In Ketosis Part 1 we discussed:
- What is ketosis?
- Carbohydrate vs fat metabolism; ketone bodies
- Nutritional and starvation-induced ketosis
- Benefits of Ketosis
- An overview of inducing ketosis
- Medium Chain Triglycerides (MCTs)
In Part 2 we will discuss:
- Different types of ketogenic diet
- A more detailed look at dietary composition and dietary fats
- Inducing ketosis
- A meal formula and drinks recipes
Ketosis and the High Fat Diet: Dietary Nuances
Many people are adopting a high-fat diet, and that’s great: incorporating healthy fats into your diet is hugely important for cognition, weight loss, cell-signaling, mineral absorption, and hormone production.1-3 However, not all fats are created equal.
The original ‘ketogenic diet’ was formulated for epileptic patients (for whom it has been a treatment for approximately 90 years, and is comprised of 4 parts fat to 1 part protein, and almost no carbohydrate.
The original ‘ketogenic diet’ was formulated for epileptic patients (for whom it has been a treatment for approximately 90 years 4, and is comprised of 4 parts fat to 1 part protein, and almost no carbohydrate. The principal fat components are whipping cream, cheese, and fatty meats. This helps to put you in ketosis by restricting carbohydrates, and providing enough fats for burning fats (beta-oxidation) and production of ketone bodies. This original diet is effective for its intended purpose: reducing epileptic seizures by inducing ketosis. However, as the quality of much dairy and meat is questionable, due to non-organic farming practices, use of antibiotics in animal feed, and growth hormones to fatten-up livestock, fatty dairy and fatty meats can cause health problems via inflammatory side-effects and raised triglycerides. Furthermore, many people are intolerant to the sugar and protein in dairy, lactose and casein, respectively. A ketogenic diet needs to be thought out a little more intelligently, in order to achieve nutritional ketosis and keep the quality of the diet high by keeping inflammation in check. Remember – overweight and obesity results from inflammation. Inflammatory foods cause systemic inflammation, resulting in hypothalamic inflammation, which results in leptin and insulin resistance causing your body to think you’re thinner than you are, and to hold onto your fat stores.5-9It’s complicated, but this is why calorie restriction alone, and the calories in/out model is flawed.
Care and attention should be paid to the different types of fat, the quantities and ratios of each, and their source which dictates quality. Eating a high-fat diet doesn’t necessarily mean you will be in ketosis, as you need to limit carbohydrate intake; even if you are in ketosis, the types of fats you are eating could be detrimental to your health. What is the overall point here? Eat the correct amount of the corrects fats in order to induce and maintain ketosis without compromising other aspects of your health.
In order to choose what fats we’re going to eat, we need to understand what they are. There are a range of fatty acids (FAs) (called fatty acids because their biochemical structure contains a carboxylic acid group, COOH). From the list below, you can see that they are classified according to saturation and chain-length.
- Saturated FAs have a hydrogen molecule at every position in the carbon chain (dairy, meat, butter, coconut oil, MCTs).
- Unsaturated have open positions for hydrogens that are filled with double bonds between carbon molecules.
- Mono-unsaturated fatty acids (MUFAs) are FAs with only one double bond (olives, olive oil, macadamia nuts, avocados).
- Polyunsaturated FA (PUFAs) are FAs with multiple double bonds (EPA/DHA fish oils, vegetable oils).
- Short-chain Fatty Acids (SCFAs) have a short carbon chain (1-6 carbons). They can be found in butter, and are made by fermentation of dietary fibre in your gut by your intestinal microbiome (bacteria). These have various health benefits.
- Medium-chain Triglycerides, which we have discussed before, have a medium carbon chain length (6-12 carbons).
- Long-chain Fatty Acids (LCFAs) have 12 or more carbons, and include eicosapentaenoic acid (EPA) docosahexaenoic acid (DHA). Recognise EPA and DHA? They’re the magic omega-3 oils that make fish oils and oily fish so healthy.
Here are a few important rules to remember when formulating your diet:
- Maintain a correct ratio of omega 3:6 fats. Eating two avocados a day (MUFA)? Then make sure you’re eat plenty of oily fish (wild salmon, anchovies) and taking an EPA/DHA fish or krill oil supplement.
- MCTs = energy and ketosis. MCTS are processed by the liver for use as energy (by conversion to ketone bodies) and are not stored as fat, so very helpful for putting inducing and maintaining ketosis.
- Saturated fats are solid at room temperature, and are better for cooking, because their lack of carbon-carbon double bonds means they are less susceptible to oxidation, unlike vegetable oils like olive oil. (Read more about this here.)
- High-fat doesn’t necessarily mean healthy. Know exactly what fat is going into your body!
Protein Over-consumption and Insulin: The Enemies of Ketosis
Insulin is a hormone that your body secretes in order to keep your blood sugar levels stable. Too much blood sugar, and insulin tells your body to store the excess glucose as glycogen, the storage form of glucose. How does this relate to ketosis? Too much insulin will prevent you entering ketosis, and insulin spike (like after eating sugar) will take you out of ketosis. This is why one of the main principles of the ketogenic diet is severe carbohydrate restriction; this keeps insulin low and allows the initiation and maintenance of ketosis. However, there is a sneaky mechanism that raises levels of insulin: gluconeogenesis, the process of synthesising (neogenesis) glucose (gluco) from amino acids. Amino acids are the building blocks of protein. If you eat too much protein, there will be excess amino acids within your body which will be used in gluconeogenesis to form glucose; excess glucose will spike insulin and take you out of ketosis! Eat a moderate amount of protein, and try to eat the protein with fibre (like spinach or kale), which will slow down protein digestion and prevent an insulin spike.
