What Is the Ketogenic Diet?
The ketogenic diet is a food regimen that shifts the the body from burning carbohydrate-based fuel to burning fat-based fuel, and it comes with a surprising number of health benefits. Overall, the food eaten on a keto diet is very low in carbs and high in fats. Though it easily overlaps with Paleo, it is distinctly different.
Decreasing carbs until your body burns fat, or “going keto,” may be the newest nutrition trend, but its history dates back to the 1920s. Fasting had long been a treatment for seizures in early medical practice, but it was the introduction of a nutrition plan that mimicked the effects of fasting that had the most influential and lasting effect on seizure frequency.
How does this fasting-with-food protocol work?
The ketogenic diet shifts the substrate for the body’s daily metabolic processes. The human body typically uses carbohydrate—specifically, glucose—as its primary source of fuel. This is glaringly obvious in the case of the sugar- and grain-filled Standard American Diet, but a Paleo diet does not automatically align with a ketogenic diet either. No matter whether your day begins with bagels and Frappuccinos or a homemade sweet-potato frittata, a diet that includes ample carbohydrate is not ketogenic.
A ketogenic diet may be adapted for a variety of nutritional and caloric needs, as well as a variety of “diet approaches.” Whether your preferred method of eating is intuitive or by-the-numbers, the ketogenic diet can be crafted to fit your physiology and your personality
The ketogenic diet is built upon a foundation of dietary fat, with protein and carbohydrate filling in calorie and macronutrient needs depending on the individual. When administered as a part of a medical nutrition therapy protocol, most ketogenic diets maintain a 4:1 ratio of fat calories to combined protein and carbohydrate calories. This makes for a strict, very high-fat, very low-carb diet plan, where 80 percent of calories come from fat, protein calories are calculated using bodyweight, and carbohydrate fills in the remaining calorie requirements.
One method that is gaining popularity in the clinical setting is a “modified Atkins” approach, in which calories are not restricted or measured and carbohydrate is limited to 10-20 grams per day. The ratio of fat to combined protein and carbohydrate calories is approximately 1:1, making this approach more manageable for populations who aren’t accustomed to weighing and measuring foods.
When fat replaces glucose as the primary fuel source, the body produces ketone bodies. This occurs in the Krebs Cycle, also knowns as the Citric Acid Cycle, an energy-generating process that occurs in the mitochondria of cells.
The switch from erratic sugar-based energy to steadier, slow-burning fat-based energy sources has myriad benefits: balanced blood sugar levels, sustained energy, improved cognitive function, mood regulation, and increased efficiency in heart and brain tissue. Research has observed that ketone bodies offer therapeutic benefits to damaged or diseased brains.1
Why Go Keto?
Shifting to ketosis has a myriad of surprising effects on the body’s health. Pursuing ketosis may be beneficial for populations struggling with blood sugar regulation, insulin resistance, or metabolic syndrome. Anecdotal evidence suggests polycystic ovarian syndrome may also be improved by a ketogenic protocol, and current medical research is investigating the impact of the ketogenic diet on neurological disorders like Alzheimer’s disease, Parkinson’s disease, and traumatic brain injury.2, 3
There are few people, however, who should not attempt a ketogenic diet:
- Patients with inborn errors of fat metabolism should strictly avoid ketosis.
- Pregnant women have altered macronutrient metabolism during gestation, and as such should not attempt a keto protocol.
- Breastfeeding women may experience reduced lactation on a ketogenic diet and may want to avoid ketosis or consider supplementing with larger doses of starchy carbohydrate while breastfeeding.
- Underweight women may experience adverse hormonal or fertility-related effects, and a ketogenic diet should not be undertaken until a healthy, stable weight is achieved.
As always, if you have a chronic disease and think you may benefit from a ketogenic diet, it is best to attempt the protocol under the supervision of a trained clinician.
What to Eat on a Paleo-Friendly Ketogenic Diet
At its most basic, the diet should be made up of ample sources of fat, moderate amounts of protein, and a sprinkling of carbohydrate.
Fat: Makes up the majority of the diet, including nut and seed butters like coconut butter, cacao butter, macadamia nut butter, and sunflower seed butter; animal fats like ghee, schmaltz, tallow, and lard; plant oils like cold-pressed olive oil, coconut oil, and responsibly sourced palm oil; plus olives, coconut milk or cream, and whole nuts and seeds.
Protein: Consumed in moderation, with enough for growth and/or lean body mass maintenance and repair. Include grass-fed or pastured cuts of beef, lamb, or pork; free-range eggs and poultry; sugar-free bacon or other cured products; wild-caught fish and fish eggs; and grass-fed or pastured organ meats. The preferred method of calculating protein needs follows the “one gram per killogram of bodyweight” rule, and this should be adjusted for individual growth or recovery needs. It is important to balance protein with carbohydrate to prevent gluconeogenesis, which depletes the body’s muscle and other tissues when carbs are low .
Carbohydrate: Included in small doses to avoid gluconeogenesis, to add fiber, and to aid in digestion. Include non-starchy vegetables like leafy greens, broccoli, cauliflower, cabbage, garlic, onions, leeks, celery, asparagus, and the like, in addition to low-sugar fruits like berries, citrus, and avocado.
Functional Foods: These items offer benefits that go beyond calorie and macronutrient needs. A holistic ketogenic diet should include bone broth (which is a rich source of collagen, gelatin, and electrolytes) as well as a low-carbohydrate food-based probiotic (like that from coconut water kefir or traditional lacto-fermented condiments like kimchi, pickles, or sauerkraut) and low-carbohydrate sources of soluble and insoluble fiber to nourish intestinal bacteria and promote motility.
Resources and Further Reading
Eat Fat, Lose Fat by Dr. Mary Enig and Sally Fallon
The Keto Reset Diet by Mark Sisson
Keto Clarity by Jimmy Moore
The Keto Diet by Leanne Vogel
Johns Hopkins Epilepsy Center
The Charlie Foundation
Keto News by Dr. Eric Kossoff
Ketogenic Diet – A nutritional protocol that shifts the body’s metabolic requirements, allowing it to utilize a fat-based fuel source instead of a glucose-based fuel source.
Ketones – A fuel source produced by the body when glucose is scarce and fatty acids are abundant. The known ketone bodies are beta-hydroxybutyrate, acetoacetate, and their breakdown product, acetone.
Ketosis – A state in which the body primarily uses ketones for fuel instead of glucose.
Protein – A macronutrient composed of amino acids; yields 4 kcal (calories) per gram.
Fat – A macronutrient composed of fatty acids; yields 9 kcal per gram.
Carbohydrate – A macronutrient composed of glucose; yields 4 kcal per gram.
Gluconeogenesis – The process that creates glucose from protein (often tissue) in the body, often in states of stress when carbohydrate sources are not readily available. May occur on a ketogenic diet protocol when protein intake is too high and carbohydrate intake is too low.
Insulin – A hormone secreted by the body in response to high blood glucose that signals the tissues to absorb glucose for use or storage.
- Paoli et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 August ; 67(8):789-96. doi: 10.1038/ejcn.2013.116. Epub 2013 Jun 26.
- Baranano KW, Hartman AL. The Ketogenic Diet: Uses in Epilepsy and Other Neurologic Illnesses. Curr Treat Options Neurol. 2008 November ; 10(6):410-419
- Gasior M, et al. Neuroprotective and Disease Modifying Effects of the Ketogenic Diet. Behav Pharmacol. 2006 September ; 17(5-6): 431-439.
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