How to do Keto Right
This high-fat, low-carb diet has grown in popularity due to its benefits for brain health, ability to decrease inflammation, enhance weight loss, and stabilize blood sugar. On the ketogenic diet, you typically have no more than 50 grams of carbohydrates per day. The ketogenic diet also is composed of about 70% fat, 20% protein, and only 10% carbs (1).
While this diet has helped countless people improve their health, it’s important to know some essentials about the diet going into it. In this article, we discuss how to do keto in the way that will bring the most health benefits to your body. We begin with a discussion of “dirty keto” and “clean keto.”
Dirty Keto
Let’s first start with what NOT to do. If you do a “dirty keto” diet, you will likely still have high fats, moderate protein, and low carbs. You may even achieve ketosis- when your body switches from using glucose from carbs as energy to ketones from fat. However, your body will not be receiving the nutrition it needs to sustain health for the long run. If you’re not spending time in the kitchen to prepare wholesome, keto meals, you are likely in this camp. Dirty keto may:
Contain a lot of processed foods- If you’re doing keto correctly, you are focused on whole, nutritious foods. On dirty keto, you might order the bacon cheeseburger (with no bun) from a fast food chain restaurant and believe that is a meal that adheres to the keto standard. You may also be snacking on a lot of the prepackaged food that is labeled as “keto.”
Have high amounts of sodium and additives- Lots of the prepackaged keto foods contain high sodium, added sugar, and additives that are inflammatory to your body. High sodium may contribute to high blood pressure as well as heart disease (2,3). While salt should not be an issue when sticking to whole foods, it can become a major issue when a diet mostly consists of processed foods. Additionally, look out for unhealthy vegetable oils (canola, corn, soybean, cottonseed, grapeseed, safflower) in ingredients as well as various types of sugars. All of these are inflammatory and will stunt your progress toward health goals.
Have fewer micronutrients- If you eat a primarily processed keto diet, your body is going to miss out on the micronutrients (vitamins and minerals) that it needs. While you might be able to supplement some of these micronutrients, it is wiser and more effective to consume them regularly in your diet (4). Eat lots of colorful, organic vegetables and eat proteins from reputable sources.
Clean Keto
If you do keto the right way, you will spend some time and energy investing in high-quality, whole foods that you prepare in your kitchen. Your body will thank you for it! Here are some foods that you want to focus on:
Eat high amounts of fresh, low-carb veggies. This is where you will get so many of your important micronutrients. A good rule of thumb for keto is eating vegetables that grow above the ground, such as broccoli, spinach, kale, cauliflower, zucchini, cabbage, and asparagus. Root vegetables tend to have more carbs, especially white potatoes and sweet potatoes.
Eat plenty of high quality meats, which are pastured, wild-caught and/or grass-fed. Wild-caught fish is also a good option. These meats have higher amounts of omega 3s, lower amounts of omega 6s, antioxidants, and other disease-fighting substances. In contrast, non-pastured meats will give you more calories, higher fats, and fewer of the substances your body needs. Processed meats, like bacon and hot dogs, also contain nitrates and can be high in sodium. Bacon and hot dogs are okay to enjoy on keto as long as they are occasionally eaten and come from a good source.
Eat small amounts of low-carb fruits, like strawberries, blueberries, and blackberries. While you want to avoid most fruits, especially high-carb ones, like bananas and grapes, low-carb berries, in moderation, will give you the antioxidants and micronutrients that your body needs.
Eat natural, healthy fats. These may include delicious fruit and nut oils, pastured butters and ghee, and pastured animals fats, such as lard. Once again, it’s best to choose organic, pastured, and grass-fed whenever possible.
Keto vs. Paleo-Keto- Should I Have Dairy?
While the ketogenic diet traditionally allows dairy, if you adhere to a paleo-keto diet, dairy is not permitted, with the exception of ghee for those who tolerate it. If you would like to try a ketogenic diet, you may be wondering if it would be better for you to avoid dairy and adhere to a paleo-keto diet. Here are some things to consider for removing dairy:
Do I have a dairy sensitivity?- If you have a dairy sensitivity, consuming dairy will likely give you unpleasant symptoms, such as gas, bloating, abdominal pain, fatigue, headache, or brain fog. When a food sensitivity is ignored, it can lead to chronic disease and inflammation. To find out if you are sensitive to dairy, you can do lab testing, which will measure Immunoglobulin G (IgG) and Immunoglobulin A (IgA) levels. These will test for antibodies for dairy. This type of testing will detect if you have delayed responses to dairy, which can occur up to 5 days after you have consumed dairy. Often we find patients with chronic illness have a sensitivity to dairy and don’t realize that some of their pain, headaches or gastrointestinal struggles are from this. Also, if you are sensitive to a food and continue to eat it, it elicits an adrenal response, which will raise your blood sugar levels and possibly keep you from getting into ketosis.
