ketogenic diet

All About the Keto Diet, How It Works and Should You Try It?

Everyone seems to be carried away by the wave of this latest fashion, the ketogenic diet. Although it has been in use since 1921, it seems to have gained popularity recently. The benefits of the keto diet have been championed by many celebrities.

The ketogenic diet was first invented by Russell Wilder. It was used as a treatment for epilepsy and had its own medical relevance as a food choice for pediatric epilepsy. With the advent of antiepileptic drugs, the diet has lost its importance.[1]

The keto diet has driven dozens of people crazy with its effective results on weight, muscle gain and bodybuilding.

ketogenic diet

The idea behind the keto diet changes the way the body metabolizes the food you eat. It diverts the burning of carbohydrates from the burning of fats by reducing the consumption of carbohydrates and accumulating fats with a moderate amount of protein.

A keto diet can be followed for as short as 2 to 3 weeks and can be extended up to a year. However, a slow transition from a keto diet to a regular diet and vice versa may be better tolerated.

What is a keto diet?

The key macronutrient in the keto diet is fat and it is the primary source of fuel. A keto diet is a diet high in fat, low in carbohydrates and moderate in protein. This generally results in a food intake of:

  • Fat reaching 65 to 75% per day
  • Proteins as moderate as 15-20% per day
  • Carbohydrates as little as 5-10% per day

Being on a keto diet can mean that you eat more heavy cream, oily fish, oils, avocados, seeds, nuts, and low-carb green leafy vegetables and that you give up all of your carbohydrate treats staples such as cereals, rice, potatoes and fruits, to name a few.

Keto diet types

It is recommended to choose your diet taking into account your fitness goals and the type that best suits your overall health.

A study published in 2018 in the Indian Journal of Medical Research mentions four types of keto diets.[2]

1. The Standard Keto Diet (SKD)

The standard keto diet is the most widely used and highly recommended type of keto diet.

Carbohydrate, protein and fat measurements in grams are as follows:

  • 20–50 g for carbohydrates
  • 40–60 g for protein
  • No fixed bars for fat content

2. Targeted Keto Diet (TKD)

The targeted keto diet is aimed at physically active people, including athletes, fitness enthusiasts and trained people.

This diet consists of eating 25 to 30 g of carbohydrates just before an hour of exercise. These carbohydrates can also be taken after exercise. Since exercise can increase your need for carbohydrates, you can customize your diet for an additional source of carbohydrates to provide energy for physical activity.

Athletes, or anyone who exercises, can improve their fitness and muscle mass more when performing a TKD than when doing a SKD.

3. Keto cyclic diet (CKD)

The keto cyclic diet is a great idea for people who want to lose weight but find the dietary restrictions daunting.

This type becomes easy for the individual by switching between low carbohydrate diet periods followed by a high carbohydrate period towards the end of the week.

This diet is mainly recommended for advanced athletes, including weightlifters, professional athletes and runners. Dieting for part of the week can make their bodies more flexible in using fat as fuel.

Before their match or competition, they can replenish their glycogen levels by consuming a diet rich in carbohydrates for 2 days. This will give their muscles maximum glycogen storage, which can be beneficial for physical activity.

4. High protein keto diet (HPKD)

The protein-rich keto diet follows the lines of the Standard Approach (SKD), but the protein level is different. In HPKD, you need to increase your protein intake to significant levels.

A higher protein-to-fat ratio in your diet can help the body lose stored fat, maintain lean muscle, and build muscle during exercise. When following HPKD, it is recommended that you increase your protein intake to 1.5 g per pound of your lean muscle mass.

Note: Standard and protein-rich keto diets are more common and have been widely used by people, while cyclical and targeted approaches are the latest methods used by athletes and weightlifters to monitor their physical and nutritional intake. However, the standard method remains the most studied method. Consult your healthcare team for personalized advice on the keto diet and your health.

This article covers the different aspects of the keto diet according to the standard approach.

The science of the keto diet

The key to maintaining a healthy body weight is to maintain a balance between energy intake, energy expenditure and to be aware of the nutrient density of what you eat. Carbohydrates, fats and proteins are the macronutrients necessary for your body’s livelihood.

