The Ketogenic Primer: The Guide To A Scientifically Healthy Diet

Caution! Bread!

It’s been a while since I posted. It isn’t that I forgot about or abandoned this blog. I’ve been wanting to post for some time now. But I knew the next post had to be the big reveal on what the diet is. I wanted to get it right. But I came to realize after 2 weeks of stalling that it will never get done if I don’t just take a stab at it. I accepted that this won’t be the 100% primer for this diet (or shall I say “lifestyle” since a diet might imply that it is a temporary change) and I may miss some very important points along the way, but the good thing about a blog is I can dive into the fine details in individual posts. So if you have questions, ask them in the comments and I’ll either answer them there, in a series of blog posts, or both.

Anyways, if you want to know the science, read all the sections. It is a very long post (probably will be my longest ever) but I encourage you to understand it all and empower yourself (otherwise you may just be seen as someone following another “fad diet”). Otherwise, skip to the bottom to read what my diet consists of. But make sure you come back and read all the sciencey stuff later!

Ketones? Ketosis?

You’ll read this word over and over again throughout my blog: Ketones (or “ketone bodies”). Ketones are a byproduct of the breakdown of fatty acids, a process that the liver is responsible for. What’s so fascinating about these so called ketones? They are an efficient alternative fuel source for your body. I can almost guarantee that you have been told your entire life that your body runs only on glucose (what carbohydrates/sugar breaks down into). Well I am here to tell you, this is entirely untrue. Before we get further, just to clarify, sugar is carbohydrate. And all carbohydrates are just varying length chains of sugar. The bigger the chain, the more “complex” the carbohydrate (takes longer to break all the way down into glucose).

Ketosis Diagram

Ketone production and use diagram

Under the right conditions, fatty acids are able to be released from fat cells and oxidized in the liver. And when this happens, a large amount of ketones are produced as a byproduct. The state of having elevated ketones in your blood is called “ketosis.” This state is highly beneficial to health in general. For example, your heart runs at 28% greater efficiency with a mix of ketones and glucose than glucose alone. And the same goes for your brain. In fact, ketones are being explored as a treatment for degenerative brain diseases (neurodegeneration like Alzheimer’s) and treatment for epilepsy (safe for treating children too), just to name a few uses. Alzheimer’s is sometimes referred to as Type II diabetes of the brain (or more commonly Type III Diabetes). And we all know (or should know) that Type II diabetes is caused by elevated blood sugar levels. Basically too much glucose is bad news. Ketones come to the rescue. But ketones don’t come easily!

In order for your body to constantly produce enough ketones for you to be in ketosis, your body has to be efficient at oxidizing fatty acids. In fact, your body has to rely on oxidizing fatty acids. Unfortunately, carbohydrates are your body’s preferential fuel when they are present. This is because it takes much less energy to break down and produce energy (in the form of ATP, which I’ll discuss later) than any other macronutrient. Not to mention, blood sugar at high levels will kill you, so your body MUST regulate itself and clean up the excess sugar ASAP. The simpler the carbohydrate, the faster it breaks down. Meaning a snickers bar with pure sugar will provide energy much faster than a slice of whole wheat bread. So in short, if carbohydrates are present, your body won’t turn to fat burning and won’t produce ketones. It can’t rely on breaking down fatty acids if it is too busy chomping away on carbohydrates.

Blood Glucose & Insulin

On the other hand, if you restrict your carbohydrate intake, given enough time, your body will switch over from searching for carbohydrates to searching for fat. There are many hormones that play a role in ramping up this process as well. We will get to a lot of them in the future, but the one we will focus the most on is insulin. So what is insulin exactly? It is a hormone that is released by the pancreas when the pancreas gets a signal that your blood sugar is higher than normal. Insulin’s role is to sweep up the excess sugar in your blood and feed them to your cells. It has to do this because high blood sugar can be incredibly toxic (ask any diabetic). And it is unfortunately indiscriminate in what it feeds. This means it feeds your muscle cells as well as your fat cells. In other words, insulin adds fat to your body. What is worse is when insulin is adding to the fat cells, it blocks fatty acids from exiting the fat cells. So basically, when insulin is present, fat release/burning grinds to a halt. It runs in reverse.

