Ketogenic Diet Programming for Success
Ketogenic diets are all the rage as they have been shown in studies to reduce inflammation, improve metabolism and enhance brain function. Many individuals do not know how to successfully enter into and maintain ketosis. Natural ketosis is an incredible physiological state that can be measured and cycled or maintained for excellent health.
Many people continue to confuse natural ketosis with the pathological ketoacidosis. Ketoacidosis is due to an extreme insulin deficiency such as in Type I diabetes and advanced type II diabetes. In this condition the concentration of ketones are ten times higher than in natural ketosis. In ketoacidosis, the blood sugar is also extremely high while in natural ketosis the blood sugar is stable and low (1).
How Are Ketones Formed:
The body has two major energy sources, it burns glucose or ketone bodies. The majority of people burn glucose primarily because they are constantly supplying a steady form of sugar, starches and proteins that can be turned into blood sugar. When one either fasts or goes on a low-carb, moderate protein and high fat diet (which is the foundation of the ketogenic diet), they switch their energy source to fat.
In particular, the fatty acids are broken down into ketone bodies. The three major forms of ketones produced in the body include Acetoacetate, Acetone and Beta-HydroxyButyric acid. These are released into the blood from the liver when insulin levels are low and hepatic liver metabolism is increased (2).
Measuring Ketone Levels:
There are three ways to measure ketone body formation: breath, urine and blood. Breath testing measures acetone, urine measures acetoacetate levels and blood looks at beta-hydroxybutyric acid. Blood measurements are the most accurate but the testing is more expensive. All three areas can help guide you to understand how to maintain ketosis with your unique biochemistry.
The skin prick blood spot test is the most accurate way to measure ketosis. Most people will enter into a light nutritional ketosis (between 0.5-1.0 mmol/L on the meter) within two or three days. It typically takes two to three weeks to get into a stable optimal ketosis of 1.5-3.0 mmol/L (3).
Urine ketosis shows the amount of ketones that are not being used through metabolism. Some people will be in ketosis, yet only show low levels of ketones on their urine strips. Others will show higher levels. The more energy you are expending (exercise, physical work, etc.) the more you will use ketones as an energy source and the less ketones will be in your urine. However, if you were relatively sedentary you may very well notice more ketones in your urine.
The Ketogenic Nutrition Plan:
The body stores protein as lean muscle tissue and carbohydrates in the form of glycogen. During ketosis the body is primarily burning fatty acids in the form of ketosis and it is preserving protein and glycogen stores. This creates a physiological state of fat adaption where the body is burning through fat stores.
The result of fat adaption is improved lean body tissue, better brain function, improved energy and more restful sleep among other things. You become fat adapted by building all your meals around good fats sources such as avocados, coconut oil, olive oil, pastured butter, nuts and seeds and organ meats.
Macronutrient Percentages:
I try not to make too big a deal about macronutrient percentages and personally, I do not measure my own. I just intentionally look to avoid high carbohydrate foods and consume as much good fat as I can. Some individuals following the ketogenic diet want to measure and track and so the best strategy is to have your nutrition plan contain good fat sources making up 60-80% of total calories.
Protein makes up 10-25 percent of calories based on physical demands. Someone who is exercising more intensely will need about 20-25 percent of calories from protein whereas someone is sedentary or doing lighter forms of exercise who should be on 10-15% of calories from protein. Carbohydrates make up around 5-15% of total calories.
Sources For This Article Include:
1. Manninen AH. Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood “Villains” of Human Metabolism. Journal of the International Society of Sports Nutrition. 2004;1(2):7-11.
2. Veech RL.The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins Leukot Essent Fatty Acids. 2004 Mar;70(3):309-19. PMID: 14769489
3. Mitchell GA, Kassovska-Bratinova S, Boukaftane Y, Robert MF, Wang SP, Ashmarina L, Lambert M, Lapierre P, Potier E. Medical aspects of ketone body metabolism. Clin Invest Med. 1995 Jun;18(3):193-216. PMID: 7554586
There has been some concern with ketogenic diets causing hypothyroidism and other hormonal issues, as well as starving good flora. What are your thoufhts on this? Paul jaminet seems rather against this… Also, what are your thoughts on resistant starch supplementation?
Also, how do u maximize peristalsis and minimize constipation? This is a chronic issue for me due to dysbiosis and mycotoxins exposure. I do daily coffee enemas, but am not able to go on my own (this has been a near life long issue).
Bee – I think a ketogenic can be outstanding for someone with hypothyroidism. The key though is to get a lot of good fiber from ground flax, hemp, pumpkin or chia seeds. These seeds are very low carb, mod protein and high in good fats and they contain tons of soluble and insoluble fiber to help move the bowels and improve gut function. Healthy gut microflora produce 20% of the T4:T3 conversion.
