By Dr. Mercola
There's emerging scientific evidence that a high-fat, low-net carb and moderate protein diet is an ideal diet for most people. However, compliance tends to be low for a number of reasons.
Discussing this is Randy Evans, who has a master's degree in nutrition and works with Dr. Jeanne Drisko at the University of Kansas Integrative Medical Center. I recently interviewed Drisko on her clinical use of nutritional ketosis.
Evans grew up on a dairy farm in Southern Iowa at a time when agriculture was largely still organic. "I actually grew up eating mostly real whole foods," he says, noting his interest in nutrition was an outgrowth of his upbringing. His interest in the ketogenic diet emerged when he began working with Drisko five years ago.
"Our goal with most patients is to push back on those low-fat guidelines we got in the '80s … and to encourage people to incorporate healthy fats in every meal … We're really just getting carbs from Mother Nature here," he says.
Getting Started on a Ketogenic Diet
The nutrient ratio Drisko and Evans typically recommend for their new patients is a 1-to-1 ratio of healthy fats to net carbs plus protein. This means your grams of healthy fats will be about equal to your combined grams of non-fiber carbs and protein put together.
This ratio, they found, is fairly easy for most people to achieve, and will get most people very close to nutritional ketosis.
"We shoot for that ratio first and then … we'll advance them to the ratio of maybe 2-to-1 or 3-to-1 or even 4-to-1. That's just more and more fat. That's when you actually start to restrict some of the starchy carbs and fruit more.
But for most people, the moderate version gets them pretty close to trace ketones," he explains.
Consider MCT Oil
Adding medium-chain triglyceride (MCT) oil or coconut oil to meals is one way of increasing the amount of healthy fat in your diet. MCTs get their name from their chemical structure.
Fats consist of chains of carbon molecules connected to hydrogen atoms. There are two basic types of MCT oil being sold:
- A near 50/50 combination of 8-carbon chain (C8, caprylic acid) and 10-carbon chain (C10, capric acid) fats
- 100 percent C8
The pure C8 oil converts to ketones more effectively than C10, making it a preferred choice, even though it's a bit more expensive. You'll want to start with 1 teaspoon of MCT oil and work your way up, adding 1 teaspoon at a time over the course of a few weeks.
A typical dosage is 2 to 3 tablespoons of MCT per day, although you could go up to 5 or 6 tablespoons if needed. If you experience gastrointestinal (GI) distress or diarrhea, it would be necessary to cut back.
While it's not harmful to overdose on MCT, your body will rid itself of the excess by causing diarrhea, so starting out with 2 or 3 tablespoons would be asking for trouble. If you have trouble tolerating the MCT oil you could try the powder form, which tends to be easier on the stomach.
Advice on Implementing a Ketogenic Diet
To implement a ketogenic diet, the first step is to eliminate packaged, processed food items. If you have food allergies or sensitivities, you'll need to be careful to avoid those items as well. Aside from that, the No. 1 emphasis is to eat real whole food, plenty of healthy fats and as few grains as possible.
Evans recommends avoiding dairy, as it can be difficult to stay in ketosis if you eat or drink a lot of dairy products. The galactose in dairy is a carbohydrate and you can easily use up your entire net carb allotment by drinking a single glass of milk. The protein casein in dairy can also trigger or contribute to inflammation in individuals who are sensitive to it.
"We have essential proteins and we have essential fats. We don't have any essential carbs," Evans says. "They certainly can help us. [But] our goal is to always make sure we're emphasizing the food essentials.
When we go ketogenic, we're just making a slight shift in what the image of their plate looks like. It's easy enough to ask people to eat half portions. They kind of ease into this, to eat half portions of maybe beans, sweet potatoes or the starchy veggies. Not many grains.
Grains are just too energy dense and we see so much sensitivity to that. I'd say more along the lines of the starchy veggies. Maybe cut back to half portion of fruit. At the same time, we always add a little of that oil in there."
The key to success on a high-fat diet is to eat high-quality healthy fats, not the fats most commonly found in the American diet (the processed fats and vegetable oils used in processed foods and fried restaurant meals).
Evans recommends getting two servings of healthy fat with every meal. For example, you could add one-half avocado and a tablespoon of olive oil to your salad. Besides MCT oil, high-quality healthy fats include:
✓ Olives and olive oil (make sure it's third party-certified, as 80 percent of olive oils are adulterated with vegetable oils.
Also avoid cooking with olive oil. Use it cold.)
