Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (32 page)

Can I eat dairy on a ketogenic diet?

This is another one of those “your mileage may vary” issues. Everyone is different, but personally, my ketogenic diet includes lots of dairy products, including heavy cream, sour cream, cream cheese, and hard cheeses. These are a big part of my personal low-carb, high-fat diet, and they have never given me any issues with producing adequate ketones. However, others are very sensitive to dairy and need to cut it out of their diet because of digestive and metabolic side effects. If you are concerned that full-fat dairy might be an issue for you, try cutting it out for thirty days and see how you feel. (By the way, never consume low-fat milk or yogurt; not only does the absence of fat reduce satiety and lower ketone production, the fat that’s removed is replaced with a lot of sugar.)

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Many proponents of a Paleo lifestyle think dairy should be avoided. Dr. Loren Cordain, author of The Paleo Diet, once showed a slide of an intimidating moose with huge antlers and asked, “Are you going to milk that?” But while milk products should be avoided because they contain lactose (sugar), most people can remain ketogenic very well while consuming full-fat dairy like cream and cheese.

How long will it take for me to see improvements in my weight and health after getting into ketosis?

Many people on a ketogenic diet have tried many different diets in the past. They may begin to doubt what they are doing is correct if they don’t see the desired results quickly. This often turns into an obsession, and they spend a lot of time reading about what they’re doing wrong in their diet and looking for loopholes. They seek out anecdotes for permission to stop pursuing ketosis. This anxiety and doubt manifests itself in many physical symptoms until the person finally gives up, eats more carbs, and feels better psychologically that they’ve done something good for themselves. But they never got to truly experience the full benefits that a ketogenic diet could offer them.

– Dr. Zeeshan Arain

This is a tricky question because the answer depends on individual factors: how long it takes you to become keto-adapted, what your state of health was like prior to beginning the ketogenic diet, and how well you adhere to your personalized strategy for getting into ketosis (sticking with your carbohydrate tolerance and protein threshold levels is key). But most people begin to lose both weight on the scale and inches around the waist within a few days. Once you reach nutritional ketosis, you should have more energy, complete appetite control, more even moods, and much clearer thinking.

Certain health issues—elevated blood sugar, high blood pressure, problematic cholesterol markers (namely higher triglycerides and lower HDL)—should begin to normalize within a matter of weeks. But even if you don’t see results that quickly, be patient. Persistence pays off, and if you’re showing good ketone levels in your testing, then you should see these effects soon. Don’t doubt yourself just when you’re on the verge of experiencing what keto can do for you.

Is being in ketosis safe over the long term? If not, then who should avoid doing it?

Sustained, long-term ketosis can have side effects in some individuals, but these are usually easily managed and are most common during the first few months, when the individual is gradually becoming keto-adapted. Most of the problems people have with the ketogenic diet are experienced early on and can usually be remedied by proper hydration and mineral supplementation.

– Dr. Dominic D’Agostino

Because of the common confusion about ketosis, primarily from those who mistake it for ketoacidosis, questions about the long-term safety of a ketogenic diet have arisen. But a study by researcher Dr. Hussein Dashti that was published in the Fall 2004 issue of the medical journal
Experimental and Clinical Cardiology
found that a ketogenic diet produced “a significant decrease in the level of triglycerides, total cholesterol, LDL cholesterol and glucose, and a significant increase in the level of HDL cholesterol in the patients” and that “the administration of a ketogenic diet for a relatively long period of time is safe.” I’ve been eating this way for over a decade, and I know plenty of others who have been keto-adapted for much longer. There is no evidence of problems related to following a ketogenic diet as a permanent lifestyle choice.

So is there anyone who should avoid getting into ketosis? While the vast majority of people will find tremendous health benefits from being on a ketogenic diet, it may not be right for everyone. As we’ll cover in more detail in a moment, type 1 diabetics should approach it with caution because of the risk of ketoacidosis (as discussed in chapter 1). Also, if you have any problems with your gall bladder, you may need to address them before beginning a ketogenic diet (more on that later).