Blood glucose testing as done by diabetics and people like me who want to know what is going on with their blood sugar.

Overtime, this process of insulin sweeping away blood sugar to your cells can become dangerous. When your body is bombarded with sugar constantly and insulin has to constantly be produced, your body may stop responding to insulin to an extent. This is what doctors and scientists call “insulin resistance.” Basically, the more insulin resistant you are, the less your body responds to insulin. This means your blood sugar levels stay elevated for longer after a carbohydrate filled meal. Insulin can no longer do its job as efficiently as it used to. Your blood sugar levels can rise to very dangerous levels and you could get infections, go blind, and a whole bunch of other nasty things. And since your body is now pretty bad at feeding it’s own cells, you get hungry and end up eating more! So the combination of consuming excess calories and having high levels of (fat release blocking) insulin all the time will lead to obesity. This entire insulin resistance thing can also be called Type II Diabetes. Knowing this, don’t you think it is silly that some people still foolishly say that obesity causes type II diabetes? Isn’t it the other way around? Type II diabetes is a cause obesity. Or even more accurately, Type II diabetes is caused by the same thing that causes obesity. And varying levels of insulin resistance up to type II diabetes causes weight gain. What is scary is that 8-9% of Americans are diabetic. Just under a third of these people don’t know they are diabetic. Even scarier, 25% of Americans are prediabetic. And almost all Americans have some degree of insulin resistance over a normal healthy level. This is why so many people are overweight. They keep supplying their bodies with sugar, which raises insulin over a healthy level, and a vicious cycle takes place where they crave more sugar. Carbohydrates set you up to fail.

The absence of dietary carbohydrates (or at least the restriction of dietary carbohydrates) keeps insulin levels at bay which allows your fat cells to release their fatty acids. And when your body isn’t too busy breaking down those carbohydrates for energy, it will start to burn the fat. Ketones are produced. Your body has energy without all the adverse affects of sugar/insulin.

Low Carb vs High Carb Blood Sugar

My own blood sugar taken throughout a low carb day vs a high carb day. Low carb is steady and high carb is all over the place. (click image for larger view)

Big Word: Gluconeogenesis

A healthy person only has the equivalent of about 4/5 of a teaspoon of sugar in their blood while fasting

I agree. The idea that your body doesn’t need glucose at all is silly. Your body definitely needs it. However, your body doesn’t need as much of it once it has gotten used to ketones for fuel. The large spikes of sugar (which spikes insulin) is what is dangerous. So what we need to stay healthy is a low and constant supply of glucose. If you try to do this by eating carbohydrates, you’d have to nibble on a very complex carbohydrate throughout the day. It only takes your body about 2 hours after you start eating to break down carbohydrates into glucose. According to Michael R Eades’ blog (M.D. and co-author of the book Protein Power), a blood glucose level of 80 mg/dl (which is very healthy) is the equivalent of having 4/5 of a teaspoon of sugar in your blood. That isn’t a whole lot at all. That is about 3.4 grams of carbohydrates. That is such a tiny amount. The point is, it is nearly impossible to eat a lot of carbohydrates without causing sugar spikes all over the place.

Diagram of ketogenic metabolism (found on lowcarbluxury.com)

Diagram of ketogenic metabolism (found on lowcarbluxury.com) mostly focusing on the requirements for gluconeogenesis. This particular diagram doesn’t show the production of ATP and ketones.

Fortunately, you don’t need to eat carbohydrates to keep your blood sugar from plummeting. Your body is very good at regulating itself in order to survive. How would cavemen survive for days without food and still have the energy to hunt if we couldn’t regulate ourselves? In a state of low levels of glucose, your liver produces glucose in a process known as gluconeogenesis (pronounced glue-co-knee-oh-genesis). This is the process of breaking down protein into glucose. Yes, protein is also a source of glucose when it needs to be. But this process can’t happen without adequate fatty acids. Fatty acids are needed to fuel this process. So through this process you get multiple sources of energy. ATP from the breakdown of the fatty acids, ketones, and glucose. All of these things fuel your body. So if you are eating enough fat and adequate amounts of protein, you can create all the energy you need, in a controlled and steady pace.

