Food Freedom Friday Edition 234 - Debunking Keto Myths

It would be wonderful to live in a world where the answers to all your health questions were black and white: “Eat this, and you will feel good; don’t eat this, or you will not feel good” Unfortunately, health is not quite that definitive, and often you often find yourself navigating through the grey areas to find the truth.

With the keto diet showing up all over the news, in forums, magazines, and in conversations at the gym, there are many things being said that are true, and just as many that are not so true as well.

A few myths that have been debunked about following a ketogenic diet.

The Human Body Requires Carbohydrates To Survive

This one may be hard to wrap your head around considering there are actually some cell types that do have an absolute requirement for glucose and cannot use fats or ketones for fuel. These include red blood cells which lack mitochondria, the organelle required for ketone utilization. Research has demonstrated that even after 40 days of fasting, glucose levels are maintained, despite consuming no food. This begs to wonder where the glucose to fuel these cells comes from when carbohydrates are restricted, such as with a ketogenic diet? Once you are keto-adapted (in a state of sustained nutritional ketosis), there are two primary sources that contribute to glucose maintenance. The first is from amino acids through a process called gluconeogenesis. This occurs when certain gluconeogenic amino acids are broken down into glucose. These amino acids can come from the protein consumed or stored in muscles. However, when ketones are circulating in your blood and the brain begins preferentially using ketones for the fuel, glucose requirements are reduced, therefore the need to break down muscle is reduced. This is one of the ways that ketones are muscle-sparing. The second source of glucose is from the glycerol backbone of triglycerides. Triglycerides are the storage form of fat and contain one glycerol backbone attached to three fatty acids. When the body breaks down stored fat while in ketosis, the fatty acids are detached from this glycerol molecule to make ketones, and the glycerol molecule can be converted into glucose, accounting for most of the body’s glucose requirements when keto-adapted.

The Ketogenic Diet Is The Same As A Low-Carb Diet

Many people begin their ketogenic diet by cutting out carbohydrates and replacing these sugars and starches protein-based foods. Those who are used to restricting dietary fats may approach a ketogenic diet and foods with hesitation. A ketogenic diet is a high-fat, adequate-protein, very low-carbohydrate diet. Even though your macronutrient calculations may have you falling under the allotted daily grams of carbohydrates, the amount of fats and proteins consumed must be considered as well. Fats contain ~9 calories per gram, while protein and carbohydrates contain ~4 calories per gram. Given this information, portion sizes will likely be reduced when following a ketogenic diet, and this may be more of a psychological barrier than a satiety one. Adding additional fats to meals in the form of oil, butter, ghee, or full-fat dairy can transform a low-carbohydrate meal into a ketogenic meal. Consider adding quality fats to protein sources to slow the digestion of protein and attenuate any glucose/insulin responses that could potentially prevent one from “entering” or “kicking out” out of ketosis. If you are not entering ketosis following what you believe to be a ketogenic diet, by removing almost all carbohydrates, you may be overconsuming protein or you may be metabolically challenged and require further support. You could try adjusting your macronutrients to include higher quantities of dietary fats and less low-fat protein sources (higher fat protein sources will also provide more satiety) or consult with your health care provider to determine your insulin sensitivity status.

You Can Eat As Much Fat As You Want.

A ketogenic diet does not imply you have free reign to eat as much fat as you want. 

While about 75% of your daily calories should come from fat sources, if have a significant amount of fat to lose, some of that requirement needs to come from your own fat stores. Eating fats is healthy and satisfying but over-consuming will not encourage, and may even prevent your body from accessing its own fat supply for energy.

Fill your diet with a moderate amount of a wide variety of fats including butter, coconut oil, olive oil, nuts, seeds, fish, grass-fed red meat, eggs, turkey, and avocado.

Nutritional Ketosis Puts You At Risk For Ketoacidosis

This is one of the most common myths, and despite being proven wrong time and again, people still want to believe that the ketogenic diet causes ketoacidosis. Ketoacidosis is a valid concern given that it can be a life-threatening event where ketone bodies cause a dangerous imbalance in blood pH. However, this condition occurs primarily in those with type-1 diabetes or insulin-dependent type-2 diabetes, and is uncommon in healthy individuals with a fully functioning pancreas.

