The ketogenic diet’s history is an interesting one. One that shares roots with the modern paleo diet and the Paleolithic era way of eating. Many of our ancestors ate a ketogenic diet due to their lacking variety in potential food sources. In 1863 William Banting wrote a well known historical publication of his anecdotal success of abstaining for starches to combat his obesity. The diet was shown to be beneficial for some types of epilepsy in the 1920’s and has since been shown to be efficacious among a wide array of diseases. Atkins sparked a low carb weight loss revolution in the 70’s and was seen as a heretic. Around that same time our government, under the McGovern committee, established our nation’s first Dietary goals for the United States. These guidelines sent our nation on a path towards high carbohydrate diets and avoidance of too much dietary fat. The history of diet politics and our country’s nutritional guidelines, as well as the ketogenic diet’s history, have been explained exhaustively by scientists and journalists alike. I would encourage you to read Gary Taubes’ article in the New York Times, What If It’s All Been a Big Fat Lie? (Linked below). Long story short, the ketogenic diet is nothing new. But there are some new things we are learning about it.
Not that you need a reminder, but the health of our nation isn’t doing so well. In truth, it is currently unwell. Since the advent of processed foods, refined vegetable oils, and our societal wandering away from a whole food diet, we have burdened ourselves with an onset of chronic degenerative diseases. Many of which are lifestyle related, reversible (to an extent), and costing our nation a great deal. In 2017 the United States spent an estimated 327 billion dollars on diabetes, and this annual cost is only projected to rise.
The ketogenic diet caught fire again recently. Likely due to a combination of people sharing their weight loss on social media, recent studies discovering exciting new things about ketosis, and a boom in keto-friendly snacks in the food industry. There are many appealing benefits people tout while eating a ketogenic diet. Mental clarity, appetite suppression, higher levels of energy and more. The modern messiah style preaching likely played into its resurgence, now that anyone who has done the diet has shared it with everyone they know on social media (myself included). Hi my name’s Mike, do you have a minute to talk about the all powerful ketogenic diet? I wouldn’t shut up about it. In truth, I was thrilled with what it had done for me and wanted others to experience it too.
But during this widespread keto confusion, I have met many people who have told me they’re “doing keto” when in reality they’re just trying to avoid the carbs. Keto and low carb are similar, but not the same. The ketogenic diet is one that consists of 65-85% dietary fat, under 50 grams of carbohydrates a day, and the remainder protein. These guidelines can accommodate a range of protein intakes, which will differ depending on your goals for the diet.
How the diet works is a fascinating aspect of our physiology. The science can be complicated and overwhelming, but for our purposes, we’ll keep it simple. Consider the analogy that your body is a car, primarily fueled by gas (carbs). There is machinery in your car that will also allow it to run on diesel (fats). This transition of switching your fuel source from gas to diesel takes time. Your machinery can be running on diesel in a few days, but that doesn’t mean it is doing so efficiently.
When we eat, blood sugar rises, and insulin is released to transport the glucose to working tissues or into storage. When blood glucose and insulin stabilize, as seen with a ketogenic diet, the body is actively using stored and dietary fat for fuel. Your blood sugar has leveled out and is not high enough to pull energy from when it is needed. Without consistent spikes in blood glucose, insulin levels out as well. This is when the liver breaks down fat and produces ketones like betahydroxybutyrate (BHB). Your liver is now producing BHB and fatty acids for fuel, instead of relying on glucose. Nutritional ketosis is defined as maintaining blood levels of BHB above 0.5 mmol/L. When you eat a ketogenic diet consisting of 65-85% dietary fat, and very low carbohydrate (under 50 grams a day), your body transitions from using glucose and carbohydrates as a primary fuel to fatty acids and BHB. You had a gas car, now it’s running on diesel.
During this interplay, insulin acts as the gatekeeper to your body fat. When it is elevated, it inhibits the process of lipolysis (breakdown of fat), and tries to move glucose into storage. Protein and fat do not raise blood glucose to the extent carbohydrate does, and they therefore elicit a lower insulin response. If you slam a dozen Krispy Kreme’s after a week in ketosis, it’s safe to say your machinery is back running on gas (carbs/glucose). Your blood sugar and insulin will spike, and your liver will refrain from mobilizing and breaking down stored body fat.
The body takes a while to learn how to optimality run on these new fuels for them to elicit their greatest benefits. Your tissues and organs are learning a new language so to speak, and it takes time. Ketogenic cycling is another topic, but when first pursuing a ketogenic diet it is more beneficial to stay in ketosis than cycle in and out.
In Part 3, we’ll look at some of the main medical conditions that ketogenic therapies are being shown to be helpful for. I’ll share an interesting story about an epileptic patient I had during a rotation in nursing school. I’ll talk about the foods I consistently eat when on a ketogenic diet, how I made the change to eating a high fat diet, and how I altered my physical and performance goals to further benefit my state of ketosis. As an aside, up until this point I have been writing about the ketogenic diet in relation to a normal, moderately active, general wellness pursuing individual.
And please know, this blog does not warrant any medical advice or nutritional recommendations. Before undertaking a massive dietary shift like going from the standard American diet to a ketogenic diet, you should consult your primary care provider. This blog constitutes nothing more than personal opinions, findings and summaries of the current literature on the above topic.
When searching the internet for the heavy hitter ketogenic researchers, it doesn’t take long to come across Drs. Jeff Volek & Stephen Phinney. The two have been in the game their entire careers, and have put out more quality peer reviewed studies than I have time to read. As a service to the general population, they published a book that includes everything a curious mind would want to know about the diet’s history, the underlying physiology, and its widespread clinical applications. The book is called The Art and Science of Low Carbohydrate Living and I can not recommend it enough. It has served as a launching pad for my continued readings and research about the diet.
Gary Taube’s NYT article –