February 6, 2016
Not All Low Carb Diets are Ketogenic – Part 2
The following are general guidelines for ketogenic diets:
Carbohydrate - Most of what determines how ketogenic a diet is how much carbohydrate is eaten, as well the individual's own metabolism and activity level. A diet of less than 50 or 60 grams of net (effective) carbohydrate per day is generally ketogenic. However, athletes and people with healthy metabolisms may be able to eat 100 or more grams of net carbohydrate in a day and maintain a good level of ketosis, while an older sedentary person with Type 2 diabetes may have to eat less than 30 net grams to achieve the same level.
I personally do well on 30 to 50 grams of carbohydrates per day. A nutritionist supports me in planning the carbohydrates to not overdo the total and take me out of ketogenic.
Protein - When people first reduce carbohydrates in their way of eating, it doesn't seem as though the amount of protein they eat is as important to ketosis as it often becomes later on. For example, people on the Atkins diet often eat fairly large amounts of protein in the early stages and remain in ketosis. However, over time some (perhaps most) people need to be more careful about the amount of protein they eat as the bodies of many people seem to "get better" at converting protein into glucose (gluconeogenesis). At that point, each individual needs to experiment to see if too much protein is throwing them out of ketosis and adjust as necessary.
Fat - Most of the calories in a ketogenic diet come from fat, which is used for energy. The exact amount of fat a person needs to eat will depend on carbohydrate and protein intake, how many calories they use during the day, and whether they are losing weight (using their body fat for energy). Depending on these factors, somewhere in the range of 60-80% of calories will come from fats on a ketogenic diet (even up to 90% on, for example, the Ketogenic Diet for Epilepsy). People tend not to overeat on diets this high in fat, so calorie counting is rarely necessary.
When eating this large amount of fat, you can imagine that the types of fats consumed are very important. Many authors advise steering clear of oils that are high in polyunsaturated omega-6 fats (soy, corn, cottonseed, safflower, etc). Dr. Stephen Phinney, who has been doing research on ketogenic diets since the 1980's, has observed that people don't do as well when they are consuming a lot of these oils (mayonnaise and salad dressings are a common source). This could be because omega-6 fats can be inflammatory, especially in large amounts, or some other factor, but people didn't feel as well or perform as well athletically in his experiments.
On the other hand, fats high in medium-chain triglycerides, such as coconut oil and MCT oil are often encouraged, as these fats are easily turned into ketones by the body. In general, people on the ketogenic way of eating tend to consume a lot of foods high in monounsaturated and saturated fats such as olive oil, butter (often butter from grass-fed cows is recommended), avocado, and cheeses. The "high oleic" types of safflower and sunflower oils (but not the regular forms of these oils) are also good choices, as they are high in monounsaturated fats and low in polyunsaturates. This way of eating also avoids canola, soybean oils, and other vegetable oils.
I would seriously urge everyone to stop using the term diet to refer to ketogenic way of eating. Call it a food plan or better yet name it “way of eating” because this is something you need to do if you have type 2 diabetes. Diets often fail and are short-term at best and with the problems discussed in 'Part 1' (yesterday's blog), you will need to use this for the long-term.