Ketogenic Diet Part 3: Reality Check



I originally thought there was no point in repeating what other people have said about the ketogenic diet.  However, after doing some research for this article, I realized that many new websites, seeking ad clicks, have sprung up.  And now, it's necessary to point you to some right resources.  This article will help you identify which sites are worthwhile, and which are just clickbait.  Let's start with some myths.

Myths

There are lots of myths surrounding the diet.  You can find a list of ordinary myths anywhere, such as, bad breath, constipation, etc.  These are all potential annoyances, but there's a growing amount of just plain bad information too.  A site may not be legit if:

1.  It overly focuses on the keto flu, gives dire warnings about fiber and oily tarry stools, etc.  

 2.  It uses macros, percentages, or oversimplifies the diet as a "Protein and Fat" diet.  Also see #7 below.

3.  It tells you that you have to use their product for best results. Or must eat dairy, or must take enzymes....  the list of possible scammy products is endless.

4.  The website looks like a very long blog post, and ends with an option to buy something.  I haven't seen that kind of thing much lately, but it's sure to resurface.  The web's version of  snail mail circulars will never die.

5.  You can't figure out who wrote it.  Even Dr. Mercola, for all his "buy my product" links, you can find him, you can consider both sides of whether or not he's legit, but a website in a vacuum is a red flag.

6.  It makes a surprising claim, and you can't corroborate that claim anywhere else (remember to include PubMed when you look, lots of good information isn't found in random articles).  

7.  It tells you it's as simple as discarding the carbs and replacing with fat (this is really common on LCHF websites geared toward bodybuilders).

8.  It claims you don't need to worry about calories.  Actually, the point is that you can eat fewer calories and still not feel particularly hungry.  But unlike amphetamines (which are used as diet pills in weight loss clinics), the hunger loss effect is due to the ketones your body produces to feed your brain.

9.  It says that you can't do it if you're vegan.  I'm not a huge fan of vegan, but I don't like "you can't" messages.  If you calculate it right, you certainly can.  The resources for vegan keto are skimpy at best, that's a pretty good one, from a dietician, but she fails to mention the ratio, so hmm. If you must be vegan and keto, I'd recommend working with a dietician specially trained in the Keto diet (ask a neurologist's office staff if you're not sure how to find one).

Specifics to address some myths:

The keto flu shouldn't last longer than three days at the most.  For most people who have a gallbladder, they can fast for 24 hours.  If you're transitioning without a 24 hour fast, you might feel odd for a week but not longer.  The 24 hour fast is easy, eat an early dinner on day 1, and eat a late dinner on day 2, with nothing but water in between.  A small squeeze of lemon is permitted but nothing else.  It's tricky if you must eat with medications.  In that case, drink a gulp of milk but nothing else. When you begin to eat, be ready with keto foods.  Use the extra time to make some keto meals.

The only really scary effect of the keto diet while your body is transitioning is if you begin vomiting.  If so, stop immediately and see your doctor. Some tiny percentage of people have an enzyme deficiency that makes it very hard to make this metabolic switch from carbs to fat.  But because your brain needs fat to think, you probably already are aware and have been aware of it since you were a child.  I've never known anyone who experienced this, though. It's a rare genetic condition that causes acidosis if you have the genetic trait, and are fasting or eating a high protein diet.  However, it's not an excuse to scare everyone.  Here is a detailed list of contraindications.

A good keto diet plan includes a ratio in grams, of Fats ---------------  to --------------- Protein +Carbohydrates and limits Carbohydrates to 40g/day or less.  I put a big space there because people get it mixed up, usually like this  Protein + Fat --to-- Carbohydrate.  That's WRONG, if you see that, go to the next website.  A children's diet can be 3:1, but an adult should stop at 2:1 because at any higher ratio, an adult will not meet their protein needs.  If you are going to calculate a 1:1 keto diet, the best place to learn how is in this book by Dr. Kossoff. 

Now, it's true that in practice, a keto diet usually works out to be 75% of calories from Fat.  But if you're not measuring your foods, you're opening yourself up for disappointment.  You'll see what I mean, if you use a good nutrition tracking website such as the one called Chronometer.com  and you see how small variances and inaccuracies of measurement can cause big long term effects.  For example, if you had just 10 grams wrong every third day, and your child is an epileptic dependent on the diet.  They may have seizures after one week, or two weeks.  It adds up over time.



Here's a visual example from Cronometer.com which is a website that allows you to track your nutrition intake from foods.




