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Everyone seems to be swept away by the wave of this latest dietary fad-the ketogenic diet. Although it has been used since as early as 1921, it seems to have surged in popularity quite recently. The benefits of the keto diet have been advocated by many celebrities.
The ketogenic diet was first coined by Russell Wilder. It was used as a treatment for epilepsy and had its own medical relevance as a dietary choice for pediatric epilepsy. With the advent of antiepileptic medications, the diet lost its significance. (1)
Over the years, it has become quite popular as a means to lose weight and build muscle.
What Comprises a Keto Diet?
The key macronutrient of the keto diet is fat and it is the primary source of fuel. A keto diet is a high-fat, low-carb, and moderate-protein diet. This typically translates to a dietary intake of:
- Fat as high as 65–75 percent per day
- Proteins as moderate as 15–20 percent per day
- Carbs as little as 5–10 percent per day
Being on a keto diet can mean you are eating more heavy cream, fatty fishes, oils, avocados, seeds, nuts, and green leafy vegetables low in carbohydrates and ditching all your staple carbohydrate treats such as cereals, rice, potatoes, and fruits, to name a few.
Types of Keto Diet
It is recommended to choose your diet bearing in mind your fitness goals and the type that best suits your overall health.
A study published in 2018 in the Indian Journal of Medical Research mentions four types of keto diets. (2)
1. The standard keto diet (SKD)
The standard keto diet is the most prevalent and highly recommended type of keto diet.
The measurements for the amount of carbs, proteins, and fats in grams are as follows:
- 20–50 g for carbohydrate
- 40–60 g for protein
- No set bars for the fat content
2. Targeted keto diet (TKD)
The targeted keto diet is for physically active individuals, including athletes, fitness enthusiasts, and trained individuals.
This diet involves eating 25–30 g of carbs right before an hour of exercise. These carbs can also be taken after exercise. As exercise can raise your need for carbs, you can customize your diet for an extra source of carbohydrates to provide energy for physical activity.
Athletes, or anyone who exercises, may improve their fitness and muscle mass more when implementing a TKD than when doing SKD.
3. Cyclical keto diet (CKD)
The cyclical keto diet is a great idea for individuals who want to lose weight but find the dietary restrictions to be daunting.
This type goes easy on the individual by shifting between periods of low-carb diet followed by a high-carb period toward the end of the week.
This diet is mostly recommended for advanced athletes, including weight lifters, professional athletes, and runners. Following a keto diet part of the week may make their body become more flexible in using fat as fuel.
Prior to their game or competition, they can replenish their glycogen levels by consuming a high-carb diet for 2 days. This will give their muscles peak glycogen storage, which can be advantageous for physical activity.
4. High-protein keto diet (HPKD)
The high-protein keto diet runs along the lines of the standard (SKD) approach, but the level of protein is different. In HPKD, you are required to up your protein intake to significant levels.
A higher protein to fat ratio in your diet may help the body lose stored fat, retain lean muscle mass, and grow muscle mass when working out. When following the HPKD, it is recommended to rev up your protein intake to 1.5 g per pound of your lean muscle mass.
Note: The standard and high-protein keto diets are more common and have been used widely by people, whereas the cyclical and targeted approaches are the latest methods used by athletes and weightlifters to monitor their physique and nutrient intake.
However, the standard method remains the most researched method. Consult your healthcare team for individualized guidance about the keto diet and your health.
This article covers the various aspects of the keto diet in keeping with the standard approach.
The Science of the Keto Diet
The key to maintaining a healthy body weight is maintaining a balance between energy intake, energy expenditure, and being mindful of the nutrient density of what you are eating. Carbohydrates, fats, and proteins are the macronutrients that are required for the sound sustenance of your body.
While there is no one-size-fits-all approach to weight loss, some studies suggest that low-carbohydrate diets are associated with a reduced risk of cardiovascular diseases and weight loss.
A meta-analysis of randomized controlled weight loss studies (over 1 year) suggests little to no evidence for prescribing low-fat diets for weight loss. In fact, lower-carbohydrate diets led to greater weight loss. (1)
Your body is programmed to convert the carbohydrates in your food to glucose. This glucose is the instant go-to fuel that provides your body with the required energy to get through the day.
When there is a lack of glucose as a result of a shortage of carbohydrates (fasting or skipping meals), your body starts breaking down the glycogen deposits, then fat, and lastly the proteins. When you cut down on carbohydrates to a seemingly low level, you also curtail your glycogen levels and expedite fat breakdown.
Once you are low on glucose and there is no glycogen left to metabolize, your body releases fat from the adipose tissues. The fats are metabolized in the liver, where they are broken down to ketone bodies. These ketone bodies are then used as a source of energy once the body’s glucose levels are exhausted or too low. This is the idea behind the keto diet.
