Thursday, March 10, 2011

A Guide to Ketosis

Here is the guide to ketosis. The contents of this article can be located here. If you're currently wondering what on earth ketosis even is, then you're in luck for I plan not only to befuddle but also to enlighten. All you have to do is read on.

I've personally had fantastic results on keto, and I really believe in the validity of this diet - not only in terms of fat-loss, but also in terms of health-gain. There is a lot of understandable skepticism and tons of misconceptions about keto; I want to let newcomers know, however surprising it may be, that keto (or at least a diet low in grains/sugars and high in fats) is a very healthy diet with numerous benefits.

This guide is very long so I've partitioned this post into subsections. The links contained within the contents are 'clickable' and will transport you directly to that section. You can also right click and select "copy link address" of a particular section/section title, and you can either bookmark it so that you can return to a specific section easily or you can give the link to a friend if you want them to read a particular section. If you want to return to the contents of the page simply click on the 'upwards' arrows that are next to each of the section titles within the main article.

Contents 

I. Why You Should Care About Ketosis: The Benefits of a Ketogenic Diet
1A. Ketosis Increases Neuronal Stabilization and Mental Focus
1B. Ketosis Promotes the Loss of Body-Fat and LDL Cholesterol
1C. Ketosis Eliminates Various Ailments such as Type 2 Diabetes and Hypertension
1D. Ketosis Treats Several Diseases such as Alzheimer's and Various Cancers
1E. Ketosis Promotes Cardiovascular Health
1F. Ketosis Preserves Lean-Body Mass
1G. One Will Lose Body-fat More Quickly on Keto Than Not
1H. Ketosis Blunts Appetite and Increases Meal Satiety

II. Understanding Ketosis; An Overview of Metabolism
2A. Metabolism Defined
2B. The Krebs Cycle
2C. Glycolysis
2D. Fat Lipolysis and Fatty Acid Beta-Oxidation
2E. Citrate Synthase Inhibition and Beta-ketothiolase Activation
2F. Ketogenesis and Ketosis

III. The Basics of the Ketogenic Diet
3A. Entering Ketosis: A Macro Ratio for Keto
3B. Saturated vs. Polyunsaturated Fatty Acids
3C. Sample Ketogenic Meal Plan
3D. The Wonders of Fiber
3E. How to Enter Ketosis Quickly, Easily, and Reliably
3F. How to Know You're Under Ketosis
3G. The Gloom of Induction
3H. Losing Body-Fat
3I. Building Muscle-Mass
3J. Aerobic Exercise
3K. Glycogen Refeeding
3L. Reentering Glycolysis Correctly
3M. A list of Ketogenic Foods
3N. Step by Step Guide to the SKD, TKD, and CKD

IV. Keto Testimonials
4A. ladysixstring
4B. Dominaterisk
4C. sepatown
4D. vgisverbose

V. Useful Resources and Websites for the Keto-Minded
5A. The Cook's Thesaurus
5B. Restaurant Nutrition Facts
5C. Keto Macro-Nutrient Calculator
5D. Keto Goods Online
5E. Keto Recipes Galore
5F. Further Information

VI. Keto FAQ
6A. What is the ketogenic diet in simple terms?
6B. Is ketosis unhealthy?
6C. Is ketosis unnatural?
6D. How can you lose fat if you eat fat?
6E. Is it best to bulk on keto or on a normal diet?
6F. Are ketostix reliable?
6G. Please leave any questions in the comments.

 I. Why You Should Care About Ketosis: The Benefits of a Ketogenic Diet

1A. Ketosis Increases Neuronal Stabilization and Mental Focus 

Ketogenic diets have long been a known and established treatment for epilepsy. Ketosis somehow stabilizes the brain in a way that a normal glycolytic metabolism does not.  It turns out based on Devivo’s “Chronic Ketosis and Cerebral Metabolism” that ketosis actually increases the ATP/ADP ratio in the brain; in other words, under a ketogenic metabolism there is actually more energy available for your brain to utilize, so the brain is able to function more efficiently, quickly, and effectively than it would otherwise be able to.

Many people cite anecdotal experiences of "brain fog" as proof that ketosis actually hinders mental thinking, but this is false. This misconception arises from the fact that one must undergo a period of induction into ketosis (approximately 10-30 days) in which the body adjusts itself fully to a ketogenic metabolism. It is during this induction period that people experience the physical and mental sluggishness that is often associated with ketosis; unfortunately, these people often employ "glycogen refeeds" prematurely so that they suspend themselves in a perpetual state of ketogenic adaptation.

The article Your Brain on Ketones goes into further detail on the mechanisms behind the stability of the brain under ketosis.

  1. Chronic Ketosis and Cerebral Metabolism  
  2. Ketogenic Diets in the Treatment of Epilepsy: Short-Term Clinical Effects

1B. Ketosis Promotes the Loss of Body-Fat and LDL Cholesterol and the Retention of HDL Cholesterol 

If your goal is to rid yourself of body-fat and LDL cholesterol, then it simply does not make a single bit of sense not to be on a ketogenic diet. Under a normal glycolytic metabolism, fat exists only as a backup or reserve fuel. Your body does not like to use it. When your body requires energy under a glycolytic metabolism, it first scans your blood-stream for glucose. If not much blood-glucose is found, then your body will command the liver to convert its stored glycogen into glucose. If not much glycogen is found, then your body will breakdown muscle and fat. Fat is the very last option. Under ketosis, fat is the very first option for energy ahead of anything else.

