For the last six weeks, I have been following a strict ketogenic diet, eating 75 percent fat, 20 percent protein, and 5 percent carbohydrates. My motivation for going keto was centered around optimizing my energy levels. I’m always looking for ways to get an energy boost since being diagnosed with narcolepsy when I was 14 years old. At that time, I started eating gluten-free (which helped dramatically), but in the last few years I have identified an undeniable association with a rapid onset of fatigue after eating foods that are moderate to high on the glycemic index. There’s a good chance that you or someone you know can relate to that feeling of painful fatigue after eating higher carbohydrate meals, even without a narcolepsy diagnosis. This prompted me to dive into the ketogenic diet, knowing that physiologically the body is able to produce more ATP when it’s running on ketones.
Why keto?
The goal of a ketogenic diet is to train the body to run on ketones instead of glycogen (stored glucose), which is typically the body’s main source of fuel. The goal is to reduce carbohydrates enough—usually 5 percent total carbohydrates—in order to enter a state of ketosis, which takes a minimum of three to four days to accomplish. You can test whether or not you’re in ketosis by checking the amount of ketones in the blood.
There is strong evidence demonstrating an association between the ketogenic diet and weight loss as it is thought to lower appetite, reduce lipogenesis, and increase metabolic efficiency. There is also strong research demonstrating improved outcomes for cardiovascular disease, type 2 diabetes, and epilepsy. Areas of emerging evidence include cancer and neurological diseases such as Alzheimer’s disease and Parkinson’s disease.
How I use keto in my practice.
As a dietitian nutritionist in functional medicine, I use ketogenic dietary interventions with some of my patients that present with neurodegeneration, insulin resistance, and type 2 diabetes or pre-diabetes. In January of 2017, I created an eight-week ketogenic program for a group of patients with type 2 diabetes that were completely resistant to their medications. Of all the groups I’ve ever led, I’ve never seen such incredible success within one group of individuals. They experienced significant improvements in their hemoglobin A1c and insulin levels, worked with their doctors to reduce their metformin and insulin, and reported a much better quality of life after eight weeks of changing their diet.
But it wasn’t until attending mindbodygreen’s revitalize and listening to Mark Hyman, M.D., and Carrie Diulius, M.D., talk about the ketogenic diet that I realized that this was something that I needed to do for my own health. When I returned home from the conference, I was able to recruit a friend to do the diet with me, which I’d highly recommend—it helped tremendously to have that support!
What eating ketogenic is actually like.
Eating ketogenic is much more complicated than simply increasing your fat intake. Getting into ketosis requires a very specific tracking of macronutrients. I struggled in the first two weeks more than I ever have in changing my eating habits. I would stand at the refrigerator at night and look for additional food to eat even though I wasn’t even hungry. The idea of only being able to have certain types of foods and such a high proportion of fat really got to me at first.
I struggled in the first two weeks more than I ever have in changing my eating habits.
But after the first week I observed myself getting acclimated, and after the second week I began to notice a shift in my energy levels. I also observed that my clothes were fitting me differently, and I felt slightly more toned (although I don’t know what it translated to because weight loss was not my goal, and I forgot to weigh myself at the beginning). It took a total of two weeks for me to start to really notice a difference in my mitochondrial health and to experience an incredible boost in my energy levels, reduction in fatigue, and improved mental clarity.
I used urine strips to assess my state of ketosis. In order to know if you are even in a state of ketosis, you can track through blood or urine collection. Despite eating about 25 grams of net carbohydrates (total carbohydrates minus fiber) per day, I only reached the low end of ketosis. This is why diligently tracking your intake is key. Tracking was difficult for me because my approach as a dietitian has always been to use food as nourishment for your cells instead of focusing on food as a number of calories or grams of carbohydrates. I generally do not recommend counting calories, and I personally have never been a calorie counter, so it was an adjustment to track every last bite that entered my mouth each day. But I reminded myself that this was only temporary, and I provided plenty of patience and space for myself in those first two weeks especially.
I realized very quickly that the key to success (with anything but especially keto) is planning and finding delicious recipes and resources to make this an enjoyable experience. I established some delicious snack options that made it possible to eat on the go. Incorporating dairy back into my diet made it much easier to adhere to as well. A few of my snack staples included:
- ½ avocado with lemon juice, Himalayan salt, and pepper
- ¼ cup unsweetened shredded coconut, 2 tablespoons cacao nibs, 1 teaspoon melted grass-fed butter
- Grass-fed beef jerky
- Jicama sticks with guacamole
- 2 tablespoons almond butter
- 2 cups kale with ½ avocado, massaged avocado
- Homemade grainless granola
- Homemade keto bread
What’s next?
The hardest part of any diet is figuring out what to do after the diet. For me, the ketogenic diet is not realistic to follow all the time long-term, but it does make me feel much better. Because of this, I am transitioning into a cyclical ketogenic diet at this point. A cyclical ketogenic diet provides the opportunity to rotate between eating ketogenic and eating a whole foods maintenance diet that may include sweet potatoes and apples (in other words, a little more balance). There are different types of cycling—some may follow ketogenic five to six days per week and then save one to two days for a “splurge” on higher carbohydrates foods. The other popular option is a weekly cyclical ketogenic diet, which means eating ketogenic for one week and then switching to a whole foods maintenance diet the next week and rotating from one to the next. There’s some preliminary research that indicates that this style of eating may help prevent memory decline and promote weight maintenance.
The keto diet is not necessarily a long-term way of eating, and just remember, it is certainly not for everyone. Eating ketogenic can be considered extreme, and it’s best to work with a health care provider or registered dietitian to ensure that you are meeting your nutrient needs. It is essential that those with diabetes proactively work alongside a physician and registered dietitian to monitor your medication or insulin and the consistency of your carbohydrate intake.
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