Keto Diet Top 10 Questions Answered by a Doctor

Kiah Connolly, MD
     
Kiah Connolly, MD

Keto has recently boomed as the new weight loss messiah. But what makes this diet different from other transient fads? And how can you make sure you're doing it correctly? 

Here's your top 10 keto questions answered by the experts:

1. What is Keto Diet?

The ketogenic diet is rooted in controlling macronutrients with a goal of transitioning the body into a metabolic state called ketosis. Many people believe that this state of ketosis accelerates weight loss. In other words, ketosis encourages the body to become more effective at burning fat - and potentially promotes faster weight loss. But in order to transition into ketosis you need to shift your macronutrient balance. This classically includes a very low carbohydrate, high fat, and moderate protein intake.

The keto diet initially gained traction in the early 1900’s for a very different purpose: to treat seizures in children with epilepsy. Research was done on the keto diet for this use and it’s still successfully utilized as a therapy for this population today (1).

So what about weight loss?

While research on the keto diet for health and weight loss is still truly in its infancy,  early results seem promising. Keto diet seems to be an effective tool for weight loss – and may offer additional benefits for people with certain conditions, such as diabetes.

2. How Does Keto Work?

The keto diet works by transitioning your body into a metabolic state called ketosis. Our bodies enter  ketosis to get energy we need to function. In ketosis your body uses fat to make an energy source called ketone bodies through a process called ketogenesis.

In other words, your body starts burning fat for fuel. It’s thought that the body may become more efficient at burning fat when it’s being utilized for fuel in this way and overall metabolism may also be relatively sped up in this state compared to other diets (2, 3, 4). Furthermore there’s some evidence to suggest that once in a state of ketosis, people may be less hungry - possibly due to a suppression of a hunger hormone (ghrelin) (5).

While this is a natural process, we aren’t typically in a state of ketosis. This is because our bodies almost always prefer using glucose for energy. And we easily get glucose by eating carbohydrates. Even when carbohydrates aren’t readily available we can still usually access glucose from its storage form (called glycogen)  in a process called glycogenolysis. Because it will always prefer to use glucose for energy, your body needs to be deprived of glucose sources in order to enter into ketosis.

3. How long does it take to get into ketosis?

Achieving ketosis can take anywhere from a couple days to a couple weeks, depending on the person. 

You enter ketosis when your body is deprived of glucose. This means not eating glucose and eliminating your glucose storage. One way to do this is through starvation. But as we all know that’s not exactly sustainable - or desirable - for anyone. Another way is to eliminate (or significantly limit) carbohydrates in your diet, through the ketogenic diet. Successfully entering ketosis often requires exceptionally low carbohydrate intake – often less than 20 grams per day. Exercise can help burn off your glucose stores more quickly.

4. How to Get into Ketosis Fast?

While this really depends on the individual, most people enter ketosis within 1 week. How quickly you enter ketosis depends on how significantly you limit your carbohydrate intake. It also depends on how much glycogen ( stored glucose) you have and how quickly you burn it.

So the fastest way to get into ketosis is to consume very few carbohydrates and burn glycogen stores quickly – like by exercising. Some people can enter ketosis in as little as 48 hours. 

5. How to Know if You’re in Ketosis?

You can tell that you’re in ketosis by measuring ketone bodies in either your urine or blood. Most people on the ketogenic diet use urine test strips to determine if they’re in ketosis.  There are a variety of urine test strips that can be purchased from most pharmacies. These urine test strips usually use different colors to represent varying levels of ketone bodies. Most sources recommend a goal ketone level of 0.5 to 3mM. It isn’t recommended to go higher than 3mM as there hasn’t been any evidence to suggest it’s more beneficial, and it often indicates a state of starvation – meaning you’re really not getting enough food!

keto diet protein and fat

6. Is the Keto Diet Healthy?

Many people enjoy successful weight loss through the keto diet – which alone can have tremendous health benefits. In fact, the biggest health benefit of the keto diet probably comes from weight loss. Obesity is a major risk factor for the biggest health problems our society faces today. Losing weight, and keeping it off can help prevent diabetes, hypertension, strokes, heart attacks, and more.

There is also other evidence to suggest that the keto diet can help improve cholesterol and insulin sensitivity (5, 6, 7, 8, 9). While there have been many other claims linking the keto diet to improving everything from parkinson’s to alzheimer’s disease, there isn’t yet any good evidence to support these theories (10).

But like any diet, being healthy on keto depends if you do it right. Using the keto diet as a license to load up on processed cheese and as many other unhealthy fats you can get your hands on won’t make you healthy. An overabundant consumption of calories in excess of what you burn will likely still lead to weight gain – even if you’re in ketosis.