✓ Coconuts and coconut oil (excellent for cooking as it can withstand higher temperatures without oxidizing)
✓ Butter made from raw grass-fed organic milk
✓ Seeds like black sesame, cumin, pumpkin and hemp seeds
✓ Grass-fed meats
✓ Lard and tallow (excellent for cooking)
✓ Ghee (clarified butter)
✓ Raw cacao butter
✓ Organic-pastured egg yolks
For other foods that you can include in your ketogenic diet, Paleo Flourish Magazine1 has created a comprehensive infographic that encompasses various food groups, such as vegetables, fruits (in small amounts), meats and organ meats, nuts and seeds, dairy and more. You can download the ketogenic diet food list for free or embed it on your website.
Is Water Fasting a Good Idea?
Ray Cronise, author of the yet-to-be-released book, "Our Broken Plate," has done a lot of work with extended water fasting.2 I used to be really opposed to long-term water fasting, but more recently I've started to give it some more thought. He recommends fasting anywhere from three to 21 days, and while this could be dangerous for some — especially if you're underweight or have cancer cachexia — it may actually be beneficial for overweight or obese individuals.
"I think there's great value there," Evans says. "I always think about those natural [stimuli] that can help with longevity genes … Fasting is important. We ask most of our patients to … have a tight eating window. In other words, we start there. We do have patients who will progress to fasting. But we'll start them [out by] saying, 'Let's go with a couple of meals a day, or three meals a day, but squeeze those down to 12 hours or 10 hours. Get that long off time.' You've got to have a small fast there …
I had two patients who did a strict fast on their own. They were cancer patients. They just decided to do it. One had weight to lose but the other not … I have two patients doing the 5-to-2 plan where you do that minimum calorie fast every third day or twice a week. They seem to do well with that."
If you're type 2 diabetic and overweight, I believe fasting for one, two or even three weeks could really help you jumpstart the process of nutritional ketosis, which will allow you to effectively burn body fat. Barring more advanced strategies such as fasting, it will typically take patients two to three months or even much longer before they're in nutritional ketosis, Evans says.
Naturally, if you're diabetic and/or taking multiple medications for chronic illness, fasting is something you need to do under close medical supervision.
If You're Ill and/or Taking Medication, Be Sure to Remain Under Close Medical Supervision
As just one example, if you're on high blood pressure medications and your blood pressure suddenly begins to normalize, you will then become hypotensive and could potentially have a stroke. So if you're on medication, your doctor will need to monitor and alter your medication dosages as you go along. On the upside, if done carefully and correctly, a two- or three-week fast could potentially eliminate a person's need for most drugs.
"I agree. I think it would be remarkable. It's interesting to think about a place to do that — [a] new model of healthcare to do that in. In the medical center we're mostly dealing with outpatients … You could take more metabolic risks if you were able to have them in-house. That's the challenge … Some people are better than others at compliance and recording. That's why I think [Drisko] kind of defaulted to the slow and steady."
Tip That Can Help Identify Your Ideal Meal Times
Intermittent fasting is an alternative to extended fasts, and it's a lot easier to do for most people. While I used to recommend skipping breakfast and make lunch your first meal, I eventually learned that for most, skipping dinner is a far more effective strategy. This is because your least metabolically active state is while you are sleeping, so the last thing you want to do is add fuel you don't need in the evening. Doing so will simply generate excess dangerous free radicals.
The challenge then becomes to determine the most appropriate time to eat your breakfast. By wearing a 24-hour glucose monitor, I have learned that you can pin-point the ideal time to break your fast by tracking your glucose. Simply measure your glucose at regular intervals in the morning, and when you notice your glucose level rising, even though you haven't eaten, it's a sign you're undergoing gluconeogenesis.
Basically, your body is starting to break down protein (muscle), turning it into glucose. This is not a healthy process, so when this occurs, you'll want to eat something to avoid muscle degeneration. In my experience, that will typically occur after 16 hours of fasting or so, although it's highly individual. If you're a competitive athlete, this strategy may not be appropriate, but it could work for most average people.
Find Your Motivation
Any change can be a challenge, and dietary changes can be particularly tricky. It can be helpful to identify your motivation. Why are you making this change? Do you want to lose weight? Have more energy? Sleep better? Recover from a chronic disease? As noted by Evans:
"If somebody's interest is not having to worry about food all the time, a high-fat diet is one of the best ways to not have to carry food around with you. As a dietitian, I'm trained to tell people to eat all the time. For years, I did that myself. I carried food everywhere I went. It's so liberating not to have to carry food all the time. If you get good healthy fat in your diet, you can go a long time without eating.
I think one of the biggest motivations we have is encouraging people to get off the carb wagon and become fat-burners. They have more energy. They're able to switch between fuel sources. They tend to become less inflamed, lose a little weight, along with all the other myriad of symptoms that can be improved like GI health, sleeping better or just having more energy
[W]e want to get these people pushing towards three months of a dietary change and say, 'Hey, if you don't like it, you can go back to the way you used to [eat].' Most people feel enough difference, they don't go completely back. They might fall off the wagon, but they generally will say, 'I don't want to feel like that,' and get back on it …
A lot of people ride that food roller coaster. They get the sugar high. They get the crash. The sugar high, they crash. That's what most people are on. If we get them off of that, that can do dramatic things for health. It certainly just makes them feel better."
