What’s a ketone?
It’s a chemistry term. It refers to a structure which is responsible for certain reactions, characterized by a carbon-oxygen double bond.
Many “keto” proponents don’t start here and also don’t realize that fructose-containing foods are filled with ketone-bonded energy. But, as you’ll soon see, these foods would not constitute “keto” compliance because of their tremendous sugar load.
This leads us to the central theme of the keto craze: proportions of one fuel versus another. Regardless of what some bros have told you, it’s not so much about one or the other. It’s the proportions.
To put things in perspective, elite cyclists might be considered “keto” at a dietary carbohydrate number of 1,000 grams. One thousand grams of carbs is only 4,000kcal. Some of these guys burn 14,000kcal on a competitive day. From where do you think that other 10,000 is coming?
What is ketosis?
This is a name we slap on the condition someone enters when they don’t have supra-adequate access to blood sugar or glycogen.
The body sees that it can’t easily get sugar into tissue (prediabetes and diabetes) or that it has little available to do so (fasting, dieting, high fat/keto nutrition, intense prolonged exercise). Begrudgingly, it relents to breaking down stored fat. During this breakdown, the liver produces these things we call ketones.
To a certain extent, therefore, any diet which results in reduced body fat was ketogenic, whether or not it abided by the name “keto.” Any time the human body breaks down fat, it will make ketones. This is a biological law. Any diet which didn’t result in fat loss was not promoting sufficient beta-oxidation and never produced a significant number of ketones even if the adherent called it “ketogenic dieting.” This is not an opinion. This is the known and non-debated biochemistry of fat loss. Fat loss is ketogenic whether you achieve it through bodybuilding dieting, veganism, paleo or otherwise. Therefore, to the question, “does keto cure obesity and diabetes?”, the answer, by definition, is yes. In fact, it’s the only cure for both.
Now don’t confuse controlled nutritional or exercise-induced ketosis with another condition called diabetic ketoacidosis. In insulin resistant individuals, they become so addicted to sugar, yet so incapable of utilizing it, that the body will amass outrageous amounts of energy in the blood (disposing of none), which is an acid load. This drops the pH of the blood dangerously and can be fatal. This has almost nothing to do with what we’re talking about when restoring a person to health through intelligent eating patterns.
To oversimplify, the human body can run on sugar in a wanton inflammatory state or it can churn along productively with something called beta-oxidation. Getting the body to remember beta-oxidation isn’t so easy; and this difficulty is the place from whence ketogenic diets arose. Most people must pass through severe withdrawal to achieve fat loss. Your brain is addicted to sugar at multiple levels. Yet not one cell in the body intrinsically requires external carbohydrates. Again, this isn’t my opinion. This is the unanimous declaration of the National Academies of Science, Engineering, Medicine, the National Research Council, and the National Institutes of Health (p. 275; https://www.nap.edu/read/10490/chapter/8 ). We can fuel everything with fats and protein, and liver function. But people have trained their bodies to reject the efficiency of beta-oxidation, and they require sugar emotionally, mentally, socially, and physically.
Depending on the severity of your addiction, there may be no “easing” into ketosis. People who have defined life with the abuse of alcohol can’t easily step into a healthy relationship with alcohol. In the same way, carb-addicts can’t easily step into a healthy relationship with carbs.
So we get rid of carbs, right?
Well, sort of. You have to understand that you likely have a severe mental and physical illness. SEVERE. And it’s been normalized in our society. So you have ZERO social support to go through the withdrawal symptoms. One of the first symptoms of withdrawal is misinterpreted as hypoglycemia. And I want to be sensitive here. So read closely. Ninety-nine times out of one-hundred, this is complete bullshit. I am the strongest advocate for science literacy I know. I rely on CONDUCTING science. I have people test blood sugar when they feel low. In SIXTEEN YEARS I had only one single client who was right about being hypoglycemic and she is an actual type I diabetic.
So I have people test blood sugar, because I actually believe in DOING real science. I know that this is a huge departure from other science advocates whose idea of science is the act of sharing vaguely science-related memes or pointing to consensus opinions. Ninety-nine percent of people who experience or fear hypoglycemia, when they test, discover HIGH blood sugars, not low. They’re addicts. They’re experiencing extreme drug withdrawal. Additionally, in the average populace, there is basically no such thing. Why? Because we aren’t even supposed to run our bodies on blood sugar alone. The human race wouldn’t exist if we required constant external carbohydrates. All of prehistory and almost all of history was not marked with swinging through the drive-through and eating snickers bars 5-10 times a day.
What are people usually referencing when they say “keto?”
