Ketosis is a condition where high levels of ketone bodies (ketones) in the body are observed.
Ketones represent a group of 3 molecules – acetoacetate (AcAc) /, tri-beta-hydroxybutyrate / 3-β-hydroxybutyrate (3HB) / and acetone.
Ketones can be seen as an alternative fuel. AcAc and 3HB can also be used as a source of energy from many organs in the human body when needed.
Probably most of the readers know that the human body relies on three essential nutrients as a source of energy – carbohydrates, fats and protein.
Carbohydrates and fats are the main source of energy, and protein is used as such to a very small extent.
Falling into the bloodstream and subsequent processing of these nutrients. They break down to their constituent parts, namely, carbohydrates to glucose, fat to fatty acids, and protein to amino acids
Most organs can use both glucose and fatty acids as their source of energy, but unlike others, our brain relies almost entirely on glucose because fat can not cross the blood-brain barrier.
Since there are a variety of factors in reality that can lead to glucose deficiency (for example prolonged fasting due to lack of food), as a survival mechanism. The brain has the ability to use another type of fuel – ketones.
The brain does not rely entirely on ketones and always uses a certain amount of glucose because our body has the ability to synthesize itself (by the process of gluconeogenesis, for example).
Even if no carbohydrates are taken. Instead of 100%, however, in such situations glucose decreases considerably as a source of energy – about 30-40%.
The process of creating ketones (ketogenesis) occurs in the liver and depends to a large extent on glucose and insulin levels.
Glucose and fatty
Glucose and fatty acids are metabolised to acetyl coenzyme A (acetyl CoA). It, in turn, binds to the oxaloacetate molecule and enters the Krebs cycle to produce energy.
Through the process of the glycolysis pyruvate is being synthesized , which is a precursor to the oxaloacetate, is synthesized by the glycolysis process.
If glucose and insulin levels in the blood are low, it also leads to a significantly reduced glycolysis process. In this case, instead of the oxalacetate being associated with acetyl CoA, it is used in the process of gluconeogenesis.
All this creates a situation where, if acetyl CoA does not bind to oxaloacetate, it is used instead of the Krebs cycle to produce ketone bodies.
Briefly, if the blood glucose levels are low enough, this allows the metabolism of liver fat to shift to the production of ketones.
Why ketogenic diet is popular ?
Ketogenic diet has gained increasing popularity over the past 20 years and is currently one of the most common ways of eating.
The classic Ketogenic diet was created back in 1920. At that time, there are already some scientific papers showing significant improvement in symptoms and a significant reduction in seizures in people suffering from epilepsy that go through a period of complete starvation.
Scientists at Myo Clinic, looking for a way to imitate as much as possible from the metabolic adaptations of the body in complete starvation, reach the keto diet.
In essence, this type of diet is one in which food predominates fat and, to a lesser extent, protein and carbohydrates. Over the years, the diet has undergone a variety of changes, and several variations can be encountered at the moment.
Ketogenic diet in its original form is created with a purely therapeutic purpose, as a possible solution in people where medication therapy does not give satisfactory results (refractory epilepsy). According to the available data, nearly 30% of epileptics do not work optimally.
Excluding proven efficacy in epileptics, the popularity of this type of diet is based mainly on some claims that the ketogenic diet leads to more effective weight loss than other types of foods that contain more carbohydrates. However, this is not the case and we will discuss the article first.
Variety of ketosis and most commonly used foods in this type of diet
Classical Kethogenic Diet (CKD)
In the classic Ketogenic diet, between 80 and 90% of the nutrients of the day are in the form of fats, 10 to 15% are released for protein, and carbohydrates are only about 5%.
For acquiring fats it is being emphasized by various oils, especially coconut, olive oil, nuts, oily fish and others. The protein is acquired through oily meats and fish, and carbohydrates are mainly leafy vegetables.
Since this type of diet is primarily used for therapeutic purposes, including kids and newborns. Hospitalization is often required to allow the patient to be monitored by a team of professionals familiar with this regimen. Strict control and monitoring of calories and food, which you include in your menu is required.
Often the diet starts with one or two days of complete starvation.
When used therapeutically, in most people the effectiveness of the diet starts to be noticeable about 2-3 months after the start. A large percentage of patients stop this diet after about 2 years without seizures.
Modified Atkins Diet (MAD)
The modified Atkins diet, also known as the Atkins diet or Atkinson diet, is one of the most common modifications of the CKD.
The reason for this is that this diet variation also has very high therapeutic efficacy, but is much easier to follow, is less restrictive, and reduces some of the keto diet’s negatives, which we will mention below.
