I thought would take two months took me fourteen.  But, it was gratifying.

I learned a powerful lesson. Wherever life has pinned you, fettered you or barred you in, put down the shovel, and pick up the pick-axe.  Second, if you really listen, your spouse may point out the tool you really need. Don’t be afraid to chip away at it a piece at a time.

Finances

Stop waiting for the sharper shovel or the bigger back-hoe to dig yourself out of your harrowing debt, mega mortgage, or your income dwarfing spending. The jackpot or financial windfall won’t come. While others await the jackpot, put down your shovel and shoulder your pick-axe.

  1. Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
  2. Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
  3. If you must, pick up a side-hustle for extra to sharpen the pick.

Once you’ve lifted one flake, chip away at the next. Making progress will make it easier to continue.  It doesn’t matter how long it takes, just keep at it.

Marriage

You long for resolution of the apathy, progressive resentment and mutual stalemate that permeates your relationship.  You look in vain for the bigger shovel that will uncover the treasure that years of apathy have buried. You long to uncover your dreams and needs that have been covered and hardened under the clay of resentment.  The shovel and the back-hoe won’t help you here.

Drop the shovel.  Shoulder your pick-axe.

  1. Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
  2. Hold her for five seconds longer every time you hug.
  3. Find a gift you can give her once a week, just because.
  4. Put down your phone and look her in the eyes when she talks to you and listen. Really listen and the flakes of hard clay will unveil the beauty of her soul.
  5. Find a way to praise her every day, even if it is through a simple text.

Health

You long to rid yourself of your addiction to sugar, bread, stress, and sleep deprivation.  You’ve tried to scoop them out of your life.  You even hired a trainer with some muscle to force you to change.  You’ve tried in vain to save yourself from yourself.

Trying to use the shovel here is like trying to use the shovel on steel forged walls of your life’s prison fortress.  Forget the shovel.  Shoulder your pick-axe.

  1. Start with one meal and make some substitutions.  My dietary plan can help you with this.
  2. Go to bed an hour earlier. Really, you’ll be surprised that the focus you have will more than compensate for the hour of lost time in the evening.
  3. Add a quality vitamin to your morning routine.
  4. Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
  5. Simply remove the “white stuff” from your meals. You will be amazed at the results.
  6. Put down your phone for 30 minutes and read that book you’ve been meaning to read, instead of surfing Facebook.

Grand-standing with your back-hoe doesn’t help you.  Just swing the pick-axe once or twice.  Simple daily picking with the sharp point weakens the hardest of ground and the prison walls in our lives.  It takes time, so be patient.

Find the weak point, apply the pick.  Day by day, little by little you will be free.

I’ve been there.  I’m with you.  Keep me posted on your journey.

If you’re looking for a program that teaches you how to do this, check out my membership site.