Ketogenic Diets: A Guide to its Practicality as a Diet Tool
An Important Disclaimer before I dive into the content for this article:
As it is now 2018, we increasingly live in a world where society tends to become attached to their viewpoints on polarizing topics. No matter what bulk of research, statistics, or anecdotal support is presented to people, their stubbornness will not let them change their mind. The fitness/nutrition sphere is no exception.
Therefore, the content that I present in this article derives from a couple sources. First, I have adapted well known concepts from experts in the field who I respect as being trustworthy and credible. I also personally looked at both sides of the arguments and added my practical takeaways from my own level of expertise and experiences.
People who preach the principles of fitness/nutrition backed up scientific research and data have a responsibility. That responsibility is to make judgements and inferences from the information presented to them and side with the arguments that have the soundest data behind them. Most claims made in science are backed up by a degree of probability and nothing backed up by research is perfect. But with mounting evidence in one area over the other, we can make claims that it is VERY PROBABLE that one side of the coin is better than the other.
As coaches looking to incorporate these findings into our practice, it is our duty to further dive into whether optimal findings based on high degrees of probability in research can even be practically implemented in a non-research setting. This being said, I will present to the reader my current viewpoints on the subject. Of course, if better data comes out that outweighs the practicality of my current thoughts.... then I will happily change my viewpoint.
Outline
THE PROCESS
MISCONCEPTIONS
WHERE IT WORKS
WHERE IT HURTS
STRATEGIES TO HELP
1. THE PROCESS
I will start off with quick overview of some of the scientific concepts of Ketosis and Ketogenic Diets.
Your body and brain mainly run of blood glucose (primarily from dietary carbohydrates) circulating in the blood to keep everything running. In periods of low carbohydrate consumption, the body will switch to converting fats to fatty acids and ketones. While things like your muscles can indeed use fatty acids for fuel, they do not serve as fuel for the BRAIN. This is because they are bound to albumin in plasma and so do not traverse the blood-brain barrier. In starvation, ketone bodies generated by the liver partly replace glucose as fuel for the brain [1].
Of course, because this is not a black/white or on/off process, "ketosis" is when your body produces ketones that surpasses a threshold where organs such as brain will then more run on ketones then carbohydrates. This is done by a diet restricting carbs and protein leading to more fat consumption to yield these higher ketone levels [2]. This is called being "Keto Adapted". Whether or not some individual falls under this state can be determined by measuring a variety of physiological markers. Fatty acid metabolism can be analyzed by looking at their respiratory exchange rate and blood markers. In addition, someone who is keto adapted will have:
increased levels of ketolytic enzymes
increased levels of fatty acid oxidative enzymes
decreased levels of carbohydrate metabolic enzymes
decreased levels of insulin
A particular individual's carbohydrate/protein intake that results in ketosis depends on factors including, but not limited to, their lean body fat %, training, and how quickly the body metabolizes circulating blood glucose.
The ancient Greeks were the first to observe the benefits of ketones in order to treat epilepsy in children through fasting. The fasting lowered blood glucose levels and increased ketone levels. In the 1920s and 30s the term "Ketogenic Dieting" was derived from the production of ketones seen in low carbohydrate consumption. Through advances in pharmacological agents in modern medicine, ketogenic diets were reserved to treat these seizures or other neurological conditions [3][4]. The diet was later rebirthed in the 1980s and 90s as a popular weight loss diet.
At times, the Ketogenic diet was termed the 4:1 diet due to older guidelines recommending a ratio of 4g of dietary fat per gram of protein and carbohydrate. Today there are several prevalent guidelines including higher protein variations recommending 50g-150g/day of carbohydrates or less [2]. Most people when using the phrase ketogenic diets refer to a Low Carb/High Fat (LC/HF) dietary breakdown or macronutrient partitioning.