The keto diet revamps the body’s metabolism by making fats the primary source of energy. It uses fats to generate energy rather than store them. Once your body has reached ketosis, your ketone levels will measure around 0.8 millimoles/liter. You can test it using urine strips, a blood meter, blood sticks, or a breath analyzer for acetone levels.
Benefits of Going the Keto Way
Some studies have shown that the keto diet is associated with some health benefits.
1. Helps you lose weight
Keto has been used successfully by some people to lose weight rapidly. Following a restrictive diet short on carbs can help retain muscle mass and reduce body fat to a great extent.
A 2018 study published in the Journal of International Society of Sports Nutrition found that following the keto diet may be an alternative dietary approach in men to reduce fat mass and visceral adipose tissue while maintaining lean body mass. (3)
2. Curbs your hunger pangs
Most of the foods included in the keto diet can keep you satiated for a long time. The snacks recommended in the keto diet are filling even in small amounts.
Unlike other low-calorie diet plans, the keto diet may help keep hunger hormones (such as ghrelin) low and appetite-suppressing hormones (such as leptin) high.
3. May help with mental clarity
The keto diet may help eliminate the fogginess in your brain and clear your mind.
Although there is evidence regarding this point, this diet’s benefits on brain activity without these disease states require further research on humans.
4. Stabilizes blood sugar levels
With a relatively low carb intake requirement, the keto diet can help people with high blood sugar.
The human body makes the enzyme insulin to lower blood sugar levels after eating carbohydrates. A person with diabetes and insulin resistance will have to take medications to bring down the sugar levels due to the functional disability of the insulin in their bodies.
A study in 2017, published in Nutrients, states that obesity may be accompanied by the development of insulin resistance and type 2 diabetes in many cases. It also suggests that a keto diet can help lower the rising blood sugar levels in such individuals. (4)
A keto diet can help stabilize the sugar levels in such individuals by reducing the carbohydrate level in their diet itself and avoiding the rise in blood sugar. It can also help keep their energy levels at optimum.
A Full Keto Diet List
The keto diet is all about the quantity of fat, proteins, and carbs that you take in a day. To comply with the nutritional amounts, it is necessary to stay abreast of the nutrition facts and dietary inclusions and exclusions.
Foods to include
Incorporate the following foods in your meal plan when going on a keto diet.
1. Natural fats
The cornerstone of the keto diet is fats. Eating foods high in fats such as eggs, meat, lard, tallow, and fish will serve the purpose of providing a high fat content to the diet.
Include high-fat sauces such as garlic butter and béarnaise sauce in your meals.
2. Vegetables growing above ground
Vegetables growing above ground tend to have a lower carb count per serving than those growing below the ground and growing alongside the roots.
Keto-friendly vegetables include cauliflower, broccoli, zucchini, cabbage, and leafy green vegetables such as lettuce, spinach, and kale. Aside from being low in carbs, such vegetables also provide a source of fiber, antioxidants, vitamins, and minerals.
You can fry these vegetables in a high-fat oil or butter and eat them with sauces and dips that have a high fat content.
Dairy products that concur with the keto diet are butter, high fat cheese, heavy cream, and small amounts of high-fat plain yogurt. However, milk and low-fat sweetened yogurts and drinks such as café lattes are high in carbohydrates and are not keto friendly.
4. Nuts and seeds
Nuts and seeds, for snacks or as part of a meal, are nutritious inclusions in the keto diet. Keeping in mind your dietary needs, you can eat a moderate amount of any nuts or seeds when on a keto diet.
Examples include flaxseeds, chia seeds, pumpkin seeds, macadamia nuts, pecans, cashews, Brazil nuts, and almond butter.
Note: Avoid nuts that are coated with sugar and salt.
Unlike other low-carb diets, the keto diet is not considered high in protein. Most proponents of the keto diet recommend eating mainly grass-fed, organic, wild caught, or pasture-raised sources of animal meats or seafood to get proteins.
6. Low-sugar fruits
Almost all fruits, large or small, have a high carb content, barring avocado and a few berries. You may consume:
- A generous serving of avocado, a healthy fruit abundant in fat
- A moderate serving of berries such as raspberries and blackberries
Foods to avoid
Because the keto diet is all about restricting your carbohydrate intake, observe absolute abstinence from foods high in carbs to achieve your desired results:
1. Grains and cereals
Whole grains and cereal-based products are primarily carbohydrates. Avoid all types of grains (or include a very small serving) such as wheat, rice, oats, barley, rye, quinoa, maize, and corn when following a keto diet.
You will have to give up on cereal-based products, which include bread, pasta, porridge, oats, and muesli, among others.