It varies. Medical researchers Wilder and Peterman coined the term “ketogenic diet” in the early 1900s, defining it as a carbohydrate intake of 15 or fewer grams per day, protein intake of 1 gram per kilo of body weight per day, and a fat intake 4 times the sum weight of protein plus carbs. What’s most interesting is that scientists in the 1920s were discovering that fasting was a powerful therapeutic intervention for many diseases; and this formulation of the ketogenic diet was an effort to get all the benefits of fasting while still having some food. Moreover, Wilder and Peterman were hoping this ratio would lead patients to greater compliance over longer periods of time. Pay attention. Ketogenic dieting was devised IN ORDER TO BE easier to follow and for higher compliance. Don't you dare talk about how it can't be sustained. That was its very purpose.
By definition, any diet which works is ketogenic. This is an undeniable biochemistry reality. But what people often refer to when they use the phraseology “keto” is somewhere between “low carb” and “no carb.” And even these have different definitions for different people. But let’s just assume something in the ballpark of Wilder and Peterman’s definition, and place the number at less than 25 grams of net carb (everything that isn’t fiber or sugar alcohol) per day.
The beauty of this is its simplicity. Thus, it CAN work. But it’s missing vital specifications, like how many grams of dietary fat, fiber, protein, and micronutrients. Therefore, some people can thrive in the simplicity if they naturally hit the other checklist items. Everyone else, if they’re going to become more healthy while “keto,” needs to pay attention to the other nutrient sufficiencies. My primary concern in wanton keto dieting is that people degenerate their gut flora in the absence of sufficient resistant starches and fiber. My secondary concern is the possible absence of omega 3s (or so-called “dirty keto”). My tertiary concern is one I’ve tested firsthand: insufficient protein leading to loss of strength and lean mass. I tested wanton keto (ie - no special attention paid to protein sufficiency) for over a year. I was able to easily stay lean; but I could not maintain as much muscle mass or strength. We’ll table this piece of the discussion for now, because dietary sufficiencies are a massive subject in and of themselves (see here: https://www.elev8wellness.com/…/food-how-much-to-have-of-wh…).
Can keto really cure cancer, diabetes, obesity, alzheimer’s, epilepsy, etc.?
Let’s try to keep the discussion on known biological mechanisms, not anecdotes.
Regarding type 2 diabetes and obesity, the answer is a definitive yes. As you deplete the body of energy, glucose transporters will become more sensitive (curing both), which IS going to be a state of ketosis.
Regarding epilepsy, the answer is NO. It cannot cure epilepsy. It is an effective treatment for many. In fact, it’s the only way to reduce seizure severity for the anti-epileptic drug non-responders. Why? Because seizure IS imbalance of the inhibitory and excitatory mechanisms. The cells which govern those mechanisms, when relying on glucose, have variant energy availability (and therefore erratic responses). The cells which govern those mechanisms, when relying on the never-ending and steady stream of ketone fuels, don’t experience variable operation. One of the coolest facts about ketogenic dieting for epileptics is that some of the benefits PERSIST after discontinuing the diet.
Regarding Alzheimer’s, there is promise here, but the implementation must be specific. Dr. Mary Newport created a buzz around this when her husband’s rapidly declining health and advanced Alzheimer’s was reversed by raising his ketone levels. Unfortunately, people erroneously took from this story that coconut oil cures Alzheimer’s. Even she seemed confused by the outcome, spending a lot of energy on talking about coconut oil. The issue with Alzheimer’s is accumulated products and inability to get energy into brain cells. Simply eating fats won’t necessarily accomplish either. Fasting, followed by an emphasis on ketone fuels IN THE ABSENCE OF INFLAMMATORY FOODS, will help the underlying pathology. But simply adding fats to an already-unhealthy and overly carb-laden diet will not even reduce symptoms, let alone cure the disease. This is yet again where there is a monumental difference between two people’s definitions of “keto”. We don’t need merely to eat a bunch of medium chain triglycerides. We have to clear the body of excess energy, cell waste, and reset counterproductive processes. Follow-up research on Alzheimer’s in recent years, has, therefore, emphasized the fasting component more than the addition of oils. And the fasting (which, by the by, invokes internal production of ketone fuels) does reliably improve memory in Alzheimer’s patients: https://www.ncbi.nlm.nih.gov/pubmed/29307281
Regarding Parkinson’s, ketogenic/high-fat dieting does reduce symptoms and severity of the disease: https://www.ncbi.nlm.nih.gov/pubmed/30098269. My suspicion, however, is that the clearance of energy will play a more vital role. Thus, like with Alzheimer’s, I believe we will begin moving the discussion toward intermittent fasting, since we’ve already seen that brain cells improve when we temporarily reduce or clear energy. The issue with studying long-term effectiveness, like any study on nutrition, is long-term compliance, which we’ll return to at the end of the post.