High Fat Is Nothing Without Vegetables!
In addition to eating the right types of fat in the right quantities, you need to balance your ketogenic diet with plenty of fibrous veg from SCFAs in your gut. Too many LCFAs (coconut oil) can have harmful effects, which are prevented by fibre and SCFAs.10
How to Enter and Stay in Ketosis
- Eat a high fat diet.
- Severely restrict carbohydrates. Less than 50g per day, ideally less than 30g.
- Eat a moderate amount of protein, always accompanied by some fibre and lots of fat (like MCT oil or raw extra virgin olive oil). Aim for 1-1.5g protein per kg of body weight per day.
- Eat high quality fats and proteins, and avoid poor quality fats and proteins.
- Eat LOADS of vegetables and fibre.
- Incorporate fasting into your regime (fasting also induces ketosis; the ketogenic diet mimics the physiological effects of fasting).
- To help the adaption period to eating high fat, take a betaine HCL digestive enzyme supplement.
Rather than provide recipes, let’s look at a formula, keeping the principles of ketosis in mind.
- Base of fibre: veg and salad (e.g. spinach or kale).
- Some high-quality, fatty protein. (e.g. sardines, wild salmon, eggs, shellfish).
- Loads of fat. Drizzle on raw extra virgin olive oil, MCT oil; cook with ghee and coconut oil; sprinkle over nuts.
Hot, fatty drinks are an amazing way of putting your body into ketosis, maintaining ketosis, reaching the amount of fat you need, and providing various other nutrient-dense goodies like collagen and cocoa powder. They’re quick and easy to make, save time, and are portable.
For all drink recipes, combine by blending. When using tea, stronger flavours like Earl Grey or Chai (like in Chai Latte, which is delicious if you add stevia to sweeten) work better.
- 1-3 tbsp Grass-fed butter or ghee
- 1-3 tbsp MCT oil or powder/’Brain Octane’ oil
- (Collagen (types 1 and 3) optional)
- (Coconut cream optional)
- MCT powder
- Coconut cream
Pre-bed Ketogenic Drink:
Having a drink before bed maintains and increases the levels of ketosis. As your body will have more energy while you sleep, your sleep quality will improve, and you will wake up feeling fresher. The collagen also contributes to this, as it is protein in a very bio-available form, for the growth and repair during the night. A ketogenic drink before bed means you will wake up with higher levels of ketosis; these levels will be further increased with your morning drink, meaning more energy at the start of the day.
- 1-3 Tbsp Grass-fed butter or ghee
- 1-3 Tbsp MCT oil or powder/’Brain Octane’ oil
- Coconut cream/milk
- Collagen (types 1 and 3)
- Tea/cocoa powder
The benefits of the ketogenic diet are undeniable, but it can seem daunting. It’s a lot to remember, and can be difficult to implement, and adherence can be difficult. However, if you’re eating Paleo, and doing it well, the only thing you really need to do is change the levels of macronutrients: reduce carbs, moderate protein, and increase fat. The rest is just in the detail.
- Mitchell, D. C. (2012). Progress in understanding the role of lipids in membrane protein folding. Biochimica et Biophysica Acta, 1818(4), 951–956.
- Graber, R., Sumida, C., & Nunez, E. A. (1994). Fatty acids and cell signal transduction. Journal of Lipid Mediators and Cell Signalling, 9(2), 91–116.
- Iqbal, J., & Hussain, M. M. (2009). Intestinal lipid absorption. American Journal of Physiology. Endocrinology and Metabolism, 296(6), E1183–94.
- Veech, R. L., Chance, B., Kashiwaya, Y., Lardy, H. A., & Cahill, G. F., Jr. (2001). Ketone bodies, potential therapeutic uses. IUBMB Life, 51(4), 241–247.
- De Souza, C. T., Araujo, E. P., Bordin, S., Ashimine, R., Zollner, R. L., Boschero, A. C., … Velloso, L. A. (2005). Consumption of a fat-rich diet activates a proinflammatory response and induces insulin resistance in the hypothalamus. Endocrinology, 146(10), 4192–4199.
- Friedman, J. M., & Halaas, J. L. (1998). Leptin and the regulation of body weight in mammals. Nature, 395(6704), 763–770.
- Friedman, J. M. (2000). Obesity in the new millennium. Nature, 404(6778), 632–634.
- Wisse, B. E., & Schwartz, M. W. (2009). Does hypothalamic inflammation cause obesity? Cell Metabolism, 10(4), 241–242.
- Schwartz, M. W., Woods, S. C., Porte, D., Jr, Seeley, R. J., & Baskin, D. G. (2000). Central nervous system control of food intake. Nature, 404(6778), 661–671.
- The Dark Side Of Coconut Oil: A Cautionary Tale For Coconut Oil Extremists. (2015, December 21). Retrieved from http://www.bengreenfieldfitness.com/2015/12/dark-side-coconut-oil-cautionary-tale-coconut-oil-extremists/