While there is no single approach to weight loss, some studies suggest that low-carbohydrate diets are associated with a reduced risk of cardiovascular disease and weight loss.

A meta-analysis of randomized controlled weight loss studies (over 1 year) suggests little or no evidence to prescribe low-fat diets for weight loss. In fact, low-carb diets have resulted in greater weight loss.[1]

Your body is programmed to convert carbohydrates from your food into glucose. This glucose is the instant fuel that provides your body with the energy it needs to get through the day.

When there is a lack of glucose due to a shortage of carbohydrates (fasting or skipping meals), your body begins to break down glycogen deposits, then fats and finally proteins. When you reduce carbohydrates to a seemingly low level, you also reduce your glycogen levels and speed up the breakdown of fat.

Once you are low in glucose and there is no more glycogen to metabolize, your body releases fat from fatty tissue. Fats are metabolized in the liver, where they are broken down into ketones. These ketone bodies are then used as an energy source once the body’s glucose levels are depleted or too low. This is the idea behind the keto diet.

The keto diet reorganizes the body’s metabolism by making fat the main source of energy. It uses fat to generate energy rather than storing it.

Once your body has reached ketosis, your ketone level will be around 0.8 millimole / liter. You can test it using urine strips, a blood meter, blood sticks or a breath analyzer for acetone levels.

Who should not try the Keto diet

Some cases warrant caution when pursuing a keto lifestyle.

The keto diet is contraindicated in patients with:

  1. Pancreatitis – inflammation of the pancreas
  2. Liver disorders that have compromised function
  3. Fat metabolism disorders
  4. Primary carnitine deficiency – a condition in which the body is unable to use fat for energy
  5. Carnitine translocase deficiency – a rare autosomal recessive disorder that limits the conversion of long-chain fatty acids to energy, mainly during periods without food
  6. Porphyria – the accumulation of chemicals that produce porphyrin, an essential component for the functioning of hemoglobin in the body
  7. Pyruvate kinase deficiency – an inherited disorder that affects the enzyme pyruvate kinase, which can affect your red blood cells

While some studies suggest that the keto diet is safe for most people, its long-term safety is not yet fully understood.

Benefits of Following the Keto Path

benefits of the keto diet

Some studies have shown that the keto diet is associated with certain health benefits.

Helps you lose weight

Keto has been used successfully by some people to lose weight quickly. Following a restrictive diet short of carbohydrates can help conserve muscle mass and reduce body fat to a large extent.

A 2014 study said that a low-carb diet can help people lose weight. Recently, studies have been conducted on the keto diet to highlight its relevance.[2]

A 2018 study published in the Journal of the International Society for Sports Nutrition found that following the keto diet can be an alternative dietary approach in men to reduce fat and visceral adipose tissue while maintaining lean body mass.[4]

Stop your hunger

Most of the foods included in the keto diet can keep you full for a long time. The snacks recommended in the keto diet fill up even in small quantities.

Unlike other low-calorie diets, the keto diet can help keep hunger hormones (such as ghrelin) low and appetite suppressing hormones (such as leptin) high.

Can help with mental clarity

The keto diet can help clear the fog in your brain and clear your mind.

The keto diet has been used for its neuroprotective effects in brain disorders, namely Parkinson’s disease, Alzheimer’s disease and epilepsy.[2]

Although there is some evidence on this, the benefits of this diet on brain activity without these medical conditions require further research on humans.

Stabilizes blood sugar levels

With a relatively low carbohydrate intake, the keto diet can help people with high blood sugar.

The human body makes the enzyme insulin to lower blood sugar after eating carbohydrates. A person with diabetes and insulin resistance will need to take medication to lower the sugar level due to the functional inability of insulin in their body.

A study in 2017, published in Nutrients, indicates that obesity can be accompanied by the development of insulin resistance and type 2 diabetes in many cases. It also suggests that a keto diet can help lower the rising blood sugar in these people.[5]

A keto diet can help stabilize the sugar levels in these people by reducing the level of carbohydrates in their diet and preventing an increase in blood sugar. It can also help keep their energy levels at an optimal level.