2. MISCONCEPTIONS
There are a multitude of misconceptions when it surrounds the Ketogenic Diet. Most claims support Ketogenic Dieting as the most efficient fat loss diet on the market. The first point to make is that when creating a successful fat loss diet for an individual, there are several factors that must be taken into account before devising an attack plan. There is a hierarchy of general principles that are the most important when creating a fat loss diet.
These principles outline important variables to give attention. Some variables include caloric consumption, macronutrient partitioning, micronutrient consumption and meal frequency. An individual’s diet will detail what kind of changes need to be made to the variables in the current diet to yield the most optimal results for the client's specific needs.
A general population individual who is overweight at 30% Body Fat looking to lose 20 lbs over the course of the year will only need to worry about the 80-85% of the general principles that work for mostly everyone, as adherence will be the key. On the other hand, a Natural bodybuilder currently pushing 5% Body Fat in the weeks leading up to a competition will have to dip in to the finer details of optimality to achieve the results he or she wants.
Understanding the above means that no matter how optimal in theory the Ketogenic Diet is, it is just a tool in the toolbox. To build a solid physique or even a house, there are a multitude of tools to use. Some tools are important in all diet plans, while some should be considered optional. For certain individuals, using one tool may hinder or help along building your ideal physique. I will touch on later where this "tool" can work and where it will not. But for now, I will dive into how good this dieting tool is in relation to other dieting tools.
MISCONCEPTION 1: NON-HYPOCALORIC KETOGENIC DIETS > HYPOCALORIC DIETS
The one essential tool needed for weight loss is a caloric deficit. Without a reduction in calories from an individual's maintenance calories, fat loss simply does not happen. Exceptions to this case include relatively untrained individuals and those using performance enhancing drugs. It is impossible to bypass the physical laws of thermodynamics. If you burn the same amount of energy as you consume, the system will be in balance and no weight loss will happen. Based on this very basic scientific principle, hypocaloric diets will always supersede Ketogenic diets that are not hypocaloric [6].
Not to mention, for general health benefits fat loss itself yields beneficial changes in metabolism. Fat loss has been shown to improve blood pressure, lipid profile, and other cardiovascular risk factors as well [7][8].
Ketogenic Diets love to coin the phrase "eat more fat/burn more fat", which is true. If you have more dietary fat, then of course you will burn more fat. But if not in a caloric deficit, then you will not burn primarily BODY fat for fuel, only dietary fat.
MISCONCEPTION 2: ISOCALORIC LOW CARB/HIGH FAT > HIGH CARB/LOW FAT
As talked about in MISCONCEPTION 1, calories are the key to body fat loss. Now what about more efficient fat loss? If two diets are both in a caloric deficit and at the same caloric deficit (termed "isocaloric"), then it does not matter whether it is LC/HF or HC/LF. There are no partitioning benefits on a physiological level. There may perhaps be benefits to both on an intuitive level on choosing one vs the other, which I will touch on later. The size of the caloric deficit is what matters not the macronutrient ratio of carbs/fat [6][9][10]
An important point also to touch on is the role of protein in relation to the Carb:Fat Ratios. Most ketogenic diet studies supporting more fat loss on a LC/HF diet are also Higher in protein than their "isocaloric" HC/LF counterparts. First off, a higher protein consumption on a hypocaloric diet will help retain lean body mass. This leads to more body weight being that of body fat than a diet with less than sufficient protein (in the case of the HC/LF diets in several studies). I also say "isocaloric" because an increased protein consumption results in an increased effect of the thermic effect of food [5]. In short, this means your body ends up spending more energy to digest this added protein resulting in a larger calorie deficit than its isocaloric counterpart containing a smaller protein percentage. This can result in some studies claiming ketogenic diets are better at fat loss when isocaloric, but in reality the subjects are in a larger caloric deficit due to the increased thermic effect of food.
Therefore, in isocaloric conditions along with equal protein consumption, HC/LF=LC/HF.
