your ultimate guide to ketosis and ketogenic diets — 601-38

Jill Bridges, SATI STAFF

When looking up effective ways to diet, you may have run across the term “ketosis” and wondered what it means. “Ketosis” refers to a natural state of our body’s metabolism that occurs when our nutrition intake has been altered. Specifically, our bodies induce ketosis when relatively low levels of glucose (a type of sugar) are available in our blood, forcing it to switch to using molecules called “ketone bodies”, which are created by breaking down fat stores.

In other words, “ketosis” refers to a state where our bodies burn fat directly as its main energy source. It occurs when limited amounts of blood glucose are available. Sometimes, this condition happens naturally, such as when people fast, engage in intense physical activity, or have accidental changes to their diet, but other times people purposefully induce ketosis for dietary reasons.

In these cases, these people are said to be eating a “ketogenic diet” that intentionally induces a long-term, consistent state of ketosis. If you want to learn more about ketosis, and the ketogenic diet — including the possible four health benefits of a ketogenic diet — read on.

Is ketosis healthy?

Popular low-carb, high-fat and high-protein diets like the Atkin’s diet, South Beach diet, low-carb diet and paleo diet all try to induce ketosis to some degree, allegedly causing the dieters to lose weight.

But are these diets what we would call “healthy”? Does ketosis actually cause us to lose weight, and are there unintended side effects people of a ketogenic diet should worry about? The short answer to one of those questions is that, yes, putting our bodies in a long-term state of ketosis can cause us to effectively lose more amounts of body fat and body weight compared to a low-fat, calorie restricted diet [1,2].

The longer answer to whether a ketogenic diet can be healthy or create dangerous side effects is more complex. Researchers are still exploring the consequences, and negative side effects are possible if people do not get the balanced nutrition they need.

How is ketosis different from a normal metabolism?

Each cell in our body has its own “power plant” for generating energy called mitochondria. To help our cells and tissues do work that we need to survive, like making our heart beat and our lungs breathe, mitochondria break down bigger energy materials to make a simple material called Adenosine triphosphate, or “ATP.” ATP can be thought of as the basic energy source we need to live. Every day, we make and use our own body-weight equivalent in ATP [3].

Normally, to make ATP, our mitochondria break down glucose, a simple type of sugar that our blood can carry quite easily. When we eat food, it is broken down either in our intestines or our livers into its most simple nutritional components, which include glucose. Our blood then carries this glucose to all of our cells so they can use it to make ATP and then use energy to do work. This type of typical metabolism is called “glycolysis.”

Glycolysis depends on the body eating regularly and getting the amount of calories it needs. Sometimes, we eat more calories than we need, so the body turns excess energy into lipids (fat cells), which can be broken down by the liver when needed. Eating starchy foods rich with simple carbohydrates or foods sweetened with lots of added sugar provides our bodies with the highest quantities of freely available glucose.

Why do bodies go into ketosis?

Our bodies do not always have enough energy available from glucose to survive. This state occurs normally in brief windows, such as in between meals or during intense physical exertion, or it may occur in a long-term situation if someone was not eating enough carbohydrates or sugars to fuel glycolysis.

In these instances, our cells and mitochondria cannot rely on blood glucose to get the energy they need. Instead, our mitochondria can switch to a different energy source, the aforementioned “ketone bodies.” Ketone bodies are derived from fatty acid chains, which are stored in our adipose (body fat) tissues. So, to get these ketone bodies, our liver has to break down fat at a higher rate than usual.

That is ketosis in a nutshell. Our bodies tend to slip in and out of ketosis throughout the day if we are leaving gaps in between meals or engaging in physical activity. People can also purposefully induce ketosis over a long period by eating a “ketogenic diet” — one very low in sugar and simple carbohydrates. By purposefully restricting our diet in this way, we make our bodies more likely to burn fat throughout the day, causing us to lose weight.

Ketosis vs. ketoacidosis — aka why ketosis is not a medical emergency

People can commonly get confused — and alarmed! — when they read about “ketosis” in certain medical contexts. That is because the word “ketosis” can be used as a shorthand for ketoacidosis, an extremely dangerous and possibly fatal metabolic condition. Ketoacidosis only occurs in extreme situations, such as during starvation, sustained periods of binge drinking and as a result of complications from type I diabetes.

While ketosis refers to a metabolic state where ketone bodies are at a higher level in the blood than normal, ketoacidosis refers to an extreme state where the blood is flooded with levels of ketone bodies. Since ketone bodies are mildly acidic, the body must balance out the pH with bicarbonate, a buffering molecule that can be made from carbon dioxide (CO2). In ketoacidosis, this buffering mechanism is overwhelmed, leading to dangerously low blood pH.

Acidic blood can cause huge complications for your metabolism and damage to your organs. Brain tissues can also fail to get the glucose they need because of insulin complications. If left untreated, ketoacidosis can lead to coma or death. Luckily, treating most cases of ketoacidosis is easy. Blood sugar levels can be corrected, and insulin can be added to help the body re-adjust.