2. Beans and legumes
Although beans and legumes are the source of proteins for millions of vegetarians and vegans around the world, they are also a source of carbohydrates. These include lentils and beans of all types such as kidney beans, pinto beans, chickpeas, and black beans.
3. High-sugar fruits
Fruits contain carbohydrates primarily in the form of sugar. Although fruits have an abundance of nutrients, the sugar content in them makes them restricted to a keto diet.
All fruits including bananas, apples, mangoes, and pineapple must be eliminated or severely restricted when following a keto diet, except avocado and a few berries.
4. Starchy vegetables
Starchy vegetables such as potatoes, sweet potatoes, parsnips, squash, and carrots all contain carbohydrates. Avoid foods prepared from such vegetables as French fries and chips.
Beverages including soft drinks, sports drinks, fruit juices, and even vitamin water contain sugar. Therefore, they would need to be eliminated when on keto. Besides, restricting sugary beverages is recommended for overall health.
Refrain from eating sweet treats including cakes, cookies, candies, donuts, frozen foodstuffs, chocolate bars, and donuts.
Note: Always check your market purchase such as sauces, dressings, condiments, packaged foods, and ketchup for sugar labels. Also, limit the use of honey, maple syrup, agave, and artificial sweeteners to a minimum.
6. Seed oils
Certain seed oils are processed such that they have a low smoke point and become oxidized on heating. The abundance of omega-6 fatty acids in some seed oils can bring about inflammation and increase the risk of heart diseases.
Limit seed oils such as corn oil, soybean oil, canola oil, peanut oil, grapeseed oil, and sunflower oil if you are on a keto diet.
A Typical Keto Meal Plan for a Day
Once you are aware of the keto diet’s dos and don’ts, you can plan your meals accordingly. Just focus on the key ingredients of a keto diet – high fat, moderate protein, and low carbs.
You can plan your keto meals for a day according to your nutrition levels.
With no bars on the consumption of total fat for a day, the set limit is 20–50 g of carbohydrates and 40–60 g of protein a day.
You can personalize your meals:
- Your breakfast may include eggs with sautéed greens, bacon, or sausages and cold coffee with high-fat milk and heavy cream.
- Lunch may be a chicken salad or a cup of bone broth, salads with leafy greens, olives, tuna, and a dressing of blue cheese.
- Dinner may comprise a steak with sautéed vegetables.
A typical keto meal plan for a day may look like the following:
- Breakfast: Almond butter yogurt sundae – To 2/3 cup of full-fat plain Greek yogurt, swirl in 3 tablespoons of almond butter. Top it with ¾ cup of fresh raspberries.
- Mid-morning: Snack on 1½ ounces of Brie cheese.
- Lunch: Chicken kale salad – Take 2 ounces of grilled chicken, 3 cups of baby kale, and 2/3 of an avocado in a bowl. Add 2 teaspoons of red wine vinegar and 1 tablespoon of olive oil. Mix everything well.
- Evening snack: Eat about 15 Kalamata olives.
- Dinner: Sautee 1 cup of broccoli and 4 ounces of broiled salmon in 1 tablespoon of avocado oil.
Total calorie intake for this meal plan: 1620
- Total fat – 127 g, 25 g being saturated fat
- Cholesterol – 195 mg
- Protein – 85 g
- Total carbs – 41 g (16 g of sugar and 25 g of fiber)
- Potassium – 2765 mg
- Sodium – 1520 mg
- Phosphorus – 1130 mg
Who Shouldn’t Try the Keto Diet
Some instances warrant caution when pursuing a keto lifestyle.
The keto diet is contraindicated in patients with:
- Pancreatitis – inflammation of the pancreas
- Disorders of the liver that have compromised its function
- Disorders related to fat metabolism
- Primary carnitine deficiency – a condition wherein the body is unable to use fats for energy
- Carnitine translocase deficiency – a rare recessive autosomal disorder that restricts the conversion of long-chain fatty acids to energy, mostly during periods without foods
- Porphyria – the accumulation of chemicals that produce porphyrin, a component essential for the function of hemoglobin in the body
- Pyruvate kinase deficiency – an inherited disorder that affects the enzyme pyruvate kinase, which can affect your red blood cells
While some studies suggest that the keto diet is safe for most people, its long-term safety is not yet well understood.
Risks With the Keto Diet
There are some potential risks and concerns when following a keto diet. These include:
- The presence of high cholesterol in the diet may entail a risk of heart diseases. (2)(4)
- The ability of this diet to plummet the levels of sugar to a low level can risk the well-being of patients with diabetes or hypoglycemia. People suffering from diabetes and taking insulin or medications to manage their sugar levels require a doctor’s consultation to adjust their medications before starting the keto diet.
- Nutritional deficiency can occur due to the absence of various micronutrients including magnesium, phosphorus, selenium, and even essential vitamins A and C.
