What is the ketogenic diet?

    The ketogenic diet (KD), also known as the keto diet, is a high-fat, very low-carbohydrate, moderate-protein diet. The KD plan is simple:  its purpose is to shift your body to a fat-burning metabolic state known as ketosis. The metabolic state in which the body relies on ketone bodies (derived from fatty acids) for energy as a result of glucose depletion is known as “nutritional ketosis”.  The KD was first developed in 1921 to treat epilepsy, and research has since demonstrated  the benefits of the ketogenic diet for a number  of health conditions, particularly in addressing  pediatric epilepsy and metabolic conditions  such as obesity.

How the keto diet works

    Under normal conditions, glucose from carbohydrates is the primary source of fuel for the body. However, when carbohydrates are severely restricted from the diet and glucose stores are depleted, the body will metabolize and utilize fats as an alternative source of fuel.

    When dietary intake of carbohydrates is limited, the body will first use available glycogen stores. Glycogen is the storage form of glucose found primarily in the liver and skeletal muscle. The body is able to store up to 600 grams of glycogen, representing approximately 2,000 to 2,400 calories of stored energy. However, this number may vary based on individual differences including diet, body mass, and activity level.

    Once glycogen stores have been depleted, the body will undergo gluconeogenesis in which glucose is produced endogenously (in the body) from substrates such as lactic acid, glycerol, and certain amino acids.

    Finally, when endogenous glucose production is insufficient, the body will shift into ketosis and fat will replace carbohydrates as the primary macronutrient used in energy production. This shift will occur after approximately four days of consuming a reduced carbohydrate diet of up to 20 to 50 grams per day in a 2,000 calorie per day diet.

    During the biochemical process of ketogenesis, the body metabolizes stored fats into fatty acids, which are then metabolized to ketone bodies. The most common ketone bodies, beta-hydroxybutyrate and acetone, are formed primarily in the liver. A series of reactions convert ketone bodies to acetyl-CoA, which then enters the Krebs cycle, a metabolic process that releases energy, and is converted to the high-energy molecule adenosine triphosphate (ATP). ATP, known as the “universal energy currency”, provides energy to the body and drives biological processes.

    Ketone bodies, used in various parts of the body including the heart, brain, kidneys, and muscle tissue, are able to produce more ATP than glucose, making them an efficient energy substrate. Additionally, ketones may enhance anti-oxidant capacity, reducing cellular damage from free radicals.

Signs of ketosis may include:

• Reduced hunger

• “Fruity breath” that occurs as a result of acetone, a byproduct of ketone metabolism, being eliminated through respiration

• Elevated ketone bodies measured in urine

• Weight loss

Who would benefit from the keto diet?

The KD may benefit individuals with certain conditions, including:

• Alzheimer’s disease

• Amyotrophic lateral sclerosis (ALS)

• Autism

• Brain trauma

• Cancer

• Depression

• Epilepsy

• Migraines

• Obesity

• Parkinson’s disease

Precautions

    Studies have demonstrated the beneficial effects and safety of a short-term ketogenic diet for up to six to twelve months with a gradual transition back to a standard diet. When switching to a ketogenic diet, you may experience short-term side effects such as nausea, headaches, fatigue, and dizziness, referred to as the “keto flu”. This is because your body shifts from burning glucose to fatty acids. Although the keto flu is commonly experienced within the first few weeks of the diet, staying hydrated and consuming electrolytes throughout the day can help counteract some of these side effects over the long term. Season your food with sea salt or pink Himalayan salt, and sip on bone broth which is high in electrolytes. You can also consider speaking with your integrative healthcare practitioner about supplementing with electrolytes, which should contain a balance of magnesium, sodium, potassium, chloride, and calcium.

    Long-term adverse effects of the ketogenic diet include hepatic steatosis (fatty liver), hypoproteinemia (low blood protein levels), and kidney stones. Due to the diet’s possible effects on the kidneys, it is essential to monitor renal function when you are on the plan. In some cases, monitoring bone density may also be recommended as progressive reduction in bone mineral content has been observed in children with epilepsy on a long-term ketogenic diet.

    In addition, contraindications exist for a number of health conditions including liver failure, pancreatitis, fat metabolism disorders, and porphyrias, as well as primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, and pyruvate kinase deficiency. Furthermore, individuals with diabetes who are considering following a ketogenic diet should consult a healthcare practitioner; if insulin or other hypoglycemic medications have not been modified to account for carbohydrate restriction, severe hypoglycemia may occur.

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