Ketogenic Diet Improves Cognition and Weight Loss
Your brain will also work better when operating on a more efficient fuel (i.e. fat or ketones). Many times, improved cognition will be one of the first things people notice when starting a ketogenic diet. People also report elimination of hunger pangs and food cravings.
And then there's the weight loss. When I first started this nutritional program, I weighed 180 pounds. I ate 2,500 to 3,000 calories a day, yet dropped down to 164 pounds. I've since realized I have to eat a minimum of 3,500 to 4,000 calories a day just to maintain my ideal weight. As noted by Evans:
"It's so counterintuitive … because we've been so engrained to think that fats are bad for us; that it's going to make us fat and that it has a lot of calories. We find almost universally that if people move toward the high-fat diet, they lose weight without trying and a lot of times will struggle to maintain weight. We have to tell people on a ketogenic diet to eat more and more. It shows you the truth that it's not as simple as calories in and calories out. We know that didn't work. It never has worked.
The ketogenic diet or a high-fat diet is one of the best ways to experience that for yourself, because you will find that you're eating probably more calories than you ever ate and you're a lot happier and you may still lose weight. I think it creates leanness — that ability to switch between fuel sources is a very easy way to make somebody lean."
Ketogenic Diet or High-Fat Diet Is Anti-Inflammatory
There are two basic fuels your body can use for energy: sugar and fat. One of the reasons why you want to burn fat is because it's a "cleaner" fuel. While it's a bit more complicated than this, a simple way to explain why fat is a preferable fuel over sugar is that it burns without creating a lot of pollution in the form of reactive oxygen species (ROS) and secondary free radicals. Sugar is a dirtier fuel in that it creates far more ROS. In excess, sugar causes inflammation and premature degeneration.
"To me, it's very simple. A human being is made of fat. Our brain's mostly fat. Our hormones are fat. We're really fat machines in a lot of ways. It kind of makes sense that [fat] would work well for us," Evans says.
"I usually tell patients [fat] is a very anti-inflammatory fuel [for your body] … It makes sense to me that we're kind of programmed for that kind of fuel. To have variety in the diet, put fasting in there, and interval training. It's a lot of those things that actually push those longevity genes that we hear so much about … It's amazing how many of those natural stresses actually push your body in a good way."
A Nutrient Tracker Is an Invaluable Tool
Using a nutrient tracker will radically improve your ability to understand your ketogenic diet nutrient targets and assess the nutrient value of your food choices. Ideally, you'd enter the foods you plan on eating before you actually eat. This way you can modify your meal if you find your nutrient ratios are off kilter.
The other component I place great value on is restricting protein to a certain level. I like to keep mine under 70 grams a day, as eating more protein than your body actually needs for muscle maintenance and repair will activate the mTOR pathway, which plays an important role in aging and cancer development.
There are a number of trackers available, but my first choice is Cronometer.com/Mercola. That's my revision of the basic Cronometer tracker, and it's already set to default to macronutrient levels that will support nutritional ketosis.
"We're actually going to use that program as well," Evans says. "We've used other programs. A lot of those [used] user generated data, [which is] a ballpark [estimate] at best. Our goal is to get our patients to switch over to Cronometer, which looks great and [is] certainly much more accurate.
That's how we guide people toward the ketogenic or higher fat: using those numbers. It's very important to have that. Again, it can be motivational for people looking at their days' meals … You can actually think if you want to consider that ratio; we talked about comparing your grams of protein and net carbs to fat. That 1-to-1 ratio, for most people, is when they start to get ketones."
More Information on Ketogenic Diet
You can find more information about the KU Medicine Center, where Evans works, on www.kumc.edu, including contact information should you want to make an appointment.
Drisko's clinic finds that intravenous (IV) vitamin C can be an important adjunct along with the ketogenic diet during cancer care. IV vitamin C is a powerful prooxidative therapy that targets the unhealthy cancer cell and leaves the normal cell unharmed. When combined with ketogenic diet, IV C can be a "one-two knockout punch" to the cancer cell. To learn more about IV vitamin C, attend the University of Kansas Integrative Medicine conference www.kumc.edu/VitaminC.
I would also encourage you to attend the ACIM Conquering Cancer Conference in Orlando, September 22 through 24. I will be there along with a long list of other excellent speakers. There, you'll learn more about how to implement a ketogenic diet and much more. Evans is one of the 10 people I've invited to a brainstorming session the day after the conference, to help improve the quality of information in the new book I'm writing on this topic.