Keto: Everything You Need to Know

The Ketogenic protocol or more commonly known as Keto is growing in popularity and no doubt you have heard about it, but are probably wondering what it is and why is there so much hype around it?

There is often a lot of confusion around what is keto and if it is right for particular individuals. It is important to remember everyone has different needs and requirements and the keto diet is not a panacea! However, for those that it is beneficial for, it has shown to have some profound effects, especially in aiding in chronic health conditions.

From High Fat Low Carbohydrate (HFLC), Paleo to Keto and everything in between there is some great confusion around the differences between them and what they are and what is the best approach. It becomes easy to get confused as within each approach (HFLC, Paleo & Keto) there is multiple sub-approaches to the protocols. For example, someplace greater or less focus on greens or proteins than others. It is no wonder everyone is lost and not sure where to start. My goal with this article is to cut through all this and simplify a very overcomplicated topic to arm you with the knowledge to make the best decision for your individual needs.

Let’s first define each of the key protocols, their history, philosophy and approach to nutrition.

 

1. Paleo protocol

Is the true ancestral approach that has been designed around how our ancestors used to live in the Palaeolithic Era.

Why? Our ancestors were lean, fit and remarkably free of chronic inflammatory disease. It works off the evolutionary process that for 66,000 generations, humans ate primarily meat, fish, fruits and vegetables, nuts and seeds, and some starchy plants. While being physically active and not sitting for long periods.

For this reason, the Paleo approach aims to emulate our ancestors as much as possible, moving away from processed foods to a wholefoods diet that has more of a balanced split between fat, carbohydrate, and protein.

 

2. Ketogenic protocol (Keto)

The ketogenic protocol is very low-carb, that replaces carbs with high amounts of fat that triggers the body’s natural metabolic process known as “ketosis.” Through restricting carbohydrates, you deprive your body of its natural fuel source, glucose, this forces the body to burn stored fat for fuel instead of glucose. This process promotes your liver to produces “ketones”, a type of fatty acid, and sends them into your bloodstream where your muscles and other tissues can use them as fuel. Ketones are your 4th fuel substrate so fat, protein, carbohydrate, and ketones. It was once believed producing ketones (ketosis) was dangerous as it was thought to be a catabolic state but with the endless amounts of new research, it has been shown to be a preferable source of fuel for humans, offering wide-ranging benefits. One of the quickest ways to achieve a state of Ketosis is fasting, however, it can also occur in the absence of glucose within your diet. External sources such as Exogenous Ketone Supplements have also been shown to greatly speed up this pathway achieving ketosis within 30 mins vs a few days for nutritional ketosis. Exogenous Ketones can be a great aid, especially in the early phases of a ketogenic diet and when looking for optimal performance, I will discuss these in my next article to provide you with a more in-depth understanding.

What does this state of ketosis achieve:

History & Application:

The ketogenic protocol was first coined and used clinically in the 1920s as an alternative therapy for children with epilepsy. However, fasting which also puts you into a ketogenic state is a key component of most, if not all, religions and has been used to treat disease for thousands of years.

Nowadays, people use the keto protocol primarily for:

  • Weight loss
  • Increased Energy & Mood
  • Increased mental clarity & Focus
  • Increased Performance (Mental & Physical)
  • Better Sleep
  • Faster Recovery
  • Longevity

Chronic Health Conditions that might Benefit from Keto:

  • Type 2 Diabetes
  • Cancer (glycolytic driven cancers)
  • Multiple Sclerosis (MS)
  • Epilepsy
  • Metabolic Syndromes
  • Traumatic brain injury (TBI)
  • Alzheimer’s disease
  • Dementia
  • Parkinson’s Disease (PD)
  • Autism spectrum disorder (ASD)  
  • Migraine headaches
  • Gastrointestinal conditions eg. Irritable Bowel Syndrome (IBS)
  • Skin conditions eg. acne vulgaris, acne rosacea, eczema, and psoriasis

Conditions that are Contraindications Warrant Caution:

  • Those with genetic conditions that affect fatty acid metabolism, including primary carnitine deficiency, pyruvate carboxylase deficiency, etc.
  • Pregnancy. The exception may be gestational diabetes, but even then a low-carb diet with some whole-food carbohydrates is a safer choice, provided the patient can reach the proper blood sugar targets.
  • People with gallbladder disease, or no gallbladder at all, since they can have trouble digesting fats.
  • People with kidney disease, including a history of kidney stones. Some studies suggest that keto can benefit patients with kidney failure, but patients with other kidney issues may be harmed.
  • People with HPA axis dysfunction and high levels of chronic stress.

(Chris Kresser, 2018)

Can this state be measured?

Yes, there are multiple methods of testing, from breath, blood to urine. As everyone will respond differently it is a great idea, especially early on, to track and quantify what constitutes as being in a state of ketosis. After a while, you will develop the ability to associate the feelings and responses linked with the state.

Although it is a great idea to track, I personally believe too many people begin to fixate on the numbers aiming to achieve deeper states. A higher number does not necessarily mean you are getting any more benefit and chasing the number could be costing you in other areas such as increased stress response. The bottom line, don’t get carried away chasing numbers.