Sue – I would also recommend the ground chia, flax, pumpkin or hemp seeds for you. Most likely you will also need a good yeast killer – such as Yeastonil and a good Gut repair supplement like RepairVite
The issue is that seeds and nuts don’t digest well…. I’m trying an autoimmune paleo diet coupled with low oxalate, low histamine, low fodmaps, and anticandida/mold lol. Lots of food intolerances.
What is your views on oxalate.. Seems like the latest research shows it is contributing to several gut and autoimmune issues. Susan Owens is the lead researcher in this and I’d love your thoughts. It seems like many people who try to eat healthier end up getting sicker due to high intake of so called healthy foods that are actually high oxalate
How much coconut oil and seeds (pumpkin seems to be low ox and also anti parasitic) is good per day?
Oddly, coconut (like milks, butter) tend to evoke “binge like” urges to eat more coconut stuff. Idk why…. It did come up as a mild allergen on a test in nov, but I take those with a grain of salt lol. Any idea behind this weird urge with coconut?
I do coconut milk Kefir with meals
Also, what are some good evening snacks? I can’t seem to sleep without something in my tummy
Stacy, I haven’t looked into oxalates as being a problem and haven’t found that with my clients. I will study it more though. Low fodmaps and anti-candida is very smart and the Ketogenic diet is basically doing that. You can use as much coconut oil as you like – I recommend a minimum of 1 tbsp per 50 lbs of body weight.
You probably want the coconut because your body is craving a good fuel source and the MCT’s in the coconut oil provide such a good and easy fuel source. You can have a scoop of coconut oil before bed or a scoop of grass-fed butter on a flax or chia cracker.
It’s mostly coconut milk and coconut butter that sets off these cravings…. And the fodmaps in these makes me beyond nauseous. Any idea what going on? I haven’t been using much in terms of the oil… Just coconut milk Kefir and then the late night overeating of Co butter/milk 🙁
Stacy, those two are probably sugary, therefore causing you to crave sugar.
regarding seeds and nuts … not sure if this solves the issue of not digesting well, but I put my chia seeds, flax seeds and almonds in my Vitamix with a cup of almond milk, some protein powder and cocoa powder and stevia … whir it up till completely smooth, add 1 1/2 – 2 cups ice and it comes out like a soft serve ice cream … soooo good, soooo filling.
That sounds great Sue! Keep up the good work!
with adrenal fatigue do you suggest more carbohydrates while staying in ketosis or more of a cyclical approach? there is a lot of conflicting information if women need more carbs to make proper hormone levels. Thoughts? also, have you seen a LCHF diet affect (decrease) overall WBC count? is there anything that can help raise WBC levels? Thank you!
Hey Addie,
I recommend a cyclical ketogenic diet for adrenal fatigue. One lower carb day and one day with slighly more carbs. But be sure to use a lot of coconut oil and grass-fed butter/ghee so you are continually making ketones.
I prefer to have people get their extra carbs from berries so they get extra anti-oxidants with them.
Coconut oil is really good for WBC’s. Also using lots of antimicrobial herbs such as garlic, onions, oregano, basil, thyme, etc.
I wanted to sincerely thank you for taking your time to reply to my question. Do you suggest one low carb day, then the next day a higher carb day, and repeat? or more consecutive low carb days in a row (2-3), followed by a higher carb day.
Do you think a high fat diet could cause WBC’s to fall or is there little chance of that correlation?
Thanks again! Have learned so much from you. Blessings.
Should I count total carbs or net carbs if I’m trying to stay around 20 grams per day?
You only need to count net carbs Kim. So total carbs – fiber = net carbs
Dr. Jockers
I workout 3-4 a week. Do you have any recommendations using a Keto Macro Calculator. The calculator I found have me on .8-1lb protein which I believe its kind of high. I only have 5lb to loose to get to my goal. My current ratio right now is 60F/30P/10C for weight loss. Any recommendations?
That sounds right Noy. If you are working out intensely than you want about 25-30% protein. So the 60/30/10 should be perfect.
I think you’re missing one element of the program. High oxalate foods tend to be high in biounavailable copper and when you go Keto, your oxalate consumption increases and so does your unbound copper. For nearly a year my family did Keto with lots of spinach, greens, raspberries, nuts, almond flour, xyla and chocolate.
When we finally removed the oxalates, I dumped oxalates for 5 months. (10-15 bowel movements) daily. Multiple other females had the same problem. All the guys in our family dumped oxalates for 2 months. I never would have believed it if it hadn’t happened to us.
Now we are all dealing with a build-up of bio-unavailable copper and iron in the liver. Both caused by Oxalates, HFCS, and enriched products.
Sorry to hear about this Kimberly, thanks for sharing your experience!