The Basic Ketogenic Diet

Note: Please note that if you are interested in a Ketogenic Diet used to treat Epilepsy or Pediatric Epilepsy, please start at Johns Hopkins who are the pioneers in this field. The wikipedia page for the Ketogenic Diet diet also has information on the diet as it relates to treating epilepsy. The diet below is simply for rapid and effective weight loss and uses a 1 to 1 fat to protein ratio rather than the 4 to 1 fat to combined protein and carbs ratio of the Ketogenic Diet pioneered by Johns Hopkins used to treat epilepsy.

Disclaimer: I am neither a doctor nor self proclaimed nutrition expert so please consult your doctor before starting any diet or taking any action that affects your health and wellbeing.

After finishing Gary Taubes latest book, which seems to have rapidly become the cornerstone of a new approach to nutrition, I’ve become very interested in the Ketogenic diet. The speed of weight loss I’ve seen is incredible and my energy level has remained high. The science behind a ketogenic diet is solidly backed up by Taubes research published in “Good Calories, Bad Calories” and “Why we get fat“.  According to Taubes’ research, it may also be the only way for people who have become severely insulin resistant, to effectively lose weight.

The Ketogenic diet has always lived on the fringes of diet lore and has been seen as extreme. But the reality is that the low glycemic index diet (Low GI Diet) is effective because it is close to, but not quite, a ketogenic diet. Other diets like the South Beach Diet are also only effective because of the reduction in carbs and consequently insulin levels.

The science behind this diet looks solid and it is part of the massive shift in nutrition research we’ve seen in the last few years. Prominent sport physiology experts like Tim Noakes have come around to this way of thinking and Tim in particular has said that everything he wrote about “Carboloading” in Lore of Running is wrong. (Lore of Running is considered the running physiology bible by many and contains much more than nutrition advice)

I’ve decided to put together a “Basic Ketogenic Diet” for my own reference and because the Ketogenic diets out there are either targeted at extreme bodybuilders (and usually cycle in carbs) or are peppered with pseudoscience and superstition. If you find anything technically wrong in this article please correct me as loudly as you’d like in the comments and please cite your source.

First a summary of the science behind the Ketogenic Diet.

Keep in mind I’m summarizing hundreds of pages of explanation and supporting data into a few paragraphs:

When you eat carbs your blood glucose level is raised and your pancreas secretes insulin. This insulin puts your muscle and fat cells into “storage mode”. Your fat cells store away the glucose as triglycerides. Insulin also prevents your fat cells from breaking down those triglycerides back into fatty acids and releasing them into your blood stream for use as energy. This is important: Insulin both causes fat absorption and prevents fat from being used as energy.

If you were to eat sugary snacks throughout the day you are keeping your insulin level high which constantly keeps your fat cells in a state of absorption and prevents the release of fat and its use as energy.

Eating fat and protein does very little to raise your insulin level.

So the bottom line here is, if you want your body to burn fat – meaning if you want your fat cells to break down triglycerides into fatty acids, release them into your blood stream and actually use them as energy – you need to keep your insulin level as low and absolutely avoid spikes in insulin.

A note on calories: Counting calories or increasing exercise output, according to the research of Taubes and many others, is a bad way to try to lose weight because what usually happens is instead of your body burning fat to make up for the deficit in calories, it simply decreases the amount of energy it expends. So you end up lethargic and still fat.

There is a lot more to this, but the science above is the rationale behind all Low GI, Low Carb and Ketogenic diets. It is why you lose weight on these diets while consuming the same number of calories.

Low Carb and Low GI diets work because they cut out carbs that cause spikes in insulin, which you now know will cause fat absorption and prevent fat burn.

The Ketogenic diet takes this one step further. It keeps your insulin level low which puts your body into fat-release-fat-burn mode, but also significantly increases the fat content in your diet and teaches your body to use fat as energy. Your body (your liver in particular) will enter a state of Ketosis and will break down fat into fatty acids and ketone bodies which will be used as energy.

During the diet you can measure how much fat your body is burning by monitoring your output of acetoacetate using Ketostix. When you enter a Ketogenic state, you will see a Ketone output of 5 to 20 mg/dL (According to “Why we get fat” by Taubes and my experience). The Ketostix I have also measure blood glucose which is useful to test for Ketoacidosis which you are not at risk for unless you are diabetic.

