Author: Malaina Morales, AP
What is a Ketogenic Diet?
A ketogenic diet involves the restriction of dietary carbohydrates within a range of 0-50g (ideally below 20g) per day in order to maintain a state of ketosis, which occurs when the body begins to use fat as a primary fuel source instead of glucose. Ketosis is a beneficial and often therapeutic state in which the body uses stored and dietary fat to make ketones for energy. Evidence suggests that it is effective for lowering blood glucose and insulin levels, reversing dyslipidemia, and reducing body weight.1
Understanding Your Hormone-Regulated Metabolism
Insulin is a peptide hormone secreted by the beta cells of the pancreas in response to rises in blood glucose. Among other functions, it is responsible for allowing glucose to enter your body's cells and leave the bloodstream. Under normal conditions, this maintains a normal blood glucose level. When insulin becomes pathologically elevated due to frequent blood sugar spikes, insulin resistance can occur. This happens when the body's cells become desensitized to insulin's effects. This can allow excess sugar to remain in the blood, leading to hyperglycemia. Insulin also has the additional function of blocking Hormone-Sensitive Lipase, the hormone that is responsible for liberating fatty acids from our fat cells. This is partly why chronically elevated insulin can make it extremely difficult to lose body fat.
Restoring Insulin Sensitivity and Blood Sugar Stability
In individuals with insulin resistance, blood glucose tends to spike higher and remain higher longer. It is well-documented that persistent hyperglycemia leads to the complications seen in Type 2 Diabetes, which includes damage to the nerves, arteries, eyes, kidneys, and heart. Therefore, insulin-resistant individuals may benefit from removing foods that lead to high insulin and glucose levels. These foods include but aren't limited to: bread, pasta, rice, potatoes, and sugar. Simply put, lowering carbohydrate intake and focusing on healthy proteins, fats, and vegetables will help to restore normal insulin function by normalizing blood glucose and insulin levels.
While ketones fulfill much of our energy demand on a ketogenic diet, some glucose is still necessary. Glucose is essential for human life; so how do we get it on a ketogenic diet? The simple answer is gluconeogenesis, a process in which the liver (and kidneys to a lesser extent) synthesizes glucose from several non-carbohydrate substrates including lactate, glycerol, and certain gluconeogenic amino acids such as alanine. Thanks to this process, we can make all the glucose we need while deriving 0% of it from dietary carbohydrates. Yes, that's right: dietary carbohydrates are not essential or required. The liver is designed to efficiently meet our energy demands by synthesizing the right amounts of glucose and ketones (no more, no less) to keep our blood sugar levels stable. Blood sugar stability is the key to losing weight, restoring insulin sensitivity, and improving metabolic health.
Misconceptions About the Ketogenic Diet
1. You will lose muscle mass
Although ketones are present in both circumstances, a ketogenic diet is not the same as starvation. Loss of muscle mass can occur due to starvation or inadequate protein intake, but neither is the case for nutritional ketosis. As long as you ensure adequate fat and protein intake, muscle loss should not be a concern. The amino acids used for gluconeogenesis will come from dietary protein, not your skeletal muscle. In addition, ketones have a muscle-sparing effect.3
2. You will only lose water weight
It is true that diuresis occurs during the first few days of ketosis. As insulin levels drop and glycogen stores get depleted, your kidneys will start to release water and sodium. After this initial phase, the body will regulate its water balance and begin to utilize fat tissue for fuel.
3. It will increase your risk of heart disease
A ketogenic diet may actually help to reduce heart disease risk by reducing body weight, increasing HDL, lowering triglycerides, reducing harmful Pattern B (small, dense) LDL, lowering the triglyceride to HDL ratio, reducing plasma insulin and blood glucose levels, reducing inflammation as measured by hs-CRP, and lowering blood pressure.4 5 6 Some individuals do experience elevations in LDL cholesterol, however; evidence indicates that LDL should not be painted with a broad brush, as the atherogenicity of Pattern B (small, dense) LDL is much more significant than that of Pattern A (large, fluffy) LDL.7
4. There is a risk of ketoacidosis
Ketosis is not the same as diabetic ketoacidosis. Ketoacidosis is a potentially life-threatening complication of diabetes in which the pancreas is unable to secrete insulin, causing blood glucose levels spike to extremely high levels. Without insulin, glucose is not able to enter your cells, creating an energy crisis. To compensate, the body begins to make extremely high levels of ketones that are not seen in nutritional ketosis.
5. You can start and stop keto and keep the weight off
To obtain maximum benefit and results, it is recommended that you sustain ketosis long-term and avoid stopping and starting the diet. This is especially crucial if you are insulin-resistant, as it takes time to heal a malfunctioning metabolism. If you decide to transition off of it, we advise a lower-carb approach (100g/day) focused on whole foods in order to maintain your results.
6. Keto is a Fad Diet
It is estimated that Homo Sapiens evolved from early hominids between 200,000 and 300,000 years ago. Before the advent of agriculture about 12,000 years ago, our ancestors may not have had reliable or consistent access to plant foods or carbohydrates. It is speculated that fruits and edible tubers were sometimes available, but many plant foods that we consume today either did not exist then or were inedible and populations living in harsh climates likely had to derive most of their food from hunting. For much of human history, ketosis was a normal physiological state, whether food was scarce or the only available food sources were animals.
It has been demonstrated that a ketogenic diet is a safe and effective way to lose weight and improve markers of metabolic health. We utilize this approach to help those with disorders of insulin regulation such as Type 2 Diabetes, prediabetes, obesity, and dyslipidemia. There are endless ways to tailor the diet to suit your own individual needs and preferences. Integrative Care will offer you all the support and guidance you need to help you find what works best.