A Bit More On Fatty Acid Oxidation and ATP

Back on ATP. ATP is adenosine triphosphate. It is what everything is broken down into to fuel your cells. This is truly the main fuel source for your body. Many people will tell you that ATP only comes from glucose. But the reality is that a molecule of glucose breaks down into 30 ATP. What most people don’t know is that fatty acids also break down into ATP. A long chain fatty acid can be broken down to around 150-300 ATP depending on the length of the fatty acid. However, more energy is also needed to break down fatty acids than glucose (because the structure is much more complex). So the net ATP is less than 150-300. This is why glucose is burned first follow by fat. If your body needs to break down fat for energy, it actually works harder to do so. Basically, your body’s metabolic rate increases just to break down the fat for the energy it needs. Very little known fact. Neat huh?

The Dreaded “Starvation Mode”

This is one of those things I hear all the time. “If you don’t eat carbohydrates and enough calories, your body will go into starvation mode, eat away your muscle, and lower your metabolism!” This is somewhat true. In the world of body building and weight training in general, the term gluconeogenesis is frowned upon. This is because in a body that is reliant on carbohydrates and hasn’t adapted to the process of using ketones, the protein is taken from the muscle (catabolism) to provide fuel for the body. This is very bad. So if you are exercising too much while your body still craves glucose as its only fuel source, or if you aren’t eating enough, your energy stores will be depleted. Your body will force the gluconeogenesis and if you aren’t constantly eating protein, the protein will come from your muscle. You will lose fat since gluconeogenesis requires fatty acids. But you will also get weaker since you are losing muscle. The ketones produced will only supply a small amount of energy since your body doesn’t know how to use them efficiently yet (has not adapted to use ketones). So more gluconeogenesis happens than is actually needed.

So how do low carbers get away with this? As I stated before, if your body is adapted to using ketones, you are in the clear. Your glucose requirement goes way down. Ketones are king. In a body that is keto-adapted (as some call it), gluconeogenesis supplies glucose but the main reason it is happening is to supply the ketones. In fact, while you are exercising and keto-adapted, your body does an interesting thing. The lactate that is produced in your muscles while contracting are sent to the liver. The liver then converts this lactate into glucose. The glucose is sent back to the muscle to be used up along with ketones. It would seem that this is perpetual energy. But the process of converting lactate into glucose also requires ATP (energy that would come from breaking down fatty acids). So really, the only thing you are using up while exercising in a ketoadapted state is fat (for the most part)! This process is called the Cori Cycle.

Marathoners: Prime examples of a carbohydrate dependent athlete

Marathoners: Prime examples of carbohydrate dependent athletes

So whenever someone tells you that you need carbohydrates to stay out of starvation mode, tell them they are wrong. Look at some marathon runners. Many of them are so scrawny. Skin and bone. This is because carbohydrates aren’t muscle sparing. Ketones are. But these people live off of the idea that they need to eat two pounds of pasta before a race. Just about every other calorie restricted diet will cause you to lose muscle along with fat. A low carb diet helps you hold on to the muscle and lose almost entirely fat.

So What Do I Eat?

Big juicy steaks.

Fat. Fat with a moderate amount of protein. Most of which is animal fat. You really want to avoid fats with a lot of Omega 6 fatty acids (the higher ratio of omega 6 to omega 3 fatty acids is linked to inflammation which causes heart disease). Actually, probably about 50-60% of my calories (at least) come from fat. Less than 5% of my calories come from carbohydrates. And the calories that do are mostly complex carbohydrates. The rest is protein. (4 calories per gram of carbohydrate or protein. 9 calories per gram of fat) Too much protein in some people can be broken down just like carbohydrates (just a bit slower) so it’s safer to stay on the low to medium side. Too little and you don’t have enough to fuel gluconeogenesis and your body will catabolize it’s own muscle. But you will be surprised to find that you need very little to prevent this catabolization. The main focus should be on very little carbohydrates, and high fat intake. The protein will work itself out. The reason for the high fat content is because you need it to fuel the processes that create ketones and the small amount of glucose required.

