What is the number-one diet trend for 2019? According to a recent annual survey among Registered Dietitians (RDs), keto, or ketogenic, was the “most popular diet” among consumers1. Interestingly, second on their list was intermittent fasting. It should be no surprise that keto also topped the list as the number-one diet googled in 20182…ten times more popular than other top trending diets. Others on this list included the carnivore, Mediterranean, fasting, and low-FODMAP diets.
While different in many aspects, outside of fasting of course, all of these diets have one theme in common. Each focus on modifying carbohydrate (CHO) intake and reducing refined CHOs and added sugars. Estimations as to how much sugar an individual consumes on an annual basis varies, but we can safely say the amount of sugar eaten is at an all-time high.
Personally, I dislike the word diet. To me, it represents a departure from taking a healthy, balanced approach to eating, it generally focuses on extreme limitation (or hyper-focus on a few allowable foods), and it’s not sustainable in the long-term. When I think of some popular diets fitting into this category, the cabbage soup, master cleanse (lemon juice, maple syrup, cayenne pepper and water 6 to 12 times a day), tuna and baby food diets come to mind.
In addition to their extreme tenets, these diets lack scientific substantiation to support their effectiveness and safety. It would not surprise me if some individuals reading this blog might ask, “Shouldn’t the ketogenic diet be added this list?” I know many well-educated, nutrition and health professionals who would agree. Unfortunately, low-carb to most individuals means indiscriminately eating a lot of meat loaded with saturated fat (i.e. original Atkins diet) while excluding almost all other foods. This is not a ketogenic diet.
Many associate a low-carb diet with no-carb. A bias against these eating plans still runs deep despite the fact they have been proven to be safe and effective in numerous, well-designed clinical trials. In 2018 there were over 300 studies published on the ketogenic diet3. Some lasted for more than two years showing not only it’s “longer-term” safety, but also demonstrating its ability to be followed for an extended time. It may be a surprise to some, but technically CHOs are not essential nutrients since the body can make glucose from protein when needed4. However, CHOs do contain many nutrients like fiber and disease-preventing phytonutrients, which are important to good health. Their complete avoidance is not recommended.
What exactly does ketogenic mean and what are ketones?
Almost all CHOs are broken down into smaller substances called glucose, which is a primary source of energy used to fuel the body. The body can also make glucose from protein, if necessary. In the absence of CHOs or high amounts of protein, the body can also make energy (ketones) from fat. The process of converting fat into energy is called ketogenesis or nutritional ketosis. Once the body depletes its stores of glucose, the body will use fat and fat stores to make ketones, which can also be used as a source of energy5. This effect is the key to weight loss when following this plan.
Eating low-carb should focus on eating lots of non-starchy vegetables (CHOs) including greens (spinach and all kinds of lettuce), mushrooms, broccoli, cauliflower, zucchini, green peppers and more. Moderate amounts of certain fruits can be eaten. Berries are especially good due to their lower sugar content including strawberries, raspberries, black berries and blueberries6. Other fruits can also be included as long as their total CHO content in grams (g) is considered. Putting an emphasis on these healthier CHO sources can make it a plant-focused eating plan. Avoiding refined CHOs, especially those with added sugar, is also an important element of a low-carb lifestyle.
By reducing CHO intake, fat and protein take its place to ensure enough calories are obtained. It is important to eat enough protein to maintain muscle mass and provide essential amino acids necessary for various biochemical functions within the body. Protein can also be used to make sufficient glucose needed by the brain4. The key to eating keto is to not eat too much protein. Remember protein converts to glucose, so too much protein will take the body out of nutritional ketosis. When following the keto plan, fat should be a primary factor when planning what to eat. For most this is difficult as we have been programmed for so long to avoid fat in order to lose weight. Healthy sources of fat include extra virgin olive oil, olives, avocadoes, butter, coconut oil and more6. There is no need to avoid them when following keto. Fat can also prolong the time a person feels full as fat digests slower than protein and CHOs.
Achieving weight loss on keto
The key to achieving weight loss when following a ketogenic eating plan is to carefully monitor your intake of CHOs in grams consumed. Most people will start generating ketones when their carbohydrate is limited between 20 to 50 g a day. Initially, your body needs about 48 to 72 hours in order to switch from glucose as a primary source of energy to ketones. This transition period may cause nausea, constipation and headaches, often called the “keto flu” lasting 1 to 4 days7. This is normal and can be minimized significantly by consuming adequate fluid and electrolytes like sodium (i.e. broth). Once desired weight loss is achieved, CHOs can be increased, but I recommend keeping them to no more than 100 to 130 g a day. This is the actual RDA (Recommended Dietary Allowance) for carbohydrates established by the National Academies of Sciences4.
Keto-friendly products by PURE
There are several products by PURE, which are more keto-friendly than others, but almost all can be used if you are staying within the sweet spot of 20 to 50 g of CHOs daily. For example, 360 Complete Shakes contain 19 g of carbohydrates, which seems like a lot; however, when you deduct the fiber content (11 g) from total CHO, the net carb content is 8 g. I do not include fiber as part of my daily CHO intake. When using products by PURE, take into consideration their net CHO content. Daily Build liquid provides 8 g CHO, but I use Daily Build capsules since they contain less than 1 g CHO per serving. Goyin has 3 g net carbs.
The PURE encapsulated products like Daily Detox, Sleep Trim, Immune6, Cleanse (including liquid), GPS Adapt, Serene, etc. do not contain enough CHO to limit them beyond the recommended serving amounts. CalciuMK+ contains 3 g of total CHO per serving, so it too can be used as part of a ketogenic eating plan. Another acceptable product is the ENERGY with all its flavor variations. This product contains 6 g of total CHO, but 3 g are from naturally-sourced erythritol, which can be deducted because it does not provide calories as a source of energy. Mila is also a great keto-friendly product, because it contains 0 g of net carbs (5 g fiber).
Due to the diet’s prominence, foods like almond and coconut flours, which can be used for baking; are now readily available. There are many great low-carb recipes on line making the keto lifestyle easier-than-ever to adopt and follow. Be careful, as “low-carb” by some individuals’ definition would not fit into a ketogenic plan since they contain too much CHOs. Remember, the goal is to keep CHO intake to 20 to 50 g a day during weight loss.
Lastly, as a word of caution, persons using insulin or other glycemic medications, and individuals with cardiovascular disease, should consult with a physician prior to adopting a ketogenic eating plan. Low-carb eating limits the production of and need for insulin, so adjustments to medications will likely be necessary. Blood sugar that is too low is very dangerous. Adjustments made to medication should only be done under the guidance and supervision of a licensed physician. Studies show eating a ketogenic diet significantly lowers blood triglycerides and increases HDL cholesterol, but may also increase LDL cholesterol. Opinions are mixed, but if your doctor has asked you to limit your intake of saturated fat due to certain cardiovascular risk factors, you should follow their advice.
By Darin Blackhurst, MS, PURE, Director, R&D and Quality