Ketogenic Diets

I am fascinated by the science of nutritional ketosis and the potential for what a ketogenic diet can do for our health. We all know that sugar is bad, but recent scientific evidence is suggesting that a diet that restricts all carbohydrates to less than 5% of total calories is really good for us. It makes us more energy efficient, protects our brains, and has been shown to reverse some very complex and treatment-resistant disorders like seizures, Alzheimer’s, Parkinson’s Disease and certain cancers.

I’m particularly interested in the effect of a ketogenic diet on energy–something we all aspire to have more of.

I’ve been using low-carbohydrate, nutrient-dense food plans with my clients for years to support health and reverse chronic illness and have always been impressed that nearly all of them enjoy a rise in their energy. They talk about feeling “lighter,” “more motivated,” and “more like themselves.” For my clients, and I suspect all of us, this is the bottom line: how to get our energy production back on line. It underpins everything that makes life worth living.

It was first observed in the 1920’s that high fat diets helped children with refractory seizures. Ketogenic diets have become popular more recently as part of treatment approaches for neurodegenerative disorders, weight loss and cancers. A common denominator of this multitude of conditions is a deficiency of mitochondrial (mitochondria are the power generators within our cells) energy production, and in the case of cancer, a reliance on glucose for energy.

While the science of using nutritional ketosis as a medical therapy is very young–just a few small human trials, though many more pilot studies underway–the physiology is well worked out, the animal studies are striking and there is abundant anecdotal evidence that ketosis is good for us.

Chemical Energy (ATP) Production:

As long as glucose is around it will be used by the body to make chemical energy (ATP), which we then use to power all of the processes of our bodies. When glucose is not available, such as with fasting, starvation, intensive exercise or a very low carbohydrate-content diet, the body will switch its metabolism to the use of fats for energy. The liver will take the fatty acids derived from our dietary fats and convert them into ketones. Ketones are then utilized by the brain, heart and skeletal muscle to make energy.

The Good Things About Using Ketones to Make Energy:

  1. More energy is produced from ketones than glucose per molecule of oxygen.
  2. Energy produced by ketones is cleaner, generating fewer toxic free radicals needing removal and remediation.
  3. By impacting gene expression, ketones up-regulate glutathione synthesis, the master antioxidant, protecting cells from oxidative damage.
  4. Ketones result in an increased number of mitochondria in cells, amplifying energy production capacity.
  5. Ketones favorably modulate brain chemistry by reducing the excitation that can lead to toxicity. It does so by decreasing glutamate and increasing GABA levels.
  6. Ketones increase neuronal autophagy: a process by which damaged mitochondria that over-produce superoxide (damaging free radicals) are cleared away along with protein aggregates that mediate neurodegeneration.
  7. Ketones cause a rise in many protective anti-oxidants.
  8. Serum glucose levels are lower (glucose is a toxin above a certain blood level).
  9. Insulin levels decrease, favoring a healthier physiology.
  10. There is less oxidative stress as evidenced by lower levels of reactive oxygen species (toxic free radicals).

My own hypothesis is that ketosis, in addition to all of these physical attributes, also leads to improvements in the experience of energy and wellbeing and reduces common symptoms associated with energy deficiency, such as headache, brain fog and body aches.

A review of the scientific literature on PubMed revealed that there are no studies looking at the ketogenic diet and fatigue. This surprised me because an important mechanism by which ketones seem to impact neurodegenerative (Alzheimer’s, Parkinson’s Disease, ALS) and seizure disorders is via their favorable effect on mitochondrial energy production. Fatigue is the most obvious and common manifestation of a chemical energy deficit.

Is a ketogenic food plan effective for garden-variety fatigue?

My own experience with myself as well as clients would say that it is highly likely. But I also realize that when I prescribe a food plan we are introducing multiple variables, with the lower sugar content being just one of the attributes that contribute to the improvement in energy and health that people enjoy.  The food plan is always a part of a larger Functional Medicine prescription that supports them in a myriad of important ways. The food plan itself is beneficial in numerous ways, including enhanced nutrient content, reduced inflammatory potential, and exclusion of toxins and irritants-all variables that would impact energy.

