By Dr. Mercola
Many of us are familiar with and fully appreciate the value of a low-carb, high-quality high-fat and moderate-protein diet, but implementing it can be a challenge. Domini Kemp and Patricia Daly have written an excellent resource to help with this, called "The Ketogenic Kitchen: Low Carb. High Fat. Extraordinary Health."
Nutritional ketosis has powerful therapeutic benefits, not only for treating a wide variety of chronic degenerative diseases but also preventing them. The primary challenge really lies in implementation and compliance with the program.
Kemp and Daly are both cancer survivors who say nutritional ketosis played an important part in their recovery. The book was written to fill a need they themselves had while learning how to implement this powerful metabolic intervention.
Kemp's Bouts With Melanoma and Breast Cancer
An Irishwoman born and raised in the Bahamas, Kemp is a chef and food writer now living in her native Ireland. In her 20s, she was diagnosed with malignant melanoma. This was followed by a breast cancer diagnosis in her 40s.
"It was at that point I went, 'OK, I need to do a lot more than just the typical diet we're being advised [to eat]. Certainly in [Ireland], the food pyramid is still heavily promoted. I looked at all the leaflets in the cancer ward and I thought, 'No. There has to be a better way,'" Kemp says.
"I kept trying to find what was going to be suitable for somebody with breast cancer who'd been diagnosed for the second time with cancer, and what I could do to support my system to the very best [of my ability] through treatment.
Really, going on a low-carb diet seemed to be an absolute no-brainer … For me, low-carb was just great. I really upped the exercise and focused on just supporting my system through chemotherapy, a mastectomy and then radiotherapy. It was around that time I met Patricia."
Daly's Fight to Keep Her Eye
Daly became a nutritional therapist in 2011 and had been in practice for about a year when she met Kemp. Like Kemp, Daly had been diagnosed with cancer at an early age, receiving a diagnosis of malignant melanoma of the eye at age 28.
She got the standard of care, which involved plaque radiotherapy — one of the most invasive therapies in conventional cancer care. As a triathlete, she knew her body well and recognized the importance of taking personal responsibility for her own well-being during and after treatment.
"Having grown up in Switzerland, I grew up with a lot of complimentary therapy. For me, it was always obvious that I want to do something to help myself as well. That's why I started training in nutritional therapy a month after finishing treatments," Daly says.
"Initially my treatment worked very well, but I relapsed very quickly. Not even two years after, the tumors had more than doubled in growth and I had to go back to … the strongest possible radiotherapy on my eye.
The tumor had moved so close to my optic nerve that they had to radiate the optic nerve as well. As a consequence, … just 18 months later, my vision had tunneled in and things were looking dire.
I had pretty much everything you can possibly develop in an eye. I had edema. I had excessive angiogenesis (blood vessels that supply blood to the tumor) … I had cataracts on the way to developing glaucoma. You name it.
It so desperate it was suggested that I do Avastin injections as a first protocol, and if that wouldn't work, I would have to have my eye removed. I was 30 at the time. I was just, 'Whoa, there has to be another way.' I'd had the ketogenic diet in the back of my mind already.
I had started researching it, obviously, as a nutritional therapist. That's when I [decided], 'OK, now I'm really being pushed to the edge. It's now or never. I can't lose anything now, except my eye.'"
Bridging the Gap Between Science and Cooking
Both Daly and Kemp grew up on carb-based diets. Daly, as a triathlete, was particularly into carb-loading. Today, Kemp is in remission after completing her cancer treatment three years ago, and she feels great.
Daly has been officially in remission for six years now, and she still has vision in her eye. Personally, I believe a ketogenic diet has the power to alleviate tremendous amounts of suffering.
Every day, 1,600 Americans die from cancer and the evidence suggests a majority of them may be effectively treated with this dietary approach. Kemp and Daly are really great examples of this.
When Daly and Kemp first decided to embrace the ketogenic diet, there were virtually no eBooks or recipes available, which made it difficult to tailor a meal plan.
"I very much relied on the research of Dr. Johannes Coy and Professor Ulrike Kämmerer in Germany," Daly says. "I was very blessed to have the [German] language. [A]t the time, Thomas Seyfried, [Ph.D.], Dominic D'Agostino, [Ph.D., they] were all just coming online.
But it was very difficult to bring it all together and fill that gap between science and cooking, basically. How do you actually cook to match that?"
Kemp agrees, saying one of the main incentives for writing the book in the first place was that this is the book they both wished they'd had when they were diagnosed with cancer and were trying to implement a carbohydrate-restricted diet.
Sunlight May Influence Your Disease Risk
On a side note, albeit a very important one, I recently interviewed Dr. Alexander Wunsch, who really drives home the importance of sunlight for optimal health.
Basically, while the food you eat (primarily carbs or fat) is converted to electrons that are utilized in the mitochondrial transport chain and transferred to oxygen, only 30 percent of the ATP consumed in your cells actually comes from those electrons.
