Eating fat to burn fat may seem strange, but it actually makes all sense and is what promises ketogenic diet. In this article we will understand how this happens and why these diets have become common recently.
The ketogenic diet has existed since the 1920s when it was developed in the United States to be used in the treatment of refractory epilepsy in children, i.e. cases of difficult treatment. However, it fell into disuse with the advent of new anticonvulsant drugs in the 1940s.
Today, ketogenic diets are used by many people for the purpose of weight and fat loss, in the treatment of metabolic syndrome, obesity, diabetes and even cancer.
Basically, ketosis is a metabolic condition in which the body obtains energy not glucose (which would be the most common functioning of the body, called glycolysis), but molecules called ketone bodies.
These ketone bodies are produced by the liver during periods of food (fasting) or carbohydrate (low carb diets) restrictions, to be used as an energy source.
So ketosis is nothing more than this state in which the body draws energy from a source other than the usual. (It is important to mention that from the biological point of view, both are normal ways of obtaining energy.) We say here that the glycolysis state is more common because most people's diets are highly inclined to a major consumption of carbohydrates.)
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children.
The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain-function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories to maintain the correct weight for age and height. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as nuts, cream and butter. Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.
The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant drugs. In the mid-1990s, Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC's Dateline programme and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.
Almost half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet. The most common adverse effect is constipation, affecting about 30% of patients—this was due to fluid restriction, which was once a feature of the diet, but this led to increased risk of kidney stones, and is no longer considered beneficial. There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective. Clinical trials and studies in animal models (including C. elegans) suggest that ketogenic diets provide neuroprotective and disease-modifying benefits for a number of adult neurodegenerative disorders. As of 2012, there is limited clinical trial data in these areas, and, outside of paediatric epilepsy, use of the ketogenic diet remains at the research stage.
At the beginning of carbohydrate deprivation, the first stock of mobilized energy is glycogen, present in the liver. Glycogen is nothing more than a complex carbohydrate that can be easily broken into glucose to be released into the blood. Decreasing blood sugar levels without replenishment by feeding leads to the release of glucagon, the hormone that promotes glycogen breakdown.
When all of the glycogen is consumed, the body starts to get energy from the lipids, both from food and adipose tissue. When fats are used as the main energy source, a favorable caloric balance (ingesting fewer calories than daily demand) leads to the burning of the stocks, that is, the body starts to consume the fat present in the adipose tissue to achieve Energy and the resultant effect is what most people want, the loss of that fat that bothers them with the preservation of lean mass. As already mentioned, this breaking of fats leads to the formation of ketone bodies that will be used by the cells in obtaining energy, and which will characterize the ketogenic state.
One question that may arise at this point is: even without carbohydrate intake, should blood glucose not remain at adequate levels? Yes, otherwise hypoglycemic seizures may occur and may have serious consequences. However, the liver is able to produce glucose from other non-carbohydrate compounds such as lactate, glycerol (a constituent part of triglycerides, ie fat) and amino acids, by a process called gluconeogenesis. In this way, even without the ingestion of a large amount of carbohydrates the glycemia can be finely controlled by the body.
Let us now understand the benefits expected when making such a diet properly.
Fat Burning Makes It Easier
In diets high in carbohydrates, the main energy source comes from this macronutrient. All carbohydrates are broken down to glucose to be used in mitochondria, the cellular organelles responsible for producing energy with the generation of ATP, the molecule that stores all converted energy.
This is the classic way of obtaining energy. An abundant supply of glucose ensures the maintenance of this cycle and saves the burning of other sources, fats and proteins.
When the body goes into a state of ketosis, the whole system of fat oxidation for energy becomes activated to ensure the energy supply in the shortage of carbohydrates, using as main source the fats, that is, the body prepares to burn the Fat efficiently and this process becomes easier.
Saves Muscle Mass
The ketogenic diet is a great way to lose weight without compromising muscle mass. The result is the reduction of body fat index and muscle definition. With adequate protein supply from the diet, ie at least 1.5g protein per pound of body mass per day, and with the abundance of ketone bodies in the bloodstream, the body does not have to break down the proteins of the muscles in Amino acids to produce glucose, thus avoiding the catabolic state of lean mass.
In addition the amount of calories consumed should also be adequate, because in extremely low calorie diets the liver's ability to metabolize fats may not be enough to provide the energy the body needs for all daily activities, which will invariably lead to It to seek energy from other sources, that is, from the breaking of proteins. Therefore a food plan adapted to the individual conditions is extremely important for a satisfactory result.