MISCONCEPTION 3: CONTROLLING INSULIN IS KEY TO BURNING MORE FAT
A big argument for the Ketogenic diets revolve around the hormone debate, primarily giving insulin a bad rep. Insulin, in short, is a storage hormone that is released by the pancreas to signal the start of several pathways. These include glucose being stored in the muscle and liver, amino acids being taken up by our muscle cells and body fat being stored. Before going on it is important to touch back on 2 important points discussed earlier.
1. The First Law of Thermodynamics says that energy can only be transferred, not created
2. The body is a dynamic SYSTEM depending on a host of variables that themselves can change other variables
Isocaloric, protein equated HC/LF diets will signal the release of more insulin than those of LC/HF ones. But when looking at the body as a system it is obvious as to why insulin does not necessarily correlate with more body fat gained or less body fat lost while dieting. If controlling calories in a HC/LF diet, you have more insulin BUT less fat to drive into adipose tissue. On the reverse end, LC/HF diets produce less insulin, but have MORE fat available from diet to subsequently drive into adipose tissue.
MISCONCEPTION 4: HIGH KETONE LEVELS=MORE BODY FAT BURNED
Continuing off of MISCONCEPTION 3, you do not need high insulin levels to store body fat. Carbs as we know can be converted to fat through the process "de novo lipogenesis".
Now how hard do you think the body has to work to turn dietary FAT into body FAT? It’s not very hard.
A measurement tool that can be evaluated for ketosis is ketone levels. Touching from points made earlier, higher ketone levels are the result of the decreased consumption of carbs and protein AND the subsequent increase of dietary fat to counteract the subtraction in calories. Therefore, you burn more FAT on a low carb diet because you are simply eating more dietary FAT. Elevated ketone readings to do not necessarily mean that this is from the individual burning more body fat, but perhaps due to the fact of increased dietary fat.
It all comes down to a balance of storage vs oxidation which I will hammer on again, is determined by caloric intake. The body is a dynamic system and if you eat carbohydrates, it will primarily use carbohydrates as fuel and vice versa for fats.
3. WHERE IT WORKS
Based on the misconceptions I have laid out, as it stands today there is high probability that Ketogenic Dieting (or LC/HF) is indeed not superior to HC/LF diets as a dieting tool for fat loss. Now continuing from MISCONCEPTION 2, there are a multitude of variables that are influenced from starting a Ketogenic Diet. The change to these variables subsequently result in fat loss. Most of these altered variables revolve on changing the most important principle in fat loss, the caloric balance of an individual.
The following scenarios either lead to a direct decrease in caloric deficit or an indirect decrease through a variable than will then directly decrease it:
1. EASY TO HYPER-FOCUS CUTTING OUT A FOOD GROUP: A very easy way to shave calories from one's current diet is to just cut out an entire food group. This decrease in food selection makes the individual eat less when they consciously avoid foods containing any amount of carbohydrates, resulting in a caloric deficit. Which in turn leads to point number 2.
2. DECREASED CONSUMPTION OF HIGHLY PALPABLE FOODS: The obvious is a conscious decrease in sugar consumption, which does justice for drastically reducing caloric expenditure due to the palpability of sugary foods. But with these even comes a decrease of the most palpable foods, aka those containing high amounts of sugar AND fats. For example, Ketogenic guidelines will most likely lead to a reduced consumption of foods such as donuts, pizza, cakes, and chips that are contain sugars along with the extra calories they contain with fats. Not to mention, most snacks contain primarily carbs, although usually not without a sneakily unnecessarily high fat content (ex. Belvita Cookies, but the snacking topic I will hopefully touch on another day by itself).
3. INCREASED FOOD AWARENESS/MINDFULLNESS: Just having more of an awareness of selecting foods to fit the Ketogenic guidelines will most likely result in a caloric deficit. This is done by being more mindful of food selection and portion sizes. Since Vegetables are low in carbs and filling, many people on Ketogenic diets tend to increase their vegetable intake from their former baseline. The process of planning out meals and being aware of what actually goes in and out of your body in itself results in a decreased caloric deficit.
