This is the third part of abbreviated content from the lecture Merits of a Ketogenic Diet given last January 2019. This article will cover:
- What does one eat on a ketogenic diet
- How to measure ketones
- How does one balance electrolytes
- How to improve fat and protein digestion
If you missed the science behind the ketogenic diet, check out Part 1 and Part 2 of this series.
What to eat
On a ketogenic diet, the bulk of calories comes from fats (60-70%), proteins (15-25%), and low-starch vegetables (5-15%). This is the caloric breakdown, but not what percentage is covering the plate. For example, the majority of a plate might be filled with vegetables, then fish, with pesto and salad dressing on top comprising the fat calories.
For many people, finding high quality fats is the largest adjustment to the diet since it's a switch from relying on carbohydrates for energy. 70% of calories from fat breaks down to about 8-10 tablespoons fat/day for men and 6-8 tablespoons for women. A person would not necessarily need to measure the amount of fat. Many proponents of ketogenic diets say limitless oils on the diet. Keep in mind if you are following the diet for weightloss reasons, that if you exceeded your caloric requirement daily even with oils, it could sabotage weightloss efforts. Also, if you are not used to eating a lot of fat, your body may need some help in digesting it (read on for more) and too many oils at first may not be a good idea. Plan to ease into it if these are new foods for you.
If you read about the ketogenic diet on the internet and in cookbooks, you'll find a plethora of recipes that include dairy-based foods or coconut oil. Many people with health issues do not tolerate dairy foods very well due to dairy's large molecular peptide structure (that makes dairy a target for those with leaky gut) or difficulty digesting dairy. For many, the casein in dairy is just as aggravating to the immune system as gluten, or perhaps more. Also, coconut oil may not be tolerated well by individuals and can tend to be "heavy" on the liver when taken in excess and may therefore result in a food reaction (headache, mood issue, skin issue, fatigue, etc).
The fats I typically suggest include (if tolerated): olive oil, butter or ghee, avocados, eggs, bacon, lard, other cold-pressed oils (such as flax or hemp), nuts and seeds. If you are adopting a keto diet to lose weight, then I would avoid eating a lot of nuts in terms of quantity. I avoid dairy and find it easy to make a dairy-free pesto one or two times weekly that I add to eggs, fish, meat, etc for a quick fat. Others find a home-made mayonnaise or avocado mayonnaise is an easy way to add fat. When I want to mix it up, I may make a coconut milk-based sauce for a meal. Snacks like organic beef jerky provide fat as well as protein. I like the Mighty beef jerky brand. Snacks generally are not needed since the meals are more satiating than carbohydrate-based diets.
Proteins suggested would be wild fish and seafood, grass-fed meats (such as lamb, beef, bison), free-range poultry and pork. Grass-fed red meats tend to be higher in Omega-3s than poultry which is a generally higher in Omega-6s. Red meats also tend to be higher in fat. If you are eating a lot of skinless chicken on the diet, for example, you'll have to work a little harder to add fat to meals. Cooking a whole bird and incorporating the fat and skin with meals is preferable from this perspective. To assess how much protein you should take daily, I suggest a protein calculator. Generally a bare minimum for a women would be 60grams protein daily and this may be inadequate for many. If you have trouble getting into ketosis, you may find you are taking too much protein and it is getting converted to glucose. Therefore, using a protein calculator while tracking your levels may be helpful.
Vegetables on the keto diet tend to be lower-starch ones. When you first start the ketogenic diet, you want to keep your carbohydrate intake to less than 20-30grams of carbohydrates daily. Specifically, it should be less than 20-30 grams "net carbs" daily. "Net carbs" is a term that takes into account the fiber in the food and subtracts it from the net carbs gained. For example, a typical avocado may have 15 grams carbohydrate but when it's net carbs are calculated, it only yields 5 grams. Here is an example of a chart that can be used to see which fruits and vegetables are low in net carbs (in the chart at the link scroll down to get to the un-processed foods. These are the ones you should enjoy). Low starch vegetables include: leafy greens, sprouts, asparagus, broccoli, bamboo shoots, bok choy, brussel sprouts, cabbage, cauliflower, celery, cucumber, fennel, garlic, green beans, mushrooms, summer squash, seaweed, etc.
If you eat more than 20-30grams carbohydrates and are like most people, you will probably consume too many carbohydrates to burn fat for energy and thus will not make ketones. However, generally, people that exercise a lot can eat more protein and more carbohydrates and still make ketones.
