Aug 20, 202013 min read

Keto – What, Why, How

For the last few weeks I have been experimenting with 'Keto'. Google 'Keto' or 'Ketogenic diet' and you will get a bewildering array of diet pages, Facebook groups, rave reviews, warnings, recipes, expensive keto products, keto food police and diet pill scams. As with anything that suddenly becomes fashionable, lots of folk jump on the bandwagon as yay or naysayers and it's unbelievably confusing so I thought I would put together some simple and easy to follow information along with my own experience of doing keto. I will try to cut through the hype and hysteria so you can decide whether or not you want to try it yourself.

The recent news relating to obesity and the links to the Covid virus is quite alarming; it appears that we're facing a double-whammy – people who are obese stand a greater risk of serious consequences if they get the virus, but the lockdown most of us have experienced has resulted in many people comfort eating and putting on weight and more people are reaching that obese category – this is usually interpreted as having a BMI of 30+. So it's understandable that a diet that promises so much will also be getting some scrutiny.

You may have seen the headlines – 'Lose 6kg in 6 days!', 'Keto causes diarrhoea' , 'The Bacon and Egg Diet', 'Eat-as-much-as-you-want-and-never-get-fat diet', 'Cure all known illnesses with keto' - ok, so I made that last one up, but it's these kinds of headlines that grab our attention and lead us to believe that keto is a new diet which is the best/worst diet ever! Even my beloved Dr Michael Mosley's latest offering on TV gives 5 volunteers the chance to 'Lose a Stone in 3 Weeks', and he is essentially getting his volunteers into ketosis to achieve this.

So what is it?

Keto or, to be more precise, ketosis, is a natural state our bodies go into when we significantly reduce our intake of carbohydrates resulting in low blood glucose and insulin levels. Very briefly, when this happens, the body begins to burn fat in the absence of carbs, and the liver converts fat into small amounts of glucose, and fatty acids into ketones which the body can use for fuel. This is in fact a very natural process which our hunter-gatherer ancestors would have relied on given the very small amounts of carbohydrate naturally available; a ketogenic diet is one that hunter-gatherers naturally live on most of the time.

Our bodies function extremely well on ketones as a fuel source, and in fact may actually prefer it to glucose; most of us will be in a state of mild ketosis in the morning, having not eaten for many hours. Many people who are fat- and keto-adapted, i.e. they can effectively use fat and ketones as fuel, find that they have more energy and eliminate the energy-crashes they get when on a higher carbohydrate diet. Not being dependent on regular carbohydrate intake is also very freeing as our bodies all carry plenty of stored fat for energy and to create ketones to fuel our day-to-day lives.

If you have ongoing health problems or are on medication, or if you have any doubts, please consult your doctor before embarking on a ketogenic diet

What it isn't

Many of the alarmist headlines and warnings come from people (even medics) who confuse 'ketosis' with 'keto-acidosis'. Keto-acidosis is a very dangerous state where ketone levels are extremely high and is normally only found in Type 1 diabetics or alcoholics with damaged livers. As an example, ketone levels in someone with normal liver function who is keto-adapted will have around 0.5 – 3.0 mg/dl in the bloodstream; someone with keto-acidosis could have levels in excess of 15mg/dl. So a ketogenic diet is never going to get you close to these levels.

So why do keto?

Keto isn't new as a diet. As far back as the 1920s, ketogenic diets were being used to treat children with drug-resistant epilepsy and it is still used today with children and adults and has allowed some patients to come off epilepsy medication altogether.* The Atkins Diet, promoted by Dr Robert Atkins in the 1970s, is ketogenic, as is the very popular Blood Sugar Diet, devised by Prof Roy Taylor and promoted by Dr Mosley.