Risks with the Keto Diet

There are risks and potential concerns when you follow a keto diet. These include:

  1. Having high cholesterol in your diet can put you at risk for heart disease.[2][3]
  2. The ability of this diet to lower sugar levels to a low level may risk the well-being of patients with diabetes or hypoglycemia. People with diabetes who take insulin or medications to manage their sugar levels should consult a doctor to adjust their medication before starting the keto diet.
  3. Nutritional deficiency can occur due to the absence of various micronutrients, including magnesium, phosphorus, selenium and even essential vitamins A and C.
  4. Lack of fiber in the diet can lead to constipation problems.
  5. Low levels of carbohydrates can reduce the sugar levels necessary for normal brain function. This can cause confusion, fuzzy thoughts, irritability, and mood swings.

It is highly recommended that you seek the help of a registered dietitian before changing your diet to keto.

What is Keto Flu?

Some people on the keto diet may experience symptoms called “keto flu”[1] once they hit ketosis.

These symptoms appear as a result of the body’s transition to get its energy needs from carbohydrates to fats. The keto flu is short lived and may go away in a week or two once the body has adjusted to the keto diet.

Symptoms of keto flu include:

  • Nausea
  • Tired
  • Headache
  • Dizziness
  • Muscle aches
  • Fog

As these symptoms may have been caused by the electrolyte imbalance, these can be prevented by drinking lots of water and monitoring your salt intake. However, consult your doctor if you have hypertension.

A Complete List of Keto Diet

The keto diet is about the amount of fat, protein and carbohydrates you take in a day. To respect the nutritional quantities, it is necessary to keep abreast of nutritional facts and food inclusions and exclusions.

Foods to include

foods to eat keto diet

1. Natural fats

The cornerstone of the keto diet is fats. Eat foods high in fat like eggs, Meat, lard, tallow, and fish will serve to provide a high fat content to the diet.

Also add oils rich in fat such as coconut, red palm, Lawyer, or olive oil in your preparations. You can also use clarified butter, ghee, or MCT oil in your dishes.

Include high-fat sauces such as garlic butter and béarnaise sauce in your meals.

2. Vegetables growing above the ground

Vegetables growing above the ground tend to have fewer carbohydrates per serving than those growing below the ground and growing along the roots.

Keto-friendly vegetables include cauliflower, broccoli, Zucchini, cabbage, and leafy greens like lettuce, spinach, and kale. Besides being low in carbohydrates, these vegetables also provide a source of fiber, antioxidants, vitamins and minerals.

You can fry these vegetables in high-fat oil or butter and eat them with high-fat sauces and dips.

3. Dairy products

Dairy products that match the keto diet are Butter, high fat cheese, heavy cream, and small amounts of natural fat-rich yogurt. However, milk and low-fat sugary yogurts and beverages such as café au lait are high in carbohydrates and are not suitable for ketos.

4. Nuts and seeds

Nuts and seeds, for snacks or as part of a meal, are nutritious inclusions in the keto diet. With your dietary needs in mind, you can eat a moderate amount of nuts or seeds on a keto diet. Examples include flax seeds, chia seeds, pumpkin seeds, macadamia nuts, pecans, cashews, Brazil nuts and almond butter.

Note: Avoid nuts coated with sugar and salt.

5. Proteins

Unlike other low-carbohydrate diets, the keto diet is not considered high in protein. Most proponents of the keto diet recommend eating primarily organic, grass-fed, wild-caught or grass-fed sources of animal meat or seafood.

6. Low sugar fruits

Almost all fruits, large or small, have a high carbohydrate content, except avocado and some berries. You can consume:

  • A generous portion of Lawyer, a healthy fruit rich in fats
  • A moderate portion of berries like raspberries and blackberries

Foods to avoid

keto diet foods to avoid

Because the keto diet is about limiting your carbohydrate intake, observe absolute abstinence from carbohydrate-rich foods to get the results you want:

1. Grains and cereals

Whole grains and cereal products are mainly carbohydrates.