In ADA, the percentage of fat in the diet is reduced to about 60-65%, the protein increases to about 30-35% and carbohydrates can reach 10%, depending on the weight of the next one and its caloric intake.
Most importantly, it remains to reach and maintain the ketosis state and accordingly, the intake of nutrients can be further adjusted.
Modification of Atkins does not necessarily require strict control of the amount of food.
In fact, MAD is the variance that is used very often as a weight loss tool. Diet, in which a person is allowed to eat as much as he wants and to lose weight despite everything. Of course this is not the case, but through such marketing the diet has become very popular.
Treatment with low glycemic index
The Low Glycemic Index Treatment (LGIT) is very similar to the distribution of macro nutrients to those of MAD.
This diet generally follows the same distribution (60-65%: 30-35%: 5-10% for fat: protein: carbohydrates), but here is also a serious consideration of the glycemic index of foods that are consumed.
In fact, the diet allows you to eat anything that has a glycemic index below 50.
MCT Ketogenic Diet
Food fats can be classified according to the fatty acid chain length.
MCT is an abbreviation for medium-chain triglycerides (Medium-Chain Triglycerides).
Unlike long-chained, medium-sized ones are handled in a slightly different way, allowing them to be quickly taken up, to enter directly into the liver and metabolized to ketones.
Thus, ketogenesis and ketone levels in the body are further stimulated by allowing more protein and carbohydrates to be included in the diet without significantly inhibiting ketogenesis.
Unlike other modifications, implementation, and MCT recommendations, the ketogenic diet varies according to different clinics and specialists.
Carbohydrates are limited to about 5-10% but fat can vary between 60 and 80% and protein between 15 and 30%.
The most important thing for this modification is the high intake of medium-chain triglycerides. The recommendations vary, but between 30 and 60% of the total daily fat should be in the form of MCT.
Since high intakes of medium-chain triglycerides can lead to stomach upsets. Their amount is mostly adjusted according to the tolerance of the next type of meal.
The higher the percentage of fats in the form of medium-chain triglycerides, the better. It is advisable to have their intake distributed evenly throughout the day.
The intake can also be supported by dietary supplements containing medium chain triglycerides.
Who should avoid keto diet?
The levels of ketones in our body under normal conditions are extremely low, and ketogenesis increases only in certain situations, such as prolonged starvation , very low carbs and more fat, prolonged physical exercise (sport), but also in physiological diseases such as diabetes type 1.
Dangerously high at values above 10 mM, where can ketoacidosis occurs.
Here we must mention a very important thing, the difference between ketosis and ketoacidosis, which many people confuse.
Ketoacidosis is a life-threatening condition of extremely high levels of ketones in the body. Ketoacidosis can occur primarily in diseases such as type 1 diabetes, if the patient does not inject insulin on time. In more serious cases, ketone levels in the body may reach up to 25 mM.
Another thing that can cause ketoacidosis is the intake of high doses of isopropyl alcohol, as well as the abrupt cessation of alcohol after long-term abuse (alcoholic ketoacidosis).
Under normal circumstances, however, the body has everything it needs to control ketone levels and ketogenesis. In healthy people, insulin and glucose levels almost never fall so low that ketogenesis goes out of control.
Even after a few days of complete hunger or adherence to the so-called ketogenic diet, which we will look at below, ketone levels do not exceed 7-8 mM and this does not pose any danger.
The ketogenic diet may be beneficial in certain diseases as an aid to their treatment.
Reduction of seizures in patients with epilepsy
Controlling epileptic seizures is the main reason for creating and following this type of nutrition. Efficacy is undisputable and proven many times.
Unfortunately, not all people have the same result, but most scientific data show that:
in 50% of people seizures decreased by over 50%;
about 30% reach a 90% reduction;
between 5 and 15% managed to get rid of it completely.
Pyruvate dehydrogenase deficiency aid
Deficiency of the pyruvate dehydrogenase enzyme complex leads to a number of neurological complications and compliance with a ketogenic diet is among the main recommendations for tackling the problem.
But not all people agree with this.
GLUT1 Deficiency Assistant
Glucose transporter 1 deficiency is an inherited neurometabolic disease in which the brain does not reach enough glucose. This can lead to seizures and cognitive problems.
A ketogenic diet is a possible solution that can be tried, but some reported complications such as high hypertriglyceridemia have to mentioned.
Cure for migraine
Тhere is not a lot of information, but the keto diet has the potential to help deal with episodic or chronic migraines.
Cure for diabetes type 2
A number of scientific studies have shown that following a low-carb diet helps reduce some important markers such as blood sugar levels, glycated hemoglobin, triglycerides and some others.
Although “low carb” encompasses a relatively wide range of carbohydrate volumes, much of the research is precisely in the case of a keto diet.