Most of the rest is created in response to sunlight, with the near-infrared range being of particular importance. So exposure to outdoor light is really essential for health. LED light sources emit mostly blue light and no near-infrared at all, which increases your risk for chronic degenerative diseases like cancer.
LEDs are also particularly damaging for your eyes, and promote age-related macular degeneration (AMD) — a primary cause of blindness among the elderly — and cataracts.
Sun exposure during the day is also important for optimal sleep at night, and sleep is another healthy lifestyle ingredient that can either help or sabotage your mitochondrial health. If you think just eating a high-fat, low-carb diet will be enough to resolve cancer, you may be disappointed. You really need to address your lifestyle as a whole, and support your health from all angles. As noted by Daly:
"It's not a coincidence that the World Health Organization (WHO) classifies shift [work] or any irregular work as a probable carcinogen. That's how I first came across this … I never talk about the ketogenic diet; it's always the ketogenic lifestyle, because there are so many different things that can have ketosis."
Not All Fats Are Healthy
Another important point that needs to be made is that while a ketogenic diet is high in fat, not all fats qualify for inclusion in a ketogenic diet. Most Americans eat fats that will drive their health in the wrong direction. This includes margarines, butter-like spreads and processed vegetable oils.
Healthy fats, on the other hand, include coconuts and coconut oil, MCT oil, raw grass-fed butter, lard, ghee, avocados, pastured egg yolks, grass-fed dairy and raw nuts like macadamias and pecans, just to name a few.
Another healthy fat that is very important is the marine animal-based omega-3 fat docosahexaenoic acid (DHA). DHA is actually a structural component of your cells and is not burned as fuel. It's incorporated into your brain, and is involved in the conversion of photons from the sun into electrons that fuel your mitochondria.
You can take supplements like krill oil or fish oil, but I don't think they're as good as eating seafood low in mercury, such as wild-caught Alaskan salmon and smaller fish like sardines and anchovies. Keep in mind that, contrary to popular belief, you CANNOT get sufficient amounts of DHA from plant-based omega-3 sources. To learn more about the significant differences between these sources, please see my previous article, "The Critical Differences Between Omega-3 Fats From Plants and Marine Animals."
Ketogenic Pitfalls and Challenges
One thing keeping many from ever implementing a ketogenic diet is the mistaken belief it will require a special skill set in the kitchen, or that it will be more labor intensive than the cooking they're used to already. Granted, if you've never cooked a fresh vegetable, you'll have to learn something new, but other than that, a ketogenic diet is actually quite easy to follow once you've grasped the basics.
Another common pitfall is lack of monitoring. If you're healthy, this may not be of great importance, but if you're trying to address a chronic health condition, please realize that this is not just another diet, it's a powerful metabolic therapy. So get the appropriate blood tests and monitor your condition. Don't think you can just slather extra butter on everything and all will be well. You do need the appropriate support and monitoring.
It can be tremendously helpful to use a nutritional tracker. My favorite is cronometer.com/Mercola. This is my version of the basic tracker, which has been specifically designed to support nutritional ketosis, and it's entirely free to use. Health care professionals can also sign up for a professional account, which allows them to access and evaluate all of their clients' data.
Daly has also written a Keto and Low Carb picture guide eBook that visually shows you what different amounts of fat, protein and carbs actually look like on your plate.
"Some people think, 'I'll just weigh 20 grams of chicken; that will give me 20 grams of protein.' No, this is what it looks like. And this what it looks like if you eat 1 gram of net carbs of broccoli," Daly says. "It's this visualization that I feel makes it so much easier for people, because it's all so abstract. Nobody weighs their food until they actually have to."
The Benefits of Intermittent Fasting
Aside from a ketogenic diet, intermittent fasting is another powerful tool to increase mitochondrial biogenesis, thereby optimizing your health and improving your chances of recovering from chronic disease.
Both water fasting and intermittent fasting (which tends to be easier to implement than longer water fasts) have been shown to have a beneficial impact on many chronic diseases. Since it dramatically upregulates your body's ability to burn fat for fuel again, it's also a powerful way to shed excess weight.
"There's a great paper that was talking about women that fast for 13-plus hours have a great decrease in breast cancer recurrence," Kemp says. "I know I feel great if I can do an overnight fast [and] make sure I don't eat for 13 hours. But also during the day, I just find that I'll have some coffee with a splash of cream, and that will keep me going all day. I feel great, energized and very focused. It's such a relief not to be worrying about food all the time. I found that works really well for me."
Daly agrees, saying she fasts for practical reasons as well.
"Initially when I started going on the ketogenic diet, just having three meals a day was a huge challenge. When my daughter started going to pre-school, I just had to skip breakfast. It was too hectic in the morning … I think exercise is brilliant as well when you're fasting, because I do feel it makes it a lot easier to fast. I really extended my window [when I added exercise].