Stir frys are a good way to incorporate lots of veggies and meat

Stir frys are a good way to incorporate lots of veggies and meat

Of course, if all you are eating is meat, you won’t get all of your vital vitamins and minerals. So eat your veggies. But stay away from starchy veggies. I’m sorry, no more potatoes and grains like rice (remember, I’m the Asian Without Rice!). Opt for non starchy veggies that are dense in nutrients like spinach, broccoli, collards, artichokes, kale, cauliflower, etc. And you can have small amounts of higher carbohydrate veggies like bell peppers, onions, or a bit of tomato.

Are fruits out of the question? No. Not all fruits. Oranges unfortunately are off limits since it has so much simple (even if natural) sugar. But higher fiber/lower sugar fruits like strawberries and blueberries are surprisingly safe. The only way to know is to look it up.

Salmon has a lot of anti-inflammatory (aka anti heart disease) omega 3 fatty acids.

Salmon has a lot of anti-inflammatory (aka anti-heart-disease) omega 3 fatty acids.

My rule of thumb is no more than 25 grams of carbohydrates a day. This is a bit extreme but the lower the better. Some people can get away with 80 grams or less and still be in ketosis. But most fall somewhere around 40 grams. But if you have the will power to go lower, do it. The only way to find out is to experiment and find what works for you. More on this later, but a simple and inexpensive way to see if you are in ketosis is to get these test strips at your pharmacy called “Ketostix” (not KetoDiastix) or the CVS brand “Ketone Test Strips.” You basically get a bit of urine on the end and see if it changes color. If you are going to try a higher carbohydrate intake (40-80 grams), make sure you spread it out throughout the day. Remember, the idea is to reduce blood sugar spikes. The more carbohydrate you eat in a short amount of time, the higher the fluctuation. Try to aim for about 10-15 grams of carbohydrate a meal, tops.

Also, the omega 6 to omega 3 fatty acid ratios are very important. This ratio directly affects that amount of inflammation in your body. The recommended healthy ratio is 3:1 or 1:1 (lower numbers on the left is healthier) omega 6 to omega 3. The average American gets 15:1 to 30:1. No wonder why heart disease is running rampant. Do Google searches to find out the ratios of the foods you want to eat. Rule of thumb, stay away from refined veggie oils! But check to be sure. Here is a starting point!

So in summary, I eat lots of meat and animal products (steak, fish, pork, cheese, butter, yummy) and veggies without starch or high amounts of carbohydrates in general. Oh and I definitely supplement with multivitamins. I won’t sugar coat it (hey look, a pun!) it gets difficult sometimes. The entire supermarket is loaded with foods that are packed with carbohydrates. There are very little choices for lunch that are low carb. You might get funny looks from people when you go out to eat and throw away that hamburger bun. This is why I encourage you to empower yourself with all of this info. You can then tell people that you know what you are doing and that you aren’t some lunatic :) .

What Happens When I Start?

At first you may feel like this...

At first, you may feel like this…

Unfortunately, the first few days for people starting a ketogenic diet aren’t entirely pleasant. Many people (myself included) experience something casually known as “low carb fever.” Lucky few, like my lovely fiancée, Rhiannon, have never experienced this. It isn’t dangerous as some people might tell you. It is just uncomfortable. You may feel a bit fuzzy and light headed. You may feel a bit lethargic. You might also feel a little dehydrated or hot. This is because your body is sitting around waiting for carbohydrates. It is so dependent on them from years and years of carbohydrate binging. Your body is burning some fat at this point (not a ton) and producing some ketones, but not enough to fully fuel your body. On top of that, your body won’t know exactly how to use these alternative fuel sources efficiently yet. Until your glycogen in your liver is depleted, you won’t be ramping up the ketone production much. This only takes a few days.

But in no time you will be feeling like this 24/7!

But in no time you will be feeling like this 24/7!

After 2-3 days, most people feel great. And over the next 2 weeks while your body ketoadapts (for some it can take a couple months), you will start feeling more and more alert. As stated previously, your brain actually runs more efficiently on ketones. Many people report feeling more alert and clearer minded than ever. And you won’t have that 3PM mid afternoon crash that you used to have while eating sugar. You will also find that you are hungry less. You can go much longer between meals before feeling a bit hungry. Basically, get over the first few days and you are golden.