Can people with diabetes eat a ketogenic diet safely?

Under normal conditions, people without diabetes will not reach a state of ketoacidosis from eating a ketogenic diet because normal insulin production and normal insulin reactions help the body regulate when to start and stop ketosis. Our brains can also get the glucose we need from things like proteins if our nutritional intake stays balanced.

However, if you have type I diabetes, you should consult your doctor before making major dietary changes like switching to a ketogenic diet. Also, anyone switching to a ketogenic diet should take care to get the nutrition they need to prevent serious conditions. Even though non-diabetic insulin production helps regulate ketone over-production, care should be taken to still eat a moderate amount of carbs (50 simple carbs per day for most people) and get balanced nutrition.

What does a ketogenic diet look like?

Now that you know what ketosis is and how a ketogenic diet induces a recurring state of fat-burning ketosis, you may wonder how, exactly to get started on a ketogenic diet. The answer, as always, is “it depends.” Individuals need different levels of nutrition depending on their age, sex, height, weight, typical level of activity, genetics and their pre-existing condition.

Therefore, you should always consult a doctor or nutritionist for personalized advice before making major dietary changes. You should also always ensure that you are getting proper nutrition even as you restrict things you normally eat. For instance, many people on a ketogenic diet fail to get the needed sodium levels, so you may have to actually add salt to foods to stay healthy [4]!

All that aside, a typical ketogenic diet for a healthy individual above 18 and below the age of 50 might contain around 50 to 60 grams of carbohydrates total a day. Instead of getting calories from starches or sugar, they must get around 80 percent of them from fat. Proteins intake is also increased, although not to the degree recommended in diets like the Atkin’s diet.

A sample ketogenic diet meal plan

A daily meal plan for a hypothetical 28 year old person on a ketogenic diet might look like this (inspired by Livestrong [5]):

  • Scrambled eggs with cheddar cheese, onions, mushrooms and spinach cooked in olive oil with a side of bacon and some avocado slices
  • Spring green salad with pan-roasted salmon, hard-boiled eggs, tomatoes, cucumbers topped with low-carb dressing; handful of almonds as a side or snack
  • Heavy protein dinner, such as oven-baked pork chops, with a side of Brussel sprouts and broccoli topped with a fatty peppercorn cream sauce
  • Snacks can include cucumber slices topped with hard salami, celery sticks covered in almond butter or some cubes of hard cheese
  • Desserts can actually be quite indulgent, such as coconut oil “fat bombs” made with coconut oil, pure cocoa powder, vanilla extract, sea salt, a touch of honey and some chopped walnuts all blended in a food processor, molded into bite-sized chunks and cooled in the refrigerator or freezer overnight

Optimal nutrition on a ketogenic diet

Individuals should be cautious that they do not eliminate important sources of nutrition when they switch their diet to a high-fat, low-carb ketogenic diet. For instance, a daily allotment of 25 grams to 30 grams of dietary fiber should still be ingested, so dieters should be sure to eat non-starchy, fibrous vegetables like kale, broccoli, celery, asparagus, tomatoes, cabbage, cauliflower and leafy greens in general. An optimal mix of vitamins and minerals is essential.

Also, individuals with medical conditions should consult their doctor or licensed nutritionist before making major dietary changes. For instance, women who are pregnant and nursing, postmenopausal women, people with diabetes, people with certain medical dietary restrictions, and individuals with cancer should all speak with their primary care providers to determine the best way to optimize their diet.

When done in conjunction with your health care provider’s input and as part of a balanced nutritional plan, a ketogenic diet can be extremely healthy. In fact, doctors may recommend a ketogenic diet to people with epilepsy, diabetes, cancer or a host of other conditions.

You can read on to learn more about the four biggest health benefits of a ketogenic diet:

1. Highly effective weight loss

The most immediate and obvious benefit of a ketogenic diet is that it usually leads to a state of sustained fat burning and weight loss for the body. Since a ketone state literally induces the breakdown of the body’s fat cells, any amount of in-between meals pause or physical activity can burn fat.

When compared with a traditional low-fat, calorie-restricted diet, researchers have noted a high-fat, low-carb, low-sugar ketogenic diet burns much more fat. One study noted that subjects on a ketogenic diet lost over twice as much body weight and twice as much body fat over a six month period [2]. Subjects lost an average of 18.7 lbs of body weight and 10.5 lbs of body fat.

Evidence from such studies indicates no major side effects or negative health consequences, and one even noted a higher incidence of side effects among those who tried a low-fat, low-cholesterol, reduced-calorie diet compared to a ketogenic one [1].

2. Low appetite cravings

Many people drop out of diets because they constantly feel hunger but cannot snack on the indulgent foods they are used to. Research indicates that not only do individuals on a ketogenic diet have less issues with the food they eat, but they also report less hunger cravings in general [6]. Evidence suggests that a high-protein diet can reduce hunger cravings in between meals, especially when compared with a low-fat, calorie-restricted diet.