Note that Ketostix are used by diabetics to test whether they are entering a state known as Diabetic Ketoacidosis which is very dangerous. In this case they will see very high ketone levels accompanied by blood sugar levels of greater than 240 mg/dL. You should be seeing blood sugar levels of zero (according to your Ketostix) during your diet.

Please note that the diet outlined below is not the “Cyclical Ketogenic Diet” used by bodybuilders. It is a basic Ketogenic diet which I’ve found to be the most effective fat burning diet available. I’ve modified this diet from the classic Ketogenic diet used to treat epilepsy which recommends a 4 to 1 ratio of protein to fat. I’ve found that I can reach a state of Ketosis with a 1 to 1 ratio of fat to protein provided I keep the carbs very low.

Without further ado, the basic Ketogenic diet:

What you’ll need

The Diet

Note, you can eat as much of the foods below as you like, but I’ve found that I quickly feel full eating this diet. Don’t overeat and more importantly, don’t under-eat and make sure you’re getting the calories you need to function. This is NOT about cutting calories, it’s about releasing fat reserves and teaching your body to burn them.

Drink lots of water during the diet (but don’t go crazy). I find this helps increase my metal clarity and energy.

Taubes and others recommend not starting an exercise program at the beginning of this diet because during the acclimatization period you will not have enough energy and it usually results in people quitting the diet.

During the diet, measure your rate of fat burn by measuring your acetoacetate output with your Ketostix. Do this every time you visit the loo. You should see 5 to 20 mg/dL, and I’ve noticed it’s particularly high after a very fatty meal. Blood glucose (if your ketostix show this on a separate color tab) should be zero at all times. If it is not zero and above 200 mg/dL you may want to consult your doctor.

One of the most effective tricks during a diet is routine. Eat the same meals over and over or plan your meals ahead for the whole week. I’ve found it effective to pre-make dishes on Sunday and have them ready for the week. That makes it incredibly easy to stick to the diet because I avoid thinking which means I avoid creativity and creativity requires decision making which leads to hard choices. Just avoid the hard choices and have it all planned and some of it ready to grab and go.

The Leafy Green Salad recipe:

This is a recipe for a basic very low carb salad with lots of flavor. It’s great to add to any high-protein, high-fat meal.

  • Spinach, lettuce and/or mustard greens.
  • Red peppers
  • Tomatoes.
  • Optional raw onions.
  • Optional green beans raw.
  • Balsamic vinegar and olive oil dressing with salt and pepper. Use lemon and lime very sparingly if you add it. The vinegar actually reduces the glycemic index of this salad (and other foods).

Below I have outlined three days with a total of 9 meals that you can mix and match as you like. At the end I include a list of Ketogenic-safe ingredients you can add or subtract as you like. Remember the key is to have a high fat, high-protein and no-carb or very low carb diet. That means absolutely no sugar.

  • Day 1
    • Breakfast: 2 eggs done any way with yolks. Sausage containing no carbs or sugar. Bacon.
    • Lunch: Chicken with as much skin and oily gooey bits as possible. Steamed spinach or broccoli.
    • Supper: Steak with cheese. Fried mushrooms. Leafy green salad.
    • Before bed 1 glass of wine with a slice of cheese.
  • Day 2
    • Breakfast: 2 egg omlette with friend mushrooms, cheese and chopped parsley.
    • Lunch: A whole duck breast if you can get it or chicken again with as much fatty skin as possible. Leafy green salad.
    • Supper: Hamburger made with high fat mince without the bun. The mince can contain the usual paprika, chopped onions and garlic if you like, but absolutely no syrup or sugar. Add Cheese, tomatoes, lettuce and any other leafy low-carb greens you like.
    • Before bed 1 glass of wine with a slice of cheese.
  • Day 3
    • 2 eggs done any way with bacon and usual no-carb sausage.
    • Steak with cheese. Leafy green salad.
    • Salmon (or other fish) fried and served with Bok Choy and your leafy green salad.

You can mix and match the meals above and get a good Ketogenic burn going where you will notice rapid weight loss.