Avoid all types of grains (or include a very small portion) such as wheat, rice, oats, barley, rye, quinoa, corn and corn when you are on a keto diet.

You will have to give up cereal products, including bread, pasta, porridge, oats and muesli, among others.

2. Beans and legumes

Although beans and legumes are the source of protein for millions of vegetarians and vegans around the world, they are also a source of carbohydrates. These include lentils and beans of all types such as kidney beans, pinto beans, chickpeas and black beans.

3. Fruits high in sugar

Fruits contain carbohydrates mainly in the form of sugar. Although fruits have an abundance of nutrients, their sugar content makes them limited during a keto diet.

All fruits, including bananas, apples, mangoes and pineapples should be eliminated or strictly restricted on a keto diet, with the exception of avocado and a few berries.

4. Starchy vegetables

Starchy vegetables such as potatoes, sweet potatoes, parsnips, squash and carrots all contain carbohydrates.

Avoid foods prepared from vegetables such as fries and fries.

5. Sugar

Beverages, including soft drinks, sports drinks, fruit juices and even vitamin water contain sugar. Therefore, they should be eliminated when in keto. In addition, the restriction of sugary drinks is recommended for overall health.

Avoid eating sweet treats, including cakes, cookies, candy, donuts, frozen foods, chocolate bars, and donuts.

Note: Always check your market purchase, such as sauces, dressings, condiments, packaged foods and ketchup for sugar labels. Also, keep the use of honey, maple syrup, agave and artificial sweeteners to a minimum.

6. Seed oils

Some seed oils are treated to have a low smoke point and to oxidize when heated. The abundance of omega-6 fatty acids in some seed oils can cause inflammation and increase the risk of heart disease.

Limit seed oils such as corn oil, soybean oil, canola oil, peanut oil, grape seed oil and sunflower oil if you are on a diet keto.

A typical keto meal plan for a day

Once you know the do’s and don’ts of the keto diet, you can plan your meals accordingly. Just focus on the key ingredients of a keto diet – high in fat, moderate protein and carbohydrates.

You can plan your keto meals for a day based on your nutrition level.

  • In the absence of bars on the consumption of total fat for a day, the limit is 20 to 50 g of carbohydrates and 40 to 60 g of protein per day.

You can customize your meals:

  • Your breakfast can include eggs with sautéed vegetables, bacon or sausage, and cold coffee with high-fat milk and heavy cream.
  • Lunch can be a chicken salad or a cup of bone broth, salads with green leafy vegetables, olives, tuna and a blue cheese vinaigrette.
  • Dinner may include a steak with sautéed vegetables.

A typical keto meal plan for a day may look like this:

Breakfast: Almond Butter Yogurt Sundae – For 2/3 cup of whole plain Greek yogurt, swirl in 3 tablespoons of almond butter. Garnish with ¾ cup fresh raspberries.

Mid-morning: Snack on 1 ½ ounces of Brie cheese.

Lunch: Chicken Kale Salad – Take 2 ounces of grilled chicken, 3 cups baby kale and 2/3 of an avocado in a bowl. Add 2 teaspoons of red wine vinegar and 1 tablespoon of olive oil. Mix everything well.

Evening snack: Eat about 15 Kalamata olives.

Having dinner: Sauté 1 cup broccoli and 4 ounces grilled salmon in 1 tablespoon avocado oil.

Total calorie intake for this meal plan: 1620

  • Total fat – 127 g, 25 g being saturated fat
  • Cholesterol – 195 mg
  • Proteins – 85 g
  • Total carbohydrates – 41 g (16 g sugar and 25 g fiber)
  • Potassium – 2765 mg
  • Sodium –1520 mg
  • Phosphorus – 1130 mg

From the chef’s corner

1. Keto pancakes

Ingredients:

For the pancakes

  • 1 tablespoon ground psyllium husk powder
  • 4 eggs
  • 7 ounces of cottage cheese
  • 2 ounces of butter or coconut oil

For garnishes

  • 1 cup thick whipping cream
  • ½ cup raspberries or fresh strawberries

Method:

  1. Add eggs, psyllium husk and cottage cheese to a bowl and mix well. Let the dough rest for 5 to 10 minutes to obtain a thick consistency.
  2. Heat the butter or oil in a saucepan. Pour the batter and fry over medium-low heat, turning after 3 to 4 minutes.
  3. Whip the cream in a bowl until soft peaks form. Use this cream as a garnish with the berries of your choice.