Other possible benefits of a ketogenic diet:

More sustained energy levels, as the body can constantly use fat and create ketones for energy
Treatment and even reversal of T2 diabetes
Improved health markers such as blood pressure, blood glucose and cholesterol levels**
Steady and sustained weight-loss as the body uses stored fat for fuel and to create ketones
Fewer incidences of auto-immune conditions such as eczema, psoriasis, acne, arthritis etc.
Fewer migraines
Better mental clarity – mainly because there are no 'sugar-crashes' that leave you feeling foggy but also because the brain uses ketones very efficiently
Reduction in heartburn, acid reflux and indigestion
Reduction in sugar-cravings – very important, see my Sugar blog here

Studies are also continuing on the use of a ketogenic diet to treat some cancers and Parkinson's disease; there have been some very positive results so far but it's too early to be definitive.

I think for most people though, the steady, and often quite rapid weight-loss along with better mental clarity and sustained energy even while exercising, are the main reasons they choose to 'go Keto'. There are a number of very good studies now that have shown that a keto diet can have significant health benefits for people who want to lose weight and reverse T2 diabetes and metabolic syndrome** and some very positive reports on endurance athletes recording excellent performance on a keto diet.

So How do I do it?

There are different ways to achieve a state of ketosis and that's why there is so much conflicting advice on the internet:

Starvation – will do it quite quickly, but is not recommended!

Intermittent Fasting – will get you into a temporary state of ketosis (see my blog on IF here). In a fasted state your body turns to fat-burning and ketone production; it also switches on processes that repair cells and improve the immune system;

Taking ketone supplements – yes, these will give you higher ketone readings but they don't necessarily mean you're adapted to using ketones efficiently – as you would expect, lots of companies out there are selling supplements to 'get you into keto quickly', but like most hacks and short-cuts, they won't necessarily get you to where you want to be.

Reducing carbohydrate intake to less than 50g per day and increasing good fats – this is what is meant by a ketogenic diet.

Contrary to popular belief and numerous entries on the internet, a keto diet is not a 'bacon and egg diet'. Yes you are reducing your carbs but replacing them with huge amounts of bacon, eggs, meat, etc will not help your keto efforts; unlike fat and carbohydrates, our bodies cannot store protein so any excess will be converted to glucose and can affect insulin levels or will be excreted through the kidneys. Too much protein in the diet can also put a strain on the organs and increase production of less-desirable hormones. The recommended amount of protein is about 0.8g of protein per kg of lean body weight. For an average-sized woman this equates to around 55-65g of protein a day, but unless you have bacon and eggs for breakfast, chicken and ham salad at lunch and go completely wild at the carvery for dinner, it's difficult to have too much – and the human body is very adaptable.

I think the most helpful thing I read when I was doing this was:

Carbs – >50g per day (but there is some flexibility as I will explain later)

Protein – 55g-65g per day

Fat – All the rest! And this will depend on whether you actually want to reduce calories in order to lose weight

Start from a strong place

If your current diet is fairly high in carbs (even good ones), trying to go straight into keto will probably not be a good experience. Your body needs time to adapt to burning fat and ketones and coming from a state of carb-dependency will be a severe challenge if you go in too fast. It is true that people have had success going straight to a ketogenic diet – as Dr Mosley's volunteers did, and people who are seriously obese may want to get straight in – but it can be challenging and you just need to know how to manage it.

My absolute recommendation as a Primal Health Coach is to move to a Primal lifestyle first then move on; adapting to a Primal way of eating and living for 3 weeks will set you up ready to take the jump to keto. See my blog – 6 Simple Steps to Living Primally

The really great thing about becoming fat- and keto-adapted is that once your body has learned how to do it (or rather, re-discovered it after a lifetime of carb-dependency), it doesn't forget. You can go in and out of keto as life comes along and your body will be able to adapt – even after maybe a holiday or celebration where you have gone completely off-track (think Christmas, a summer holiday, a binge-fest with friends etc.) you can quickly get back into ketosis without having to start all over again.

So assuming you have already cut out sugar, grains and industrially produced vegetable oils, and your exercise, sleep and stress are under control, you're ready to go keto.

