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.

Insulin may be a steroid masquerading as a hormone.

Insulin

Computer-generated image of six insulin molecules assembled in a hexamer.

At the 1998 Winter Olympic Games in Nagano, a Russian medical officer asked the Olympic Committee whether the use of insulin was restricted to athletes who are insulin dependent diabetics. The incident drew attention to insulin and the IOC were swift to ban it as a performance enhancing drug.

I recently posted a question on Quora asking what the best nutrition book is, and Nutrient Timing by Ivy and Portman came up. The book is excellent and has a huge amount of physiology data on how the human body makes and uses energy. The core concept is this:

In the 45 minutes post exercise, your body has very high insulin sensitivity. This period is referred to as the Anabolic phase. By consuming a drink of protein and carbs in a 1:3 or 1:4 ratio, you can significantly boost your insulin level during this period. You can also prolong this period and increase recovery and growth by continuing to consume said drink 2 hours and again at 4 hours post exercise.

Boosting your insulin levels post exercise reduces protein loss from muscles and improves protein retention. It also speeds recovery by replenishing glycogen and creatine stores. Ivy and Portman spend much of the book citing supporting research from many studies including the Marine Corps.

The book also recommends taking an anti-oxidant post exercise to reduce muscle oxidation.

According to Ivy and Portman and many other nutritionists, the best source of protein is Whey Protein Isolate (links to the one I bought recently) which is rich in branched chain amino acids (BCAA’s). The best source of carbs in their recipe is good old Sucrose (table sugar).

Dara Torres

Dara Torres at the 2008 summer Olympics.

I was chatting to my wife about the book and she mentioned that Dara Torres (three silvers in the previous summer Olympics and the oldest swimmer to ever be on the US Olympic team) drinks chocolate milk as her favorite recovery drink. Chocolate is rich in anti-oxidants, it contains sucrose and milk has some protein, but not enough to make the ratio 4:1. (The sucrose to protein ratio is probably more like 16:1). So I’m guessing that Dara adds a source of protein like whey protein isolate to the drink.

I’m training this year for either a half or full ironman next year and doing a half and full marathon this year to build up to it. I’m currently doing two 5 mile runs and one long run (currently 10 miles) each week. I also swim 2000m two to three times a week and I do the occasional core strength workout. As I built up to my current volume my energy level collapsed – both mental and physical. Once I started looking at my nutrition and using a post workout recovery nutrition plan I came back with a vengance. Two weeks after starting the plan I ran the fastest 5 mile pace I’ve ever run and felt great afterwards.

After doing further reading online I’ve modified my recipe to have a 1:1 ratio of protein to carbohydrates post workout. A 3:1 or 4:1 ratio seems to build a lot of muscle and my goal is to stay lean but recover fast.

My current post workout nutrition plan is:

  • 1 whole raw egg, 56 grams whey protein (two scoops), two tablespoons of molasses (high in phosphorus), a tablespoon of brown sugar, two cups of skim milk, a heaped spoon of cocoa powder. Blend and drink two thirds.
  • Drink the remaining third 1.5 to two hours after workout.