Quote:
Quoted from Long term effects ...
The body weight and body mass index of both groups [under ketogenic metabolisms] decreased significantly (P < 0.0001). The level of total cholesterol, LDL cholesterol, triglycerides and blood glucose level decreased significantly (P < 0.0001), whereas HDL cholesterol increased significantly (P < 0.0001) after the treatment in both groups.

  1. Long Term Effects of Ketogenic Diet in Obese Subjects with High Cholesterol Level  
  2. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet to Treat Obesity and Hyperlipidemia 

1C. Ketosis Eliminates Various Ailments such as Type 2 Diabetes and Hypertension 

Ketosis has been shown to eliminate ailments such as type 2 diabetes and hypertension. This makes sense since insulin levels are scrupulously controlled under ketosis, and large portions of fat and LDL cholesterol are lost.

Quote:
Quoted from Effects of high ...
In the high-carbohydrate group, hemoglobin A1c decreased (from 8.2% to 6.9%, P<.03), fasting plasma glucose decreased (from 8.8 to 7.2 mmol/L, P<.02), and insulin sensitivity increased (from 12.8 to 17.2 μmol/kg/min, P<.03). No significant changes in these parameters occurred in the high-protein group, instead systolic and diastolic blood pressures decreased (−10.5±2.3 mm Hg, P=.003 and −18±9.0 mm Hg, P<.05, respectively).

Quote:
Quoted from A low carbohydrate ...
The LCKD [Low Carbohydrate Ketogenic Diet] improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.

  1. A Low Carbohydrate, Ketogenic Diet to Treat Type 2 Diabetes 
  2. Effects of high protein vs high carbohydrate intake on insulin sensitivity, body weight, hemoglobin A1, and blood pressure in patients with type 2 diabetes melitus 
  3. Comparison of a Low-Fat Diet to a Low-Carbohydrate Diet on Weight Loss, Body Composition, and Risk Factors for Diabetes and Cardiovascular Disease in Free-Living, Overweight Men and Women

1D. Ketosis Treats Several Diseases such as Alzheimer's and Various Cancers 

Alzheimer's disease most likely arises, among other factors, from abnormally low levels of beta amyloid due to a dysfunction of the glycolysis pathway in certain areas of the brain. Ketosis has been shown to raise the levels of beta amyloid, and is seen as a possible treatment for Alzheimer's disease.

Ketosis is also seen as a treatment to various cancers. Cancers are simply malignant tumors which possess a glycolytic rate that is up to 200 times that of surrounding non-cancerous cells - that is, cancer cells indirectly consume vast amounts of glucose. Without glucose, these cancer cells should not survive, and this does seem to be the case.

  1. The ketogenic diet; fatty acids, fatty acid-activated receptors, and neurological disorders
  2. Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial
  3. Implementing A Ketogenic Diet Based on Medium-chain Triglyceride Oil in Pediatric Patients with Cancer
  4. Carbohydrate restriction in patients with advanced cancer: a protocol to assess safety and feasibility with an accompanying hypothesis

1E. Ketosis Promotes Cardiovascular Health 

Quote:
Quote by Joaquín Pérez-Guisado
Contrary to past opinions, KDs also lead to improvements in cardiovascular health. When analyzing the nutritional habits of American society, carbohydrate consumption has risen, resulting in an increase in obesity and atherogenic markers such as triglycerides and VLD]. For Dasthi et al., the use of a KD with obese patients over a period of 12 weeks, in addition to being effective and safe for weight loss, also modified cardiovascular risk factors favorably in these patients. Specifically, there is a significant decrease in fasting and postprandial (in response to high-fat meals) blood triglyceride levels] and both blood levels are considered independently as risk factors for cardiovascular disease. Furthermore, the phenomenon of carbohydrate-induced hypertriglyceridemia is long established. The serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than with the low-fat diet: at 6 months and at 12 months]. Bearing in mind that the atherogenic lipoprotein phenotype is characterized by an increase in liver production of VLDL, low levels of HDL and a predominance of small LDL particles, it is surprising that low-fat and high-carbohydrate diets favor this atherogenic profile in patients who previously did not have this problem.

Low-carbohydrate high-fat diets, on the other hand, improve all aspects of atherogenic dyslipidemia, decreasing fasting and postprandial triglyceride levels and increasing HDL and LDL particle size. These diets prompt an increase in larger LDL particles, a drop in smaller LDL particles and a decrease in the cholesterol/HDL ratio, which lowers glucose levels and favors weight loss. KDs based around proteins also have cardiovascular benefits, such as decreasing total cholesterol, LDL and triglyceride levels and increasing HDL levels. When comparing low-carbohydrate/high-protein diets and low-carbohydrate/high-fat diets, it seems that the difference between both diets in relation to blood lipid levels lies in the LDL, which are significantly lower in high-protein diets. Low-carbohydrate diets clearly have short-term cardiovascular benefits, but such benefits can also be observed over longer periods of time: 6 months, since improvements in blood pressure and blood levels of total cholesterol, LDL, HDL and triglycerides are noted in the 6 month period; 12 months, since the low-carbohydrate diet was associated with a greater improvement in certain risk factors for coronary heart disease (higher HDL and lower triglyceride levels).

