ALL ABOUT THE KETO-DIET:
The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet. It has a lot of health advantages compared to the standard western diet. Most people do keto because of the weight loss, but it also has other health advantages like lowering risk for heart disease, diabetes, cancer, stroke, and much more. Just follow these simple rules:
- Low in Carbs - Less than 50g/day for most people, better below 20g.Fiber isn't counted in your carbs, Vegetables are perfectly acceptable.
- Moderate Protein
- Enough Fat- Majority of energy Variable depending on goals of weight loss or maintenance
- The Right Kinds of Fat Eat monos and saturates for fuel (butter, olive oil, coconut oil)Limit high polyunsaturated sources (soy, corn, cottonseed oil)
- To Prevent Keto Flu:
- Supplement sodium 2g/day (e.g. drink 1-2 cups of broth per day)
- Replace magnesium to stop muscle cramps
- Drink lots of water
- When in Doubt, Eat Less Carbs
- When in Doubt, Eat More Fat
How do I start and what can I eat?
So what is a Ketogenic Diet?
Some people may know it as the LCHF (Low Carb, High Fat) diet. The goal is to reduce your intake of carbs, and increase your intake of proteins.
What you can eat:
- Meat (Any type but do try to use organic or grass fed meats)
- Fish (Any type; salmon is a great fatty fish)
- Eggs (Cook them any way you like; organic is better but not recommended)
- Natural fats (like butter but olive oil and coconut oil are the best)
- Vegetables growing above grounds.
- Dairy products (Since most of my readers have PCOS, it is recommended to cut back on dairy. In moderation, it is perfectly fine.)
- Nuts (Eat in moderation)
- Berries (Eat in moderation)
What you can’t eat:
- Sugar
- Starchy foods (potatoes, bread, and pasta)
- Margarine (Actually has no health benefits and it just tastes yucky)
- Beer (Contains yeast, so it’s a ‘liquid bread.’)
- Fruit (You don’t have to eliminate it completely, but fruit does have natural sugars. Use as a substitute for desserts)
When you avoid sugar and starches, your body can then maintain a regular blood glucose level. If you have PCOS and are diabetic you may find it necessary to have your insulin medication reduced if you cut out out the sugar and starches.
Humans are meant to eat the natural foods this planet provides us with. Years and years ago, early civilizations didn’t eat boxed dinners, pasta, sweeteners, and all of our other modern comfort foods. If you go with using organic meats, you are already taking care of your body. Animals don’t need the help of humans to grow and be healthy but yet the nice sirloin steak you bought at the grocery store has been pumped with hormones. Also, the animals we eat don’t force themselves on diets to be healthy. They eat what they are designed to eat and you can’t get any healthier than that.
Although fiber is a carbohydrate, it is not digested as a simple carbohydrate and is therefore not included in your daily carb count. It's important to stress that fiber doesn't NEGATE carbs - it just isn't counted; so mixing a handful of flax meal into a bowl of ice-cream won't work!
The Research
In the study The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study, subjects were instructed to follow the low carb ketogenic diet, consisting of fewer than 20 grams of carbohydrate per day, for a 6-month study period. The diet included unlimited consumption of animal foods (meat, chicken, turkey, other fowl, fish, shellfish), prepared and fresh cheeses (up to 4 and 2 ounces per day, respectively), unlimited eggs, salad vegetables (2 cupfuls per day), and low carbohydrate vegetables (1 cupful per day). Subjects were strongly encouraged to drink at least six 8-ounce glasses of permitted fluids per day, and discouraged to drink caffeine and alcohol. Subjects were also encouraged to take one multivitamin per day and to exercise at least three times per week on their own, although this was not mandatory.
Body weight and blood pressure were measured at each visit. Blood tests were taken at baseline, 10, and 24 weeks after a 12 hour fast. Serum total and free testosterone were measured by immunoassay and equilibrium ultrafiltration; insulin by chemiluminescent immunometric assay.
Results
This research shows a low carb ketogenic diet led to significant reductions in weight, percent free testosterone, LH/FSH ratio, and fasting serum insulin in women with obesity and PCOS over a six-month period.