The first thing is to really check on your carb intake – there is a surprising amount of carbohydrate in milk for example, so if you have a lot of milky coffees (as I used to), you can quickly reach your carb limit; tomatoes and onions also have quite high carb levels so also need to be used in moderation; for the moment, fruit will also have to take some time out except for occasional berries such as blueberries and strawberries. However, most salad vegetables and leafy greens, although they contain carbs, contain so much fibre it essentially cancels out the carb content, so lots of leafy salads and a wide range of above-ground vegetables should be at the centrepiece of your meals. A word of warning though – on the Internet and Facebook groups you will find food police who will tell you that you can't have vegetables at all on keto – they're wrong. I will put a list of vegetables you can happily eat on keto at the end of the blog.

Next is your protein – make sure this is always really good quality – organic and free-range meat and eggs, fish (especially cold-water oily fish), seafood, high-quality, full-fat cheese – if you can get raw, unpasteurised cheese, even better - and some lower-carb nuts such as macadamias are all good.

Then fats – this is where a lot of people come unstuck – brainwashed as we are by 50+ years of 'fat is bad' dogma, many people find it difficult to embrace fat in the way you do with a ketogenic diet and it's where the 'Bacon-and-egg diet' moniker comes from. When you're doing keto, good fats are your friends – butter, olive oil, coconut oil, avocado oil, nut butters, bacon fat and lard are all great fats to use. Use lovely extra-virgin olive oil dressings and mayo on your salads, toss your veg in melted butter, and use coconut fat to cook curries and sauces. Good fats will make you feel full up and will help prevent hunger pangs and it's also the lever you can use to regulate your calorie intake; people who want to lose a lot of weight will still need to reduce their calories – in Dr Mosley's Blood Sugar Diet, the daily calorie limit is just 800 calories a day – but you can adjust that to suit your needs.

It's very easy to go keto eating absolute rubbish as long as your carbs are low enough, but this won't set you up for good health and vitality and you'll end up with a very negative experience of keto so optimum nutrition is essential.

My top tips for going keto:

Stock up on all the ingredients you are going to want, including lots of vegetables, berries, good quality protein and fats – as the adage goes 'Fail to Plan and Plan to Fail'
In the beginning, use a tracking app such as MyFitnessPal to get a good idea of what your required carbs, protein and fat look like over a day – after a while you will be able to make a pretty close estimate without tracking obsessively
Eat when you're hungry – as you transition to a much lower carb limit, you will feel hungry from time to time (although nowhere near as much as when you're carb-dependent), so certainly at the beginning, allow yourself to eat when you need to. I have some ideas for low-carb snacks here
BUT – make sure you really are hungry – a lot of our eating is out of habit so allow yourself to skip meals and only eat when you're really hungry – this becomes much easier as you get into ketosis
As with intermittent fasting (IF), if you think you're just wanting to eat out of habit, find ways to distract yourself until the feeling goes
Eat mindfully – take time to truly enjoy your food and make the most of every mouthful – not only will you enjoy your food more, you will find that you actually want to eat less
Watch the alcohol – there are some alcoholic drinks which are actually allowed on a keto diet – champagne and cava (Yes!), and red wine are all relatively low in carbs – BUT, alcohol calories are 'first to burn' so it will slow down your fat-burning, and alcohol is also notorious for giving you (and me) the munchies so you might find it more difficult to stick to the diet if you drink. Maybe keep the alcohol for a very occasional treat
Keep hydrated with plenty of water, black or green tea, black coffee etc.
Make sure you keep your salt intake up too – adding a little more salt than usual will help reduce symptoms such as headaches and light-headedness
To get the best out of doing keto, an initial period of six weeks is recommended to give your body time to become fully fat- and keto-adapted - many people report that the 3 week mark is when they really start seeing the benefits kick in - after your 6 week period you can dip in and out as you choose
Avoid (almost) all snacks and energy bars labelled and marketed as 'keto' – most of them are just expensive, low-quality low-carb 'non-foods' – eat good natural food instead

So What Can I Expect?