In relation to cardiovascular health, these diets have also proven to be effective for hypertension.

Low-carbohydrate/high-protein diets are more effective than high-carbohydrate diets for decreasing blood pressure (both diastolic and systolic).

Taken from: Arguments in Favor of the Ketogenic Diet

  1. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men
  2. Fasting lipoprotein and postprandial triacylglycerol responses to a low-carbohydrate diet supplemented with n-3 fatty acids

1F. Ketosis Preserves Lean-Body Mass 

Under glycolysis, you must first deplete blood-glucose and glycogen stores in order to begin utilizing fats as energy, but the breakdown of fat must then compete with the breakdown of muscle-mass. The result of this competition or duel catabolism is about as much muscle-mass lost as fat. This can of course be largely avoided thru ketosis since under ketosis body-fat is the first and primary source of energy. Ketosis is muscle-sparing for the simple reason that proteins no longer compete with fatty acids for energy utilization. Under ketosis, protein is a secondary energy source and thus muscle-mass is largely spared.

Quote:
Taken from Comparison of energy ...
Young et al. compared the effects of three isoenergetic (7.5 MJ/day), isoprotein (115g/day) diets containing varying carbohydrate contents (30, 60, and 104 g/day) on weight loss and body composition in obese men. After 9 weeks, weight loss was 16.2, 12.8, and 11.9 kg and fat accounted for 95%, 84%, and 75% of the weight lost, respectively.

A secondary explanation for muscle-preservation under ketosis might be the stimulation of chaperone-mediated autophagy.

  1. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women 
  2. Effect of body composition and other parameters in obese young men of carbohydrate level of reduction diet
  3. Ketone Bodies Stimulate Chaperone-mediated Autophagy

1G. One Will Lose Body-fat More Quickly on Keto Than Not 

The brain requires or uses rather roughly 20% of daily maintenance energy. Under glycolytic conditions the predominate form in which the brain accepts energy is glucose or glucose derivatives. In other words at least 20% of energy expended daily under a glyclytic metabolism must be taken from dietary or stored glucose. Under fat-adapted ketogenic conditions at least 80% of the energy used by the brain is in the form of (fat-derived) ketone-bodies.

As well under ketogenic conditions one will sweat, excrete, and exhale fat-derived ketone-bodies which can account for up to 100 kcal of energy lost per day.

Say that a hypothetical person requires 3,000 kcal in order to maintain his weight. Each day this person if under a ketogenic metabolism would lose an additional 580 kcal of fat than he would have lost if he had not been under a ketogenic metabolism.

1H. Ketosis Blunts Appetite and Increases Meal Satiety 

Protein and fat are known to cause greater satiety than sugars do which lends to a decrease in the tendency to over-eat; as well as this, the metabolism of ketosis has certain appetite-suppressing qualities.

II. Understanding Ketosis;  An Overview of Metabolism

2A. Metabolism Defined 

Metabolism can be defined as those particular processes by which a creature derives energy. There are several different possible metabolic processes that humans are capable of, but perhaps the most prevalent and important of them all, and the one that plays a central role in understanding ketosis is the krebs cycle.

2B. The Krebs Cycle 

The krebs cycle is the primary mechanism by which the human body extracts energy yielding molecules from food.

This is the krebs cycle:

All that we care about though is the initiation of the cycle:

As you can see, all that is required for the initiation of the krebs cycle are the molecules acetyl-CoA and oxaloacetate. Oxaloacetate is naturally regenerated from the cycle, but Acetyl-CoA must be fed into the cycle continuously. Both of these molecules can be produced from the molecule pyruvate as shown in the diagram. Pyruvate itself is produced thru glycolysis.

2C. Glycolysis 

Glycolysis begins with a glucose molecule that is phosphorylated and reduced down to 2 molecules of pyruvate.

 

Pyruvate is the molecule from which acetyl-CoA originates if you remember from the previous section. This is what happens to all carbohydrates; they are all converted into a form that can be fed into this pathway for the eventual production of acetyl-CoA.

So what happens when you do not ingest carbohydrates for a while? Well it turns out that there is a store of carbohydrates in your liver in the form of glycogen that will get broken down into glucose when none is ingested. If you do not ingest glucose for such a long period of time that liver-glycogen stores become depleted then you will take all of your energy from fatty acids.

2D. Fat Lipolysis and Fatty Acid Beta-Oxidation 

When the body is glucose-starved and glycogen-depleted then one will obtain almost all energy from fatty-acid beta-oxidation. This begins with the activation of the enzyme lipase which cleaves fats into a glycerol molecule and 3 fatty acid chains effectively freeing the fatty acids from their cell.

These fatty acid chains then undergo a series of beta-oxidations in which acetyl-CoA is produced (and free CoA is used up when it attaches to the acetate ion) after each beta-cleavage. This acetyl-CoA molecule can then enter the krebs cycle as normal.

If this is allowed to continue for a period of time then eventually the acetyl-CoA/CoA ratio will increase since now we will be producing 7,8,9+ acetyl-CoA molecules for every 1 fatty acid. When this occurs the krebs cycle will be temporarily shut down so that the acetyl-CoA molecules can no longer enter.