Cure for cancer
The ketogenic diet has been repeatedly tested to prevent or treat various types of cancer.
Unfortunately, as stated in the systematic review of English scientists from May 2017, at this stage the data are not sufficient and many are needed so that the ketogenic diet can be used therapeutically in this direction as well.
In most cases, the ketogenic diet does not hide a serious risk to health and life.
The most common side effects and ailments are mainly seen in the classic diet because of the total exclusion of certain food groups.
Increased hunger and appetite (mainly the first few days until the body adapts to the ketosis);
Deficiency of certain nutrients – calcium, selenium, zinc, copper, magnesium, vitamin D, group B vitamins, l-carnitine;
Increased risk of kidney stones;
Change in lipid profile.
Although extremely rare, it is possible to reach the life-threatening state of ketoacidosis. There are 3 such reports among scientific data. All three are for women, two of whom were breastfeeding (nursing and pregnant women are a risky group).
The ketogenic diet in all its variations is contraindicated in people with specific diseases that disturb the metabolism of fats, such as primary l-carnitine deficiency, deficiency of carnitine palmitoyltransferase enzymes, carnitine translocase or pyruvate carboxylase, as well as defects in the beta-oxidation process.
Studies conducted by de Lima in 2015 and 2017 draw attention to the fact that, in addition to changing the values of the lipid profile as a whole, consideration should also be given to the size of the lipoprotein fractions and to be regularly monitored.
Ketogenic diet with exercises
With the commercialization of some of the variations in the ketogenic diet, many times this type of diet is recommended as a replacement for optimal eating or high carbohydrate nutrition to improve sports performance and performance in general.
Although scientist research are a lot, the information is very contradictory and most of the researches have a lot of flaws
Only two of them have been peer-reviewed.
One of them, participants in off-road bikers, observed improvement in the maximum oxygen flow (VO2 max) and the oxygen flux at the lactate limit (VO2 LT) in the keto-diet group, but significantly improved performance maximum power output in the normal group of carbohydrates.
The other study was conducted with artistic gymnastics. There was no change in force during the 30-day period of compliance with the regime. There is a slight improvement in body composition – weight loss and fat percentage.
The other study was conducted with artistic gymnastics. There was no change in force during the 30-day period of holding with the mode. There is a slight improvement in body composition – weight loss and fat percentage.
While it is still not possible to deny the benefit of maintaining a low-carb and ketogenic diet, it is also not clear what the specific circumstances under which this diet can be beneficial.
Most scientific data currently have some similar conclusions:
sticking with a low-carbohydrate or ketogenic regimen can help improve body composition, mainly by reducing weight and excess fat but not optimally for muscle gain;
when looking for maximum and optimal sport performance, including aerobic and anaerobic sports, at least optimal amounts of carbohydrates are required.
Long term keto effects
Ketogenic diet and all its variations have gained enormous popularity because of their marketing as a better and more effective weight loss diet.
Over the past 15 years, the number of scientific papers exploring the effectiveness of low-carb diet has continued to grow.
Мost of them show and prove the effectiveness of the diet. They also compare this type of eating with high carbohydrate meal for better results.
The problem with most of these studies is that they have serious drawbacks.
Most are not done in metabolic compartments, which means they have almost no control over the participants and rely entirely on their judgment about what they ate and in what quantities. This judgment can vary greatly.
Unfortunately, studies made in metabolic compartments are very few, as they require extremely serious financial resources and serious difficulties are encountered in finding long-term participants. Few people have the desire to live in a lab for more than a month.
Another problem encountered in this type of research is the lack of calorie equalization and the amount of protein that the study participants are taking.
Both the amount of calories and the amount of protein have been repeatedly proven to be an important factor in weight loss. If they are not aligned with the different participants, it can not be concluded that low carbohydrates are the only cause of a better or worse result.
If these research drawbacks are not taken into account when considering their outcomes, the risk of making the wrong conclusion is very high.
However, there are studies where the methodology is at a very high level and we want to focus on them.
One of these studies was conducted in a metabolic compartment, while others were not, but each participant was given an individual diet, exact recipes and instructions on how to prepare and monitor the food. In one of them the food was personally prepared by the organizers of the study.
We also present two meta-analyzes examining studies with high-level methodology.
The results can be summarized as follows: with equal other conditions, low-carbohydrate and ketogenic feeding results in equally effective attenuation as well as high-carbohydrate.
The most important thing is to follow a mode that is most comfortable and tasty for the individual and he will be able to stick to it in the long run.
28 Day Keto Diet
If you are interested in starting a keto diet or considering, I’d definitely recommend you to take a look at the 28 day keto diet book.