Eat as much as you want ingredient ideas:

  • Beef,
  • Steak,
  • Hamburger,
  • Prime Rib,
  • Filet Mignon,
  • Roast Beef,
  • Chicken,
  • Duck (awesome if you can get it because it is very high fat),
  • Any Fish, Tuna, Salmon, Trout, Halibut,
  • Lamb,
  • Pork,
  • Bacon,
  • Ham,
  • Eggs,
  • Shrimp,
  • Crab,
  • Lobster,
  • Butter,
  • Oils (Olive Oil, Flaxseed oil, etc.),
  • Salt, Pepper, Soy Sauce,
  • Spinach,
  • Lettuce,
  • Mustard Greens,
  • Celery,
  • Cheeses,
  • Oysters,
  • Abalone.

Add for variety but in moderation:

Read the ingredients (if applicable) and make darn sure they contain no sugar:

  • Avocadoes
  • Mustard (with no sugar or carbs),
  • Tea no sugar with milk
  • Coffee black no sugar
  • Heavy Cream
  • Broccoli,
  • Cabbage,
  • Bok Choy,
  • Kale,
  • Asparagus,
  • Mushrooms,
  • Cucumbers,
  • Olives,
  • Celery,
  • Green Beans,
  • Brussel Sprouts,
  • Peppers (Red, Green, Jalapeno, Habanero),
  • Onions,
  • Nuts preferably almonds,

You absolutely must avoid all sugar on this diet because it is the highest GI carbohydrate that will very quickly spike your insulin and destroy any Ketogenic effect. Other foods to avoid roughly in order of damage they will do to the diet:

  • All sugar.
  • All Bread.
  • Did I mention avoid sugar?
  • All traditional carbs like rice, pasta, wheat, potatoes, even the low GI ones like beans and lentils.
  • Beware of sauces that contain sugar or things like corn starch.

Effects of the diet:

  • You will see rapid weight loss of up to 6 pounds for a 200 pound person in the first 48 hours. This is your kidneys releasing water as they expel their sodium due to the absence of insulin. It’s what you’ve usually heard described as “water weight”.
  • Then you should see continued weight loss of anything from 0.25 to 2 pounds per day (an eighth to half kilo lost per day). But this varies greatly between individuals and is affected by a wide range of factors including your current weight and insulin sensitivity.
  • For the first week you may experience slightly decreased mental clarity. This clears up after a week as your brain gets used to burning ketones for energy instead of glucose.
  • According to data in “Why we get fat” your Vitamin C needs actually decrease on a low carb diet, so don’t feel the need to massively supplement.
  • Research has shown (also from Taubes) that LDL (bad) cholesterol will elevate slightly but clump size will be increased which is a net positive because larger LDL is less likely to stick to artery walls. HDL (good) cholesterol is significantly elevated with a very low carb diet like this which is a very strong net positive. This also has other great health benefits e.g. Lower insulin reduces the risk of hardening of artery walls.

What about alcohol?

I’ve found a glass of wine on it’s own or with a small slice of cheese before bed seems, anecdotally, to increase my fat burn rate. Anything more than a single reasonably sized glass has the opposite effect.

Beer is the devils poison. It contains carbs in the form of maltase which raise your insulin level just like sugar does. The alcohol is turned into citrate in your liver which produces fat and that fat is efficiently stored thanks to your now raised insulin levels.

So absolutely no drinks with sugar. That means no sweet cocktails either. I also don’t buy the idea of low-carb beers.

I would imagine that one shot of spirits  wouldn’t be a problem provided it doesn’t contain any sugar and is something like Vodka, Whiskey or Tequila. I’ve heard they add caramel to tequila “gold” (the cheap crap) so avoid that.

I’ve found that drinking heavily, meaning several glasses of wine followed by cocktails or shots, has a deleterious effect on my ability to burn fat and my energy level. The effect seems to last 72 hours or more.

Conclusion

Once again I’d like to reiterate that I’m neither a doctor nor self proclaimed nutrition guru. But it does seem that both doctors and “nutritionists” including government sources have been pulling the wool over our eyes since 1960 about what we should be eating. The ideas that “fat makes you fat” and “lower calories to lose weight” are so entrenched in our consciousness that many people find the latest research difficult if not impossible to swallow.

If you would like to learn how this came to be, check out Planet Money’s excellent segment on “Who Killed Lard?” and the rise of Crisco and hydrogenated vegetable oil. It will give you an idea of the political forces that influence dietary advice.

As Gary Taubes commented: If we are going see a change in the advice that governments and health authorities are handing out, it is going to take 20 years which is a lifetime. So rather than wait for those slow moving wheels to turn, take matters into your own hands.