2E. Citrate Synthase Inhibition and Beta-ketothiolase Activation 

Citrate synthase is the enzyme that accepts acetyl-CoA for entry into the krebs cycle. When acetyl-CoA concentrations increase citrate synthase is inhibited because there exists an allosteric site of inhibition on citrate synthase for acetyl-CoA; so acetyl-CoA can bind to this site and change the conformational shape of the protein rendering it ineffective.

At the same time that citrate synthase is inhibited there exists another enzyme in liver mitochondria that is activated named beta-ketothiolase. Beta-ketothiolase is activated because free CoA is an allosteric inhibitor of it and as concentrations of free-CoA decrease the enzyme is allowed to function as normal.

At this point when citrate synthase is inhibited and beta-ketothiolase is activated all of the acetyl-CoA molecules are shunted to the liver where they bind to this enzyme beta-ketothiolase and enter the 3 enzyme long pathway known as ketogenesis.

2F. Ketogenesis and Ketosis 

At this point you have acetyl-CoA binding to beta-ketothiolase and entering the pathway ketogenesis.

The end-product of ketogenesis is the 'ketone-body' acetoacetate. Acetoacetate can undergo spontaneous decarboxylation with the loss of CO2 to form acetone which is itself lost through the breath, sweat, and urine; or it can be reduced to hydroxybutyrate.

When concentrations of these ketone-bodies increase one is said to be in the metabolic condition of ketosis. Ketosis is important for one because most fatty acids cannot pass the blood-brain barrier; only ketone bodies and specific short-medium chained fatty acids are able to pass this barrier.

Acetone is released from the breath and urine. Acetone is said to have a "fruity" smell. It is acetone that you smell in your breath and urine when under ketosis, and it may be acetone (but also largely acetoacetate) that interacts with the dried nitroprusside on ketostix to indicate ketosis. So, under a ketogenic metabolism, by simply urinating and breathing you are indirectly ridding yourself of fat.

III. The Basics of the Ketogenic Diet

3A. Entering Ketosis: A Macro Ratio for Keto 

Ketosis occurs when the body has no dietary source of glucose/sugar and its store of glycogen has been depleted. When this occurs, the body primarily begins cleaving fats into fatty acids and glycerol, and transforms the fatty acids into acetyl CoA molecules which are then in turn eventually transformed into ketone bodies in the liver. In other words, under a ketogenic metabolism, the body uses dietary and bodily fats as its primary energy source.

It is possible to induce the initiation of this metabolism thru a careful diet; this diet must contain limited amounts of carbohydrates, sugars, and proteins, and should be comprised primarily of fats.

The ideal macro-nutrient ketogenic ratio is this: 65% of your calories should come from fats 30% of your calories should come from proteins 5% of your calories should come from fibrous carbohydrates

This is your new food pyramid:

This ratio was created by assuming a man whose daily Caloric goals being 2,000 kcal possesses 150 pounds of LBM and thus requires at least 150 grams of protein for muscle-preservation making his protein requirements 30% of his energy intake. As you can see the ratio will certainly be a non-personal estimate for everyone else. Though the percentages are good enough for weight-loss it might be beneficial to calculate yourself exactly what you require. The steps to do so are contained in the last subsection of this section.

The protein/fat balance is important to a degree. If one does not consume enough protein then muscle-mass will be lost since the body requires a certain amount of glucose per day, and if one consumes too much protein then ketosis may be halted since protein is converted to glucose via gluconeogenesis. The dangers of a disruption of ketosis by protein consumption are highly unlikely as one would have to consume an unnatural amount of protein with the help of supplementation to cause this, so the more probable danger is a loss of muscle-mass. So eat enough protein if you care at all for aesthetics.

It is also vital to understand that the driving force for weight-loss even under a ketogenic metabolism is in fact an energy deficit. Ketosis works so wonderfully for everyone because it blunts appetite and increases satiety and in so doing causes a natural energy deficit. Because of these qualities it may not be necessary for very obese individuals to keep track of energy intake but as you near lower body-fat percentages it might be helpful to keep track of energy intake and ensure that you are at a deficit in order to continue to lose weight.

If you are lazy you can enter your information into the Ketogenic Macro-Nutrient Calculator in order to find out exactly how many calories of each macro-nutrient you should eat per day. A more highly recommended procedure would be to calculate energy intake and macronutrient layout yourself. You can calculate energy intake by referring to this guide, and you can calculate your macronutrient goals by referring to section 3F of this guide.

Skip down to the ultimate list of ketogenic foods to find out exactly what foods you are allowed to eat.

3B. Saturated vs. Polyunsaturated Fatty Acids 

The case for PUFAs:

There is some evidence that a ketogenic diet which utilizes a majority of polyunsaturated fatty acids versus saturated fatty acids induces a deeper state of ketosis than a diet high in saturated fatty acids. A diet high in PUFAs induces a deeper ketosis in which levels of beta-hydroxybutyrate are significantly higher, and insulin sensitivity is increased. Since beta-hydroxybutyrate levels increase when a majority of dietary fats are polyunsaturated, it stands to reason that fat lipolysis and beta oxidation activity increase as well; so, in other words, you will rid yourself of fat more quickly and easily if a majority of your fat percentage comes from things like seeds, nuts, oils, and fatty fish.

The study that this section is based on performed its experiment with a dietary ratio of 70/15/15 fats/proteins/carbohydrates, so it may not necessarily translate to the 60/35/5 ketogenic diet as advocated by Lyle Mcdonald.