- The lack of fiber in the diet can cause constipation problems.
- Low carb levels may reduce the sugar levels required for the brain to function normally. This may cause confusion, fuzzy thinking, irritability, and mood swings.
It is highly recommended to seek the help of a registered dietitian before changing your diet to keto.
What Is Keto Flu?
Some of the people following the keto diet may experience symptoms known as “keto flu” (1) once they have achieved ketosis.
These symptoms are manifested as a result of the body’s transition of getting its energy needs from carbohydrates to fats. Keto flu is short-lived and may subside within a week or two once the body has adapted to the keto diet.
The symptoms of keto flu include:
- Muscle aches
As these symptoms may have been induced by the imbalance of electrolytes, these can be prevented by drinking plenty of water and keeping a check on your salt intake. However, consult your doctor if you have high blood pressure.
From the Chef’s Corner
Here are two keto-friendly recipes you can try:
1. Keto pancakes
- 1 tablespoon of ground psyllium husk powder
- 4 eggs
- 7 ounces of cottage cheese
- 2 ounces of butter or coconut oil
- 1 cup of heavy whipping cream
- ½ cup of fresh raspberries or strawberries
- Add the eggs, psyllium husk, and cottage cheese to a bowl and mix them well. Let the batter settle for 5–10 minutes to a thick consistency.
- Heat up butter or oil in a pan. Pour in the batter and fry it on a medium-low flame, flipping after 3–4 minutes.
- Whip the cream in a bowl until soft peaks are formed. Use this cream as a topping along with the berries of your choice.
2. Keto pimiento cheese meatballs
- 1 egg
- 25 ounces of ground beef
- Salt and pepper
- 2 tablespoons of butter for frying the meatballs
- ¼ cup of pickled jalapenos or pimientos
- ⅓ cup of mayonnaise
- 1 tablespoon of Dijon mustard
- 1 teaspoon of chili powder
- 1 pinch of cayenne pepper powder
- 4 ounces of cheddar cheese, grated
- Mix all the ingredients for the pimiento cheese in a bowl. Let the mixture sit for a few minutes.
- Add the egg and minced beef to the pimiento cheese mixture and mix them using a clean spoon. Add salt and pepper to taste.
- Use this mixture to form large meatballs. Fry these balls in the oil or butter on a medium flame until properly cooked.
- Serve these meatballs with sautéed green vegetables, green salad, or customized dips of your choice.
“Cheat Meals” in a Keto Diet
A cheat meal in a keto diet is not something that is encouraged by nutritionists. It can knock out the ketosis in your system and defeat the purpose of the diet. A typical cheat meal is high in carbs and will increase blood sugar levels in the body, putting a full stop to the body’s current state of ketosis.
A single cheat meal can negate all your efforts of making your body keto-adapted, and you will have to start from scratch so that your body can jump back into its previous keto state. Not only that, a high carb meal can elevate your blood sugar levels, negatively affecting your blood vessels.
A study published in 2019 in Science Daily by the University of British Columbia Okanagan Campus corroborates that consuming just a single 75 g dose of carbohydrates in the form of fries and soda can cause adverse health effects. When on a high-fat, low-carbohydrate diet, ingesting a single dose of these foods (carbohydrates as much as 75 g) can cause damage to your blood vessels. (5)
Cheat meals can entail a risk of keto flu. A frequent shift in your diet from keto to cheat meals can also bring back the symptoms of keto flu, making it difficult for your body to bounce back into the keto diet.
Despite all that is stated above, one cannot brush aside the food cravings that you may experience every once in a while. Considering the strict nutrition demands of a keto diet and the consequences of a cheat meal, being reasonable about your choices can make a huge difference.
Try to prepare low-carbohydrate versions of your favorite dishes. Make conscious choices when going out for a cheat meal, or choose to bring out the chef in you.
Additional Tips to Follow When on the Keto Diet
- Whenever you plan to go for a cheat meal, choose something that you really enjoy so that you can start over with your diet religiously with a satisfied heart.
- Abstain from indiscriminate snacking. Try to keep your carb level low so as not to fall down from your keto plateau.
- Try to follow the cyclic keto diet, so that you have a free hand with carbs over the weekend and you don’t actually have to cheat on your diet.
- Remember that the keto diet is not the only way to lose weight. If following the keto diet is not realistic for you, there are other ways to lose weight.
- The safety of long-term adherence to the keto diet has not been established.
The idea behind the keto diet is changing the way the body metabolizes the food you eat. It diverts the burning of carbohydrates to burning fat by reducing the intake of carbs and bulking up on fats with a moderate amount of protein.
A keto diet can be followed for as short as a 2–3-week period and may be extended for as long as a year. However, transitioning slowly from a keto diet to a regular diet and vice versa may be better tolerated.