Ketogenic and Atkins Diets

I have briefly mentioned these diets in a few past posts and planned on doing a dedicated post about these diets given the amount of information about them and also the popularity of these diets lately. Here is that dedicated post.

What is a ketogenic diet? To most people’s surprise the ketogenic diet is not a new thing. This diet has been around since the 1920’s when it was developed as a treatment option for epilepsy (seizures). In the 1970’s a Dr. Atkins made some modifications to this diet and thus the Atkins diet was born. The ketogenic and Atkins diet share a lot of similarities but “work” in different ways. Atkins diet favors low carbs and moderate/high fat and protein intake and ketogenic diet features VERY low carbs, high fats and moderate to low protein intake. The ketogenic diet claims most of it’s benefits (and its name) from the ketones produced during very low carb states (or starvation) from breaking down fats. The basic principle in play for both diets is controlling insulin levels. Most people on the ketogenic diet eat less than 30 grams of carbs per day, but many will require less than that even in order to register a blood ketone level sufficient enough to be in “ketosis”.

As I briefly discussed in a previous post, studies are showing that the ketogenic diet doesn’t actually offer a unique metabolic edge in weight loss, which is the reason most people are going on it. People think it is a miracle fat incinerating diet. Most people DO have successful weight loss however, but not necessarily from being in a state of ketosis. The initial few days you will lose a lot of water weight because carbohydrates tend to help store water in fat cells. You are losing this water and will look “flatter” due to the fat cell essentially shrinking/dehydrating. You are also at significant risk for dehydration during this time, so make sure you drink a lot of water. The studies are starting to suggest that the weight loss outside of this water weight is likely from eating less overall (thus being in a hypocaloric state). When you cut out a whole food group this tends to happen. The “keto high” or “keto focus” that you get once you’re fat adapted also likely helps with the weight loss because you feel like you have more energy and are more likely to go to the gym or workout because of this. Plus fats and proteins are the most satiating (makes you feel full) macronutrients and this likely plays a large role in the weight loss as well since they are the primary macronutrients in this diet. If you aren’t as hungry, you are less likely to cheat and don’t eat as often. This is likely why we see comparable weight loss in the Atkins diet and the ketogenic diet (you aren’t in a state of ketosis in the Atkins diet so there can’t be a “metabolic edge” if they have similar weight loss). Now lets go over some pros and cons of the ketogenic diet, because I do believe it is still a good diet, it’s just not for everybody.

Pros of a ketogenic diet:

• You can most definitely, and likely will, lose weight on this diet
• It is theoretically slightly more “muscle sparing” than other hypocaloric diets
  • See “cons” for more info on this however
• You will look more shredded and vascular if you manage to stay well hydrated (due to the diuretic nature of the diet)
• When your brain is running on ketones you feel better, more energized, no crashes in the afternoon and you generally feel less “foggy”. Some people have compared the feeling to being on an “upper” or stimulant. They feel their focus is much better and their energy levels are through the roof. (This was my favorite part of the diet).
• Most people find it “easier” than traditional dieting
  • However this is not exactly true because calories in vs calories out STILL matter and you need to watch your protein intake in order to stay in a ketogenic state so you are still counting protein and carbs and SHOULD still be counting your calories.
• It can “cure” type II diabetes and control epilepsy. (see paragraph below for more information).
• It can offer marathon runners (endurance athletes) a unique edge if your body is running on ketones instead of carbs (glucose) because you don’t have to “refuel” as often and you aren’t dependent on muscle glycogen.
• There is still plenty of things you can order if you are going out with friends (steak, seafood, etc. – but watch the protein intake)
• There is promising claims that could indicate this diet is good at lowering your inflammatory markers, staving off cancer, helping you sleep, possibly helping ward off neurodegenerative diseases like Alzheimer’s and Parkinson’s, helping with PCOS (polycystic ovarian syndrome) and acne. These claims need to be more thoroughly studied however and are just theorized at this time. We will discuss the diets use in type II diabetes and epilepsy a little more below.

Cons of a ketogenic diet:

• It’s not the most feasible diet. Most people don’t realize how hard it is until they are a few weeks into it and it isn’t working as well as they thought. It’s also very hard to cut out a whole food group.
• The “keto flu” is a period of a week or two when your body is trying to switch from a carb (glucose) adapted state to a fat (ketone) adapted state. You literally get flu-like symptoms during this period and it is not fun, so if you aren’t in it for the long game and tend to cheat on weekends you have to go through this every week (although subsequent times are usually not as bad as the first time for some reason).
• You will feel like crap physically, mentally and emotionally if you do cheat after weeks or months of being compliant with the diet.
• You will still lose muscle on this diet (not just from my personal experience either). This is due to the hypocaloric nature of the diet, low protein intake (as high protein kicks you out of ketosis due to gluconeogenesis), and low muscle glycogen (less strength and muscle fullness in the gym) in this diet.
• Less strength and faster fatigue in the gym because your muscles have very little muscle glycogen in them (glycogen is stored carbohydrates in the muscles that is used for quick utilization for more energy/force).
• There are hidden carbohydrates in a LOT of foods out there and people don’t always know how to look for them. If you read my post on artificial sweeteners you know that a simple Splenda packet is 95% maltodextrin and dextrose which DO have a glycemic index greater than zero (which means they are a carbohydrate and act as such) AND they create an insulin spike still, which is your enemy on this diet. Many foods list carbs as “zero” as long as there is less than 0.5 PER SERVING. Some foods list their serving size so low that you don’t realize how fast these “hidden” carbs add up “heavy cream” is a good example.
• Probably the worst con is that if you aren’t careful your very inclined to have your cholesterol go up, which places you at increasing risk for stroke, heart attack and many other health issues. This is due to the increased saturated fat intake. Most people don’t realize that dietary intake of cholesterol (such as that in shrimp and eggs) doesn’t actually impact your blood cholesterol much at all, it is mostly the saturated fats you are consuming that increase your bad (LDL) cholesterol.