Regarding cancer, does keto cure it? Nope. Well, sort of. Not exactly... Here’s the deal: there is an ever-piling body of evidence which shows that the vast majority of tumors are inhibited with ketogenic dieting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375425/ .
The likely mechanism is that most cancer cells do rely heavily on glucose. After all, they GROW. Therefore, any effort (including keto) which works against growth works against cancer... up to a point. There’s no easy answer here. Cancer cells will grow to the detriment of the host. So the host’s tissue is already starving in comparison to the cancer cells. The benefit of ketosis is that you will upregulate the glucose transporters in host cells. That is, your other cells will be more capable of “eating” available energy. But, how do we support children (who need to grow) or cachexic patients (who need to gain weight) with wasting as a concern? Interestingly, researchers in the 1980s already showed you could slow tumor growth WHILE increasing healthy body mass with classically ketogenic dieting: https://www.ncbi.nlm.nih.gov/m/pubmed/3620317/. Just add more fats.
Though this sentence is anecdote, I’ve also personally tested and succeeded at the idea of gaining healthy tissue and no body fat with a ketogenic diet. It can be done. You can shut off unhealthy inflammatory processes while enabling healthy tissue to thrive.
This is the bugbear. Before we get to it, however, I think it stands to note that the vast majority of people doing “keto” are not even close to the parameters set up by medical researchers. And when they are, like I said, I still have a few concerns about protein, fiber, and micronutrient sufficiency. Once we get clear on those, we’ve reduced opacity along with some of the compliance factors. That is, I believe strongly that when people are sufficient across the board, hunger, cravings, and self-sabotage get as low as we can get them.
So what might a genuine ketogenic diet day look like?
For a 220lb individual:
15g net carb (w/ 25g fiber)
204g fat (this isn’t the 4x macro weight number, but a 4x kcal tabulation)
Immediately, you can see the miss. People don’t even begin to approach the dietary fat number. Even when they go “low carb,” they tend to not even approximate the 15g (and sure as heck don’t get enough fiber). And I’ve seldom found a “keto” adherent who made the protein number. That’s to say nothing of the fact that you must eat more sodium when in ketosis, since insulin is suppressed, and insulin is THE sodium retention pump. And that’s really to say nothing of b vitamins, vitamin c, d, other minerals, etc.
Largely, most people arguing against keto are working against a straw man. They sure as heck aren’t educated on the medical definition, and certainly aren’t abiding by sufficiency guidelines. Mostly, they “tried reducing carbs” once, which is the vaguest and most banal sentiment possible. Thanks a lot, influencers and popular health and fitness celebrities.
Back to compliance:
With sufficiencies, I find that compliance is incredibly high. Where people tend to get tripped up the most is “hearing” some contrary health and fitness advice (ie - fat is evil; sodium is bad; protein hurts your kidneys; it’s all about calories-in/calories-out). When we control for the contrary nonsense, compliance approaches 100%.
But “approaches 100%” is still not 100%. This is where I find it’s helpful to recall that the whole point of developing a ketogenic diet was to get the benefits of fasting without the struggle of having to fast. True ketogenic nutrition is at a level convincing the body that it is fasted. Physical activity may necessitate more food. A slip in carb compliance may require higher activity for a few days. Cravings or negative emotion are a “check engine light” for micronutrients. Did you get your omega 3s, your fiber, your minerals, your sea salt, your fat grams high enough?
Lastly, with regard to compliance, there is the ownership component. You must take ownership of your program. You can seek input, coaching, guidance, direction, advice, tips, and tricks. All great. But if you are looking for a food template or diet plan, you’re already screwed. It’s ultimately a matter of becoming efficacious and educated enough to find ways to meet sufficiencies and requirements with infinite food options.
I realize that people want it simple. “Just tell me what to eat,” they say. Or “just tell me what not to eat,” they say. However, as I excruciatingly detailed above, “ketosis” is an aggregate outcome of body mass, lifestyle, stress management, and eating. If you have a lot of muscle and you want to do hard workouts 2 hours per day, you may be “keto” at way over 300 grams of carbs.
If you aren’t very active and don’t have a lot of muscle, you may well want to abide by the Wilder and Peterman guidelines. Add to that fiber and micronutrients sufficiencies, and you’re on your way.