Blood ketone levels are regulated by insulin, just as blood glucose is. When ketones reach their upper limit (~7-8mmol/L), a small amount of insulin is released from the pancreas to help prevent any further elevation in blood ketones, this system is designed to help the body avoid what is considered ketoacidosis (~15-25mmol/L). Nutritional ketosis (ketosis achieved by following a ketogenic diet) is highly unlikely to put a healthy person at risk of reaching dangerous ketone levels. There are rare exceptions to this where ketoacidosis can occur in those adhering to a ketogenic diet in instances such as dehydration, sickness, and possibly pregnancy.

Staying hydrated, supplementing with electrolytes, easing into fasting if you choose to do so, and ensuring you know and comply with your daily macronutrient needs (especially protein) are essential to avoiding these potential downsides.

Zero Alcohol Consumption.

Some liquors, beers, and wines are OK on when following a ketogenic diet.

Although beer and wine are generally carbohydrate-heavy, there are still options should you choose to continue drinking alcohol while going keto. Most liquors, some light beers, and dry wines are low to no carb, which is keto friendly.

Alcohol is not totally off the table, but you do have to be a bit more conscious of what you choose, and be more mindful when drinking and going keto. Keep in mind your alcohol tolerance will likely be lower while following a ketogenic diet. Alcohol also tends to lower inhibitions, making it more likely to be tempted by carbohydrate laden foods (often served with alcohol) and derailing your efforts.

Although alcohol does not get stored as fat, processing and metabolizing alcohol by the liver is prioritized as alcohol is a toxin. This means that many of the foods consumed along with the alcohol are ‘stored for later’ whilst the toxin is being removed.

A Ketogenic Diet Increases Your Risk For Cardiovascular Disease

This myth is centred around the misinformation that saturated fat and cholesterol are the main causes of heart disease. Despite being shown that dietary cholesterol does not raise blood cholesterol1 and saturated fat has little correlation to heart disease,2 there is still a stigma around both. Cardiovascular risk does not boil down to a single biomarker, but rather encompasses a host of factors such as age, sex, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, smoking, blood pressure, glycemic control, and more. Several of these risk factors may be mitigated by lifestyle changes.

Low-density lipoprotein (LDL) cholesterol, as opposed to high-density lipoprotein (HDL) cholesterol, often gets a bad rap because the general understanding about cholesterol is that LDL cholesterol is the “bad” cholesterol, and HDL cholesterol is the “good” cholesterol. While this isn’t entirely misleading, what is misleading is referring to these as absolutes. LDL is usually misrepresented as the single factor that determines one’s risk for cardiovascular disease (CVD), when in fact there is more to the LDL and CVD risk story much of which is still uncovered. The danger lies with the small, dense LDL particles (as opposed to large, buoyant LDL particles), which have been shown to be associated with CVD. It is not uncommon to see a rise in total LDL levels when following a ketogenic diet. There is still a lot that is not fully understood about LDL cholesterol in the context of a ketogenic diet. As previously stated, LDL is not the only biomarker to consider when determining risk for CVD. Working with a keto-savvy physician is recommended when considering a ketogenic diet.

When part of a weight management program including exercise and lifestyle modifications, the ketogenic diet can actually improve other biomarkers of CVD risk, such as weight, HDL cholesterol, blood pressure, blood levels of saturated fat,  HbA1c,  inflammation,  and more! In fact, research has shown that carbohydrate-rich diets pose more of a health risk than ketogenic diets. High-carbohydrate diets have been associated with increases in small, dense LDL particles and reductions in HDL cholesterol along with raised triacylglycerol levels, all of which contribute to increased CVD risk.

As you can see, the understanding and application of what exactly keto is has been misinterpreted somewhat by the mainstream.  As with anything, arm yourself with information before taking a leap and continue to do your best to refine the process.