Effect on Individual Weight and Serum Metabolic Parameters
All subjects who participated through 24 weeks lost weight. The overall mean body weight change from baseline to 24 weeks was -12.1% (range: -4.0% to 16.4%) representing a mean decrease in BMI of 4.0 kg/m2 (range: 3.0 to 7.0 kg/m2) and mean percent change in body weight of -12.0% (p = 0.006).
From baseline to week 24, there were statistically significant reductions in percent free testosterone (from 2.19 to 1.70), LH/FSH ratio (from 2.23 to 1.21), and fasting serum insulin (from 23.5 to 8.2). The mean percent change in percent free testosterone was -30.0% (p = 0.04), in LH/FSH ratio was -36.0% (p = 0.03), and in insulin was -53.7% (p = 0.002). A reduction in serum insulin while maintaining fasting serum glucose (p = 0.10) and HgbA1c (p = 0.24) suggested an overall improvement in insulin resistance. Two women became pregnant during the study despite previous infertility problems.
The mean percent change in triglycerides was -25.8% (p = 0.11), in HDL was -1.9% (p = 0.77), in LDL was +1.6% (p = 0.10), and in total cholesterol was +5.4% (p = 0.53).
Effect on Blood pressure
During the 24 week period, the mean systolic blood pressure decreased 6.3 mm Hg (range: -2.5 to -15 mm Hg) and mean diastolic blood pressure decreased 9.6 mm Hg (range: -2.5 to -22.5 mm Hg) from baseline.
The hyperinsulinemia of PCOS appears to increase androgen secretion from the ovary as well as to decrease circulating sex hormone binding globulin (SHBG). This research study suggests that a low carb ketogenic diet may lead to a reversal of these processes. The study also suggests that reduction in LH/FSH ratio may be indicative of endocrine re-normalization resulting from the low carb ketogenic diet intervention, due to an improvement in insulin sensitivity.
Getting Started
Now, if you are going to start the ‘Keto’ Diet, there are some things that you should keep in mind. It is recommend to stop eating all of the bad foods cold turkey. By going cold turkey, some people have experienced some side effects that have only lasted a few days. This includes tiredness, dizziness, heart palpitations, tiredness, and irratibility. Again, this will only last a few days. Eliminating the bad foods will stop your body’s ability to retain water and will be lost through your kidneys. To avoid dehydration, drink plenty of water! There are people who don’t go cold turkey but gradually reduce their intake, and they are still successful with the keto diet, but not as successful as the people who drop the bad foods cold turkey.
What are NET carbs and how to I calculate them?
The NET carbs for a food are TOTAL CARBS - FIBER. Example: 100g of avocado contains 9g carbs. 7g of these are from insoluble fiber and don't elicit a strong insulin response; you don't count them. 9g - 7g = 2g NET carbs per 100g avocado.
Important notes:
- You can't ADD fiber to a meal to effectively negate carbs from starch and simple sugars. (See flax + ice-cream example above!)
- Many countries will already list starch and sugar carbs independently of fiber (EU, UK, AUS). Check on your nutritional labelling to be sure, never assume!
- Some foods appear to have "negative carbs" - this is not possible and it only appears during erroneous calculations and in food tracking apps like MyFitnessPal when fiber is subtracted from a food that already lists starch and sugar independently of fiber.
- Carb blockers - Some foods and supplements claim to "block" carbs or slow their absorption to the point of being effective for a ketogenic diet. Such products have not yet been or tested thoroughly and can be considered snake oil until credible evidence shows otherwise.
What about sugar alcohols?
It's important to note that there are lots of different types of sugar alcohols. Some of these are compatible with a low carb approach, some of them should be avoided due to high glycemic index or may have nasty side effects such as constipation, laxitive effects, bloating, flatulence, indigestion and heart burn.
An individual's ability to digest certain sugar alcohols can depend the gut enzymes of each person and the manner in which the sweeteners are consumed.
