The ketogenic diet, popularly called keto, has taken the health and wellness spotlight for the past couple of years.
The popularized diet triggered a huge shift in how we view nutrition. People following the keto diet are ditching carbs and loading up on fat. All with the goal of slimming one’s waistline and improving overall health.
But how is it possible that a diet low in carbs and high in fat will produce these benefits? Doesn’t that defy everything we know about healthy nutrition?
As counterintuitive as keto seems, there are countless studies to back up its many health claims. And if you ask keto dieters, the diet works better than many others.
Keto Diet Basics
The keto diet is by definition a very-low-carb, high-fat, and moderate-protein diet. The cornerstone of this diet is its macronutrient ratio, which looks like this:
- 5-10% calories from carbohydrates
- 20-25% calories from protein
- 65-75% calories from fat
It’s also usually recommended to eat 20-50g net carbohydrates daily since this seems to work for most people.
Net carbohydrates are digestible carbohydrates. You can calculate them by subtracting the grams of dietary fiber from a food’s total carbohydrate content. Some carbs are indigestible, so they don’t really count.
Shifting The Metabolism to Focus on Fat
During the first week of a keto diet, it will create a temporary energy crisis. That’s because the body normally relies on carbohydrates to make energy in the form of adenosine triphosphate (ATP).
On a keto diet, carb intake is too low to support your body’s energy demands. As a result, it’s forced to use protein and fat as a source of energy.
When the body starts using fat for energy, it converts some of that fat into ketones.
Ketones are compounds that work as fuel substitutes for glucose (carbs). There are three types of ketone molecules: acetoacetate, beta-hydroxybutyrate, and acetone. When some of your body’s energy comes from ketones, you are in a metabolic state called ketosis – the main goal of the ketogenic diet.
Keto Diet Food – At a Glance
The keto diet looks strikingly different from your standard Western diet. This diet turns the food pyramid upside down, making fats the base of the diet and carbohydrate-heavy food at the very end. Foods that keto dieters are encouraged to eat as their staples are:
- Fatty cuts of meat (always choose grass-fed/finished, pasture-raised, and organic)
- Fatty fish (get wild-caught when you can)
- Full fat dairy
- Nuts and seeds
- Grass-fed butter
- Healthy oils/fats (cold-pressed olive oil, avocado oil, lard, or tallow)
- Low-carb vegetables (e.g., leafy greens, asparagus, cucumber, cauliflower)
On the other hand, dieters are told to avoid the following foods completely:
- Cereal grains
- Most fruit
- Starchy vegetables
- Sugar and honey
Sticking to these food rules will help you reach ketosis. By avoiding foods high in carbohydrates and eating foods high in fat and moderate in protein, you’ll easily be eating within the ketogenic macronutrient ratio.
Many dieters look for recipes online or search for keto cookbooks when starting their keto diet. Below is an example of how a full day of eating keto looks like.
One Day Keto Diet Meal Plan
Salmon salad (wild-caught salmon, avocado oil mayonnaise, low-carb vegetables, salt, and pepper) on a bed of romaine lettuce.
Three pieces of string cheese or goat cheese which is more easily digested
Half an avocado with salt and pepper (if you have a Trader Joe’s nearby, the “everything spice” is simply amazing on avocados).
Keto-friendly buffalo wings with sugar-free blue cheese dressing and celery sticks (for a healthier option you can try to find raw and/or grass-fed cheese).
Whipped coconut cream with organic fresh or frozen berries
The Keto Diet Has Become Easier
Since the keto diet has been out for quite some time now, there are countless low-carb replacements for comfort carb-heavy meals like pasta, pizza, and mashed potatoes. That means keto dieters can enjoy some of their favorite meals, which makes it way easier to stick to the diet.
Besides sticking to keto macros by eating only keto-friendly foods, some keto dieters like to include MCT oil and intermittent fasting to their dieting regimen.
