An Introduction To Healthy Keto

"It's not a quick fix, it's a lifestyle." – Unknown

Introduction | What is keto? | Types | Food Choices | Healthy vs Dirty | Who is it for? | Benefits | Risks | Final Thoughts | Takeaway Points | References | Disclaimer

Introduction

The ketogenic diet has gained a lot of attention in recent years. It has become particularly popular due to its impact on weight loss in those who follow it. Even though the keto diet is associated with changes in body mass, originally it was first used as a tool in combating epilepsy in children. In the early 1920s[1][2], an endocrinologist named Rollin Woodyatt observed that the production of ketone bodies [acetone, ß-hydroxybutyrate, and acetoacetate] could be triggered not only by starvation [fasting] but also by dietary changes such as low carbohydrate intake and high-fat consumption. This notion was quickly picked up by Russell Wilder, who used it to treat his patients with epilepsy. He named this regimen of eating a "ketogenic diet."

What is a ketogenic diet?

The ketogenic diet is a food regimen that aims at decreasing the intake of carbohydrates while increasing fat consumption. Both carbohydrates and fat are used by the body as fuel. The difference between the two is that carbohydrates are converted into glucose [sugar] and are a quick and preferred source of energy, which is always taken up first by the body[2]. In such circumstances, fat becomes a secondary source of fuel. In the absence of carbohydrates, our body uses dietary fat and its fat stores to maintain energy levels. Fat is broken down in the liver and the by-products of this process are the ketones, also known as ketone bodies. When our body reaches the state where it produces large amounts of ketones, we talk about ketosis[3].

What types of ketogenic diets are there?

There are four main types of the ketogenic diet:

• Standard Ketogenic Diet [SKD] is characterized by a very low carbohydrate intake [5-10%], moderate protein intake [15-20%], and high fat consumption [75%]. It is also the most studied form of the ketogenic diet.

• Cyclical Ketogenic Diet [CKD] is divided into two different eating regimens. During the first five days, you eat according to the SKD regimen and for the remaining 2 days, the carbohydrate intake increases to 100 or 150 g per day.

• Targeted Ketogenic Diet [TKD] is based on the same macronutrient idea as the SKD regimen; however, the carbohydrate intake [5-10%] takes place before and after a workout.

• High Protein Ketogenic Diet [HPKD] has increased protein intake in comparison to SKD. It requires 60-65% fat, 30% protein, and 5-10% carbohydrates.

The choice of diet regimen is very individual and has to meet personal needs. Each one of those eating styles is different and offers slightly different outcomes, even though weight loss is always one of them. If you work out a lot, you might want to consider CKD or TKD to help you build muscle[2]; however, the drawback of these regimens is that they take you out of ketosis for a while. The same applies to HPKD. Our body converts excess protein into glucose [sugar][4], which then becomes the main source of energy. It does not happen in SKD if you follow the regimen.

What to eat and what not to eat?

When considering what the best choice of foods is when doing keto, the first thing that comes to mind is the low-carbohydrate and high-fat count. However, another element to remember and one that is equally important is nutrient density. Lowering carbohydrate intake and increasing fat consumption usually leads to fewer frequent meals. If you eat less often, you need to make sure that you fulfill your body's dietary needs and deliver all the micronutrients it requires to function properly. The best choice is such foods as:

• fats such as olive oil, coconut oil, MCT oil, butter, lard, tallow, and ghee,

• low-carb veggies such as leafy greens, broccoli, cauliflower, mushrooms, bell peppers, asparagus, zucchini, avocados, green beans, Brussels sprouts, and more,

• fruit such as berries [raspberries, strawberries, blueberries, blackberries, etc.],

• fish and shellfish such as sardines, mackerel, salmon, mussels, oysters, and others,

• eggs,

• meat such as beef, pork, poultry,

• cheese such as Gouda, Mozzarella, Camembert, halloumi, feta, cheddar, parmesan, and more,

• other dairy products such as high-fat cream [whipping cream], plain greek yogurt, cream cheese, and cottage cheese

• nuts, nut butters, seeds,

• cocoa powder and dark chocolate,

• sweeteners such as stevia, erythritol, xylitol, monk fruit powder, etc.

• beverages such as black coffee, unsweetened teas, and drinks,

• plant-based milk such as almond milk, coconut milk, and others,

• flours such as almond flour, coconut flour, and flaxseed flour.

The discussion of what to eat to correctly follow the ketogenic diet and stay in ketosis is accompanied by the list of foods to avoid in this eating regimen:

• starchy vegetables, such as potatoes, sweet potatoes, beans, beets, corn, squash, green peas, and others,

• fruits high in sugar, such as watermelon, bananas, apples, grapes, and others,

• grains, such as whole grains, baked goods, grain flours, crackers, etc.,

• sweetened dairy products, such as flavored yogurts, flavored buttermilks, traditional chocolate milk,

• juices,

• sweets,

• chips,

• traditional sugar sweeteners such as honey, sugar, maple syrup, and others.

What is the difference between healthy keto and dirty keto?

A healthy ketogenic diet or Standard Ketogenic Diet [SKD], is based on the concept where clean whole foods become the baseline of nutrition. It is accompanied by high vegetable consumption to support proper fiber intake. It's the quality of nutrients that matters the most. On the other hand, the dirty or lazy ketogenic diet prioritizes convenience, featuring items like fast food burgers, processed meats and snacks, and minimal to no vegetables. Even though they both comply with the carb vs. protein vs. fat ratio, healthy keto focuses on nutrient density. Dirty keto is easy to follow and convenient on the go but it can lead to nutrient deficiencies.