Popular Polyols
| Name | Glycemic Index |
|---|---|
| Xylitol | 13 |
| Sorbitol | 9 |
| Erythritol | 0 |
| Maltitol | 36 |
| Mannitol | 0 |
| Isomalt | 2 |
| Glycerol | 3 |
It is important to note that even if a granulated sweetener uses a sweetener with a GI of 0, it may be bulked out with another sugar alcohol such as Maltitol with a high GI.
If you are have a sensitive gut or can't kick a plateau, ditch sugar alcohols.
What is “keto flu” and how long will I have it?
During the induction phase of a Ketogenic Diet, most people experience a horrid “flu” that often makes people believe from the start that it isn’t right for our bodies. Consider it the first of your many trials to come. The flu is a manifestation of your mental and physical dependence on carbohydrates and the body is essentially going through a phase where it has to learn to use fat as fuel.
Keto flu can be treated by replenishing your electrolytes. The flu-like symptoms should dissipate in a few days or weeks. But be warned: For as long as you eat low-carb, if you don’t take care to get enough sodium, potassium and magnesium (a.k.a. electrolytes) in your diet, you may experience fatigue, muscle twitching, headaches, muscle cramping, and in severe cases, arrhythmia. Leg cramps may be the most common sign that your electrolytes are out of balance.
How do I replenish electrolytes?
Even if you go out of your way to eat lots of table salt and foods containing potassium and magnesium, you may find you need to take supplements. The minimum daily intake for the three electrolytes is given by Lyle McDonald as:
- 5000 mg of sodium chloride (salt)
- 1000 mg of potassium, in the form of potassium chloride or potassium sulfate
- 300 mg of magnesium
You can track the intake of these minerals with a tool such as myfitnesspal.com.
Most of us will not reach these suggested totals with food alone, but there are several ways to ingest extra electrolytes:
- Drink 1 or 2 cups of bouillon or broth daily
- Add salt and/or salt substitute to your food
- Take a multivitamin containing magnesium and/or potassium
- Add a teaspoon of salt and/or salt substitute to a large glass of water and drink it
- Take magnesium and/or potassium supplement pills
Unfortunately, many potassium-rich foods are not keto-friendly. For example, ''don’t eat bananas'' unless you want to get knocked out of keto.
Several companies make low-sodium salt substitutes (LoSalt, Lite Salt, AlsoSalt, etc.) for people trying to reduce their sodium intake. Luckily for keto dieters, these products tend to contain lots of potassium, which we need as a supplement. Read the product label to see how much of which minerals it contains. People with kidney failure, heart failure or diabetes should not use salt substitutes without medical advice, and according to Wikipedia, salt substitutes are contra-indicated for use with several medications.
What will my weight loss progress be like?
Results vary, but you will typically go through three phases
- Honeymoon: Lots of weight comes off fast. This is water that was tied up with glycogen. Note: if you don’t experience rapid weight loss in this period, do not despair. Not everyone is so lucky, and men may be more likely to see rapid initial weight loss than women.
- Post-Induction Stall Syndrome (PISS): Water and glycogen find a new balance and this causes a stall or even weight gain, which lasts for a week or two. Relax, PISS is both normal and temporary.
- Fully keto-adapted: After 3-4 weeks the body is burning fat as its main fuel and the brain has switched to running on ketones. A bumpy downward trend in your weight will begin. The trend is "bumpy" because there will be days or weeks when your weight stalls, or even goes up slightly. This happens to everyone, on every kind of weight-loss diet.
If a plateau lasts more than a couple of weeks, you may need to make adjustments to your lifestyle to break it.
Can I still drink alcohol/coffee?
In short, yes you can still consume alcohol. However, while the body is metabolizing alcohol you cannot burn fat; it literally impedes your progress until the alcohol is processed. If you still insist on drinking try to stick with spirits that aren’t involved with sugar. Neutral spirits like gin and vodka are great examples. Be cautious, though, alcoholic tolerance is severely lowered in low-carb dieters.
Coffee is also very diet friendly on its own but often becomes nefarious once it starts playing with its friends like sugar and milk. Most Ketopians will drink coffee with heavy cream and/or coconut oil to increase their fat intake while getting in some fluid. It’s important to note that coffee in large amounts will flush your intestines and completely mess with your hunger levels throughout the day. Weaker coffee in larger amounts is far better for you than strong coffee in small amounts. Coffee was revised as an acceptable beverage in the latest Atkins approaches and according to A New Atkins for a New You, it may actually prove beneficial in aiding weight loss gently. A small subset of ketoers complain of headaches in the first few weeks, which may be due to a reduced ability to metabolize caffeine.