Do I have celiac or a gluten sensitivity? If you are celiac or have a gluten sensitivity, dairy is cross-reactive with gluten. This means that if you consume dairy, your body will see it as gluten and have the same inflammatory response..
Do I have an autoimmune condition? As autoimmune conditions are caused by inflammation within the body, it’s best to avoid dairy if you have an autoimmune condition. Dairy, along with gluten, is one of the most inflammatory foods.
Am I overweight? If your primary concern is weight loss, removing dairy is a good idea. Eliminating dairy in your diet will help to lower inflammation and enhance weight loss.
Glycemic Index and Net Carbs
The glycemic index of a food is the ranking of the carbohydrates of that food based on how it affects blood glucose levels (5). In recognizing that not all carbs are the same and not all carbs will affect the body in the same manner, the concept of “net carbs” was created. Net carbs are the amount of carbs in a food after subtracting the fiber, as it is generally accepted that the fiber in whole foods isn’t digested and absorbed, so it won’t spike blood sugar.
While on this low-carb diet, we mentioned that you typically have no more than 50 grams of carbs per day. it’s also important to keep your NET carbs somewhere between 15 and 30 grams/day.
For example, a small banana might have a total of 18.5 g carbs. If its fiber is 2.1 g carbs, it has a net carb total of 16.4 g. As this small banana has already exceeded the low range of the net carb limit, you can see that a banana is not a great fruit choice on the ketogenic diet.
Anecdotally, in those with type 1 diabetes, fiber can swell the stomach and trigger the release of hormones that can raise blood sugar. For some individuals on the ketogenic diet, it may be best to count total carbs rather than net carbs. Work with a functional health practitioner to determine what is best for you.
Sugar Alcohols and Net Carbs
We all recognize that we have a bit of a sweet tooth, and when on the ketogenic diet, you may want to have a sweet treat. This is where sugar alcohols may come into play, though there’s some debate around them. Sugar alcohols are sweet carbohydrates that have similar sweetness to sugar but have lower calories and are somewhat resistant to digestion, similar to fiber. While they don’t have any true alcohol (ethanol) in them, they are called sugar alcohols because their chemical formula is a mix between sugar molecules and alcohol molecules. Some of these sugar alcohols are found in fruits and vegetables, but many are processed from other sugars. Like carbs, not all sugar alcohols are the same. Here are some examples of the Glycemic Index of various sugars and sugar alcohols:
While xylitol, sorbitol, and maltitol won’t raise your blood sugar as much as regular sugar, they will affect it. Erythritol, on the other hand, is fully absorbed in the small intestine and excreted in the urine unchanged, with no effect on blood glucose and insulin levels (7).
Therefore, when foods contain carbs from erythritol (only erythritol), you are able to subtract those from total carbs, like you would fiber. For example, in a Lily’s Chocolate Bar, there are 22 g of carbs in a serving, including 12 g of dietary fiber and 6 g of erythritol. For this treat, we could subtract the 6 g of erythritol since we know it won’t affect blood glucose.
Lily’s Chocolate Bar net carbs:
22 g (total carbs) - 12 g (dietary fiber) - 6 g (erythritol) = 4 g net carbs
It’s also important to be aware that sugar alcohols may cause upset stomach and bloating in some individuals. If you notice digestive issues after consuming erythritol, it may be best to avoid it.
Am I in Ketosis?
It’s important to know that it may take 7-30 days to get into ketosis. Before you reach ketosis, you may experience the “keto flu,” which feels like the flu, but is your body adapting to the new way of eating, processing food, and using energy. Your body is switching from functioning on glucose from carbs to functioning on ketones from fats. Keto flu is a sign that you are approaching full ketosis. We will describe symptoms of the keto flu below. Once keto flu has passed, we will describe some other signs that show you are in full ketosis.