Notice that the Fats percentage says 51 % if you hover over the red area? Now pay attention to the center of that leftmost circle, it says kcal (ie. ordinary Calories are more correctly written as kilocalorie, or kcal). This is a percentage by calories, it means 51% of the calories of this day's food came from Fats. You might think, ok great, then I'm at 1:1, but you're only 1:1 by Calories, not by Weight!  This is not a keto day!

Look at the bars on the right. Add together 70.8g protein + 76.8g carbohydrates = 147.6g total P+C

Look at the fats bar, 69.5g.

The true ratio of Fats :to: Protein+Carbs is 1:2 by weight in grams! That's not keto.

Now do you see how easy it is to miscalculate? That ratio (by weight in grams) should be between 1:1 and 1:2 for adults. It can be as high as 4:1 for young children but should be less strict as the child grows to allow for protein requirements to be met.


So percentages, macros, and ballpark figures don't work.  This is an exact diet.  You must buy a food scale with a grams measurement.  You should plan out your meals, four or five days ahead and make them, then store them in portion sizes.  This is not easy.  It takes dedication.

If you were a bodybuilder, age 21, you could probably simplify the diet as "remove carbs, replace with fat" because the larger your muscles, the more space for glycogen, and a little extra carbohydrate gets used up.  If you're a 40-something obese person like me, and you have trouble with mobility, it won't get used up, it will float around in your blood and mess up keto.  So, reality check... if a website is geared toward the ultra healthy, treat its advice with caution.

Just like nobody but a Strongman would eat close to 10k calories in a day and massive quantities of spinach to saturate their body with iron, neither should you try to apply that logic and expect to become a Strongman.  A middle aged man trying that would likely trigger hemochromatosis, and that's not good health.  OK I admit, I just had to mention 'strength athletes'.  They remind me that what's humanly possible is much more than what we imagine it to be. You go guys! But the point is, diets can't be applied the same way to all people and expect the same results. 
So, no, you can't use shortcuts if you want results from keto.  Be exact, use Chronometer.com (link above), and soon you will see how much variance is already present even if you do it perfectly.  Use reasonable care, with a tendency to double check. 

All ketogenic diet resources should recommend taking a multivitamin every day.  And they should all tell you that if you feel "unwell" or "achy" you should take some carbonates such as simple baking soda with water, an electrolyte drink similar to Emergen-C (but that's full of sugar so look for a cleaner one), and you might need the amino acid L-carnitine.  I don't think there's a vegan version of that.  If you're transitioning from vegan, you might also need Taurine, for a couple of months until your liver evens out.  The reasons for that are technical, you can seek out taurine and glycine metabolism if you wish to know more.

The need for a multivitamin isn't an indication that the diet is "unbalanced."  Every non organic diet right now is unbalanced enough to need a multivitamin.  I've said before our soils are depleted, and that's the best reason to eat as much organic as possible. I was vegan for a long time, I supplement with choline and taurine both, and I eat liver regularly.  I have liver pain if I don't, every person's specific health is different. 

How to start off right:

1.  Read read read!  This website is perhaps the best resource on the planet for Ketogenic dieting, click through and follow up on the references.  Then seek out some Paleo references on Keto-Paleo, or look up the Wahl's Protocol.  Note that for some odd reason Paleo doesn't always mean organic and neither Keto NOR Paleo means Celac-safe Gluten Free!  In particular, avoid trying to find Vegan, Organic and Gluten free cheese, because it's a unicorn, I've been seeking it for years. Keep it simple.


2.  Measure out four or five recipes that work for you to start, make them all ahead, or at least 3 of them, and portion them out.  You can use an intermittent fasting plan, so that you begin eating at 12 noon and do not eat after 10pm.  Or you can wing it and use an "eating every three hours" plan, that depends on what your body needs to feel right.  You can plan it for no weight loss, around 2000 calories.  Or for modest weight loss, around 1500 calories.  Anything below 1200 calories a day is considered a "VLCD" (very low calorie diet) though, and you should talk to your MD about working with a local weight loss specialist MD in your area.

3. Buy a bag of chicharrones / pork rinds and try them.  Some people like them, but they're fairly neutral in flavor.  If you can stand them, buy a few more bags, it will help your transition because they replace bread crumbs in almost any scenario.