What do I do if it makes me Constipated?
Constipation happens mostly in the early stages. A few suggestions:
- Drink more water and eat more leafy greens and other high-fiber vegetables
- Eat 1-2 tbs of coconut oil every day (also helps keep you full) or eat other sources of fat such as nuts
- Make sure your salt intake is sufficient
- Make sure your protein intake isn't too high
- Get some psyllium husk powder (the main ingredient in fiber supplement products like Metamucil) and mix it with a glass of water 1-2X/day
Why The Keto Diet helps insulin and how does it help with fat storage?
Insulin is one of the most important aspects of your body that a Ketogenic diet focuses on. It is a hormone secreted by the pancreas that regulates the metabolism of fat and carbs, specifically in the blood. Its main job is to regulate the distribution of energy to the cells of the body from fat storage. Its other job is to regulate blood sugar by producing lipoproteins (or fat proteins) that act as a bailiff for your blood stream and imprison the fat cell into your body once the glucose has been converted to fat. As you eat carbohydrates, the body must produce more insulin to keep up with ramped levels of glucose in the body and eventually your body begins to resist insulin which eventually leads to type 2 diabetes.
When you eat less carbs, less insulin is required to patrol your bloodstream and regulate your blood sugar. This means, simply, less fat storage as a result and that helps PCOS .
What are the different kinds of fats?
All foods containing fat - even pure oils - contain a mixture of three kinds of fat:
- saturated
- polyunsaturated, and
- monounsaturated.
Foods are often identified by their predominant fat; for example, olive oil as “monounsaturated” butter as “saturated” – but all real foods contain mixtures of the three.
All three types of fats are necessary and important to human health and should be incorporated into the diet in a balanced proportion. The question is, what ''is'' balanced.
- Saturated fat, particularly in the absence of high carbohydrate intake, is not dangerous to human health — on the contrary, when balanced with mono and poly-unsaturated fats in a controlled carbohydrate dietary environment, saturated fat may actually have real and measurable benefits in a number of different arenas. Saturated fat is quickly oxidized to energy, once you are keto adapted. So you can enjoy plenty of butter and animal fat guilt free. Interestingly, coconut oil is something very different: it consists of Medium Chain Triglycerids (MCT) which cannot be stored by the body, it has to immediately oxidize it. That means when you eat coconut oil, your body will immediately produce ketones, even when you are not keto-adapted. Nevertheless this does not mean you are getting all the metabolic advantages that you would get when keto-adapted state.
- In addition, the benefits of monounsaturated fats (like olive oil) are well known and well documented.
- Fats high in polyunsaturated fats, like vegetable oils, usually contain a lot of omega-6, and very little omega-3. The ideal ratio between omega-6 to omega-3 is 2:1 to 1:1, and in general this ratio is often 20:1 or even worse. It is therefore important to avoid oils high in omega-6, like corn or soy. Vegetable oils that are rich in omega-3 contains it in the form of ALA which the body has to convert to DHA and EPA to be of any use. The conversion is highly inefficient, so in practice ALA omega-3 rich vegetable oils like flaxseed oil or canola are no good choice either. The best way to get omega-3 is through fatty fish like salmon, or with a DHA + EPA supplement.
As a general rule of thumb, avoid fats high in omega-6, and run like hell from highly processed fat(anything that says "hardened", or contains trans-fats) like margarine. Eat foods naturally high in fat like meat, fish, and nuts; use plenty of olive oil, butter. In fact 50% butter with 50% olive oil approximates quite closely the composition of body fat - meaning that this is the type of fat that the body can make best use off.
Myths:
Won't fat make me fat (and diabetic)!?