Furthermore, reducing the amount of high-carb and sugary foods you eat can have positive effects on your cravings overall. Eating foods that significantly raise your blood glucose levels can lead to a spike and then drop-off, and our bodies often respond by craving more sugar-rich foods [7]. This pattern leads to a “vicious cycle,” which can even destabilize our hormone production balance and lead to diabetes [8].

Ketogenic diets break this cycle while also introducing foods that enhance our feeling of “fullness” compared to rapidly digestible sugars and carbs. If following the nutritional suggestions outlined above, dieters will also ensure they get a healthy daily supply of soluble fiber, which improves feelings of fullness and reduces cravings in between meals.

3. Ability to manage diabetes

Insulin resistance and decreases insulin production in people with diabetic conditions can lead to dangerous conditions, including hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), and ketoacidosis, which is described above. Restricting carbohydrate intake, such as with a ketogenic diet, can reduce the need for insulin and can help individuals better-regulate their blood sugar levels overall [9].

In fact, a ketogenic diet may be even more beneficial for diabetic patients compared to a low-glycemic index diet. In a study comparing the two, the ketogenic dieters had moderately better improvements in hemoglobin A1c levels and weight loss and a significantly better reduction in the need for diabetes medications. 95 percent of the ketogenic group reduced or eliminated their medication compared to 62 percent of the low-glycemic-index group [10].

Overall, eating a ketogenic diet may be a great option for those trying to manage diabetes and lose weight.

4. Improved heart health

Those worried about heart disease or other cardiovascular conditions can obtain measurable benefits from a ketogenic diet. High levels of fasting triglycerides, for instance, are used as an indicator for future heart disease risk. Studies show that carb-restricted diets like the ketogenic diet help reduce the number of triglycerides over time, especially when compared to low-cholesterol and low-fat diets [11].

Another benefit for heart health is that the amount of HDL “good cholesterol” increases. Studies in both diabetics and individuals with obesity conclude that HDL lipoprotein production increases under a low-carb, high fat diet [11,12]. Compared with LDL lipoproteins, HDL helps reduce the amount of cholesterol deposited on artery walls, reducing the risk of heart conditions like cardiac arrest.

Put simply, a ketogenic diet can help your metabolism regulate itself better while reducing common risk factors for heart disease, stroke, diabetes and more.

The Sati line

In sum, ketosis is something the body naturally does and should not be feared by itself. A ketoacidosis condition only usually occurs in type I diabetics or under severe malnutrition conditions. Regardless, care should be taken before changing your diet, so make sure you get optimal nutrition and speak with your doctor if you have a condition or known risk factors.

If you can safely switch to a ketogenic diet, then there are many benefits you will obtain. These include consistent weight loss, better management of diabetic conditions, a possible reduction in epileptic seizures, reduced food cravings and improved heart health. You can also reduce your risk factor for many chronic conditions, including diabetes, metabolic syndrome, heart disease and stroke.

Altogether, a ketogenic diet can help individuals maintain many factors needed for optimal when eaten with balanced nutrition and accompanied by regular exercise.

If these benefits sound like something you want, then go ahead and start trying to reduce your carbs and eating more heart-healthy fats. Now, pass the butter, if you don’t mind!


References
  1. Yancy, William S., et al. “A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia A Randomized, Controlled Trial.” Annals of Internal Medicine. American College of Physicians (2004).
  2. Brehm, Bonnie J., et al. “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.” The Journal of Clinical Endocrinology & Metabolism 88.4 (2003): 1617-623.
  3. Tornroth-Horsefield, S., and R. Neutze. “Opening and closing the metabolite gate.” Proceedings of the National Academy of Sciences 105.50 (2008): 19565-9566.
  4. JumpstartMD. “Role of Salt Intake in Nutritional Ketosis.” YouTube (2013).
  5. Jacob, Aglaee. “Ketogenic Menus & Meal Plans.” Livestrong. Leaf Group (2011).
  6. Mcclernon, F. Joseph, et al. “The Effects of a Low-Carbohydrate Ketogenic Diet and a Low-Fat Diet on Mood, Hunger, and Other Self-Reported Symptoms*.” Obesity 15.1 (2007): 182.
  7. Avena, Nicole. “Sugar Cravings.” Psychology Today. Sussex Publishers (2013).
  8. Samuel, Varman T. “Fructose induced lipogenesis: from sugar to fat to insulin resistance.” Trends in Endocrinology & Metabolism 22.2 (2011): 60-65.
  9. Westman, Eric C., and Mary C. Vernon. “Has carbohydrate-restriction been forgotten as a treatment for diabetes mellitus? A perspective on the ACCORD study design.” Nutrition & Metabolism. BioMed Central (2008).
  10. Westman, Eric C., et al. “The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus.” Nutrition & Metabolism 5.1 (2008): 36.
  11. Aude, Y. Wady, et al. “The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat.” Archives of Internal Medicine 164.19 (2004): 2141.
  12. Foster, G. D., et al. “A randomized trial of a low-carbohydrate diet for obesity.” The New England journal of medicine. U.S. National Library of Medicine (2003).