12 Surprising things you probably don’t know about weight loss

I just finished reading Gary Taubes book “Why we get fat” after hearing him interviewed on Russ Roberts excellent econtalk podcast.

Gary wrote a book called “Good Calories, Bad Calories” a few years ago which is quite technical and includes a long history of how the state of nutrition got to where it currently is. “Why we get fat” is a well written distilation and update of his previous book.

The following surprising facts are from “Why we get fat”:

  1. Lower testosterone or lower estrogen makes you fat because it has an inhibiting action on LDL which causes your fat cells to absorb more fat. That is why we get fat as we get older.
  2. In an experiment, mice had their ovaries removed which removed their estrogen. They ate more and got fat. When their diets were limited they got fat anyway and became sedentary to compensate for the fact that they were storing away so many calories. This illustrates a recurring concept in the book: We are not fat because we eat too much. Instead, we eat too much because we are fat.
  3. Beer is the perfect beer-belly creator because when you drink beer the alcohol is turned into citrate in your liver which aids in fat production. That’s fine, but the problem is that the carbohydrates in beer in the form of maltase cause an increase in insulin which put your fat cells into storage mode. So the new fat that the citrate produced is quickly and efficiently stored… where else but your beer belly.
  4. A high protein, high fat diet raises your LDL (bad) cholesterol slightly, but massively raises your HDL (good) cholesterol which has a strong net positive effect on your overall cholesterol.
  5. A high protein, high fat diet causes your LDL (bad) cholesterol to appear in larger clumps which are less likely to stick to your artery walls.
  6. High insulin levels caused by carbohydrate intake cause atherosclerosis (hardening of arteries).
  7. Up until 1960 the popular advice from nutrition experts was to stick to a low carb diet. Gary includes a huge amount of data and historical quotes to support this. After 1960 we somehow got screwed up and started thinking that carbs should for the base of the food pyramid.
  8. Fat does not make you fat. Carbs make you fat because they boost insulin levels which put your fat cells into absorption mode and prevent your fat cells from breaking down triglycerides into fatty acides and glycerol and releasing them to be used as energy.
  9. The reason you instantly lose 3 to 6 pounds when starting a low carb diet is because your high insulin state has been signaling your kidneys to absorb sodium which causes them to retain water. When you lower your insulin levels for the first time your kidneys release that water and you lose (in my case) 4 pounds in about 36 hours.
  10. When you eat only protein and fat, your body goes into a state of ketosis after a while which means you are using fat as energy. You can buy ketostix at your local pharmacy and perform a urine test to see if your body is in a state of ketosis and at what level. The ketostix I have include a blood glucose test on a separate color panel which is also useful data.
  11. Gary attacks the idea that you can only lose weight by decreasing calories in or increasing calories spent through exercise with the following illustration: If you accidentally over-ate 25 calories per day for 20 years you would gain 50 pounds in weight. Most of us eat outside of that narrow threshold, but our bodies manage to self regulate somehow.
  12. Most diets fail because we decrease calories consumed which simply causes us to decrease our energy expenditure and stay the same weight.

It’s a great book and completely changed my view on nutrition and physiology as it relates to diet.

The scary history of Aspartame and the scary people behind it

I was driving from OC in California back to Seattle yesterday and was listening to NPR on Siruis which I’m completely addicted to. There was a brilliant interview with author and Professor Devra Davis who recently published The Secret History of the War on Cancer which I’m probably going to buy. The show was called “Chemicals, Cancer and You” – follow the link to listen to it.

She chatted about the history of Aspartame, the sweetener in most diet sodas. Kerry (my wife) has been drinking diet soda for years (and talking about quitting for years) and after hearing the interview she’s just dumped all her remaining soda and is moving to iced tea with unrefined sugar (evaporated cane juice).

The Aspartame discussion is towards the end of the interview – perhaps 15 minutes before the end.

G. D. Searle and Co developed Aspartame in 1965. In the 1970’s the safety of Aspartame came into question after Tumors were found in rats that had been given aspartame. A grand jury was convened to investigate the drug. They never finished their work. In fact several senior people who worked for the FDA and who were involved with the investigation were recruited by Searle and the investigation into the health risks associated with Aspartame simply went away.

The guy behind it all? Searle’s Chief Operating Officer, Donald H Rumsfeld.