The latest buzzword in the world of health and wellbeing is the Ketogenic Diet (KD). Fans swear by its effectiveness in “losing fat while letting you eat fats.” What most people may not know is that “keto,” as it is commonly called, started out as a proven nutritional therapy designed in the 1920s for children with epilepsy. There was resurgence in interest the past decade because of its use in the successful treatment of seizures resistant to anticonvulsant drugs. Rapidly, new KD research spilled over to conditions like cancers, Parkinson’s, Alzheimer’s, and chronic metabolic diseases like type 2 diabetes. The recent shift of KD for “wellness” happened when it was used to improve performance of marathoners and triathletes and to enhance body composition of bodybuilders. Nowadays, it is being adapted for everyday healthy lifestyle, to address needs like weight loss and improved energy and focus.
Eating fat for fat loss
Dr. Ted Achacoso, European Double Board Certified in Nutritional Medicine and Anti-Aging Medicine, and Medical Director of BioBalance Institute, explains how the Keto Diet works. “The body has two main sources of fuel for energy, one is glucose derived from carbohydrates, while the other is fat, including fat-derived ketones. All organs in the body (except the liver which produces the ketones) can use ketones as fuel, and this is particularly important for the brain, heart, and muscles. By forcing the body to go on a very high fat diet with very low carb and medium protein intake, the body is forced to burn fat for fuel, creating a natural state called nutritional ketosis.”
When done right, studied benefits include weight and fat loss, reduced cardiometabolic risk, brain health with mental clarity and focus, and improved longevity and performance.
Last March 8, BioBalance Institute, a nutrition facility, invited Dr. Dominic D’Agostino to talk about “Emerging Applications for Nutritional Ketosis” to over 300 medical practitioners and keto enthusiasts. D’Agostino, an Associate Professor at the College of Molecular Pharmacology and Physiology from the University of South Florida, is a PhD researcher for US Navy SEAL divers through the Office of Naval Research (ONR). Having studied the neuroprotective and anti-cancer effects of ketones for 10 years, he is considered one of the world’s leading research experts on the diet.
D’Agostino explains KD for illness versus KD for health. “I would like to divide the ketogenic diet into two. One is the classic or the clinical Ketogenic diet which is used for the diseases like epilepsy and cancer. These metabolic-based therapies are very strict protocols with very specific ratios of carbohydrates, proteins and fats, so you need clinical supervision. The less restrictive one is the modified Ketogenic Diet, which is used for two purposes: for improving athletic performance and for everyday living.”
D’Agostino first clears the misconception that KD leads to diabetic ketoacidosis (DKA). “DKA most frequently occurs in type 1 diabetics with extremely low insulin levels — and who miss their insulin shots. DKA is very rare in type 2 diabetics unless there is a severe stressor, like a massive infection.”
By far, the most common misconception is equating KD with high protein diets. This comes from the false notion that the reduced carbohydrates are replaced with animal protein sources. The reduced carbohydrates are actually squared with increased fat, not protein. Much of Internet information mistakenly places value on the protein sources and not on the fat sources. “The problem with too much protein is it will actually prevent you from going into the state of nutritional ketosis. There is a phenomenon called ‘gluconeogenesis’ where your body can make glucose from substrates other than carbohydrates,” says D’Agostino. “ In fact, up to 58% of your protein intake can be converted to glucose depending on your fasted state,” adds Achacoso.
As for negative experiences, D’Agostino states, “Some people think the Ketogenic Diet is a negative thing for them. That’s because their experience wasn’t on a truly well formulated Ketogenic Diet that serves their purpose and lifestyle.”
D’Agostino stresses the importance of measuring your ketone levels. He defines “optimal nutritional ketosis” as getting blood level of ketones within 1 to 3 millimolar range for overall health benefits for the general population. There are now available urine, blood, or breath tests that can check if you are on optimal nutritional ketosis. The more advanced method to induce nutritional ketosis via ingestion of the actual ketones (called exogenous ketone supplementation) is being used by the U.S. military to enhance performance and resilience in extreme environments. This method is already at the cusp of going mainstream. D’Agostino and Achacoso already have been testing these exogenous ketones on themselves.
D’Agostino recommends supplements for people on KD. Certain minerals like potassium citrate, magnesium, and sodium can be depleted and supplementation can help balance the mild metabolic acidosis that can happen initially. L-carnitine is also needed for the fatty acid shuttle, so an increased fat intake may increase the need for this. Most people on KD may also benefit from additional fiber to preserve the diversity of the gut microbiota.
Achacoso has applied the ketogenic diet to many clients (like competitive athletes) and patients (like those with cancers or diabetes) in his practice. He stresses that all kinds of diets, keto or not, will induce micronutrient deficiencies that can eventually lead to unfavorable health consequences. “Micronutrients are vitamins, minerals, and co-factors that keep the body humming in optimal health. That is why at BioBalance, we urge you to get your micronutrient levels tested and optimized before you embark on any diet,” says Achacoso.
Once you are micronutrient-optimized, Achacoso will modify your macros based on how active or sedentary your lifestyle is, and based on your goals. He explains, “The modified Ketogenic Diet for everyday health is about increasing fats and decreasing the amounts of the other two macronutrients (carbs and proteins) in your diet. If you are doing resistance training to build muscle mass, however, then you should increase your protein intake. If you are going to be running and jumping, then you should increase your carbohydrate intake. But if you are going to be sitting all day doing office work, then it is best to burn fats for energy. But this does not mean that your calories are ad libitum.”
For lifestyle, Achacoso recommends an easier way to achieve ketosis through time-restricted feeding (TRF) or intermittent fasting. By maintaining an 8-hour feeding window and a 16-hour fast everyday (or even on just two non-consecutive days of the week), your body will naturally go into a state of ketosis during the fasting period and will start to burn fats for fuel. How to take TRF to the next level? “Eat ketogenic during your 8-hour feeding window,” says D’Agostino.