Helps Lower Insulin Levels
The insulin is a hormone closely related to carbohydrate metabolism and induces the accumulation of glucose as fat, or high levels of insulin lead to more easily accumulate in fat and block breakage.
Insulin secretion is stimulated by elevated glycemia with carbohydrate absorption from food. In a low-carbohydrate diet, insulin secretion occurs only at basal levels and this further enhances the oxidation of fat stored in adipose tissue. In addition, low levels of insulin favor the secretion of other beneficial substances to fat loss and maintenance of lean mass like growth hormone.
For patients with type 1 diabetes, a ketogenic diet can help prevent episodes of hypoglycemia, reduce the rate of glycated hemoglobin, and improve overall health. In the case of type 2 diabetes, it is able to reduce insulin resistance, which is the main cause of the disease.
Helps Control Appetite
An important aspect of the ketogenic state, is that in addition to stimulate the breakdown of fats, it seems to suppress appetite when associated with a high intake of protein, while high-carbohydrate diets only lead to increased appetite by triggering large variations and spikes insulin. This will help in maintaining the diet, which is characterized by being in small portions, since fats have high caloric density. The satiety then may be an obstacle for those who want to follow the ketogenic diet, but the good side is that after conquering the high levels of ketones it becomes easier to overcome hunger.
In this chapter, we will explore the three methods that people often use to know if they are in ketosis, each with its advantages and disadvantages. These are: blood test, colored ribbons and evaluation of symptoms.
Method # 1 - Blood Test
The only real way to know if you are in ketosis is by blood test.
I do not want to belittle the other two methods, which can provide "good clues" for you to know if you are in ketosis or not. But if you, for whatever reason, really want to ensure that entered into ketosis, you should do a blood test.
The big disadvantage of this method is that it is more inconvenient: It is the only thing that involves you leaving your house and having needles spiked in the body - an experience that not everyone likes. And to top it off, it may still end up being more expensive - which will depend on the lab and your health plan.
Method # 2 - Ketosis Measuring Tapes
One of the most popular methods for assessing the state of ketosis is the use of colored ribbons that serve to measure if you went into ketosis by measuring the pH of your urine.
Their functioning is based on the measurement of ketone bodies in the urine. Then you would put the little thing in contact with the urine and watch it change color - the more their concentration in the urine, the darker the ribbon would be, symbolizing that you would be more intensely in ketosis.
Thus, the measurement of ketosis is by concentration of ketone bodies in urine - that is, the amount of ketone bodies being eliminated. The biggest problem with this method is that in many situations, the metering tape ketosis may simply not work.
Some of the situations in which this method does not become more reliable are as follows:
- The ribbons are damaged (they have expired or become moist, for example);
- You are drinking too much fluid (and decreasing the concentration of ketone bodies. Note that the difference in fluid intake could affect even the comparison of different days or weeks);
- You take the test in inconsistent periods (one fasting test before breakfast, for example, and another after dinner);
- You are Cetoadaptado.
Just to clarify the last point, which is the most important to us: be cetoadaptado (or keto-adapted) means that your body has already adapted to use ketone bodies as an energy source - which would be a normal body process. However, since the Western diet is very concentrated in carbohydrates, most people are not quite able to fully utilize ketone bodies - that is, they are much more adapted to glycolysis than to ketosis.
This process of ketoadaptation occurs on average after 4 to 6 weeks on a diet that controls carbohydrate intake - the average time may vary from person to person (if she has ever tried fasts or other low carb diets, for example) and also Diet is more or less restrictive in relation to them.
A more restrictive diet example would be the ketogenic diet , we saw above. Already a diet example (well) would be less restrictive the diet Slow Carb .
And as long as you're not fit, it's not wise to do strenuous physical activities - that is, no marathons or daily CrossFit exercises. Once you're fit, however, your range of exercise options increases.
However, as the use of pH tapes still presents some financial expense (they are not free!) And inconvenience (urination in a ribbon) - besides the chance of incorrectness, as we show - many people end up opting for a third method.
Method # 3 - Evaluate the Symptoms of Ketosis
This third method of observation of symptoms has the following advantages: it is the cheapest of the three (as it is completely free), it is immediate (because there is no waiting for the arrival of products or results) and it does not have any inconveniences you do not have to do anything - just watch).