Because of the amount of carbohydrates in fruit, it is generally excluded from the diet with exception of low net carb fruits like lemons and avocados which typically may be eaten generously. There are plenty of fruits like berries that tend to be low carb but if you are eating adequate protein and low-starch vegetables, you likely won't want to eat more than a few berries at a time in order to keep net carb intake low.
Starting out on the diet
When starting on the diet, especially if it is for weightloss and you need to avoid nuts and dairy, etc, it can help to make soup. This is a formula I learned from Dr. Marcus Ettinger. Cook down your garlic and onions and vegetables in a fat of choice. Then add low-starch vegetables, add broth (bone broth is good) and seasonings. Blend the soup, then add 4 additional tablespoons of butter or olive oil. When you sit down to eat your soup (be sure to add plenty of raw sea salt), it will be a generous portion of low-starch vegetables and fat. Serve it with your protein of choice.
I find that making two big batches of soup per week will last most of the week and provide several easy meals.
Here is an example of a daily ketogenic diet (it's what I might eat):
Breakfast: Eggs fried in butter with bacon and vegetables
Beverages throughout the day: herbal teas, water with pinch of sea salt, lemon water with sea salt for workouts, Clearvite-CLA with collagen powder after workout
Lunch: Leftover ground beef seasoned with taco spices and sauteed cabbage and onions, avocado.
Supper: Salmon and pesto with sauteed kale and shallots.
Measuring ketones
It's important to go by how you feel on a ketogenic diet, but it also can help to know if you are making ketones or not. This can be important if you are not getting the results you want on the diet, in order to help you tweak things. An application that tracks your caloric intake from macronutrients can help with fine-tuning things. Using the protein calculator mentioned above, and aiming to get your calories from fat to be about 70% total intake will typically help with ketone production.
There are urine test strips for testing ketone levels you are producing. These are affordable and cost less than $10 online. When using these, you want to see a "trace" or "low" amount of ketones on the strip to get most benefits. If the level is very high like "++" this could be a sign that you are causing harm or are too strict and entering starvation mode which may ultimately create too much stress. A blood ketone meter can be more precise than urine. I'm not aware of any large studies of ideal levels of ketones; the current consensus from my reading is that getting above 0.5 is helpful for weightloss and athletic performance. A level of 1.5-3.0 is ideal for brain health.
Trade-offs of the diet
When the body burns fat to make ketones, the ketones have a diuretic effect. This can mean that as people lose fluid, they may also lose valuable electrolytes like sodium, potassium, calcium and magnesium. The initial loss of weight on the diet is typically welcome as some foods like gluten may cause a person to carry around an additional 7-8 pounds of fluid due to inflammation. However, if you are on a ketogenic diet longterm, you'll likely need to increase your intake of electrolytes.
Signs that your electrolytes are getting low may be muscle cramps, headache, light-headedness, etc. Typical remedies in this situation are to drink more water or bone broth and to add a raw salt to the liquids such as Baja Gold sea salt. This salt is higher in minerals than any other natural salt on the market. The Baja salt also comes in a trace mineral liquid supplement called Sole that can be more convenient than using the salt crystals. Not everyone likes the taste of salt so I suggest adding fresh lemon or lime juice to the salt with water. Extra salt may also be added to meals such as sprinkled on an avocado or egg or mixed into pesto. Pickles and olives can provide extra salt, too. Electrolyte powders such as Apex Energetic's Electro-pH can also help. Magnesium baths add extra electrolytes. Sodium and potassium bicarbonate are additional inexpensive powders that may be taken such as 1 tsp in a glass of water on an empty stomach to provide extra minerals while on a ketogenic diet. If you are unsure how to address the electrolyte issues, a Comprehensive Metabolic Panel can check levels and amounts of supplemental electrolytes can be made from it's interpretation.
How to support healthy digestion
Fat, low-starch vegetables, and protein do not always sit well with everyone. Some people will benefit from a Betaine HCl supplement to help with breaking down protein. This can be interpreted from a Comprehensive Metabolic Blood Panel if you are unsure if you would benefit from this natural supplement made from beets that stimulates stomach acid production.
Others may have trouble digesting fat and a phosphatidyl choline or lecithin supplement with every mal can be helpful with that trouble. Digestion of fats may be assessed using a Lipid Panel.
I would generally suggest a good digestive enzyme such as Allegany Nutrition's. However, Ortho Molecular makes a good combination for fats, proteins and vegetables called Ortho digestzyme.