Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (25 page)

The biggest challenge with a ketogenic diet is reducing the carbohydrate and protein intake sufficiently to get into and maintain ketosis. If you eat too much protein, your body will convert the amino acids into glucose. If you eat too many carbs, your blood sugar will be too high to have ketones. It takes fat to make the ketone bodies.

– Dr. Terry Wahls

Many people who switch to a low-carb, high-fat, ketogenic lifestyle lose weight and improve their health without ever needing to test for ketones. So can you just eat low-carb and high-fat and let that suffice?

The short answer: maybe. When I began following the Atkins diet in 2004 as a 410-pound man, any move away from the massive amounts of carbage (get it? carbs + garbage = carbage) I was consuming was going to improve my weight and health. But my recipe for success at thirty-two may not work for me now that I’m over the age of forty. Years of poor eating habits will catch up to you, and for those who have more metabolic damage or who may be experiencing hormonal challenges (especially postmenopause), it’s crucial to pay strict attention to your diet and test for ketones.

Many people believe that they’re following a ketogenic diet but are adding in foods that derail their progress toward ketosis. Maybe they’re eating a banana with breakfast, throwing off their carb intake, or having a chicken breast at dinner, sending their protein consumption too high. This probably explains why some people believe ketosis failed them: their diets weren’t strict enough to actually get them into ketosis, so they never got to experience its health benefits. Figuring out the amounts of carbohydrate, protein, and fat that are right for you and adhering precisely to those amounts makes all the difference in the world.

Increasing protein is not usually necessary and is generally self-limiting, meaning tolerance and appetite for protein will limit intake and it is therefore rarely, perhaps never, necessary to purposely increase or decrease protein intake. A substantial increase in protein may even impair the capacity to achieve a ketogenic state.

– Dr. William Davis

In chapter 2, I explained the difference between the low-carb Atkins diet, which many people have used for decades to lose weight and improve health, and the concept of nutritional ketosis. Now I want to share with you the five key mistakes that I was making in my own diet that prevented me from getting into a therapeutic state of nutritional ketosis. Correcting these major errors in my routine was absolutely necessary for me to experience the full benefits of a ketogenic diet. If you have been struggling with your weight and health goals while on a low-carb diet, these might be hampering your progress.

1. Consuming too much protein

Every individual will have somewhat different sensitivities to protein. The mice we used in my lab are highly sensitive to protein. Protein moderation at varying levels is perhaps necessary for humans as well.

– Dr. Charles Mobbs

This is discussed in detail in chapter 6, but it bears repeating, since it goes against what we’ve been told about a low-carb diet needing to be high in protein. The media and so-called health experts would have people believe that a grilled chicken breast on a bed of green leafy vegetables is a perfectly fine meal on a ketogenic diet. And while it is indeed low in carbohydrates, there’s one really big problem with this meal: there’s way too much protein in it if you want to get into ketosis. A low-carb, ketogenic diet needs to be high in
fat
, not protein, to produce adequate ketones.

It all goes back to gluconeogenesis. When you consume excess protein, your liver transforms it into glucose. If you are making lean meats like chicken breasts, turkey, and lower-fat cuts of beef and pork the central focus of your nutritional plan, then you might be defeating the purpose of going ketogenic to begin with. Consuming too much protein (and, therefore, getting more glucose in your bloodstream) can stoke hunger and cravings, and make you ravenous between meals. To keep this from happening, try to choose fattier cuts of meat and control the total amount of protein you are eating to see how that affects your blood ketone levels.

Low-carb dieting has been relatively easy for me over the last ten years, but the ketogenic diet presented challenges when I first attempted it. Restricting carbohydrates was not a problem for me, but eating high-fat was challenging at first. I also needed to significantly reduce my protein intake to achieve nutritional ketosis. It is nearly impossible for most people to maintain even moderate levels of ketosis if protein is greater than 2 grams per kilogram of body weight, unless there is very high energy expenditure through exercise.

– Dr. Dominic D’Agostino

While protein has been receiving quite a bit of attention in recent years in food marketing, if you consume more than the amount your body needs, you could be preventing yourself from being in ketosis. This is very likely the biggest mistake people make when they shift to a low-carb, high-fat diet. Yes, protein is a good thing for your body, but be aware that too much can give you problems no matter how low your carbohydrate intake.

2. Using urine ketone testing strips to measure ketosis

When patients are first beginning a ketogenic diet, I have them follow their urine ketones to confirm that they are in ketosis. However, since kidneys will adapt to and excrete fewer ketones after about a month of being in ketosis, I only expect to see a trace to small amount of ketones in the urine. If I am checking for blood ketones then I look for 0.5 millimolar or higher.

– Dr. Terry Wahls

Far too many people on a low-carb, high-fat diet are relying on urine ketone testing strips (the best-known brand is Ketostix) to measure their ketones. But, as we discussed in chapter 8, once you’re fully keto-adapted within a few weeks of beginning a low-carb, high-fat diet, it would be an error of epic proportions to believe these strips will give you an accurate depiction of how you are doing at burning fat for fuel.

I understand the allure of urine ketone testing strips. It can be incredibly exciting and motivating, especially when you’re new to this way of eating, to watch the strips magically turn from light pink to dark purple. They seem to validate our nutritional choices and prove that we’re doing something constructive for our weight and health. In a way, seeing the change in color can feel like a reward for our nutritional efforts.

Unfortunately, urine ketone testing strips can curb your enthusiasm at the very point when you are on the verge of real success with ketosis. Their inherent flaw is that they don’t measure the particular ketone body, beta-hydroxybutyrate, that your body uses as fuel once you’ve made the shift from sugar-burner to fat-burner. The ketone body measured in the urine is acetoacetate, and as ketones become your primary fuel source, acetoacetate is converted to beta-hydroxybutyrate—which must be measured through a blood test or correlated to the acetone measured by a breath test. The urine strips only detect the presence of acetoacetate, which dramatically decreases or disappears once the body is relying on beta-hydroxybutyrate for fuel, making keto-adapted dieters think they’re doing something wrong.