However, its imprecision is the greatest of all, and for two simple reasons. The first is a psychological and attentive side: people often "think" they are seeing some change, when in fact they are only more attentive to signs they would not otherwise perceive. On the other hand, reciprocally, the person is sometimes more distracted and does not observe the symptoms manifesting, even when those around him perceive them clearly.
The second side, however, is physiological: the symptoms may often not manifest in the same way in all people - who may therefore think they are not in ketosis, when in fact they are.
Having made these caveats, we will list some of the main symptoms reported and associated with the state of ketosis:
- Feeling of euphoria;
- Clarity of reasoning;
- Decreased hunger;
- Bad breath;
- Metallic taste in the mouth;
- Dysregulation of sleep;
- More frequent need to urinate (often the smell of urine may change as well);
- Cold hands or feet.
Note that these symptoms may not manifest; Or there may be only a few of them instead of all. And to make matters worse, they can occur, but due to other causes - after all, ketosis is not the only cause of bad breath or headache.
This chapter comes to demystify a confusion that is unfortunately very common - the confusion between ketosis and ketoacidosis.
Ketoacidosis is a clinical condition characterized by excess ketone bodies in the blood, and is not clinically reached through diet, but is generally symptomatic of diabetes and insulin resistance - and comes with the ketone breath mentioned above.
Ketoacidosis pictures may occur, for example, when a type 1 diabetic does not administer the correct dose of insulin. In that case, liver cells increase the conversion of fatty acids to ketone bodies to provide energy to the body. Excessive ketone bodies lower blood pH, and the kidneys try to excrete excess glucose (which can not be metabolized due to lack of insulin) and ketone bodies (which are in abnormal amounts). This process will cause the removal of water and electrolytes from the blood, which can cause dehydration, tachycardia and pressure drop. This is not a very encouraging picture
Fortunately, in the diet-induced ketosis we are treating here (so-called nutritional ketosis), the concentration of ketone bodies is much lower: while in ketosis, the concentration of ketone bodies is in the order of 0.5 to 5 mmol / L, in ketoacidosis This index is in the range of 15-25 mmol / L.
So please do not confuse your normal and healthy nutritional ketosis with a pathological condition associated with a much more serious clinical picture. Some proponents of high-carbohydrate diets are quick to associate one thing with another, but as we've seen, a blood test is enough to say with certainty which category you are in.
A ketogenic diet should be rich in eggs, meats, poultry, fish, nuts, healthy oils, avocados and vegetables with small percentages of carbohydrates. Beverages such as coffee and tea should be sweetened with sweeteners, the most recommended being stevia. Escape from pasta, breads, biscuits, sweets in general, processed foods, juices, fruits with high sugars, cereals and tubers rich in carbohydrates like potatoes and cassava.
See below for a menu suggestion of ketogenic meals in one day. Quantities should be adapted to each case, considering factors such as gender, age, level of physical activity, basal and objective caloric intake.
- Omelette, boiled or scrambled eggs
- Cold cuts (ham, salami, cheese)
- Tea or coffee
- Beef or pork
- Fish or seafood
- Leaves salad
- Broccoli or asparagus
- Olive oil
- Eggs or omelet
- Grilled or braised chicken with olive oil or butter
- Leaves salad
- Braised Spinach
- Olive oil
- Chestnuts like almonds, macadamia and Brazil nut
- Fat-rich cheeses
- Dietary gelatine (can also be consumed as dessert)
Soft drinks and diet juices are also allowed and can be eaten with meals. For those who do not miss these drinks, the healthiest option is to replace with water. Try to use little salt.
The best menu, with the right amounts and timings best suited to your lifestyle, should be made exclusively for you by a nutritionist, respecting your individual needs.
The ketogenic diets have some little known peculiarities, here are some tips about them:
The first days are the most difficult
The early days of the ketogenic diet are the most difficult, and fatigue, fatigue and even dehydration can occur. These symptoms occur because the body enters a process of adaptation to the new form of energetic obtaining. When ketone bodies are produced, the metabolism returns to normal and this sense of lack of energy is being replaced by even more disposition than before.
You will dramatically reduce fluid retention
For people who feel bloated due to fluid retention, a ketogenic diet can help a lot. In the first days a reasonable loss of weight was already noticed, mainly due to the elimination of water that was retained by the glycogen storage.
Drinking plenty of water is of paramount importance to maintain hydration and aid in the elimination of liquids. Especially before during the after the practice of physical exercises.