The ratio that was used in the study though is a 60/20/20 polyunsaturated/monounsaturated/saturated fatty acids. It may not be necessary to replicate this ratio exactly, but instead to aim for a ratio which holds PUFAs as the major fatty acid.

You can determine which keto-friendly foods contain polyunsaturated fats by checking the ultimate ketogenic food list in section 3 M of this guide; all of the foods that contain mostly polyunsaturated fats will be colored green and purple.

  1. Differential Metabolic Effects of Saturated Versus Polyunsaturated Fats in Ketogenic Diets

The case for SFAs: (the following is a repost of El_Dangeroso's post which can be found here.

Structure:  These group of fats are referred to as 'saturated' as every carbon molecule in the 'chain' of fatty acids has an attached hydrogen molecule. This makes for the most 'stable' chemical structure as in the least likely to react with any other chemicals.

This non-reactivity is a good thing as most of the threats that our body uses its resources fighting is created by oxidisation, as in oxygen reacting to another substance. This is why anti-oxidants have such a good reputation. Though it must be said some oxidation is appropriate and contributes to a healthy metabolism, as it promotes an adaptive response such as after exercise. But generally speaking we want to keep oxidisation intermittent and brief.

Cholesterol: But, doesn't saturated fat raise LDL or cholesterol, the 'bad' cholesterol? Well that's not actually established, most of the trials are short-term (<12 weeks), low-quality and the results are all over the place, some show slight reductions from reducing saturated fat but they are usually poorly controlled, as in they don't take into account what they are replacing the saturated fat with and how that effected cholesterol level. In the longer term trials the association pretty much disappears when other factors are controlled for (like smoking and obesity.).

Saturated fat does consistently and reliably raise HDL cholesterol however, and unless you're crazily out of range, indicative of a serious infection, the higher the better.

Risk of Heart Disease But even if saturated fat doesn't adversely affect cholesterol, it's still really associated with getting a heart attack though right? I mean arterycloggingsaturatedfat is almost one word it's been drilled into us so often.

Well, again the science just doesn't back this up. If you look at observational studies you'll find some studies showing that people who go heavy on the butter and bacon tend to die of more heart attacks. But the problem with these kinds of studies is that you cannot infer a causal relationship from an retrospective observational study because the 'experiment' has been tainted.

An example: Lets pretend 20 years ago we decide that people that wear more yellow clothes have less heart disease. All the health-conscious people listen to their doctors and start wearing yellow shirts, along with doing thousands of other things that health-conscious people tend to do either unconsciously or consciously (exercise, no smoking, less fast food) that can't be fully accounted for by mathematically controlling the statistics. Lo and behold a few decades later it's as clear as day that people who wear yellow clothes have less heart attacks!

If you think the above example is completely silly then think how silly it is that even the observational evidence from the last few decades is not consistent the theory. The totality of the studies of this nature don't even support an association with an increase in heart disease even though we've been told to lay off the cream and butter for decades now.

The best version of an observational study is a prospective cohort study, this is where rather than asking people to remember what they were eating ten years ago, you ask them what they eat now and at regular intervals and follow their progress for a number of years. Although still far from perfect, these kind of studies minimise 'recall' bias or the bias we all have in remembering what we eat.

There have been 25 prospective studies done examining the relationship between heart-disease and saturated fat and only four of them managed to find any relationship whatsoever. If there was a real danger from eating saturated fat, we would see a far more consistent relationship, especially considering how healthy people in general tend to avoid it based on public health recommendations.

This recent meta-analysis by Krauss et al. is the most comprehensive review of it's nature: http://www.ajcn.org/content/early/20...27725.abstract

Quote:

Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health.

Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemiologic studies.

Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD.

Results: During 5–23 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat intake were 1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD. Consideration of age, sex, and study quality did not change the results.

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

So according to the balance of evidence saturated fat is at worst benign, but could it actually be beneficial? Well yes, there are trials showing that it: -Increases HDL -Increases testosterone in men -Reduces Lp(a) (this stuff correlates with heart disease and stroke like no other biomarker out there, it's the most potent risk factor by a mile.) -Aids the clearance of excess fat from the liver (this is why a lot of people find their cholesterol jumps up on a weight loss diet, that's your body ridding itself of visceral liver fat and it is only temporary) -Sat fat will also protect your liver from the damage inflicted by alcohol and certain medications.

3C. Sample Ketogenic Meal Plan 

This is an example of an ideal ketogenic daily meal plan. Be creative and make your own meal plans.

Meal 1: Hemp seed, asparagus, and cheddar-cheese omelet with 2 slices bacon.
  • 508 calories, 43.9 g fat (77%), 23.7 g protein (19%), 4.5 g carb (4%)
  • 46% polyunsaturated, 27% monounsaturated, 27% saturated
  1. Fry 2 slices bacon in a pan. Remove bacon when cooked.
  2. Add 1 tablespoon hemp oil to the pan and mix with the bacon drippings.
  3. Combine 1 ounce chopped asparagus, 1/2 tbsp heavy cream, 2 eggs, 1 tbsp hemp seed into a bowl and stir.
  4. Once the pan is nice and hot pour the contents of the bowl in.
  5. Flip the omelet once and add 1/2 ounce chopped cheddar cheese. fold omelet.
  6. Serve the omelet and bacon with the oil and grease poured on top.