Because this diet does restrict many foods, it’s also prudent to ensure you’re continuing to consume all of the micronutrients you need that are often easily found in a more balanced diet.    

7. What to Eat on Keto Diet?

The most important part of the keto diet is minimizing carbohydrate intake – recommended to be only 5% of daily caloric intake. While this does depend on the individual’s weight and activity level, it often comes out to 20 grams of net carbohydrates per day, sometimes less. Next protein intake can be moderate and is often recommended at 25%. Fat makes up a majority of the keto diet - at 70% of your caloric intake.

It takes time learning what foods fit into your keto diet. Because fats are such a high percentage of what’s consumed, it’s important to ensure you’re incorporating healthy options into your new diet.

Examples of healthy fats include:

  • Avocado
  • Nuts
  • Coconut Oil
  • Nut Butters
  • Feta, Goat and Mozzarella Cheese
  • Olives

If your goal is weight loss, it’s also important to ensure you aren’t eating more calories than you burn. Some people enjoy successful weight loss while on the keto diet without counting calories. This is likely because they are eating fewer calories than they are burning - perhaps because they are not as hungry or because the diet restricted foods that may have been higher calorie sources for them in the past. If this works for you, that’s great.

But if you’re finding your still gaining weight while on the keto diet, the first thing to do is check your calories.

Bottom Line: Whether you’re in ketosis or not, you will still likely be gaining weight if you’re consistently eating more calories than you burn.

8. Is Keto Safe?

The simple answer is yes. Many well-done studies over the past century have demonstrated keto diet to be safe – even in children with epilepsy (11). However, there are some cautions to be aware of in certain populations.

Anyone taking medications for diabetes should talk with their doctor prior to starting the ketogenic diet as they may require more frequent glucose checks and they may need to change their medication doses. Without this more careful monitoring they can be at risk of dangerous conditions, such as hypoglycemia (low blood sugar) and diabetic ketoacidosis. People with kidney disease should also talk with their doctor about whether or not the keto diet is best for them, as they sometimes require lower levels of protein in their diet. Finally, pregnant and breastfeeding women should probably not restrict their carbohydrates low enough to enter into ketosis.

9. What is Keto Flu?  

The keto flu is the term many people use to describe unpleasant symptoms that may be experienced when starting the keto diet. Symptoms can include hunger, fatigue, mood changes, dizziness, headaches, constipation, muscle aches and more. While what causes the keto flu isn’t exactly known, it’s suspected that the sudden drop in carbohydrates and transition into ketosis may be responsible.

Ketogenesis takes time. And we may literally feel zapped of energy while our body is transitioning to using ketone bodies for fuel. Some science suggests some of us may also actually be addicted to carbohydrates – and therefore undergo somewhat of a withdrawal process when eliminating them from our diet (12, 13). Others suggest that we may become somewhat dehydrated and develop mild electrolyte abnormalities.

So what’s the best way to fight the keto flu? While again, there isn’t enough evidence to prove any treatment of these symptoms, there are a few suggestions that will likely prove helpful.

  1. Stay Hydrated

  2. Sleep

  3. Eat Salt

  4. Eat Keto Approved Foods

keto breakfast meal delivery

10. How to Start Keto Diet? (Macro App)

Starting a keto diet is a big commitment and can require significant planning and dedication. Whenever starting something new it’s always important to educate yourself about what’s involved.

  1. Get expert advice: Learn more about Keto from a doctor and/or dietitian to get science backed advice and a good overview on how the diet works.

  2. Personalize Your Keto Diet: Because what you eat depends on your unique size and activity levels, you need to determine what you should be eating by breaking down your keto macros and calorie requirements throughout the day. 

  3. Plan Your Meals: You then need to develop a list of healthy yet satisfying keto foods that fit your macros. Because the world offers limitless temptations, meal prepping can be key to sticking to your goals.

  4. Track Your Macros: Because the diet is so dependent on accurate calculation of macronutrients, it’s crucial to develop a way to track your macronutrients. Macro friendly phone apps can be a convenient way of tracking your macros anywhere you go.

  5. Determine if You’re in Ketosis: While blood tests can tell you if you’re in ketosis, you’re probably going to want to regularly test your state of ketosis by urine test strips. This will help you to determine when you are in ketosis – and modify your intake to meet your ketosis goals. It’s usually recommended to be somewhere between the range of 0.5 to 3 mM while on the ketogenic diet. Higher levels aren’t suspected to offer any additional benefit - and can be a sign of starvation, meaning you’re not getting enough food!

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