Monitoring the lipid profile
It is recommended that sources of fats are in general good, unsaturated fats. However, many foods high in saturated fats and cholesterol can also be consumed. Although not great villains as long believed, a diet rich in saturated fats can, in some cases, change the lipid profile of the blood. Follow up with your doctor to monitor this parameter and its variation. It is worth avoiding exaggerated amounts of bacon, too much fat and processed fats to minimize that risk.
Vitamins and Mineral Salts
Foods rich in carbohydrates are also suppliers of many micronutrients such as vitamins and minerals. The suspension of the consumption of these foods can bring nutritional deficiency to these factors. Thus, supplementation with good multivitamins can be a great way to maintain adequate supply. The same is true for dietary fiber.
Ketosis is different from ketoacidosis
There may be a concern with the state of ketoacidosis, very common in diabetic patients, which occurs when production and blood ketone levels exceed safe limits, leading to a decrease in blood pH and thus serious consequences. However, in non-diabetic people this does not occur.
The tactic of carbohydrate replacement
The depletion of muscle glycogen can lead to fatigue and a decrease in yield for those who practice physical activities. One strategy used to overcome this problem is the adoption of days of high consumption of carbohydrates interspersed with days of minimum consumption. In these days the fats must be consumed in small quantity. This will lead to replenishment of glycogen stores and improve muscle efficiency.
Warning for a dangerous trap
If you start a ketogenic diet for weight and fat loss, like any other diet, it is necessary that the caloric balance between intake and energy expenditure is negative, otherwise all the energy you need in the day will be obtained from the diet and all Your fat stores will be preserved.
If you spend more than you eat, then the metabolism will get energy from the breakdown of stored fat. But when that deficit is too great, the rate at which the liver can turn fat into free fatty acids and ketone bodies that will be used as fuel for cells instead of glucose may not be enough to meet the body's energy demands. This will lead to the search for alternative sources, in this case the amino acids that make up the proteins present in muscle tissue. These amino acids can be converted to glucose by providing energy. In short, you start to catabolize lean mass, which is most often not desirable, the ideal is to lose fat without losing muscle.
So this can be an important pitfall for anyone who wants to lose excess weight fast by making very low calorie diets.
The loss of lean mass besides compromising physical performance and appearance can also disrupt the process of weight loss, since the muscles demand a great amount of energy, even in the basal metabolism. Losing muscles means having a slower metabolism and consequently more difficulty in losing weight.
On the other hand, consuming calories in exaggerated amounts, greater than those needed to reach your goal, even if only from fat, will lead to weight gain, even if you are in a state of ketosis.
Thus, in addition to the concern with which macronutrients to ingest, it is necessary to pay attention to the ideal quantities of each one, larger or smaller quantities will not bring the desired effect. The nutritionist is the person best prepared to design a diet tailored to the needs of each person.
Maintaining a diet as differentiated as ketogenic is not easy. Most easy access foods are high in carbohydrates and bad fats. In restaurants it can be difficult to find the right foods for your diet, and eating on the street does not let you know the correct amount of what you are eating. Have everything you need to prepare your meals and try to plan the meals of the week to avoid any inconvenience that may make you lose your diet and lose all the results you have already gained.
Do not fall into temptation
Having foods rich in sugar, pasta, breads, sweets at home can be a dangerous trap to get off the diet. Avoid buying and storing these foods, since if you consume carbohydrates on the wrong days and quantities the ketosis state will not settle and you will not get the benefits you want from the diet. To function, the diet needs to be followed correctly.
As we have seen, ketosis can be a powerful tool in your diet. It is able to accelerate its weight loss, besides being part of an interesting mechanism of regulation of insulin, ghrelin and other hormones, besides being beneficial for treatment of other conditions, as we said.
However, you do not need to go into ketosis for weight loss. It's a great tool, yes, but it's certainly not the only way to lose weight.
In fact, many people cannot even count on this feature. This is the case for type 1 diabetics (and even type 2 diabetics if their pancreas is severely damaged). Although there are cases of type 1 diabetes in ketosis, coupled with stricter control of insulin administration, this is certainly not the rule.
(Ketosis is also not recommended for people with deficiency in the enzyme pyruvate carboxylase or with porphyria.) But I have the strong impression that if you had any of these very rare conditions, you would not be reading this text now.
"But if it is not necessary to lose weight, why talk about it so much?"
And the answer is simple: because we believe that many people can benefit from this knowledge. And because we want to provide the resources, information, and tools so that everyone can be able to make informed choices about what exact methods they want to use to achieve a healthier life.