In a recent interview with Marc McDougal about the foundational principles of Ketogenic Dieting, we decided that a question and answer formatted interview would be the best suited introduction. For the sake of space, I have divided the interview into a two part series: Part I will entail the fundamental principles of Ketogenic Dieting, while Part II will cover the different kinds of Keto Diet Protocols and exogenous keto supplementation. As I have always asserted, we at SYXGEN do not believe that all people should ascribe to a single dietary parameter (because we are all physiologically unique with different goals); however, there are certain benefits and downsides to all different dietary foci. This is why no matter what kind of nutritional programming we use, there will always be a need for all macros/micros in order to achieve all optimal functions of the body; whether through food or filling holes with supplementation.
Here's the short-hand of the most common dietary philosophies:
More Fruits/Veggies = Less Disease/Less Muscle
More Protein = Muscle Maintenance/Energy Regulation Issues
More Fat = Hormonal Regulation/Less Antioxidant Effect
SYX: To begin, Marc, I have to ask...what exactly IS keto? We hear all about "keto" everywhere, but it seems to be ambiguously used. Is it a dietary guideline, a physiological condition or what?
MARC: Well, there are three different types of "ketosis" one can be in, so let's start with defining them before we get ahead of ourselves.
Diabetic Ketoacidosis (DKA)
Starvation Ketosis (SK)
Nutritional Ketosis (NK)
It is important to distinguish that the type of ketosis we’re referring to is #3 (NK). DKA is actually a dangerous medical condition that can’t really be triggered by diet in a non-diabetic, and is therefore not a concern regarding our discussions. SK is pretty obvious, and involves the body’s backup fuel systems when in the midst of extended calorie deprivation.
As for the question, “what is keto?”; this is really two separate questions. The first being “what is ketosis?”, and the second being “what is a ketogenic diet”?
So, nutritional ketosis is an intentional metabolic state of the body that involves a significant upregulation in the production of ketone bodies.
These ketone bodies are a crucial part of our evolution. Without this system in the body we wouldn’t be walking around today. This is because the brain can only run on two fuels, glucose and ketones. Since we have an extremely limited supply of glucose in the body, our brains would pretty much permanently shut down and we would die from hypoglycemia if we didn’t have access to food for a day or two.
So at the most basic level, ketones can be thought of as a back-up survival system. However, the more we learn about these elegant little bastards, the more appealing they become as part of the primary metabolic state.
When not in starvation or an extended fast, ketones can be produced quite readily in a fed state simply by shifting around the percentages of macronutrients we consume.
To really be in NK, we need to achieve a minimum threshold of ketones (BOHB measured in a finger-stick blood spot test needs to be over 0.5 mmol/L, although some experts prefer this number to be over 1.0 mmol/L).
The optimal percentages of macronutrients can differ a bit from person to person, but a good general starting point to shift the body into NK is as follows:
However, absolute numbers also come into play, as the state of ketosis can be a finicky mistress. So percentages aside, here are some general guidelines as far as absolute numbers:
Carbs - 20-50g/day
Protein - less than 120g/day
Fat - to satiety (or, in other words, use to fill caloric needs depending on goal)
These are general guidelines, some people need to go even lower on carbs, or can get away with up to 100g of carbs, depending on things like piss-poor genetics or extreme levels of activity, etc. Some people can go higher on protein as well, however, bodybuilders used to eating 350+ grams of protein per day need to realize that this intake is completely unnecessary in a state of ketosis.
*Example of Ketogenic Nutrition Priority
So that’s what nutritional ketosis is. As far as a ketogenic diet, this is just a specific way of eating that significantly shifts the body’s fuel utilization to favor fatty acids and ketones over glucose. Think of it like taking a gasoline powered car and turning it into a Tesla Model S.
You’re really just telling your body to abandon its reliance on carbs (glucose really), and start learning how to use the fat you’re eating and the fat on your body for fuel instead. And there are huge benefits to this.
SYX: Very nice, Marc! Thank you for explaining away the amibiguities. Now that we understand the topic as "Nutritional Ketosis" and that it is a fat-dependant nutritional strategy, let's move on to the next piece of understanding. What is it that makes Ketogenic Dieting different from "Carb-Restriction" or a "VLCAL" (very low calorie) dietary parameter?
MARC: The best example I can think of regarding a carb-restricted, non-ketogenic diet is Paleo/Primal. Here you’re still reducing carbs compared to the Normal American Diet (NAD), from 60-70% down to about 30-40%. So the average American will likely see major benefits from NK just because they were previously drowning themselves in excess carbohydrates.
The problem I have with low or low-ish carb diets that aren’t ketogenic, is that many people will be in this fence-riding, metabolic limbo, where the body and brain are performing good but not great.
Ketone bodies themselves provide some serious health and performance benefits, as does the removal of dependence on glucose. You miss out on all of this with low-ish carb diets.
With a VLCAL diet, you certainly get some benefits such as reduced oxidative damage and weight loss, but compliance is atrocious because people are constantly hungry. Best case scenario is that you power through the hunger, and your metabolism responds by reducing NEAT (non-exercise activity thermogenesis), and basically tell your body to be tired and lazy to conserve energy without you making the conscious decision to move and exercise less.