2. Keto Pimiento Meatballs

Ingredients:

Meatballs

  • 1 egg
  • 25 ounces of ground beef
  • Salt and pepper
  • 2 tablespoons butter for frying the meatballs

Pimiento cheese

  • ¼ cup jalapeños or pickled pimientos
  • 1/3 cup of mayonnaise
  • 1 tablespoon Dijon mustard
  • 1 teaspoon chili powder
  • 1 pinch of cayenne pepper powder
  • 4 ounces grated cheddar cheese

Method:

  1. Combine all the ingredients for the pimiento cheese in a bowl. Let the mixture sit for a few minutes.
  2. Add the egg and ground beef to the pimiento cheese mixture and mix with a clean spoon. Add salt and pepper to taste.
  3. Use this mixture to form large meatballs. Fry these balls in oil or butter over medium heat until they are cooked through.
  4. Serve these meatballs with sautéed green vegetables, a green salad or custom dips of your choice.

“Cheat meal” in a keto diet

A cheat meal in a keto diet is not something that is encouraged by nutritionists. It can eliminate ketosis in your system and thwart the purpose of the diet. A typical cheat meal is high in carbohydrates and will increase blood sugar levels in the body, putting a complete end to the body’s current state of ketosis.

A single cheat meal can undo all your efforts to make your body fit for the keto, and you will have to start from scratch so that your body can return to its previous keto state. Not only that, a high carbohydrate meal can raise your blood sugar, negatively affecting your blood vessels.

A study published in 2019 in Science Daily by the University of British Columbia Okanagan Campus confirms that the consumption of a single dose of 75 g of carbohydrates in the form of fries and soda can have harmful effects on health. When you eat a diet high in fats and carbohydrates, eating a single dose of these foods (carbohydrates up to 75g) can damage your blood vessels.[5]

Cheated meals can put you at risk for keto flu. A frequent change in your keto diet to cheat meals can also bring back the symptoms of keto flu, making it difficult for your body to bounce back into the keto diet.

Despite all of the above, we cannot discount the food cravings that you may experience from time to time.

Considering the strict nutritional requirements of a keto diet and the consequences of a cheat meal, being reasonable in your choices can make a huge difference. Try to prepare low-carb versions of your favorite dishes. Make conscious choices when you go out for a cheat meal, or choose to bring out the chef in you.

Additional Tips

  • Whenever you plan to go for a cheat meal, choose something that you really like so that you can start eating again religiously with a satisfied heart.
  • Refrain from snacking indiscriminately. Try to keep your carbohydrate level low so you don’t fall off your keto plateau.
  • Try to follow the keto cyclical diet, so that your hands are free with carbohydrates over the weekend and you don’t have to go wrong with your diet.
  • Remember that the keto diet is not the only way to lose weight. If following the keto diet is not realistic for you, there are other ways to lose weight.
  • The security of long-term membership in the keto diet has not been established.

Resources:

  1. Masood W. Ketogenic diet StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK499830/. Posted March 21, 2019.
  2. Shilpa J, Mohan V. Ketogenic diets: advantage or scourge? The Indian journal of medical research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251269/. Published in September 2018.
  3. Kosinski C, Jornayvaz FR. Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies. Nutrients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452247/. Posted May 19, 2017.
  4. Vargas S, Romance R, Petro JL, et al. Effectiveness of the ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. Journal of the International Society for Sports Nutrition. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038311/. Posted July 9, 2018.
  5. On the keto diet? Skip the cheat day. ScienceDaily. https://www.sciencedaily.com/releases/2019/03/190327112657.htm. Published March 27, 2019

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