Who is the Healthy Keto diet suitable for?

Healthy keto has many followers and advocates. However, just like any other aspect of health, there is no universally applicable solution. The ketogenic diet is considered safe and can bring great health benefits[5][6] but those who have underlying conditions should always consult a physician or a dietician. Additionally, many people choose to combine SKD with intermittent fasting for even better health outcomes. Such a combination can be perceived as a stress factor by our body and therefore is not a suitable option for everyone.

What are the associated benefits?

The healthy ketogenic diet has proven to have a positive impact on human health. Some of its benefits include:

1. weight loss[7][8],

2. reversing metabolic syndrome[9],

3. lower insulin levels and help manage type 2 diabetes[10][11],

4. reduce inflammation[12],

5. improve cholesterol and triglyceride levels[8],

6. boost brain function[13],

7. cardiovascular health[14][15],

8. may help against cancer[16], epilepsy[17], Alzheimer’s disease[12][13] and PCOS[18].

Are there any risks?

The ketogenic diet is considered safe for most healthy people. However, there is an adaptation period that our body goes through that lasts around two weeks. During this time some temporary side effects may appear, which are referred to as 'keto flu'[19]. To those side effects belong:

• digestive upset such as constipation, diarrhea, nausea, vomiting,

• the feeling of hunger,

• sleep issues,

• feelings of low energy, which can impact athletic performance,

• cognitive issues such as poor concentration.

Additionally, people with type 1 diabetes are at risk of developing ketoacidosis[20]. If you have any health conditions, refer to your doctor for guidance. Lastly, it is essential to consume large amounts of vegetables to prevent any nutrient deficiencies.

Final Thoughts

The ketogenic diet can be a great boost to your health if you stay on track and follow its rules. It is not restrictive in terms of calories but rather the macronutrient ratio has to be obeyed for you to be able to reach ketosis. If you can and want to combine it with intermittent fasting, you may expect even better benefits. However, as with any diet out there, it needs consistency. Only then can it become a lifestyle choice and a long-term commitment.

Takeaway points

• choose healthy keto instead of the convenience of dirty keto,

• nutrient-dense foods are essential,

• helps reach great health results such as insulin regulation, weight loss, and more,

• can be combined with intermittent fasting,

• temporary side effects,

• not a 'one size fits all' approach,

• induces ketosis,

• uses fat as energy,

• requires commitment.

References

This article contains 20 citations:

[1] Wheless JW. History of the ketogenic diet. Epilepsia. 2008;49 Suppl 8:3-5.

[2] Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2021 Nov 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-

[3] Tinsley GM, Willoughby DS. Fat-Free Mass Changes During Ketogenic Diets and the Potential Role of Resistance Training. Int J Sport Nutr Exerc Metab. 2016;26(1):78-92.

[4] Khan MA, Gannon MC, Nuttall FQ. Glucose appearance rate following protein ingestion in normal subjects. J Am Coll Nutr. 1992;11(6):701-706.

[5] Dowis K, Banga S. The Potential Health Benefits of the Ketogenic Diet: A Narrative Review. Nutrients. 2021;13(5):1654. Published 2021 May 13.

[6] Paoli A, Canato M, Toniolo L, et al. The ketogenic diet: an underappreciated therapeutic option? La Clinica Terapeutica. 2011 ;162(5):e145-53

[7] Dashti HM, Mathew TC, Hussein T, et al. Long-term effects of a ketogenic diet in obese patients. Exp Clin Cardiol. 2004;9(3):200-205.

[8] Bueno NB, de Melo ISV, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 2013;110(7):1178-1187.

[9] Gershuni, V.M., Yan, S.L. & Medici, V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep7, 97–106 (2018).

[10] Westman EC, Tondt J, Maguire E, Yancy WS Jr. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Rev Endocrinol Metab. 2018;13(5):263-272.

[11] Bolla AM, Caretto A, Laurenzi A, Scavini M, Piemonti L. Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes. Nutrients. 2019;11(5):962. Published 2019 Apr 26.

[12] Pinto A, Bonucci A, Maggi E, Corsi M, Businaro R. Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer’s Disease. Antioxidants. 2018; 7(5):63.

[13] Rusek M, Pluta R, Ułamek-Kozioł M, Czuczwar SJ. Ketogenic Diet in Alzheimer’s Disease. International Journal of Molecular Sciences. 2019; 20(16):3892.

[14] Sharman MJ, Kraemer WJ, Love DM, et al. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr. 2002;132(7):1879-1885.

[15] Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003;88(4):1617-1623.

[16] Weber DD, Aminazdeh-Gohari S, Kofler B. Ketogenic diet in cancer therapy. Aging (Albany NY). 2018;10(2):164-165. doi:10.18632/aging.101382

[17] Dupuis, N., Curatolo, N., Benoist, J.-F. and Auvin, S. (2015), Ketogenic diet exhibits anti-inflammatory properties. Epilepsia, 56: e95-e98.

[18] Gupta L, Khandelwal D, Kalra S, Gupta P, Dutta D, Aggarwal S. Ketogenic diet in endocrine disorders: Current perspectives. J Postgrad Med. 2017;63(4):242-251.

[19] Bostock ECS, Kirkby KC, Taylor BV, Hawrelak JA. Consumer Reports of "Keto Flu" Associated With the Ketogenic Diet. Front Nutr. 2020;7:20. Published 2020 Mar 13.

[20] Wang ZH, Kihl-Selstam E, Eriksson JW. Ketoacidosis occurs in both Type 1 and Type 2 diabetes--a population-based study from Northern Sweden. Diabet Med. 2008;25(7):867-870.

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