Not to mention the beginning of a new diet most of the time correlates with a new or more consistent workout regimen with the end goal being overall health in a multitude of lifestyle changes. All of which contribute to increasing the overall caloric deficit.
4. THE SCIENCE/MARKETING CAN HELP "BUY IN" TO THE PROCESS OF DIETING: Even with people being misinformed about what it really means to be in a ketogenic state and its optimality, the marketing behind ketogenic dieting helps people get on board. Those with a scientific background might be more willing to start dieting and making healthier lifestyle changes. This is due to the main points of the diet revolving around the physiology of what the body is going through. In other words, it makes it easier for the individual to trust the logic behind the diet and thus adhere to it. Since adherence to the plan is step number one, these individuals will already be set up for success to stick to their plan and develop good habits.
5. HIGHER PROTEIN CONSUMPTION: With pretty much only two food groups to choose from, an increase in fat will also be paired with an increase in protein for most people above their former baseline. Protein as a macronutrient results in higher levels of satiety and increased levels of muscle protein synthesis which both in themselves indirectly lead to an improved body composition [5]. This is especially the case if the high protein levels are kept there for a long period of time.
6. SYSTEM OF FEEDBACK LOOP LEADS TO CONTINUED ADHERANCE: One variable that can also be equally harmful to an individual can at times provide positive feedback. In a theoretical isocaloric situation comparing an individual switching the macronutrient ratios of their given caloric intake from HC/LF to LC/HF will result in scale weight decreases. The reasoning will be touched more in section 4. This initial drop in scale weight due to switching to low carb on top of reduction of a multitude of other factors contributing to scale weight (including sodium reduction due to less food, decreased gut content due to lower caloric intake) can start a feedback loop.
The misunderstanding of scale weight as actual body fat lost versus just being a transient effect may result in some individuals to further buy into the process of ketogenic dieting. This will lead to a continued trend of previously mentioned positive habits.
7. SOME INDIVIDUALS "FEEL BETTER" DOING KETO: Sometimes it just comes down to someone enjoying the process of ketogenic dieting. There are many dieters that opt for the LC/HF solution because it helps them stay on track and gives them the perception that it is working. At the end of the day, if something isn't broke, don't fix it. If doing ketogenic dieting results in staying in a caloric deficit when trying to lose weight, keep doing it. For some, it is easier to incorporate Ketogenic dieting into their lifestyle. In this case, no amount of opposing research can defy personal anecdotes for someone that has a track record of staying on track with the adherence aspect.
4. WHERE IT HURTS
Now where the above situations at times result in beneficial effects resulting in a caloric deficit or further adherence to the process, there are scenarios where the opposite happens based on the guidelines set out by the ketogenic diets. Here are a few:
1. CARBOHYDRATES BENEFICIAL TO TRAINING: Carbohydrates are the preferred fuel source for the brain and the muscles. Carbohydrates are stored in the muscles as glycogen to then be used for energy in resistance training. If your goal is to maximize results in the gym while retaining as much muscle mass as possible, it is a better strategy to use carbohydrates to have productive workout sessions. Performance will dip due to low glycogen storages and decreased nervous system drive that comes with the lack of carbohydrates.
Think of it this way: If you were trying to build as much muscle mass as possible, would you cut out carbohydrates? The answer does not make sense and the same can go for those using resistance training to preserve muscle while dieting down. While Ketogenic dieting has been shown to at least preserve progress in strength training in a caloric deficit, there is not much to back it up to maximize results. The machinery that signals the pathways to muscle protein synthesis is inhibited while on lower carbohydrate diets.