So I thought I would experiment on myself. I eat very well. I don’t eat grains, sugars or processed food (most of the time!) and I include healthy protein, fat and plants at every meal. My carb content is quite low by normal standards but I don’t actively count them and I don’t measure the ketones in my urine to see if I am in a ketogenic state.

Can I induce ketosis in myself, remain on my healthy food plan, maintain an optimal micronutrient intake and improve how I feel? So begins my “n of 1” experiment. Actually “n of 2” because my nutritionist colleague, Lisa, is doing this with me. It’s always nice to have companionship on these journeys!

The Liftoff Ketogenic Intensive Nutrition Food Plan (a work in progress):

The ketogenic food plan I am embarking on and which I recommend to my clients includes 30-50 grams per day of net carbs. Net carbs means total carbohydrate content of the food minus the fiber content in grams. This is important because both soluble and insoluble fiber decrease the rate that sugars are absorbed from the gut and lower serum glucose levels. Ultimately, though, the amount of carbohydrates I will consume per day will be based on what level allows my body to switch to fatty acid metabolism for energy production. I will know this by the presence of ketones in my urine.

Traditional versions of the ketogenic diet are high in fat, very low in carbohydrates (30-50 grams) and low to moderate in protein. These diets are often provided to patients and their families with emphasis only on macronutrient content (fat, protein, carbohydrates) and no consideration of the types of macronutrients that are the most healthful. Further, there is often no attention paid to the crucial micronutrient (vitamins, minerals, anti-oxidants) content of the plan. Micronutrients are critical for optimal cellular function, including energy production.

As Lisa and I explore this food plan in ourselves, we will be working toward nutritional ketosis all the while optimizing nutrition, both macro and micronutrients.

We are curious about how this food plan will impact our energy and wellbeing.

My Ketogenic Food Plan:

  1. I will start with 50-60 net carbs per day. If I am already there, I will reduce them further, say to 30 gm per day.
  2. I will check my urine for ketones using test strips (widely available at pharmacies) first thing in the morning an throughout the day.
  3. I will adjust my daily carb content as necessary until I am in robust ketosis consistently.
  4. I will continue to eat healthy protein but will keep it at 3-4 ounces at each meal. Excesses of protein (beyond what I need) can stimulate gluconeogenesis, raising glucose levels and decreasing ketones.
  5. I will eat lots of healthy fat! Most of my calories will come from fats like coconut milk (culinary version), coconut oil, olive oil, omega-3 fats, avocado, eggs and grass-fed meats.
  6. I will keep a food log and track my carbohydrate intake. I like to use The World’s Healthiest Foods website:   http://www.whfoods.com/,  to look up nutrient contents of foods. They are the most comprehensive and reliable in my opinion. You can also get a rough idea of your carb intake using an app like My Fitness Pal.
  7. I will stick to low carbohydrate content plants like greens, crucifers, nuts, seeds and tart berries (blackberries, aronia berries and raspberries). I will miss my blueberries. I’ll find a way to get a few in!
  8. I will be analyzing my micronutrient intake as I explore this food plan and report back to you!
  9. I’m curious about fiber. Will my fiber intake decrease with the higher fat content and lower plant intake? How will this impact my gut?
  10. I will check labs before and after and see what impact this food plan has on measures of glucose metabolism, lipids, inflammatory markers (hs-CRP) and nutrients.

I will embark on this expedition this week. I plan to stick with it for about a month and track my energy, wellbeing and other symptoms carefully. I look forward to reporting back to you!

KARYN SHANKS MD

Karyn Shanks, MD, is a physician who lives and practices in Iowa City. Her work is inspired by the science of Functional Medicine, body-mind principles, and wisdom gleaned from the transformational journeys of thousands of clients over her twenty-five-year career. Her work honors each individual and the power of their stories, their inner wisdom, and innate healing potential. She believes that the bones of healing are in what we do for ourselves. She is the author of Liftoff, a manual of energy recovery and healing through essential self-care practices.