Three methods of testing Ketones:

  1. Urine sticks are an inexpensive method that has been shown to be reliable in the early adaptation phase but once adapted not so reliable. Why? Your body becomes efficient at utilising ketones so you won’t excrete them through urine to the same extent, therefore showing a lower reading than it truly is. You can pick these sticks up from most pharmacies reasonably easily.
  2. Blood is known as the more reliable measure and often offers the ability to test glucose levels as well. The most popular handheld blood testing device is Precision Xtra.
  3. Breath Testing is one off upfront cost. Although it is less accurate than blood, many still prefer it as it is simple to use with no need to take blood. One of the most popular handheld devices is the Ketonix

Give me the Numbers:

The state of Ketosis has been widely debated. Mostly due to individual variance and the fact that is not like a switch, it is a gradual shift. It is now widely accepted and used within literature that 0.5mmol/L and above is defined as being in a ketogenic state. Scientists Jeff Volek and Stephen Phinney, pioneers within the field, described in their book “The Art and Science of Low-Carbohydrate Living“  ‘light nutritional ketosis’ as between 0.5mmol/L and 1.0mmol/L and ‘optimal ketosis’ is between 1.0mmol/L – 3.0mmol/L.”. However, as mentioned, everyone is different so these numbers do not make or break and they should be utilised as guides

 

3. High Fat Low Carbohydrate (HFLC) protocol

This one says it all in the title, it is all about ditching the carbohydrate and replacing with healthy fats. HFLC is very similar to Keto and even some consider them the same. I often find people who think they are leading a keto diet are actually HFLC and there is nothing wrong with this, it just depends on your goals and what works best for you as an individual. The biggest difference is the carbohydrate intake with HFLC you can eat between 50-150 grams where keto is between 20-50 grams. I spent the month of July discussing HFLC and the effects of carbohydrate so I have plenty of information to look further into, for the time being, I will just offer a brief overview. It is basically eating a greater percentage of healthy unprocessed fats, in replacement of all the refined carbohydrates that are consumed in the Western Diet.

The similarities across all three protocols

  • Less Carbohydrates than standard Western Diet (Fat: 20-30%, Protein 10-35% & Carbohydrate 45-60%). To learn more about how we got the history of the food pyramid to check out one of my previous posts Food Pyramid: We Got It Wrong! And to learn more about the effects of excessive carbohydrates I suggest reading this post Let’s Talk Science: High Carbohydrate Vs High Fat
  • Increase in the consumption of whole foods. Reduction if not removal of processed foods

The biggest differences between the three protocols:

It is important to note that some of these factors also apply within each protocol as well and as mentioned above there is a wide number of subgroups within each protocol.

Macronutrients (carbs, proteins, and fats): Macronutrients is the obvious difference across the three protocols.

  • Keto: Fat: 80%, Protein: 15% & Carbohydrate: 5%
  • Paleo: Fat: 28-47%, Protein: 19-35% & Carbohydrate: 22-40%
  • HFLC: More of a lifestyle change so no defined macro breakdown. However, it involves limiting carbs as much as possible, aiming to keep within 50-150 grams per day.

Protein Intake: This is one of the most debated topics and you will see variance not only across paleo to keto but within each protocol itself. Mostly due to the fact that excessive protein can lead to the bodies survival mechanism gluconeogenesis (production of turning protein into carbohydrate). It is believed if you deplete your carbohydrate stores and then replace with large amounts of protein it can lead to this process occurring and even though you are not eating carbs your body is creating them. There is a great academic debate going on at the moment. My current opinion and the opinion of the majority is that protein is not a key concern and it is not something you should restrict, as it is such a key component in maintaining and building tissue within the body, therefore especially important for athletes.

To speak to gluconeogenesis, it is important to remember that this is a highly un-efficient mechanism that is the last resort. Unless you are depleted of all your fat stores, which is near impossible, it is easier for your body to use your fat over going through this taxing process.

Fruit: As Paleo aims to emulate our ancestors, fruits are fine to eat. However, when following a ketogenic protocol and carbohydrates being very restricted, the majority of fruits do not fit within the requirements. For this reason, fruit is often restricted in keto. This is not to say you can not eat fruit if you can keep it within the Marcos (Carbohydrate under 5-8%). Keto individuals will traditionally stay clear of white fruits like banana, apples, pears etc as they produce a high glucose response and possess a greater amount of carbohydrate; for example a banana (Average size: 118 grams) has approximately 27 grams of carbs, this one banana alone exceeds the strictest of definitions of keto. Interestingly the carb count will drop the greener the banana. Instead, ketogenic people will often replace these fruits with vibrant colored and antioxidant-rich fruits like berries. For example; 100 grams of Strawberries is 7.68 grams of carbs.

Vegetables: Many believe these protocols are just bacon and oils, void of any vegetables. That is a whole different diet again, Carnivore diet which is growing popularity at the moment. This is an article in itself but put simply, in my opinion, this is not a sustainable long-term diet.

When it comes to vegetables due to the fiber content in vegetables you would be hard pressed to overeat and kick yourself out of ketosis with spinach, zucchini, lettuce, asparagus and kale on a keto diet. Like anything there are some you need to tread more carefully with eg: Bell Peppers (yellow Specifically), Brussels Sprouts, and beans, these possess great carb count. Myself and many others within Keto, HFLC, and Paleo believe vegetables should be the foundation of the diet due to the richness of micronutrients and antioxidants important for health. Many of which actually aid in digesting and removing harmful oxidative stressors.

Dairy: In the strict Paleo sense, dairy of any form was not consumed in the Palaeolithic Era, other than human milk in the infancy of course. It just wasn’t very practical to milk wild game. Whereas keto and HFLC are all about dairy, that is if you can handle it.

 

Reference:

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