Meal 2 Avocado and Sardine Spinach Salad with Ranch Dressing
  • 547 calories, 47 g fat (77%), 25.5 g protein (19%), 5.5 g carb (4%)
  • 51% polyunsaturated, 32% monounsaturated, 17% saturated
  1. Chop 1/4 large avocado, 1 ounce provolone cheese, 7 sardines, 1 cup lettuce, 1 cup raw spinach
  2. Mix 2 tbsp ranch dressing with 1 tbsp grape seed oil
  3. Combine ingredients in a bowl and serve with the dressing.

 Meal 3 Ground-Beef Taco with Sour Cream and Sesame Seeds
  • 518 calories, 32 g fat (55%), 53 g protein (41%), 4.5 g carb (4%)
  • 15% polyunsaturated, 37% monounsaturated, 48% saturated
  1. Fry 1/2 pound 90% lean ground-beef until brown
  2. Add a bit of water and 1 portion of taco seasoning. Mix and simmer
  3. Add 1 ounce blended Mexican cheese (reduced fat) on top
  4. Mix 1/2 tbsp sesame seeds with 1 ounce sour cream
  5. Serve ground-beef with sour cream on the side.

 Meal 4 Salmon Fillet with Sunflower Butter and Broccoli
  • 491 calories, 31 g fat (57%), 44 g protein (37%), 6 g carb (6%)
  • 48% polyunsaturated, 33% monounsaturated, 19% saturated
  1. Grill 1/2 fillet salmon until tender
  2. Boil 1 cup broccoli until tender
  3. Heat up 1 tbsp sunflower seed butter
  4. Plate the salmon and broccoli and pour the sunflower seed butter and some lemon juice on top

 Meal 5 Protein Shake with Water
  • 102 calories, 2 g fat (18%), 18 g protein (70%), 3 g carb (12%)
  • 25% polyunsaturated, 25% monounsaturated, 50% saturated 

 Daily Totals
  • 2156 calories, 156 g fat (65%), 164 g protein (30%), 24 g carb (5%)
  • 40% polyunsaturated, 32% monounsaturated, 28% saturated

3D. The Wonders of Fiber 

Fiber is mostly a form of sugar called cellulose. Humans do not possess the necessary enzymes to metabolize cellulose, so it does not activate glycolysis and it has no effect whatsoever on insulin levels. High-fiber foods are safe to eat on keto, and in fact you should eat lots of them. Green-leafy vegetables such as spinach, lettuce, and broccoli should be eaten with every meal.

3E. How to Enter Ketosis Quickly, Easily, and Reliably 

What initiates ketosis is an empty store of liver-glycogen, so this method will attempt to eliminate liver-glycogen stores in the quickest manner possible.

Here is the full-proof method to enter ketosis:

Day 1:

  • Do not eat anything after 6 p.m.

Day 2:

  • Wake up and perform HIIT (high intensity interval training) or intense conditioning/weight training on an empty stomach
  • Begin a strict ketogenic diet with 0-2% of calories attributed to carbohydrates.

Day 3:

  • Wake up and perform MISS (medium intensity steady state) or light-medium intensity conditioning/weight training on an empty stomach
  • Begin a normal ketogenic diet with 5% of calories attributed to carbohydrates

If not already, you will soon be in ketosis in a short matter of time.

3F. How to Know You're Under Ketosis 

When the body is under a ketogenic metabolism, you will exhale gaseous acetone and excrete acetone thru the urine.

Acetone is said to have a "fruity" smell, so if your breath or urine smells somewhat like fruit then you're under ketosis. Many people also report a metallic taste in their mouths when under ketosis.

There are also ketostix available at any pharmacy with which to test yourself for ketosis.

3G. The Gloom of Induction 

If this is your first time ever on a ketogenic metabolism, or if you haven't been under ketosis for a long time, then you will experience a period of induction in which your body adjusts itself to a ketogenic metabolism. The length of this induction varies, but can last anywhere from 10 to 30 days.

During this period, you will most likely experience headaches, brain fog, cramps, moodiness, and fatigue.

This is normal and temporary. After this induction period, your body will be fully adjusted to a ketogenic metabolism and your energy will be restored.

It is important to stay under ketosis until your body is fully adjusted. Do not undergo any "carb-ups" until this induction is complete. You will know because all of your symptoms and sluggishness will disappear completely and you will suddenly feel fine.

3H. Losing Body-Fat 

Sorry it's taken so long for me to update this section. My article on fat-loss can be found at http://arcitea.blogspot.com/#3I.

3I. Building Muscle-Mass 

My article on building muscle-mass can be found at http://arcitea.blogspot.com/#3O.

3J. Aerobic Exercise 

The body burns primarily glycogen when the heart rate is above 70% of its max. Therefore, aerobic exercises such as HIIT are good for burning liver-glycogen stores during induction, but such high-intensity exercise is not recommended once under ketosis as once muscle-glycogen stores are depleted, the body will begin catabolizing mainly muscle-mass under any high-intensity activity.

The ideal aerobic exercises to perform when under ketosis are MISS (medium intensity steady state) and LISS (low intensity steady state).

HIIT = Periods of high-intensity activity followed by an abrupt switch to low-intensity activity.

MISS = Maintained medium-intensity activity (lightly jogging).