You might also see the scale drop 4-6 pounds in the first week. Although this is exciting and is great for motivation, I’ll give it to you straight, most of that weight was just water. Every gram of glycogen (glucose in its temporary stored state within the liver and muscles) is bound to about 3 grams of water. An average person can store around a pound of glycogen (which means around 3 pounds of water along with it). A low carb diet works to deplete this excess glycogen and water. But just give it time and your body will become very efficient at burning fat and the (fat) pounds will come off faster than ever. All the while, you will lose little to no muscle mass. In fact, most sedentary people gain muscle when switching to a low carb high fat diet without even exercising.

Just a Few Common Concerns

Ketoacidosis: Do a quick search for this and you will find very ill informed people writing about how a low carb, high fat, ketogenic diet is bad for you. And they will most likely mention ketoacidosis. They will say ketoacidosis IS an inevitable result of this kind of diet. Ketoacidosis is bad. It is when your blood concentration of ketones rises to a dangerously acidic level. This only happens in Type 1 Diabetics. The amount of ketones to put you in a state of ketosis is hugely distant from the amount of ketones that would put you into a state of ketoacidosis. If you find yourself in ketoacidosis, you have far bigger problems to worry about. Ketosis is NOT ketoacidosis. Far from it. One is very beneficial, the other very harmful.

Clogged arteries from eating so much saturated fat!: Enough said here and here.

Coconut oil is a very healthy source of Medium Chain Triglycerides

Coconut oil is a very healthy source of Medium Chain Triglycerides. Low fat proponents avoid coconut oils because it is almost entirely saturated fat. But we now know saturated fat is beneficial and not dangerous at all.

I’m a Vegetarian: That is perfectly fine. It will be more difficult to get your high fat intake but there are things you can do. Like eat more avocado, use lots of coconut oil (very beneficial kind of saturated fat/medium chain triglyceride), eat more cheese (if you aren’t vegan), etc. You just have to do some digging around. There are definitely options. Just stay away from refined vegetable oils which are loaded with omega 6 fatty acids and don’t eat too many nuts which contain high ratios of omega 6 to omega 3s.

Nutritional deficiencies: If a low carb, high fat diet is done correctly, you shouldn’t have any nutritional deficiencies. But since you have to vary your diet enough (in choices of veggies), it is always a good idea to supplement with multivitamins. Today someone said to me “I’ll laugh my ass off when you end up getting scurvy” when I said I’ve sworn off oranges. Scurvy is caused by a vitamin C deficiency. Half a cup of bell peppers has double the amount of Vitamin C than that of a medium orange – without the ridiculously high amount of sugar. A cup of broccoli has a little over half of the Vitamin C of an orange, but close to your daily recommended dose. Don’t worry so much about deficiencies as long as you vary your choices of nutrient dense foods while keeping the carbs low.

Yo-yo dieting: 80% of people gain the weight they lose back. It is just a matter of discipline. Even I fell into this once on a low carb diet. I used it as a lesson learned. Fortunately, people who eat low carb, and more importantly high fat, have a strong advantage. Eating fat keeps you satiated. It takes longer to break down. Plus, the lack of carbohydrates keep cravings away. Carbohydrates begets carbohydrates. I’ll write more about this later, but carbohydrates make your body demand more or you get cranky and hungry. Just like an addiction to hard drugs. When the high is wearing off, your body wants more. This is not just psychological, it is very physiological. Ask any low carb dieter and they will tell you they are hardly ever hungry and sometimes forget to eat. In fact, I’ve done many over 24 hour fasts just because I was too busy and completely forgot to eat. And then went to bed and just finally realized that I hadn’t eaten that day. The risk of losing muscle while fasting on a low carb diet is very low since your glucose requirement is lower as mentioned above a bunch of times. So just practice self control and keep fat intake high. I participate (as mentioned above) in a 5-6 week interval cheat day just to still enjoy food occasionally. On this day I eat every carbohydrate in site. I may gain half a pound and set myself back a few days, but it is a great reward for staying clean on the diet and a great exercise in self control. One day. No more. An extra day or two can take you far out of a ketoadapted state and you might feel crappy for a few days when back on the diet. One last thing on yo-yo dieting. This diet shouldn’t be a temporary thing. It needs to be a lifestyle change. Remember, carbohydrates are the cause of many many diseases along with obesity as a side effect. That’s right. Obesity doesn’t cause any health issues, it just comes along with them. Getting lean is just a side effect of being healthier in general.