I've always had problems with hormones. Initially I was skeptical. Will I mess my hormones up? Actually my cycle has never been more regular. It clearly suits me. I've now started to go three or four days a month where I do a 24-hour fast. I just have one meal a day [and] that's after years of ketosis …
At the time when I started, I didn't come across [the fasting] option. I started with just going down to 60 grams of net carbs a day and reducing [meals down] to three meals a day, which for me was, as I said, a big pain."
What If You Don't Need to Lose Weight?
As with fasting, a ketogenic diet really facilitates weight loss, as it retrains your body to access and burn body fat. But what if you're considering nutritional ketosis as a metabolic therapy but you don't need to lose weight? Can you still do it safely? And, is it possible to actually gain weight if you need to?
"There are certain supplements that sometimes can make a difference," Daly says, "especially omega-3s (ideally from seafood like wild Alaskan salmon, sardines, anchovies and oysters). Sometimes you have to [increase] the carbs. That can make a quite big difference. Just a little bit. Good-quality carbs obviously.
Then also look [at] the protein. Obviously, where are the calories? Are you monitoring your calories? … Look at branched-chain amino acids and … just generally, amino acids (protein) can help as well. There are also psychological tricks. It can be helpful to eat little and often, and to put food on a much smaller plate. I have seen that with some clients it works incredibly well …
I do organic acid tests quite a bit to see, are we missing certain really crucial nutrients like CoQ10 or L-carnitine? They're the ones that are helpful. Obviously it needs to be carefully assessed."
While the strategy to put food on a smaller plate may seem counterintuitive, as this technique is often used to eat smaller portions, Daly explains that when someone with no appetite is presented with a large plate full of food, chances are they eat about 10 percent or less. A smaller plate of food will seem less daunting. You'd also need to increase meal frequency as well though.
The testing she mentions is one of the reasons why it's so helpful to have a coach. Most people can certainly implement this program by themselves. Get the cookbook, use cronometer.com/Mercola and apply the information. But there are circumstances in which you're really going to need a knowledgeable professional to guide you.
This is particularly true if you're trying to address something as serious as cancer. Daly suggests getting your oncologist and/or oncology nurse involved as well. Granted, that may be an overly idealistic goal. Most conventional oncologists are not going to even consider a dietary intervention such as nutritional ketosis. However, it's worth a try.
"We've had some interesting conversations with certain parties. It's a grassroots movement. It's starting to pick up," Kemp says. "It's brilliant that people are interested. They want to do more. Taking control of your health when you are diagnosed with cancer is really important. To feel that you're contributing something to your well-being is a vital aspect of treatment."
Besides cancer, there are a number of applications for nutritional ketosis, including as a treatment for insulin resistance, type 2 diabetes, epileptic seizures (especially in kids who are unresponsive to drugs) and neurological conditions such as Alzheimer's and Parkinson's.
As a general guideline, a dietary intake of about 50 grams or less per day of net carbs (total carbs minus fiber) while also keeping protein low-to-moderate is usually low enough to allow you to make the shift to nutritional ketosis. If you're insulin resistant or have type 2 diabetes, you may require less than 40 grams, or even as little as 30 grams per day, to get there. Cancer may warrant an even lower amount of net carbs.
To identify your personal carb target, it's important to measure not just your blood glucose but also your ketones, which can be done either through urine, breath or blood. This will give you an objective measure of whether or not you're truly in ketosis, rather than just relying on counting the grams of carbohydrates you consume. Nutritional ketosis is defined as blood ketones that stay in the range of 0.5 to 3.0 millimoles per liter (mmol/L).
That said, using a nutrient tracker will radically improve your ability to understand how much and what kind of foods help you to keep to your ketogenic diet nutrient targets while also helping you to assess the nutrient value of your food choices. You can learn more about the benefits of using a nutrient tracker in my previous article, "Track Your Way to Better Health With This Powerful Tool."
I am really excited to share with you two educational opportunities to learn from the leading experts in nutritional ketosis. You can join me for the best nutritional ketosis event in San Diego next year in August 2017. If you purchase a ticket now there is a 50 percent reduction off of the price that expires shortly. There will be around 500 to 1500 people at this event. You can view the speakers and see that this is an extraordinary panel.
If you want a more intimate setting there will be a group of 200 that will be attending a smaller event that is in West Palm Beach, FL in mid January 2017. So you can escape the cold and spend some time to learn. I am really excited as two of the people
I want to spend some more quality time with Dominic D'Agostino and Zac Bush, MD will be there. Additionally Miriam Kalamian who is helping me write my next book on this topic will be there. She Is Dr. Seyfried's nutritionist and has helped over 400 cancer patients implement this program and for many it would be worth it just to see her.
If you have any interest at all in this smaller event I would encourage you to register now as most likely the event will be sold out shortly and you can only be placed on a waiting list.
Certainly, if you've been wanting to implement a ketogenic diet but had trouble figuring out what to eat and how to plan your meals, I highly recommend getting Kemp and Daly's book, "The Ketogenic Kitchen: Low Carb. High Fat. Extraordinary Health."