There isn’t one “keto diet” but rather there are a few different approaches to eating low carb diet that can each be done ketogenically (or “keto“).
Ketogenic diets are used for a variety of clinical conditions, including seizure disorder and epilepsy, specific kinds of cancer, Polycystic Ovarian Syndrome (PCOS), non-alcoholic fatty liver (NAFL) as well as insulin resistance associated with Type 2 Diabetes and Pre-diabetes. It is also sometime prescribed by people’s physicians for use prior to or following bariatric surgery or for weight loss prior to other kinds of surgery. A well-designed ketogenic diet is not for ‘rapid weight loss’ but for gradual, sustainable long-term weight loss.
Ketosis is the state where a person is burning primarily fat and using ketones to fuel their body rather than using primarily glucose from carbohydrate for that purpose. There are essential fatty acids (fats) and essential amino acids (building blocks of protein) but there are NO essential carbohydrates. The little bit of glucose that the body needs can easily be made from fat or protein in the diet. Ketosis is hardly an usual state, but something everyone experiences when there is a long gap between meals or when they are sleeping.
What makes a low carb diet “keto” is the amount of carbohydrate in grams compared to the amount of total energy in the diet. Since each person’s toleration of carbohydrate is different, how much one can eat and be in “ketosis” varies.
Not all Keto diets result in weight loss
People mistakenly assume that a “keto” diet is automatically a weight loss diet and that’s incorrect. The ketogenic diets that are used in seizure disorder, epilepsy and in the treatment of specific type of cancer and in some forms of dementia that are designed to not result in weight loss.
What makes a diet ketogenic is the amount of carbohydrates, however the amount and types of protein eaten and the amount and types of fat eaten have a large effect on the amount and speed of weight loss. Depending on a person’s health goals and the presence of any medical or metabolic conditions, the ratio of protein to fat will vary.
Is a keto diet one-size-fits-all?
Outside of the clinical application in seizure disorder, epilepsy and cancer , ketogenic diets also have application in Type 2 Diabetes and pre-Diabetes. In these situations, each person’s ability to tolerate carbohydrate is different depending whether they are insulin sensitive, insulin resistant or Type 2 Diabetic. How much carbohydrate each person can eat and still be in ketosis also varies, too. Someone who is insulin sensitive for example, can eat considerably more carbohydrate than someone who is insulin resistant without causing a spike in their blood glucose level, accompanied by the release of insulin. For those who are Type 2 Diabetic, both the degree of insulin resistance and the length of time they’ve been Type 2 Diabetic will affect the amount of carbohydrates they can tolerate.
I like to use the analogy of ‘lactose intolerance’ to explain how some people can tolerate more carbohydrate than others. Some people who are lactose intolerant can manage to drink and eat milk products, provided the quantities are small and the person doesn’t have it too often. Others who are lactose intolerant can’t even tolerate a small amount of lactose without symptoms. Carbohydrate intolerance is similar. People who are insulin sensitive or only mildly insulin resistance will be able to tolerate more carbohydrate than those who are very insulin resistant or have had Type 2 Diabetes a long time.
The average intake of carbohydrate in the Canadian and American diet is ~ 300 g per day, which is a lot! People who are insulin sensitive or mildly insulin resistance may do very well lowering their carbohydrate amount to a moderate ~130 g per day where as others who are ore insulin resistant will very likely need to eat less than that in order to begin to see an effect.
Factors that can affect how much carbohydrate a person beginning to eat a low carb diet include gender (whether they are men or women) and whether they are insulin sensitive or insulin resistant (IR) and to what degree, and whether they have Type 2 Diabetes (T2D). How long a person has been insulin resistant or Diabetic also factors into how much carbohydrate they may be able to tolerate.
Everyone is different and because of this, there is no one way to “keto”.
Different ways to “keto”
There are a few different approaches to eating low carb diet that can each be done ketogenically or “keto”. Three common approaches are;
(3) a higher protein lower fat intake during weight loss, then a moderate protein high fat intake during weight maintenance
Each of the above types of low carb diets can each be done “keto”- with the amount of carbohydrate being individualized based on a person’s gender (male or female) and whether they have any metabolic conditions (including IR or T2D). What is appropriate for each person depends on their clinical conditions, health goals and will vary person to person, depending on their personal food preferences.
Going at it alone
While some people set out to “eat keto” on their own or by following a ‘diet book’ they’ve bought, it can be dangerous for people taking any kind of medication to manage blood sugar or blood pressure to do this. Decreasing carbohydrates suddenly can result in a dramatic drop in blood sugar and/or blood pressure which, depending on the medication that people may be taking, can be very risky. Some types of medication for blood sugar may result in blood sugar dropping too low when following a low carb diet and for people taking medication for high blood pressure, blood pressure can become too low. For people taking these kinds of medications eating a low carb or ketogenic diet must be done with a doctor’s oversight and should ideally be done with a knowledgeable Dietitian such as myself who can decrease carbohydrates gradually, while the person monitors their blood sugar and/or blood pressure daily.
Even for those not on medication, it is also important that people ensure that they are eating a nutritionally adequate diet, not just a low carb or ‘keto’ one. This is where having the help and support of a Dietitian such as myself comes in.
A little bit about me…
I’ve been helping others eat a low carb diet for about 3 years now through my private practice, BetterByDesign Nutrition Ltd. which has been in business for more than a decade providing in-person and remote services to people in the Lower Mainland of Vancouver and beyond.
Since March 5, 2017, I have been eating a low carb (and more recently a keto diet) myself and in May of last year, I opened the LCHF-Dietitian division to focus on helping people manage a number of health conditions by following a low carb or ketogenic lifestyle.
I used to be an obese Dietitian with high blood pressure, high cholesterol and 10 years as a Type 2 Diabetic and am now in partial remission from these, as I continue my weight loss journey. You can read my personal story under “A Dietitian’s Journey” on the blog, under the Food for Thought tab.
Also in the blog are articles written about the science behind following a low carb and ketogenic lifestyle, under the category Science made Simple.
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To our good health!
If you would like to read well-researched, credible “Science Made Simple” articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please click here.
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