MCT oil is a supplement containing nothing but medium-chain triglycerides. It has been used with keto since the 1970s. When you consume MCT oil, it boosts ketone body production more than any other dietary fats.
Intermittent fasting is used with keto to help deplete glycogen stores quicker but also lower blood glucose levels for greater ketosis. I highly recommend combining intermittent fasting with keto for the best results.
Benefits of the Keto Diet
The keto diet was originally designed in 1921 to treat drug-resistant epilepsy in children. However, researchers have since been exploring other potentials of this diet. So far, there is strong evidence the keto diet can help with the following (1)
There is also emerging evidence that keto can help manage the following conditions:
- Polycystic ovary syndrome
- Neurological conditions
Most people who are interested in using keto to manage any of the above problems want to know how the diet works.
According to a fairly recent review article from Current Opinion in Neurology, the keto diet works through the direct effects of ketones and glucose restriction, and because of the ways these interact with receptors, channels, and metabolic enzymes (3). The diet also seems to work by affecting a person’s genes.
To better understand keto’s mechanisms of action, let’s take a look at how it addresses each of the above conditions.
Rapid Weight Loss
When you are in a state of ketosis after being on a keto diet for a week or so, the body starts to break down fat to make energy (4).
Your body will first break down the fat from the food you eat. When that runs out, it will target the fat stored on your own body. This is why so many people experience rapid fat loss on the ketogenic diet. It trains your system to metabolize the fat on your body.
In ketosis, your body also converts some of the protein you eat into glucose—a process called gluconeogenesis.
Now you may be thinking, “but wait, shouldn’t I avoid glucose on the keto diet?”
The thing is, gluconeogenesis is energy costly. It burns around 400-600 calories daily, which boosts the weight-loss effects of this diet (5). Since not all the protein you eat is converted into glucose, it’s perfectly fine with the keto diet.
To top it off, the keto diet can also suppress hunger due to drops in insulin, its fat content, and the ketones themselves. This can help prevent overeating and excessive snacking.
Normally, fat is linked to a greater risk of cardiovascular disease (CVD), but research suggests that’s not the case with the keto diet.
Studies have found that this diet addresses some of the greatest risk factors for CVD such as excess weight, high blood sugar, elevated insulin, and even elevated cholesterol (6).
There’s also evidence that the keto diet can lead to a rise in HDL cholesterol and LDL particle size (6).
But there’s a catch. To get these benefits, you must consume plenty of unsaturated fats. You can find unsaturated fats in nuts, seeds, cold-pressed olive oil (do NOT cook with it), avocados, and fatty fish.
Type 2 Diabetes
Because keto is low in carbs, it naturally leads to drops in blood glucose levels as well as insulin.
Studies comparing keto to other diets for diabetes control found that keto achieved greater improvements in blood glucose stability and a reduced need for diabetes medication (7).
Because keto also leads to weight loss, it further addresses a common problem among those with this condition. Another great thing about weight loss is that it also increases insulin sensitivity (8). This, in turn, can lead to improved blood sugar stability.
The anti-seizure effects of the keto diet are believed to come from ketones (9).
Researchers came to this conclusion after experiments showed that the administration of ketones could reduce seizure frequency.
And because seizures are often linked to high glucose uptake by the brain, the drop in glucose and switch to ketone metabolism in the brain may also explain how the diet works for epilepsy (10).
If you’re particularly interested in this benefit, CBD oil is also shown to be incredibly effective for reducing the frequency of seizures.
There’s a strong link between insulin and acne (9).
So diets that lead to lower insulin levels should, in theory, help combat acne.
Elevated insulin levels often lead to hormonal imbalances which cause the skin to produce excess sebum and shed rapidly – one of the main causes of acne. Besides lowering insulin, ketone bodies also have an anti-inflammatory effect, which may further help with acne.
If the keto diet isn’t enough on its own, look to manuka honey. This stuff is like a miracle for acne.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is a hormonal disorder that’s often linked to high insulin levels, insulin resistance, and weight gain (11).