2. DEMONIZING A FOOD GROUP: Cutting out an entire food group makes it easier to cut calories, but it also has many detrimental effects. There are a multitude of carbohydrates that work well in any diet centered on losing weight. This includes fruits, whole grains, and higher fiber starches. Some great dieting foods include apples, sweet potatoes, berries, beans, and whole-grain pasta & breads.
Not to mention, that it is a bad habit to demonize an entire food group as BAD. Seeing foods as Good vs Bad shifts the mindset to more black and white. This can result in a more restricted and non-flexible mindset. When carbohydrates are re-introduced to the system or eaten at events/ "cheat meals", then there can be a detrimental feedback loop of guilt that sets. This is because of the extreme approach to completely take out a specific food group.
3. LOW VOLUME FOODS: Dietary Fat contains 9 calories/gram while protein & carbohydrates contain 4 calories/gram. This means that per volume of food, fats end up having the least volume of food/caloric value. This can be an issue because meals containing high fat/low carbohydrate end up not taking much space up on a plate and in the stomach. This ends up leading to less time spent eating and may trick your body into overeating.
If doing ketogenic dieting intuitively, meaning not tracking caloric intake, it is easier to overeat on fattier foods because of their higher energy density. Misjudging an extra 10 grams of Peanut Butter versus misjudging an extra 10 grams of Sweet Potato contributes to more calories eaten due to human error. Over the course of a day and week, the miscalculations come easier to come by and can mask the progress being made.
4. WATER WEIGHT SCALE FLUCTUATIONS: As a coach, we love consistent, accurate data from our clients. This makes our job easier and gives us a higher degree of certainty that particular outcomes are indeed happening. Without data, we are blind and it is difficult for us to "diagnose" when procedures and programs are working well and when they need adjustments.
With more experiences with our own diet/training and those of clients, coaches can notice trends and get better at picking out outliers and making sense of the data. This being said, I believe the scale weight fluctuations that come with Ketogenic dieting are a prime example of when the data can be skewed. In addition, without the knowledge of how drastic the changes can be influenced, the feedback of someone doing Ketogenic can be EXTREMELY misleading and can set up the individual for failure.
Glycogen, as touched earlier, is stored in the muscles as well as the liver. Glycogen is about 3-4 parts water meaning 1g of glycogen yields 3-4g of water. Cutting out carbohydrate intake reduces glycogen content in the cells, and therefore water in the body. The average man can hold about 25g/kg of bodyweight of glycogen, which can be increased more with training. From eating a moderate carbohydrate diet at maintenance to dipping carbohydrate intake to Ketogenic Diet guidelines can result in an initial loss of 6-7 lbs of JUST water. Because this is ALL water weight, there is no subsequent fat loss in this initial flush of water by simply just switching the macronutrient composition of your diet.
Now you can see many scenarios where this can be misleading. One can end up actually eating at a caloric surplus on Ketogenic dieting, but still think they are losing body fat because of this drop in water weight. Not to mention, the opposite effect will happen if carbohydrates are acutely RE-introduced to the system, perhaps at an event or "cheat" day. Many people will attribute this increase in transient water weight to fat gain and lead to them completely losing faith in the diet or giving up. Ketogenic diet gives TERRIBLE initial feedback of the rate at which it is actually working. This is ESPECIALLY the case for those who do not have a sound understanding of the physiological principles of what their body is undergoing.
This can even FURTHER the black and white thinking that carbohydrates are "BAD" and continue with the close-minded, restrictive view on food.
5. BASING YOUR DIET ON KETONE READINGS: Another suggestion of particular Ketogenic guidelines is to take Ketone readings. As mentioned earlier, Ketone readings will be higher when eating LC/HF diets. This does not mean that they will be higher if the individual is in a caloric deficit. Chasing higher ketone readings can be easier done by just eating more fat and not being in a caloric deficit. You want to burn BODY fat as a bi-product of already being in a caloric deficit.