For everyone else, if you’ve been following a well-formulated ketogenic diet that keeps carbohydrates and protein at your personal limits and that includes large amounts of whole-food sources of dietary fats for a period of six to twelve months, you have ample amounts of ketones when you test your blood or breath, and you are not seeing any improvements in your weight and health markers, then perhaps you should move on to something else. But I’ve never heard of anyone who ate a ketogenic diet and produced plenty of ketones and did
not
experience all the amazing benefits we’ve been talking about.

If you are concerned about your long-term health on a ketogenic diet, find a medical professional who is willing to work with you in a positive manner and monitor your progress. (A list of ketogenic-friendly doctors is available at lowcarbdoctors.blogspot.com.) Here’s a list of lab tests you can have run periodically to check your overall health:

• Fasting insulin
  
• Fasting blood glucose
  
• Homocysteine
  
• hsCRP
  
• NMR LipoProfile test
  
• Standard lipid profile
  
• Uric acid
  
• Full thyroid panel
  

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: There are a few very rare hereditary conditions in which the body is unable to use fat for fuel—commonly referred to as “inborn errors of metabolism.” These conditions are discovered very early in infancy, so adolescents and adults who haven’t already been diagnosed don’t need to worry.

Should a type 1 diabetic be on a ketogenic diet?

Obviously ketosis may not be appropriate for some type 1 diabetics. Otherwise, we have not observed any complications with this dietary approach.

– Dr. David Perlmutter

This is a fair question, especially since type 1 diabetics need to be concerned about ketoacidosis. But as long as your blood sugar levels are well controlled (which, coincidentally, a ketogenic diet will help with), then the level of ketones in the body will not rise to dangerous levels. And that holds true for everyone, including people with type 1 diabetes.

Keep in mind that a type 1 diabetic cannot make insulin, the hormone that pushes glucose into cells. But according to a May 2012 study published in the medical journal
Diabetology & Metabolic Syndrome
, type 1 diabetics who consumed a carbohydrate-restricted diet over a four-year period found that their requirement for insulin was greatly reduced. In other words, their condition became better as a result of a low-carb diet. If you have any specific questions or concerns about this, please consult with a physician who understands the biochemistry of low-carb, high-fat, ketogenic diets. You can find a medical professional in your area at lowcarbdoctors.blogspot.com.

Registered dietitian Franziska Spritzler says that people with diabetes, including type 1 diabetes, “often experience dramatic improvement in blood glucose control” while in a state of ketosis. Spritzler notes that there is research showing that if a type 1 diabetic is producing ketone bodies through a low-carb, moderate-protein, high-fat diet, they can continue to be just fine even if their blood sugar dips below 70 mg/dl—even though that level of blood sugar will cause hypoglycemia in anyone who uses glucose as their primary fuel source. This is why full keto-adaptation is so helpful for type 1 diabetics.

Do I have to count calories to make ketosis happen for me?

The major benefit of nutritional ketosis is that it helps regulate appetite in a way that prevents the consumption of surplus calories that would ultimately lead to weight gain and metabolic dysregulation.

– Dr. Dominic D’Agostino

This is one of the most freeing parts of a ketogenic diet—you don’t have to count calories. When your carb and protein consumption is dialed in to your personal specifications and you consume enough fat in your diet, then something pretty amazing tends to happen: you are able to feel completely satisfied, with no cravings, no hunger, and no stressing about every little morsel of food you put in your mouth. That’s what I call dieting, and it’s time to break free from the bondage of calorie-counting forever. (If you’re interested in learning why calories really aren’t what you think they are, check out
The Calorie Myth
by Jonathan Bailor.)

Does this mean you have free rein to gorge yourself on as much food as you want within your low-carb, moderate-protein, high-fat diet, without consequences for your weight and health? Not at all. But if you are not stoking hunger by consuming too much carbohydrate or protein and are eating delicious and filling whole-food sources of fat, then you won’t want to eat until you’re stuffed, and calories naturally fall into line exactly where they need to be.

Ketosis changes the way you think about food; you start to see it more as a means for fueling your body than as a physical pleasure. That’s not to say you don’t enjoy food on a ketogenic diet—you do!— but it takes away any urge to binge.

What side effects can I expect to experience when I begin getting into ketosis?