Treating the problem

What we’ve come to appreciate is that nothing is more potent at switching cells over to burning fat, than restricting carbs. No drug, no supplement, no amount of exercise training, or no amount of fish oil can shift the cell over to relying on fat in a more robust way than restricting carbs. The drug companies would die to have a medication that could do the same thing.

We are strong advocates that a well formulated ketogenic diet is not something that’s out of reach or burdensome for people. It is all about figuring it out and dialing it in. One could even go as far to say that it’s luxurious in terms of its palatability and humans instinctively want fat. Many people eat this way for life because it’s a delightful way to enjoy food. This is completely different than what you have read in other books. Imagine a way of eating that’s associated with a lot of health benefits, such as treating diabetes and prediabetic people and potentially on the other end of the spectrum, it may even be ideal for certain types of athletes.

What do the different diets look like and what exactly is a well formulated ketogenic diet (WFKD)?

Steve Phinney and Jeff Volek have pretty much coined the term well formulated ketogenic diet – just read their book: The Art and Science of Low Carbohydrate Living. Diets are usually compared to each other based on their fat, carbohydrate and protein content (although this is rapidly changing). A Standard American Diet (SAD) has about half the energy from carbohydrate. And low-carb diets are anything less than 30% carbohydrates and the ketogenic diet is actually a subset of low-carb diets. In general, a well formulated ketogenic diet is about 10% of energy from carbs, but this varies from person to person. There is a misconception out there that a low carbohydrate diet is high in protein; by definition they have to be somewhat limited in protein because proteins are fairly anti-ketogenic. Basically they are turned into glucose by the liver in a process called gluconeogenesis (gluco = glucose, neo = new, genesis = to make).

From the data that comes from research, people actually prefer ketogenic diets compared to high carb diets in many cases. The main thing is that the diet is palatable and sustainable long-term and does not take away from being happy. The hardest thing about any way of eating is sticking to it. It is such a big deal, that the government is actually putting a lot of research into the subject. At the end of the day, you have to be happy with how you live your life, so if your diet does not help you accomplish this, then it is all for not.

The goal of a WFKD is to turn your body’s metabolism into a state called nutritional ketosis. Nutritional ketosis is when ketones are made from the liver; this happens when carbohydrates are restricted and/or insulin is low. Knowing whether a person is in ketosis is difficult to know and is different for everybody. Whether or not a person is in ketosis is questionable unless you actually measure it.

A difficult topic for many people is what a ketone is and even more, the concentration of ketones. With nutritional ketosis, you are generally dealing with an order of magnitude increase in ketones relative to the carb fed state. There are many ways to check your ketones, via the blood, urine or breath. The most accurate way is blood ketones; it works about the same as measuring your glucose. Urine ketones are very easy to check, but once you are keto-adapted they may not be accurate. Breath ketones are very easy to measure and may be an accurate means of testing ketones that is ever evolving. When you check blood ketones, the result comes out in a number between 0 and upwards displayed in millimolar (mM).  So maybe going from 0.1 mM to at least 0.5 mM is kind of an arbitrary threshold that is used to tell if someone is starting to keto-adapt. Then nutritional ketosis starts at about 0.5 up to 3 or 4 or 5 mM depending on the person. What is important is to realize that nutritional ketosis is orders of magnitude lower than what we see in ketoacidosis. There is still a huge misconception amongst even healthcare professionals and physicians that associate any level of ketones with ketoacidosis as toxic byproducts of fat metabolism. In fact, nutritional ketosis can be thought of as a warming, controlled fire in the fireplace, whereas diabetic ketoacidosis is the whole house burning down. Educating people on the importance of understanding the level of ketones is important.