Fat making people fat has got to be one of the most misunderstood concepts in history. This logic doesn’t apply properly to anything else; if it did we’d all be green if we ate a lot of cucumbers. Fat makes us fat when its paired with high levels of carbohydrates, actually. That is when fat makes you fat but putting all the blame on fat isn’t solving the problem, it only points to half of the problem.
Diabetes is becoming an increasingly worrisome problem that plagues the western world. Type-2 Diabetes is a serious problem that needs to be remedied. However, it seems that most people don’t understand what complicates diabetes. Diabetics aren’t affected by large amounts off fat or protein; while they cause insulin responses it is nowhere near the response you get from carbohydrates. When a diabetic eats a hamburger with fries the sections that alter the blood sugar most drastically are the starchy fries and bun of the burger. It is not the fatty meat or pile of cheese and pickles that cause problems. It makes sense that the things that cause more drastic insulin spike would cause the disorder that surrounds insulin problems. Fat is not to blame at all; it just happens to take the fall.
What about cholesterol and heart disease?
Cholesterol is a waxy, charming lipid gracing every cell’s membrane and our blood plasma. Its jobs, which are many, include insulating neurons, building and maintaining cellular membranes, metabolizing fat soluble vitamins, producing bile, and kick-starting the body’s synthesis of many hormones, including the sex hormones. Cool stuff actually.
Given all the work cholesterol has to do, the liver is careful to ensure the body always has enough, producing some 1000-1400 milligrams of it each day. In comparison, the 300 milligram recommended limit for dietary cholesterol (your tax dollars at work in the USDA) is a drop in the bucket. And get this: our livers come with feedback mechanisms (at no additional cost) that regulate cholesterol production in response to our dietary intake. When we eat more, it makes less, and vice-versa. Imagine that!
What are HDL/LDL/Triglycerides?
First, there are high density lipoproteins (HDL/the “good” one). He has the popular job of transferring cholesterol from the body’s tissues back to the liver.
Next, there are low density lipoproteins (LDL/the “bad” one). LDL is a lipoprotein and delivery man as well. He has the disgraced job of transporting cholesterol after production from the liver to the body’s tissues.
Third, there are triglycerides, which are essentially the form that fat takes as it travels to the body’s tissues through the bloodstream. The relationship between triglycerides and cholesterol is more of an association. A high triglyceride level, which is unequivocally fueled by a high carb diet, is very often a marker for other problems in the body, particularly insulin resistance (and accompanying risk of diabetes) as well as inflammation (with its risk of heart disease). High levels are often seen with low HDL cholesterol.
The ideal LDL particle concentration is below 1000 nmol/L. Above 1600 nmol/L means high risk.
That being said, a good predictor for LDL particle is the Triglycerides to HDL ratio:
- Trig/HDL ratio in mg/dl: 1 is perfect, below 2 is good, above 3 means significant disease, above 5 means you will explode any moment.
- Trig/HDL ratio in mmol/l: 0.44 is perfect, below 0.88 is good, above 1.33 means significant disease above 2.2 means you will explode any moment.
Details about Cholesterol
Imagine your bloodstream is a highway. You want to move a given number of passengers (called Cholesterol) from A to B, with as few accidents (crashes into your artery wall that build up plaque) as possible. How can you do this?
- When you have only few passengers (low LDL-C), you can get away with using small vehicles (small LDL-particles) to carry them because this will not lead to lots of traffic. When you have lots of passengers to move (high LDL-C) and still use small vehicles, you will need lots of vehicles (high LDL-P) hence get lots of crashes (increased risk of CHD).
- When you have few passengers (low LDL-C) but large vehicles that can carry lots of passengers, your highway is empty and you will have hardly any crash. You can also get away with lots of passengers to move (high LDL-C) when your vehicles are big enough that your LDL-P stays reasonable.
- Now this is not the whole story. We got other passengers as well (Triglycerides) who want to be moved around as well. These guys take away precious seats that could otherwise be used to carry cholesterol. When you have lots of Triglycerides to carry around you will need a higher number of vehicles to carry the same amount of cholesterol. Again, more vehicles means higher risk, so high Triglycerides drive high LDL-P.
Some Women who have already lost weight on the Keto-Diet:
210lbs-130lbs in 8 months
158lbs-125lbs
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