Signs that you’re on the right track:
Keto flu - About 2-7 days after beginning the ketogenic diet, you may experience what is called the “keto flu,” which includes brain fog, headaches, fatigue, and nausea. While we don’t know exactly why the keto flu happens in the transition from metabolizing glucose to ketones, we can improve it by drinking lots of water, increasing the sea salt in our diet, and eating lots of colorful vegetables.
Fatigue - You may also experience short-term fatigue. This can be improved by increasing the amount of electrolytes you consume. Lack of electrolytes can occur because of the water loss in the beginning stages. Stay hydrated, and potentially increase salt intake as well.
Digestive issues - It’s possible that you experience some digestive symptoms at the beginning of the diet. You may oscillate between constipation and diarrhea. Make sure to eat lots of colorful veggies, and stick with it!
Insomnia - In the first few weeks, you may experience insomnia or wake up in the middle of the night, which may be unusual for you. But don’t worry- many ketogenic dieters report better sleep as they continue with the diet (8).
Keto breath - Many people report a kind of fruity breath that they experience when starting the ketogenic diet. This is caused by acetone, one of the ketones found in your breath. Though unpleasant, the keto breath should dissipate as your body adjusts.
Signs of full ketosis:
Increased ketones in blood - The most reliable way to measure ketosis is by measuring blood ketone levels. Nutritional ketosis is anywhere from 0.5-3.0 millimoles per liter (mmol/L). Testing will require a pinprick to draw blood from your finger, and you can purchase a home kit on Amazon.
Increased ketones in breath or urine - Though not as reliable as blood tests, you can also measure ketones (acetone) in your breath, or you can measure the ketones in urine through special indicator strips. Both of these kinds tests are convenient and can be found on Amazon.
Weight loss - Many people will lose weight very quickly in the first week, primarily due to water and stored carbs being used. After the first week, weight loss should be consistent if adhering to diet.
Not as hungry - People on the ketogenic diet often report feeling satisfied after eating and do not feel the desire to eat as much throughout the day (9).
Better focus and energy - After the first few weeks, many on the ketogenic diet report having more energy and better cognitive function. Research has found that the ketogenic diet can have a neuroprotective effect on the brain, especially in conditions such as traumatic brain injury (10) and Alzheimers (11).
Fasting and Keto
Intermittent fasting has become a popular way to lose weight and receive other health benefits. Studies have found it’s also a way to control blood sugar and reduce inflammation. Fasting can also trigger cell autophagy, which is when the body cleans out damaged cells to regenerate new ones. The most popular way of intermittent fasting is to do a 16/8 rule. This means that you eat within an 8 hour window during the day and fast for 16 hours a day.
There are some great reasons to combine intermittent fasting with the ketogenic diet.
Get into ketosis faster - When fasting, your body begins to switch from using carbs as energy to fats. As you know, this is the basis of the ketogenic diet, and doing the two in combination can help with this process.
Fat loss - Intermittent fasting is also a great way to lose fat mass (12). Intermittent fasting in combination with the ketogenic diet will really encourage your body to utilize fats over carbs.
Time saver - If you feel overwhelmed with the idea of prepping three keto-compliant meals a day plus snacks, it is nice to think about cutting out one meal prep a day.
Cell autophagy - As mentioned, cell autophagy is when the body removes or recycles damaged parts to regenerate new, healthy cells. It’s an important part of health, and BOTH fasting and the ketogenic diet encourage this process.
Importantly, this is NOT something you want to do if you have a history of eating disorders or risk factors for an eating disorder. There is an association with intermittent fasting and bulimia, and if you have risk factors, it is not something you want to try. Risk factors include having a past eating disorder, having a family history of eating disorder, impulsivity, perfectionism, and mood instability.
Final Thoughts
When you take the plunge and begin the ketogenic diet, it’s important to go into it knowing that your body will be experiencing some changes and you will feel the symptoms of it for the first few days or even first few weeks (see keto flu above). However, if you stick with it, your body will adapt and you will begin to reap the benefits.
You also want to make sure you are getting adequate amounts of plant foods in your diet. Make sure to do “clean keto” and avoid “dirty keto.” If you have high intake of fats, especially saturated fats, without adequate plant foods, your body can become very inflamed.
As always, it’s important to work with a functional health practitioner to make the best health choices for your particular body. Our staff would love to help you reach your health goals.
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