What about those who have diabetes? Well it depends on the type. If you have type 1 diabetes (usually develop this as a child) this diet can be dangerous because ketone formation can lead to an increased risk of diabetic ketoacidosis (DKA). Type I diabetics don’t make their own insulin so they will always require some type of insulin (usually long acting insulin) in order to keep from going into DKA. However, those with type 2 diabetes (insulin resistance, usually develops later in life and is linked with obesity) can significantly improve and basically “cure” their diabetes. The primary treatment for type II diabetes is to lower your carbohydrate intake and that is the main focus of this diet (makes sense right?). However, diabetics on a ketogenic diet are likely going to feel the “keto flu” much more than the average person because their bodies are used to operating at an abnormally high blood sugar level (so you are essentially going from 100 to 0 instead of 50 to 0) so you will likely feel symptoms of hypoglycemia and could even develop hypoglycemia (especially if you are on medications that lower your blood sugar). On that note, if you are on medications to lower your blood sugar you NEED to consult with your physician/practitioner before starting a diet like this or you can seriously injure or even kill yourself from becoming hypoglycemic or going into DKA (you likely won’t go into DKA in type II diabetes on this diet unless you are also on medications). I would recommend that any type II diabetic set on starting this diet continue to monitor their blood glucose and purchase a monitor specific for ketones to make sure they don’t get too high (which is getting into DKA territory). Diabetics will also feel significantly more crappy if they cheat or indulge in a high carbohydrate meal because their body doesn’t handle high carbohydrate loads (high glucose) very well because they are insulin resistant.

When I was on the ketogenic diet I had a few friends reach out to me with questions about it (a married couple). The husband had just found out he was a diabetic and his Hgb A1c (a measure of your average blood sugar over 3 months) was over 12.0% (this is VERY high and means your average blood sugar was over 300). This person had already started the ketogenic diet and was not yet on any diabetes medications that would prevent him from doing so. They reached out to inquire about the safety of the diet for him and also wanted some pointers and tips/tricks. Over the next few months I would check in with them and we shared some recipes and such. Months later I helped them get through a few plateaus with the diet, but they pretty much managed on their own and I am VERY proud of their results. They both lost a significant amount of weight (something like 75 pounds for the husband) and they felt and looked great! The kicker, however, was that the husband was no longer technically diabetic! His A1c was less than 5.0% (which is better than most of us), his cholesterol was improved and he no longer required medications. Keep in mind that this couple also paired the diet with exercise, but you still can’t argue with the results here.

Ketogenic diet in epilepsy. This is why the diet was invented back in the 1920’s and it worked quite well too! You have to keep in mind that we didn’t, at that time, have the anti epileptic drugs (AEDs) that we do now have however. This diet sort of fell out of style once we started developing AEDs which seemed to control the seizures much better and didn’t require such a huge lifestyle change. However, we still see people that have hard to control epilepsy despite an exhausting amount of AEDs on the market. I personally believe that this diet could be used in conjunction with AEDs in order to help control those types of patients. It could also potentially prove useful in those who wish to have a more “natural” remedy for their seizures. I advise anyone thinking of pursuing this as a potential treatment or adjunct treatment (additional treatment) to speak with their neurologist or primary practitioner first. This is not something you want to handle yourself or just do something you read on the internet. Seizures are dangerous.

In summation, the ketogenic diet has it’s pros and cons but you have to ask yourself if this diet is SUSTAINABLE. If the answer is likely no, then I wouldn’t recommend starting it unless you want to try it out for a little bit to experience some of the positive things it potentially offers. You may want to experience the feeling of the “keto high” or “keto focus” that comes once you are fat adapted. Maybe you want to do it for the potential health benefits outside of losing weight as mentioned about (keep in mind these are not proven). Just remember that this diet is likely not the “miracle fat incinerating diet” that some people claim it to be, but can still help you lose weight. I personally went off the diet because I LOVE carbs, felt weaker in the gym, was ready to go on my “mass gaining” phase again because I lost muscle and my cholesterol went up quite a bit (likely because I relied to heavily on cheese/dairy and other saturated fats instead of healthy fats like avocado or olive/coconut oil). I truly enjoyed how I mentally felt while on the diet and the seemingly boundless energy (and my God the sleep was awesome). If you are considering this diet and you have a medical condition (type II diabetes, high cholesterol, heart problems or epilepsy for instance) please speak with a medical practitioner first. I can’t stress this enough. In the same breath, you need to keep in mind that some practitioners can be a little skeptical or hesitant about starting you on, or recommending this type of diet because there just simply isn’t a lot of studies or information on it yet to determine its “safety” in regards to medicine. The more determined you are, the more likely your practitioner will work with you (especially if they know you have done your research).

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