LISS = Maintained low-intensity activity (walking).

3K. Glycogen Refeeding 

A glycogen refeed is simply the ingestion of carbohydrates for a set period of time with the main intention of replenishing the muscle-glycogen stores. If you weight-train then it would be a good idea to implement some type of refeed (either a cyclical refeed or a targeted refeed).

Here is an in-depth article on everything you need to know about cyclical glycogen refeeding written by Lyle Mcdonald himself: Training on the Ketogenic Diet.

3L. Reentering Glycolysis Correctly 

If you would like to reenter a normal glycolytic metabolism then slowly begin incorporating more and more carbohydrates into your diet. As long as you do not over-exceed your B.M.R. then you should not have any fat gain whatsoever (though you may gain a bit of water-weight).

3M. A List of Ketogenic Foods 

Cheeses | Dairy | Dressings | Fats & Oils | Fish | Flours/Meals/Powders | Fowl | Fruits, low sugar | Fruits, moderate sugar | Meats | Nuts/Legumes | Seeds | Shell Fish | Vegetables, low sugar | Vegetables, moderate sugar |

Each entry is linked to nutritional data and colored according to a code (shown below).

♥ Green = Excellent: Low Carbohydrates, High Polyunsaturated Fats
♣ Blue = Excellent: Low Carbohydrates, High Saturated Fats
♦ Orange = Good: Low Carbohydrates, Low-Moderate Fats
◌ Purple = Acceptable: Moderate Carbohydrates, High Polyunsaturated Fats
∗ Grey = Acceptable: Moderate Carbohydrates, High Saturated Fats
⊗ Red = Barely Acceptable: Moderate Carbohydrates, Low-Moderate Fats

The numbers on the side represent the macronutrient content per 100 grams in the following order:

grams of fat, grams of protein, grams of total carbohydrate / grams of fiber

Don't worry if the numbers don't add up to 100 grams because there are other things such as water composing the mass of the food. Also, these numbers are just a rough guideline and may be slightly different depending on the brand. A perfect ketogenic ratio occurs when the grams of protein are slightly more or the same as the grams of fat.

Cheeses 

Dairy 

Dressings 

Fats & Oils 

Fish 

Flours/Meals/Powders 

Fowl 

Fruits, low sugar/glycemic 

Fruits, moderate sugar/glycemic 

Meats 

Nuts/Legumes 

Seeds 

Shell Fish 

Vegetables, low sugar/glycemic 

Vegetables, moderate sugar/glycemic 

3N. Step by Step Guide to the SKD, TKD, and CKD 

All of the figures and ratios found in the step by step guide below are taken directly from Lyle Mcdonald's The ketogenic diet: a complete guide for the dieter and practitioner.

Standard Ketogenic Diet

  1. First multiply your total weight by (15 if you're a female) or (16 if you're a male). (for a more precise calculation follow this guide: http://forum.bodybuilding.com/showthread.php?t=121703981)
    • Example: Tod is a male who weighs 200 pounds.
      • 200 x 16 = 3200 Calories
  2. Decrease this number by 20% to lose weight or increase it by 20% to gain weight.
    • Example 1: Tod wants to lose weight.
      • 3200 x (1.00 - 0.20) = 2560 Calories
    • Example 2: Tod wants to gain weight.
      • 3200 x (1.00 + 0.20) = 3840 Calories
  3. Next figure out how much lean body mass you possess.
  4. Once you know what your LBM (lean body mass) is, then either multiply your LBM by (0.8 if you are non-active) or (0.9 or 1.0 if you are active) in order to find the amount of protein you should consume daily; that is, whether or not you perform any supplemental exercising.
    • Example: Tod measured his body-fat and it turns out that he's around 20% body-fat. Tod should multiply his total weight by (1 - 20%) to find his LBM.
      • 200 lbs x (1 - 0.20) = 160 lbs LBM.
    • Now that Tod knows his LBM, he will multiply this by 1.0 since he exercises 5 days a week.
      • 160 x 1 = 160. This is the number of grams of protein that Tod should consume per day (160 grams/day protein).
  5. Now determine the amount of carbohydrates to consume per day.
    • Example: Tod decided that he wants to lose weight. His Caloric needs per day are 2560.
      • 2560 Calories x 0.05 = 128 Calories of carbohydrates; 128/4 = 32 grams carbohydrates.
  6. Subtract the Calories attributed to protein and carbohydrate in order to determine the amount of fat to be consumed.
    • Example: 2560 - [(32 + 160) x 4)] = 1792 Calories of fat should be consumed by Tod; 1792 / 9 = 199 grams of fat should be consumed by Tod.
    • In Tod's particular case, he should consume 199 grams fat, 160 grams protein, 32 grams carbohydrate per day
  7. Divide the grams of each macro-nutrient by the amount of meals you will eat per day to find the grams of each macro-nutrient needed per meal.
    • Ex. Tod wants to eat 3 meals per day.
      • 199 grams fat / 3 = 66 grams fat per meal.
      • 160 grams protein / 3 = 53 grams protein per meal.
      • 32 grams carbohydrate / 3 = 10 grams carbohydrate per meal.
  8. Now use this the list of ketogenic foods and devise several meals which fit your macro-nutrient goals per meal and only eat those meals.
  9. Here are 10 sample meals that I've made in my keto log (Here) and here is an entire daily sample meal plan (Here). For even more ideas check the keto logs section at bodybuilding.com (Here).