Basing whether or not your diet is successful based on your ketone readings serves as a distraction for what is actually important. Important data to concentrate on is calories eaten, training, nutrients, how you feel, and how you look. Don't get caught up in meaningless data that will not provide helpful feedback and will only serve as something to potentially hold you back.
5. STRATEGIES TO HELP
As you can see, there are many productive and counter-productive outcomes that come with Ketogenic Dieting.
Let’s take some of the positives of both sides of the coin and combine them together:
1. Center your carbohydrates around your workouts to get the acute effects of glycogen storage and increased levels of blood glucose. If your workouts are struggling because of Ketogenic Dieting, but you still want productive fat loss, then this is a perfect strategy to incorporate. You can still keep your meals that are farther away from your workouts higher in fat if you enjoy those types of meals to stay on track.
2. If you fear carbohydrates as being bad or find it hard for you to include carbohydrates in your meals without completely going off the rails, then I would recommend the following approach. Center your meals around vegetables as a base, include your lean protein (such as chicken, egg whites, or lean turkey/beefs) and then add your filler carbohydrates last from foods with higher fiber content and higher nutrient content (ex. sweet potatoes or whole grains).
3. If you simply love carbohydrates and hate that you can't eat them on the Ketogenic dieting, then eat carbohydrates. Center your routines on making sure you are in a caloric deficit, eating sufficient amount of protein, and put the carbohydrates to good use with a solid training plan (preferably a form of resistance training). You will find it easier to stick to the plan than Ketogenic dieting and you will get better results with increased adherence.
4. If you find Ketogenic dieting works, but re-introducing carbohydrates at events or "cheat" meals masks how productive your results are, then here is a strategy to use. Include controlled refeeds with carbohydrates, whether it be a couple days long or a week long. Monitor your caloric intake and scale weight during these diet breaks. Assess how your scale weight spikes due to the influx of carbohydrates and by controlling your caloric intake, you can confirm with a higher probability that the scale weight gained is due to water and not fat. This is a productive strategy for those who are okay with restricting carbohydrates WHILE dieting, but once are done dieting want to incorporate them back into their everyday life. It also works for those who have been doing Ketogenic dieting for a while, but want to make a change without stressing about what their scale weight actually means.
I will end this guide with one last point. I have nothing against people who choose to do ketogenic dieting. I encourage those who do it to educate themselves with the reasons of why it works and not buy into the false marketing seen everywhere. I also further encourage those who do Ketogenic dieting to not demonize carbohydrates as a food group. It gets even worse if you try to push the "carbohydrates are evil" agenda on others. A further understanding of the principles that matter when constructing a diet is knowledge that I believe is worth everyone's time to understand and grasp.
I encourage anyone with extensive experiences with Ketogenic dieting to let me know your insights and reasoning for why it works for you. People who take fitness/nutrition seriously and consider it one of their passions at times, is a very niche community. I am always on board with encouraging everyone to share their experiences, be open minded about OTHER'S experiences/viewpoints, and seeking out information that CONTRADICTS what they believe in.
The TRUTH is what matters, not getting attached to one particular mindset. Adapting this mindset is how we together as a community will grow together and pave the way for better overall lifestyle when it comes to our experiences with nutrition and training :)
References:
[1] https://www.ncbi.nlm.nih.gov/books/NBK22436/
[2] http://ajcn.nutrition.org/content/86/2/276.full
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/
[4] https://www.ncbi.nlm.nih.gov/pubmed/9832569?dopt=Abstract
[5] http://ajcn.nutrition.org/content/87/5/1558S.full
[6] https://www.ncbi.nlm.nih.gov/pubmed/1734671
[7] https://www.ncbi.nlm.nih.gov/pubmed/29351490
[8] https://www.ncbi.nlm.nih.gov/pubmed/15007396?dopt=Abstract&holding=npg
[9] https://www.ncbi.nlm.nih.gov/pubmed/8561057?dopt=Abstract&holding=npg
[10] https://www.ncbi.nlm.nih.gov/pubmed/8968851