4.  If you eat dairy, your path will be more smooth for Keto.  I've been experimenting with some butter lately, and it seems ok so far.  But at the moment I can't tell whether I feel bad because of the casein in the butter or because of the mold we cleaned up from around our windows.  I'm still achy from the mold.  However it's a big advantage to be able to use cream cheese.  Cashew butter just isn't the same, so I tend to avoid dairy requiring foods.

5.  Seek out a good recipe for keto 'french toast' using eggplant.  And make some simple fried zucchini rounds for snacks.

6.  Either use a mayo you like, make fresh mayo or make a mock mayo that's high in fat.  You can sweeten the mock mayo (if it includes mustard) and have instant honey mustard.

7.  Don't be fooled by Swerve, Erythriol, Truvia, or any of the other 'fake sugars.' for daily use  Do the math for 1 cup of any of the fake sugars and compare the calories to 1 cup of sugar.  Yeah, not much savings.  The only sweeteners I use are stevia and saccharin.  Saccharin is my preference, strictly on flavor quality.  But, is it true what they say about just the flavor of sweetness spiking insulin levels?  Well the evidence is mixed, as a fellow blogger has analyzed here. I'd rather use a tiny amount of real coconut sugar (the brown sugar flavors in coconut sugar beat anything in my opinion) if I need something sweet (like a topping on simple custard).

If you're going to enjoy life while keto, you'll occasionally either celebrate with something carby (cookies, cake, etc), or you'll end up baking with unusual fake sugars and not saving many calories.  A good use of the high calorie fake sugars is to find one that is converted to fat by gut microbes, before you absorb it.  As long as you're not having a birthday party every week, it will be fine.  Maria Emmerich has a lot of great recipes using Swerve mostly. We're all human and celebrating together is an important part of life. Don't renounce the love of life!
8.  The healthiest way to go keto is to avoid trying to fake everything you're missing, and learn to appreciate the naturally keto snacks and foods that come from various ethnic cuisines.

9.  Slip fiber or seaweed nutrition into anything you can get away with.  Lots of foods can 'hide' and are even enhanced by the addition of chia or flax seeds, ground.  For instance, scrambled eggs with ground flax looks speckly, but tastes perfect. 

A List:

... of classic keto foods you can use as a springboard for your own take on this neurologically healing diet:

Oopsie Rolls / Oopsie Bread

Keto Ice Cream (I got an ice cream machine for about $10 at a yard sale)

Custard and Chocholate Custard (or Carob, I think I actually prefer carob to chocholate!)

Guacamole

Eggplant "French Toast"

Egg Nog  (in a thermos, this is a great workday sip)

Mug muffins based on nut flour and coconut

Coconut cream... soup!

Chicken soup, with all the fat, or with added fat, use freshly cut spiral squash for noodles

Bacon, Eggs and Tomato (the classic!)

Deviled eggs, or Angeled Eggs  (my recipe!)

Roasted meat of your choice with coconut oil + peanut butter dip

Cauliflower Pizza Crust

Homemade ranch dressing (or honey mustard), green salad and roasted chicken slices


Tip #10 --  Find a Keto cookbook you really like.  I still think the Atkins books are good, but since then, there have been so many!  Most new authors deserve to be read more widely.   Here's one I haven't seen before, but I love few-ingredient types of cookbooks.

Bonus tips:  Macadamia nuts are exactly keto!  If you like them, stock up! Beware of keto snacks that aren't gluten free.

A Real Warning  - In truth, there have been cases of people dying from the diet, usually because it induces pancreatitis.  But when people object to the diet, they don't say that.  They say it causes "kidney problems" which is a holdover from the objections against  the Atkins diet.  But mantras like that can hide the real risks, so I encourage you to look for and find the actual risks and avoid dogmatic thinking.  Does the Keto diet have risks?  Yes!   Can it sicken, or even be deadly in some people?  Yes!  Remember what I said about children can do a more strict keto diet than adults because adults need more protein?

In my experience, the greatest risk is to the pancreas.  Here's a tragic case report of a girl who died because her pancreas was inflamed and bleeding and they didn't discover it in time to save her.  She had been on the diet since infancy, and died at age 9.  My heart breaks to read such stories.  They do exist, and it's important to remember that mainstream medicine isn't prepared to deal with the complications of a keto diet.  Your best defense is to know your own body and the real risks. That's the reality check I wanted to share most. 

Well that concludes my short course on the Keto Diet! I don't think it's for everyone, but many people can benefit from it.  Leave me a comment and let me know what you think. 

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