I'm not going to lie – my first few days were quite hard even coming from a Primal lifestyle. Even though my carbs were not high before, the reduction to <50g is still quite a drop. My first change, as I have already mentioned, was the amount of milk in my coffee – I have always liked milky drinks and I am a sucker for a latte but even using full-fat milk (which has a lower carb content than skimmed), I was easily getting close to my 50g. I now have 2 small cafe con leches a day but to give you an idea, even those have 9g of carbs between them, so you can see how quickly it can mount up. Many keto enthusiasts use a splash of double cream to get the creaminess without the carbs, or even coconut cream, although I haven't tried this. I also found I had to think carefully about snacks – the roasted salted nuts in my Primal snacking recipes are great for Primal but will give you a carb hit that will take you out of keto levels; stick to lower-carb raw nuts such as macadamias and almonds.

You may suffer from carb- or keto-flu; when you significantly reduce your carb intake, you may have a few days of feeling out of sorts – headache, tiredness, grumpiness, lethargy – this is simply because you have taken away the fuel your body is used to i.e. carbs, and it hasn't yet adjusted fully to burning fat. Take it easy, drink plenty of low/no carb fluids and it will pass. Once you adapt to fat-burning, you should get a burst of energy and a refreshing clarity of mind – many people say that it actually feels different from the energy they get from carbs.

You should get quick weight-loss – obviously this is why a lot of people do keto and it is very gratifying to see the weight come off. Latest research suggests that rapid weight-loss is a good indicator of future losses and of keeping it off – providing the diet is properly nutritious. Some of this will be water which is lost when you stop eating the carbs, but some will be fat as your body turns to its own fat reserves for energy.

You will stop feeling hungry as often – once the carb-cravings and keto-flu have subsided, apart from more energy, you will probably find that your hunger is much more stable. Because you're not on the carb-insulin-carb roller-coaster, and your body has a ready supply of energy from fat and ketones, you just don't get the terrible cravings that a high-carb diet produces; missing a meal won't send you into a panic and doing IF becomes a doddle. When you're hungry, you're properly hungry and I found that I enjoyed my meals far more but was hungry less of the time.

I can't speak from experience, but some keto-ers find a real improvement in athletic performance once they're fat- and keto-adapted. As I could never in any way be described as 'athletic', I can only report second-hand on this one.

What Do I Need?

Apart from a good supply of keto-approved foods, not much. Some people like to use 'Keto sticks' to check if they're in ketosis – you simply check your urine and the scale on the jar will tell you if you're producing ketones. However, producing ketones and actually being able to use ketones are two different things – someone who is fat- and keto-adapted may well have a lower reading than someone just starting out because they are using some of the ketones they produce as fuel. That said, it may be useful in the first few weeks to check if you're in ketosis – if you're into that sort of thing.

Ketone supplements are big business (por supuesto!) and people who are keto-adapted claim that they can give a boost if they need extra energy or concentration. I haven't used them so I can't comment but I'm not generally a fan of supplements as I think you shouldn't need them if your diet is optimal.

Journaling can be a good way to record your experiences as you make your foray into keto – just a brief record of hunger and energy levels and weight-loss can be quite motivating.

Some final thoughts:

Personally, I think being fat- and keto-adapted is a huge step in personal health. The science now is very strong that this is the way our bodies are meant to be fuelled and the short and long-term health benefits are clear. Having said that, most of the long term studies into keto have been with men and there is some evidence that some women do less well on keto. I did indeed find that I had more energy and clarity of mind and although I wasn't calorie counting, I still lost over 2 kgs in a few days so I am very happy to go into keto from time to time but I don't want to stay there permanently. This is absolutely an area where you need to try it and see what works for you.

Keto-approved Fruit and veggies

Green leafy veg - lettuce, chard, spinach etc.

Avocados

Asparagus

Celery

Spring onions

Cauliflower and broccoli

Courgettes

Aubergines

Cucumber

Kale

Bell peppers

Olives

Mushrooms

Tomatoes (in moderation)

With most of these, you can eat as much as you want as the fibre cancels out the carbs.

I would love to hear about your experiences with doing keto if you choose to try it – there are fewer studies on how women respond to keto so it would be great to add to the numbers.