The ketogenic diet has been a hot topic in the nutrition world for a while now, so you’re likely to have thought, “Is it for me?” While I don’t blanket recommend one diet for everyone, the therapeutic use of the ketogenic diet can’t be understated. When done correctly and under the supervision of your medical provider, it can yield some pretty fantastic results.

What does the ketogenic diet entail?

Let’s start at the beginning. When you eat carbohydrates (whether that be from vegetables or bread) they break down into a molecule called glucose. That glucose is simple, easy, and fast energy that your body can utilize to maintain its cellular functions. Your body loves glucose because it’s cheap and fast and your body isn’t required to dip into its energy stores (aka your fat tissue) for extra energy to keep you alive. However, your body can also sustain life off of other forms of energy, which is the premise of the ketogenic diet as it requires your liver make ketones (an alternative energy source to glucose) to fuel your cells.

A simplified explanation of how the ketogenic diet can help a wide variety of concerns from ADHD to weight loss is that it can encourage the body to create and sustain life on ketones. When your cells need to perform a function—for example, your heart to beat, your brain to process information, or your stomach to digest foods—and it doesn’t have enough of that fast, cheap glucose to perform it, it will break down fat into fatty acids instead. It will then produce ketones, which can be used for cellular energy. When you significantly decrease the amount of glucose you’re consuming on a day-to-day basis through your diet, you end up with a build up of these ketones, and that’s the what we call “nutritional ketosis.”

The ketogenic diet in its simplest form is a low-carbohydrate, moderate protein, and high-fat diet. Up to 75% of your macronutrients will come from fats, 20% from protein and 5% from carbohydrates, aiming to keep either the total or net grams of carbohydrates under 30g.

The pros of the ketogenic diet

Your mitochondria love ketones

If you quickly forgot all of your high school biology (no judgement here!), you may have forgotten that the mitochondria are the battery packs of your cells, and are responsible for creating ATP (your cellular energy). Research has been done on conditions that may be caused by a decrease in mitochondrial function such as Alzheimers, Parkinson’s, fibromyalgia, and chronic fatigue syndrome. What they also found in this research is that when you’re in a state of nutritional ketosis, your mitochondria function better, and can generate a high output of cellular energy. The implementation of the ketogenic diet in these patients can help to improve their quality of life.

Ketogenic diet can promote lower insulin levels

When you eat a diet low in carbohydrates, which break down into glucose, you’ll have lower insulin levels, because it is insulin’s job to open up the cells and allow glucose in. High levels of insulin can stop fat loss, can decrease the sensitivity of the cells to the signal of other hormones (such as thyroid hormone), and can be pro-inflammatory.

A common metabolic condition that’s affected by higher insulin levels is PCOS or polycystic ovarian syndrome. Women with PCOS typically have pain around the time of ovulation, dark hair growth on the face and body, cystic acne, abdominal obesity, and hormonal imbalances, which can cause irregular periods, infertility, and significant PMS symptoms. Researchers studied how the ketogenic diet could impact PCOS and found that not only did the studied women have symptom reductions, but their blood biomarkers also revealed that their bodies became more able to promote weight reduction and unwanted hair growth, and they were more hormonally balanced.

The cons of the ketogenic diet

People often eat unhealthy ratios of certain foods in the name of “It’s Keto!”

When it first became trendy, many people were excited about this new diet that allowed them to binge on bacon, butter, cheese, and a large juicy steak—and so that’s how this trend got stuck in people’s mind. High protein, high “fat,” with most of that fat being from animals. (And let’s be honest: Unless you’re buying high quality, organic animal proteins, the fat content is not as desirable and can actually add more inflammation to your system.)

One way that people do ketogenic incorrectly is by consuming most of their fat from dairy sources—cheese, butter, milk, creams. Sure, those foods are high in fat, but dairy can also be pro-inflammatory. It can increases insulin-like growth factor, cause excess mucus production, and cause a lot of GI distress (70% or more of our world’s population is lactose intolerant).

The healthier way to get your high fat is by focusing on vegetable sources of fat, and by incorporating butter, ghee, avocado oil as your cooking agent (instead of your main course). This way, you meet your fat goals and still get the health benefits of the ketogenic diet.

Similarly to the fat debacle, another area where I find that patients get stuck is by binging on processed meats—deli meats, conventionally raised bacon, jerky, hot dogs, etc. From a macro standpoint, these patients are spot on. However, many of these processed products are linked to cancer and other diseases, so we have to think instead about proteins that are more minimally processed.

I also notice that people go hog-wild (pun definitely intended) with amount of protein they’re eating. Often, I see the total amount of protein per day skyrocketing over the 20% of total calorie intake goals. If you’re finding yourself on the ketogenic diet and plateauing (or if the diet never worked for you in the first place), try moderating your protein intake and seeing if that makes a difference!

Many people who engage in the ketogenic diet forget that vegetables aren’t the enemy—they have many of the micronutrients you need to fuel your biochemistry. Incorporating non or low-starch veggies into your routine can help increase the health benefits of being in ketosis and provide you with the micronutrients you need to survive.

Sure, vegetables contain carbohydrates and aren’t we supposed to be restricting those? Yes. However, keeping your ketone levels well monitored (through blood, urine, or breath tools) can make sure that the amount of net-carbohydrates you’re getting from vegetables is not taking you out of ketosis.

There are medical conditions/medications that would make me not recommend the ketogenic diet

Like all nutritional programs, there are certain people who may not be a good fit for the ketogenic diet, especially without guidance from a medical professional. Individuals who have a history of kidney stones, genetic risk factors for high cholesterol, advanced liver disease, reflux/heartburn, IBS-C, cardiomyopathy, and certain metabolic conditions aren’t a good fit—the ketogenic diet could exacerbate your symptoms and it has the potential for causing harm.

On the flip side, there are conditions that could benefit from being nutritional ketosis, and the ketogenic diet could promote disease remission (type 2 diabetes, non-alcoholic fatty liver disease, morbid obesity, migraines, cancer, and those medicated for depression). But if you fall into this category, you should definitely be working closely with a medical profession before you attempt to do this on your own.

The ketogenic diet is one that I think requires a really high level of collaboration between you, your medical provider, and their clinical staff—that’s what ensures successful health outcomes. We use the diet is for a very specific purpose, whether that be to decrease fasting insulin levels, reverse diabetes, combat PCOS, overcome thyroid hormone resistance, lose weight, or decrease pain from fibromyalgia. Monitoring your blood work while you’re on the diet is essential, to see if eating ketogenic is actually causing a shift in your blood biomarkers, like we want. We also need to work together to make sure the types of ketogenic food you’re eating are promoting health, and that you’re not feeling hungry, faint, or discouraged. It’s a partnership the whole way through!

Interested in learning more about what foods might be right for you? Give us a call, for a free 15-minute consult!

Dr. Cassie Wilder

Dr. Cassie Wilder is a registered Naturopathic Medical Doctor (NMD) and founder of MIMC. Her passion is empowering her patients through education, understanding, and support through their healing journey. After graduating from Iowa State University with a Bachelors of Science in Kinesiology and Health, Dr. Wilder earned her Doctorate of Naturopathic Medicine from Southwest College of Naturopathic Medicine & Health Sciences, a fully accredited and nationally recognized institution in Phoenix, AZ. During her clinical training, she received extensive hands-on training with many leading experts in the field of functional medicine and developed a passion for treating hormonal imbalances, thyroid disorders, cardiovascular concerns, and adrenal fatigue.