The Basics of a Ketogenic Diet

by Mireille Najjar

The ketogenic diet remains one of the most extreme types of low carbohydrate diets, yet its potential role in tumor regression and pediatric epilepsy treatment has become an increasing topic of study among researchers and health professionals worldwide.

What is the Ketogenic Diet?

The ketogenic diet is a low-carbohydrate, moderate-protein, high-fat diet often used to control seizures in children with epilepsy. In such cases, the diet is usually recommended when two or more anti-seizure medications fail to control the seizures or result in harmful side effects. The diet requires careful monitoring by a medical support team, including a pediatrician, a neurologist and a dietitian. After two to three years, a normal diet is reintroduced gradually, depending on the progress of the child. A doctor may also slowly reduce the dosage of medications at this time.

High fat sources common in the ketogenic diet

High fat sources common in the ketogenic diet

Some individuals follow the diet to lose weight and have reported successful short-term weight loss after several months by eating low-carbohydrate, high-fat meals daily. Several studies have also reported unknown or beneficial long-term effects of the diet, particularly in obese patients with high cholesterol. While it can induce rapid weight loss, it is always important to consult a doctor or dietitian before beginning a ketogenic diet.

How Does the Diet Work?

The ketogenic diet works by shifting the body’s energy source from carbohydrates to fat. When the body is in a fasting state, it creates molecules called ketone bodies that build up as the body burns fat for energy—a process called ketosis. The exact reason is unknown, but researchers believe that the high production of ketone bodies improves seizure control in some epileptic children who show no signs of improvement with medication. Some studies, such as a 2010 case report in Nutrition & Metabolism, also show evidence of reduced tumor growth in cancer patients who receive chemotherapy and radiation along with the ketogenic diet.

Characteristics of the Diet

In general, the ratio of fat to carbohydrates and proteins is four to one (4:1) and must be tailored specifically for each individual. This is approximately 60 percent of calories from fat, 35 percent from protein, and 5 percent from carbohydrates. When starting out, it is recommended to limit net carbohydrate intake, which is the amount of carbohydrate in a food that the body is able to use for energy, to 20 grams per day to help the body enter ketosis. Afterwards, it should be limited to less than 50 grams per day. The amount of net carbohydrates per day is dependent on an individual’s own metabolism and activity level.

Many people—particularly adults—find the ketogenic diet difficult to follow since it is very limited in the types and variety of food it allows. The diet is based mostly on fat, protein and vegetables (specifically green leafy vegetables) that provide most of the carbohydrates you eat. Since the diet does not supply sufficient amounts of vitamins and minerals, people usually need to take vitamin and mineral supplements. They must also be completely committed to following the diet for it to work effectively.

Below are some tips on what you should and should not eat, as well as general tips, while on the ketogenic diet:

Foods to Eat

  • Eat plenty of green leafy vegetables like spinach, lettuce, cabbage, broccoli, cauliflower, celery and cucumbers. Limit vegetables like red and yellow peppers, onions and tomatoes, and avoid starchy vegetables like potatoes since they contain higher amounts of carbohydrates.
  • Consume peanut butter, cheese or boiled eggs as a snack. Nuts (with the exception of macadamias and walnuts) should be consumed in moderation since they are rich in inflammatory omega-6 fatty acids.
  • Meat, such as beef, pork and lamb, can be cut or prepared any way you like.
  • Leave the skin on poultry (chicken, turkey, quail, duck, etc.) to increase the fat content. It can also be prepared any way you like.
Beef stir fry, an easy-to-prepare ketogenic meal

Beef stir fry, an easy-to-prepare ketogenic meal

Foods to Avoid

  • Avoid low-fat foods. Since you are getting most of your calories and energy from fat, you need to make sure you are eating enough high-fat products, such as bacon, full-fat dairy (including raw and organic milk products, such as heavy whipping cream, sour cream, cottage cheese, cream cheese, hard and soft cheese, full-fat yogurt, etc.), mayonnaise, oil and butter.
  • If you choose to drink coffee, avoid extra sugar and milk. Instead of sugar, use a sweetener such as Stevia or EZ-Sweetz®. Replace milk with almond milk or heavy cream for a low-carbohydrate alternative.
  • Do not eat fresh, dried or frozen fruit since fruit is high in carbohydrates and fructose, the natural sugar found in fruit. If you choose to eat something sweet, you can eat one or two strawberries, but the fructose might prevent ketosis.
  • Avoid all grains and grain products, juices made from fruit and vegetables, beer, milk (1 percent and skim), beans and lentils, which are all high in carbohydrates.

Important Tips to Consider

  • Check the carbohydrate content of everything you eat. Some foods, such as processed sausages, cheeses, and sauces, contain hidden carbohydrates. For example, added honey and artificial sweeteners in regular low-carbohydrate mustard can increase its carbohydrate content. Be sure to check the carbohydrate content of mayonnaise and oil-based salad dressings, too.
  • Keep track of your daily food and carbohydrate intake. Keep a spreadsheet, use an online food intake tracker, or record the foods you eat in a journal. Write down how you felt each day and any changes you made. If you go off track, you can look back and see what was successful for you.
  • Always choose the lowest carbohydrate options to make sure you do not exceed your daily carbohydrate limit of 50 grams per day. Also, check food labels for net carbohydrates, which are the total carbohydrates minus the amount of fiber.
  • Take a daily multivitamin to replenish the nutrients lost while following the diet.

1-Day Sample Menu (4:1 ratio, approximately 1,884 calories)

Breakfast: Eggs (4 whole eggs, ½ avocado)

Total calories: 419
Fat: 31 g
Protein: 25 g
Net carbohydrates: 5 g

Lunch: Chipotle salad, no dressing (lettuce, chicken, mild salsa, cheese, sour cream and guacamole)

Total calories: 585
Fat: 38 g
Protein: 45 g
Net carbohydrates: 9 g

Snack: Large spinach salad (spinach, olive oil and vinegar dressing)

Total calories: 340
Fat: 32 g
Protein: 4 g
Net carbohydrates: 2 g

Dinner: Cheesy chicken (2 grilled chicken breasts, ½ cup cheese)

Total calories: 380
Fat: 15 g
Protein: 62 g
Net carbohydrates: 4 g

Snack: 24 almonds

Total calories: 160
Fat: 15 g
Protein: 6 g
Net carbohydrates: 3 g

Daily Totals:

Calories: 1,884
Fat: 131 g (63.7% of calories from fat)
Protein: 140 g (30.9% of calories from protein)
Net carbohydrates: 23 g (5.4% of calories from carbohydrates)

Mireille Najjar is a first-year Nutrition Communication student originally from Lebanon. She has a background in nutrition and dietetics and hopes to further strengthen her true passion—writing—here at Friedman.

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