Keto or No?

Keto, or the Ketogenic Diet is all the rage right now.  So what's the truth?  Does it work?  Is it healthy?  How do you do it?  At almost every turn you hear someone talking about how much weight they lost "doing keto".  There's talk of improved health risks, combating cancer and other lofty claims.  Tons of celebrities and public figures have gone keto and it's one of the hottest search keywords and topics today.

What is Keto?
Keto, in short, is using fat for fuel, instead of glycogen (carbohydrates).  It's transforming your body's fuel source, like switching a car from regular gasoline to diesel fuel.   Without the presence glucose, ketones are made from the liver. Ketones are water-soluble molecules that include acetoacetate, beta-hydroxybutyrate, and acetone.

"It's a grandiose idea and very attractive."  Krista Scott-Dixon, a nutrition consultant for one of the most respected health & fitness companies out there, Precision Nutrition said recently in a Tonic news article: "Keto evangelists leverage this idea of an alternative fuel source as one of the diet's main selling points. It sounds 'sciencey.' It's sort of logical. And that makes the diet easy to buy into.  Keto has this sort of 'truthiness' and contrarianism.  But I think the interest in this diet comes from the basic human desire to find some magic formula that will take your problems away, make you feel good, transform your body, and give you health, energy, and confidence. It's an attempt to fill the basic human desire for transcendence."

My first knowledge, or learning of ketosis was back in 2002 in some of my first  studies into nutrition, reading Arnold Schwarzenegger's 1998 book The New Encyclopedia of Modern Bodybuilding.  In it he states:

"Ketosis is the result of carbohydrate deprivation.  Your body requires adequate amounts of carbohydrates in order to properly metabolize body fat.  As the saying goes, "fat burns in the furnace of carbohydrate." When there is not enough carbohydrate in the body for this process to take place (Usually as a result of an overly strict weight-loss diet), the body has to take emergency measures.  The primary symptom of ketosis is ketonemia, the appearance of ketone bodies in the blood.  Ketone bodies are the products of the incomplete burning of fats.  These ketones can be used in place of glycogen for energy production, and they can also be used as energy to fuel brain and nervous system function.

The problem is that ketone bodies are not nearly as efficient in fueling exercise as glycogen.  In a prolonged state of ketosis, you tend to be sluggish, your mental processes suffer, and your body gradually becomes dehydrated.  Worse, in the absence of carbohydrates your body begins to metabolize larger and larger amounts of amino acids (protein) for additional energy...Any kind of serious deprivation is detrimental to your health and training intensity."

He goes on to say "Though this condition should be avoided, a lot of bodybuilders like the ketosis diet anyway.  Since it lets you eat both a lot of protein and fat, being in ketosis tends to reduce your feelings of hunger."  He then explains the process of how to check if you are in ketosis or not buy getting and peeing on test strips from the pharmacy.  He ends by stating: "Bottom line: Cut back your carbohydrates as far as you want as long as the test strips don't change color.  When you do, increase your carbs."  
History of Keto

The original ketogenic diet was developed in the 1920's to control pediatric epilepsy under the direction of scientists.  They found that the lack of glucose and instead elevated levels of ketones reduced the frequency of seizures in these kids.  Fast forward to today, it's just exploded in popularity but there hasn't been any long-term studies or attention on the keto diet really since this time.  

My Experience
I couldn't help but think, "Am I missing something? Did something change?"  That's why I dug up Arnold's old definitions from 98'.  As with anything I recommend or do not recommend to clients, I test it myself.  I research and I want an informed opinion or real experience with the subject.  Exercise, supplements, diet, program...whatever.  I pride myself in being a test subject, or human guinea pig, I feel that it's part of my job.  As a professional I just don't feel right any other way.  I am a firm believer in "practice what you preach".

I tried eating Keto for about 3 weeks earlier this year.  I combined it with intermittent fasting via Tim Ferriss' advice to reach ketosis faster.  He said he can reach ketosis in under 24hrs instead of 3-4 days.  I did everything but consume the exogenous ketones or MCT oil, and in the entire 3 weeks I only reached a high of 0.3 mmol/L.  I measured my blood levels, almost daily.    