With a keto diet, you can still get the fat burning benefits of a VLCAL diet, while remaining in the “fed state” (which keeps leptin and thyroid function normal). You get all of the benefits of a low-carb non-keto diet, plus more. Many people make the mistake of thinking the “drastic” reduction in carbs will wreck the gut microbiome (not true) or cause people to become deficient in fiber, which in reality, is an arguably useless, non-essential “nutrient”.
SYX: Ok, that makes sense. I've worked with several autoimmune cases that benefited from switching to a Paleo-like protocol because of the antioxidant properties of high veggie/fruit recommendation. Also, it seems like every medical study and TV show regarding weight loss, seems to use the VLCAL protocols. I never agreed with those recommendations for the same reasons you just argued, so I am glad to hear you prefer not to torture your clients with energy yo-yo's either!
So now that you mention nutritional ketosis can negate those issues and even replace some of the commonly referred to as "essential" nutrients, how exactly are such deficiencies overcome? And what other nutritional deficiencies are prevalent in ketogenic nutrition?
MARC: These are major misconceptions about keto dieting. People think that if you’re not eating fruits and veggies and whole grains all day, that you must be missing a ton of important nutrients. Turns out when we look at the actual science, as well as long term case studies, people can thrive off of even zero carb diets (meat and water), as long as they’re including things like organ meats. For example, see two of my favorite articles on veggies and fiber, and their uselessness:
Fiber: end the fantasy – myths / realities of an indigestible “nutrient”
The key to avoiding deficiencies in ketosis, is eating high fat meats and organ meats. If you don’t want to eat organ meats, you can get your K2, CO-Q10, Omega-3’s, Arachadonic Acid, and other important micronutrients from an all-in-one High Vitamin Butter Oil/Fermented Cod Liver Oil here.
All that being said, one thing pretty much every keto-eater should supplement with is sodium. In ketosis, the kidneys become extremely efficient at excreting sodium, and when sodium drops, the delicate electrolyte balance in the body handles this by dumping potassium to compensate. When sodium drops, mental and physical energy follows. When potassium drops, muscle follows. So by adding sodium (pre-workout is a great time to take 1g sodium), you avoid this problem.
In fact, of all of the people I’ve coached through ketosis, I’d say 80% of the time they call or text me telling me they feel run down, and I tell them to up their sodium by 1-2g, they immediately feel better.
There are some additional supplements that I do feel will optimize a keto diet, and I’m actually 90% done with an e-book on the topic, so I’ll let you know when that’s done. But for the most part, eat high fat meat, eat organ meats, and aim for 4-6g total sodium per day (more on this in Part II).
SYX: Ok, gotcha. So in ketogenics, we would replace high fiber intake with organ meats or cod liver oil, and make sure to get enough sodium. Sounds pretty simple, but definitely a big change for most people! Next up is a question about gender differences. Do men and women adapt differently to ketogenic dieting? If so, what do those differences look like?
MARC: I see quite a bit of overblown discussion about how females respond poorly to ketosis, and, well, I completely disagree. So do all of my female clients. I do notice a slightly longer adaption phase though, overall. For instance, if a guy is fully “keto-adapted” in an average of 14 days, it may take the average woman 18-21 days. Other than that, no issues. So ladies, just be patient during the initial phase and you’ll be fine.
SYX: Is this due to differences in hormonal systems perhaps? It makes me wonder...are there any hormonal or organ systems that undergo more stress during nutritional ketosis than on other kinds of diets? The first that come to mind are of course thyroid, neurological, inflammatory response, etc.
MARC: One of the things I’m a pretty big stickler about is lab testing. I’ve looked at hundreds of lab results over the years, and I have yet to identify any sort of keto-related problems regarding lab values being sub-optimal. That being said, many people have issues that should be addressed before getting into ketosis, like gut dysfunction (major one), or pre-existing issues with lipids, thyroid function, adrenals, etc. But if you have normal/optimal functioning in these areas already, and you are using a well-formulated keto-diet, you should absolutely expect these systems to keep functioning the same or better. Actually, I’ve had clients go on keto diets with pre-existing clinical hypothyroidism who were able to restore normal thyroid function and go off their meds. Lots of examples like this. Take home point is, do thorough labs before starting keto, repair existing problems, do follow up labs every three months or so, and have someone qualified helping you out to make adjustments to make sure your body is functioning optimally.
SYX: AWESOME! That completely explains why there is so much variance in people reporting getting better or worse when experimenting with higher fat dietary protocols. All great information, and I think there is plenty of information here to get people started on their keto-journey. So let's recap Part I of this interview:
"Ketogenic Dieting" is actually a metabolic state in which the brain and body are energetically dependent on ketones and fatty acids (rather than glucose) via nutrition parameters...NOT through inducing starvation (SK) or diabetic ketoacidosis (DKA).
Nutritional Ketosis is achieved by making fat the primary macronutrient used by the body, unlike Paleo/Primal or VLCAL diets, although many of the same benefits can be obtained through proper keto dieting. And
If you have hormonal, digestive or other known issues; it is in your best interest to be working with a qualified practitioner to identify whether nutritional ketosis is a viable option for you.
Thank you all for reading Part I of our interview with Marc McDougal of Depasi Fitness Solutions on the ins and outs of Ketogenic Dieting, and look for Part II to be released next week!