Since the keto diet addresses all three of these issues, it could help women with this condition. Studies have found that the ketogenic diet leads to decreased androgen secretion caused by elevated insulin in women with PCOS (12).
There is also evidence the diet can improve depression in women with PCOS.
Because keto was found to be effective for epilepsy, which is a neurological condition, researchers examined how this diet could work for other brain disorders like brain cancer, Alzheimer’s disease, Parkinson’s, sleep disturbances, headaches, migraine, pain, autism, and multiple sclerosis (13).
The therapeutic efficiency of keto in these disorders has to do with improvements in energy metabolism on this diet. Since the brain is the most energy-hungry organ, it makes sense that improving the way it uses energy can make it work better.
Reduced oxidative stress from switching to ketosis may also explain why keto has a positive impact on brain health.
There is reason to believe that keto can be effective as an adjuvant cancer therapy, and there is even evidence to support this notion (14).
Researchers have long ago noticed that cancer cells metabolize glucose at a higher rate than normal cells. They also noticed that most cancer cells can’t survive on ketones.
So, depriving cancer cells of their main source of energy makes sense when fighting cancer. Lowering blood glucose levels also causes drops in insulin and insulin-like growth factor, which are two other drivers of cancer proliferation. The greatest benefits were seen in brain cancers, likely because the brain uses most of the ketones produced during ketosis.
Troubleshooting the Keto Diet
While there’s ample evidence that keto can be an effective remedy for a wide range of conditions, it isn’t perfect. The keto diet can cause short-term and long-term problems. Luckily, most are easy to manage with a bit of diet tweaking. Problems you may come across on keto include:
The Keto Flu
The keto flu is a popular way of referring to flu-like symptoms experienced in the first week of starting keto. These symptoms may include
- Muscle cramps
- Brain fog
- Nausea and constipation
The keto flu is believed to be a result of electrolyte imbalances and mild dehydration caused by glycogen depletion when your body enters ketosis for the first time (15).
To treat and even prevent the keto flu, keto diet experts recommend consuming plenty of fluids with electrolytes, especially sodium (3-5g), potassium (3-4g), and magnesium (400mg). You can get these electrolytes from sea salt, organic bouillon cubes, low-carb vegetables, nuts, seeds, and mineral water.
Weight loss and low insulin levels can help balance out hormones in conditions like metabolic syndrome and PCOS. However, chronically low insulin levels with a keto diet may cause problems with thyroid hormones in some people (15) and even increase cortisol levels (16), which may promote weight gain, insulin resistance, and cardiovascular disease in the long-run.
To counteract this, many keto dieters opt for occasional carb-refeeds instead of long-term ketosis. A keto diet variant that includes weekly carb refeeds is called the cyclical ketogenic diet (CKD).
The CKD involves eating a standard keto diet for 5-6 days a week followed by high-carb eating for 1-2 days a week. During carb refeed days, dieters are advised to stick to foods like:
- Sweet potatoes
- Butternut squash
- Spaghetti squash
- Brown rice (soaked for 24 hours before cooking)
These foods will help increase your carb intake to up to 300g per day while also providing adequate amounts of fiber and micronutrients. Carb refeeds are said to temporarily raise insulin levels and, in this way, curb any possible side effects of long-term ketosis.
Another benefit of carb refeeds is that they help increase muscle glycogen for better workouts.
The Bottom Line
There are many reasons people go on a keto diet, but the most common ones seem to be weight loss, diabetes control, and better overall health.
In medical practices, however, this diet is used to treat drug-resistant epilepsy. Many people following this diet want to know the mechanisms behind its efficiency. And so far, most evidence points to the improved energy metabolism and the therapeutic effects of ketones on this diet. Research on keto has yet to unveil just how this diet works to fight problems like excess weight and seizures, but at least we know that it does work.