It is said you are in light nutritional ketosis with levels between 0.5-1 mmol/L and optimal ketosis with levels 1-3 mmol/L.  Over 3 is high ketone levels, and over 5 is dangerously high and indicative of ketoacidosis (read on into Drawbacks).  

I didn't feel any ill effects, no "keto flu", headaches, cravings, etc. nor did I feel any positive effects i.e. increased mental clarity, energy, etc. but then again I obviously didn't reach ketosis.  My LDL cholesterol numbers did suffer.  I didn't see any noticeable difference in weight loss.  I found it very, very hard to eat that much dietary fat (70-80% of total calories) day in and day out.

I guess I can be considered an "experienced dieter" or "weight loss expert" with hundreds upon hundreds of competition weigh-ins made for tournaments and fights, not only by myself but my clients and athletes as well...and then to not see any changes, even at the very minimum on the scale, it was disappointing.  It wasn't efficient, it wasn't working, and it was a lot of hard work with nothing to show for it.  
Are You Really in Ketosis?
With my experience of only reaching to 0.3 mmol/L I found myself wondering if others had the same problem?  The diets particulars are somewhat vague and hard to find and it seems everyone has their own personal tweak on it.  One thing that is consistent is 70-85% of calories must come from dietary fat.  That leaves only 10-15g of carbs per day, with some stretching to 20-30g...that's just one piece of fruit.  The problem, however is with protein.  If you consume any more than the absolute minimum amount of protein that your body needs, it will break it down into glucose.  So that is eating a lot of fat, very impractical.  Eating that much of any one macronutrient is actually really hard to do.  Possible, but not probable. 

If ketosis is indeed reached, along with undernourishment (not enough fiber, intestinal problems, etc.) some people get elevated markers, their c-reactive protein, uric acid, LDL particle numbers, and/or homocysteine, and even disrupted hormone production, especially in women.  High levels of ketones can be poisonous to the body. When levels get too high, you can develop DKA (Diabetic Ketoacidosis).  “DKA is a condition that is so serious it can lead to a coma or death if not corrected," according to the American Diabetes Association.
When there is an excessive amount of ketones in your blood, they make it very acidic and your body will draw calcium from your bones. Stated in a recent Popular Science article: "There are few to no studies on healthy adults undertaking a non-therapeutic ketogenic diet, but studies of epileptic children on the diet show increased bone demineralization and high calcium levels in the blood." 

For an an in depth look into drawbacks, the pros, the cons and the facts of keto from people much smarter than me, two Ph.D.s' click here

Is Keto Healthy?
That largely depends on your metrics and definition of healthy.  Can you lose weight with keto?  Absolutely.  Can you improve your blood sugar, blood pressure and cholesterol?  Sure.  Does keto do it any better or faster than any other sensible approach to eating?  Probably not. 

Are those your ideal markers (weight loss, blood sugar, pressure and cholesterol) to define "health"?  If they are, then yes, keto is healthy.  Is "keto" getting you to change your eating patterns, eat less processed foods, unnecessary carbs and junk food?  Then yes, keto is healthy.  Is keto the one and only diet you have been able to stick to after many failed attempts with other diets, and you feel better and see results?  Then yes, keto is healthy.      

Bottom Line
Your success with any common diet is directly determined by how closely you follow it day-in and day-out; consistency.  Diets are based off controlling one of the four things: Type (macronutrient), Timing, Portion, and Hormone Response.  Diets work with consistency in one (or more) of these areas.

I follow two basic principles when approaching diet and eating:

1.  How does it make you feel?  Be honest.  Test out certain foods, keep a journal and jot notes down as soon as you eat something or keep a log over time, weeks and months.  If keto makes you feel great, no one can argue with you.  It's certainly done wonders for lots of people.  Find what works for you.   

2. Balance.  Is there a serious deprivation of any one thing?  Anything extreme?  If so, you might want to reconsider or cycle on and off.  Too little or too much of something for too long sways any balance in far directions and isn't sustainable.   

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