Wrapping It Up!

I apologize for the ridiculously long post. There is just so much to be said on the matter that I barely covered the surface! And I apologize for the lack of more cited sources. If anyone really wants them, hit me up in the comments and I’ll post them. I just had so much to write and so little time to dig up the many many articles and studies that explain all of this. But hopefully by now, you have a good understanding of what this diet/lifestyle is and why it is the only truly healthy diet out there. I am not beating around the bush with this. Other macronutrient breakdowns are very detrimental to your health no matter what you hear on Dr. Oz and the Today Show. Trust me on this. Actually, don’t trust me, trust the science.

Yes, I am indeed the asian with the cheese bowl. I am also a huge nerd and love science. My real job as the co-founder and technical director for Inphantry keeps my nerdiness factor at a record high. In my spare time, I am obsessive about diet and nutrition. Maybe even too obsessive... Keep reading and I'm sure you will pick up little bits of who I am along the way!

8 Comments on "The Ketogenic Primer: The Guide To A Scientifically Healthy Diet"

  1. Ryan Grant says:

    Pretty Good. I often don’t eat the rice I am given and people always get angry, probably because they haven’t read your article.

    • Derek Tran says:

      Thanks for reading/commenting Ryan! Glad to see there are others out there that understand these concepts. It is funny that people casually say carbs make you fat. But then when asked what makes you fat, they say fat, eating too much, and not exercising.

      • Ryan Grant says:

        Good to read something that doesn’t tell you how you must eat if you want to lose weight and keep muscle. Most people will write there exact diet as opposed to talking about how to find the diet that fits you. Everyone has a different metabolism and everyone has different daily activities and exercise routines.

        You hit all the points without being overly specific. Like to add that its good to eat something with some protein every 2-3 hours to regulate everything and prevent muscle digestion. People with hypoglycemia are encouraged to eat protein and fat rich foods rather than high carb foods because it regulates blood sugar rather than raises it (which is the whole point). Same goes for diabetics.

  2. Pranav Reddy says:

    Haha Ryan. losing fat and putting on muscle is actually the reason i stated a ketosis diet. I just don’t know if a really high fat content is the best thing for me. I feel like i am doing some long term harm to my body, even though i see short term weight loss. What do you think?

    • Derek Tran says:

      You definitely are NOT doing long term harm to your body. If anything, you are preventing a countless number of common diseases (of which most would ultimately lead to death) by staying on a high fat low carbohydrate lifestyle. Especially heart disease believe it or not. One can argue (with plenty of science to back it up) the carbohydrates are like gasoline. Many bad byproducts. And fat is a clean burning fuel source. No nasty harmful byproduct. The only argument people have against eating fat, is your cholesterol levels. I’ve been meaning to write on this forever, but as you can see, in the past few months I haven’t been actively writing. I have been completely inundated with my job and have been dying to getting back to writing. But Dr. Peter Attia can explain it a million times better than I can… That is if you can stick it through and read his entire 9 part series (and he is still writing more). But even after reading the first part, you will know more than most physicians even know about cholesterol. I highly recommend EVERYONE read it when they have the time. You can find it all starting here: http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-part-i

      In the (hopefully) near future, I’ll be writing a much more… condensed version of his series to sum it up for people who want to know the science but don’t need THAT much detail. So stay tuned. I promise, I’ll start writing again real soon!

  3. eunho says:

    May I know specific keto meal plans? I am also asian(Korean) and this isn’t really working for me. My heigt is 160cm and weight is 49kg. Will it be possible for me to loose my weight to 46kg? Becasuse I already am not overweight.

    And do I have to eat meal 3 times a day to be in ketosis?

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