Targeted Ketogenic Diet

  • Before weight-training consume 25-50 grams carbohydrate, and after weight-training consume another 25-50 grams carbohydrate with some whey protein. Dextrose (which can be bought at bodybuilding.com's store) is good for this purpose.
  • You can begin this diet on day 1 of a standard ketogenic diet

Cyclical Ketogenic Diet

Before beginning

  1. Follow the steps in the standard ketogenic diet outlined above and begin the diet. After about 3-5 days of dieting in this manner you will feel tired, sluggish, moody, irritable, light-headed. This is good because it means that you are following the diet correctly.
  2. Once the negative symptoms begin, that means that you've entered ketosis. Now maintain ketosis without any refeeds until the symptoms disappear and you feel better. This may take 2-3 weeks.
  3. If you are performing any type of weight-training then employ a TKD (targeted ketogenic diet) until the symptoms disappear.
  4. Once the symptoms disappear you are fat-adapted and can begin a CKD (cyclical ketogenic diet) if you'd like.

Steps to a CKD

  1. Begin on Monday (for example) and weight-train with intensity every day until Thursday.
  2. On Friday perform a depletion workout. This should be a full body workout. Interval-training is superior to weight-training for maximal glycogen synthesis, but either is fine.
    • An example of interval training for full-body depletion might be sets of burpees. An example depletion workout utilizing weight-training can be found (Here).
  3. Approximately 5 hours before your depletion workout, consume 25-50 gram carbohydrates with a small amount of protein and fat. Dextrose would be a good bet for this.
  4. Approximately 1-2 hours before the depletion workout, consume 25 grams glucose and 25 grams fructose. (honey with some fruit would be good for this).
  5. Perform the depletion workout.
  6. For the first 24 hours of your carb-load after completion of the depletion workout, 4.5 g/lb LBM of carbohydrate should be consumed. A ratio of 70/15/15 carbohydrate/protein/fat should be employed.
    • Example: Tod has a LBM of 160.
      • 160 x 4.5 = 720 g carbohydrate; 720 x 4 = 2880 Calories carbohydrate.
      • 2880 / 70 x 100 = 4114 total Calories.
      • 4114 x 0.15 / 4 = 154 g protein.
      • 4114 x 0.15 / 9 = 68 g fat.
    • For the first 24 hours Tod should consume 720 g carbohydrate, 154 g protein, 68 g fat.
    • For the first 24 hours Tod should consume high GI carbohydrates. Here is a glycemic index list of foods: GI food list.
  7. For the second 24 hours of your carb-load, 2.3 g/lb LBM of carbohydrate should be consumed. A ratio of 60/25/15 carbohydrate/protein/fat should be employed.
    • Example: Tod has a LBM of 160.
      • 160 x 2.3 = 368 g carbohydrate; 368 x 4 = 1472 Calories carbohydrate.
      • 1472 / 60 x 100 = 2453 total Calories.
      • 2453 x 0.25 / 4 = 153 g protein.
      • 2453 x 0.15 / 9 = 41 g fat.
    • For the second 24 hours Tod should consume 368 g carbohydrate, 153 g protein, 41 g fat.
    • For the second 24 hours Tod should consume low GI carbohydrates. Here is a glycemic index list of foods: GI food list
  8. After the second 24 hour carb-load period, begin again your standard ketogenic Caloric level and macro-nutrient ratio.
  9. Employ intense weight-training to deplete muscle and liver glycogen in order to return to ketosis.

IV. Keto Testimonials

If you'd like to showcase your keto transformation in this section then please go here.

4A. ladysixstring 

Quote:
Quoted from ladysixstring

found out about low carb because my boyfriend is a member of something awful. from jan-april i did about 30g of carbs a day and lost most of my weight. i literally only monitored carbs and everything else was fair game. in may i went to 60g of carbs a day for various reasons, i only really retained some water weight, but didn't lose any. then starting in june i found that this subreddit existed and i switched over to keto. now i am still at 30g of carbs a day, but i monitor my ratios of fat and protein more closely and i am eating more fat in general than i had before.

i started at 165lbs at the beginning of january, i actually believe i am around 135lbs now

4B. Dominaterisk 

More photos here.

Quote:
Quoted from Dominaterisk

I'd actually eaten a ketogenic diet since 2000 for medical reasons and for weight maintenance. I went off the diet in 2009/2010 at the urging of my ex-boyfriend and again later after I met my fiance and didn't want to seem like a picky eater. Ballooned up to 185 (after years of being 125-130) and finally in early December said 'enough is enough.' I'm on my way down to 120, where I'll be staying on a ketogenic diet for life.

- November/December: 185 lbs, BMI ~30 - March 27: 165.4 lbs, BMI 26.6 - June 19: 144 lbs, BMI 23.2

4C. sepatown 

Quote:
Quoted from sepatown

I started eating low-carb after my type II diabetic father had great success with it, not only stabilizing his blood sugar, but getting to a healthy weight. We work together and eat lunch together almost everyday, so it was easier for me than most to figure out what to eat. I've lost over 90lbs, and I'm not done yet.

Before I put this pic together I was feeling a bit discouraged because I still have a gut. As soon as I got the pics done, my first though was "Holy shit I used to be a total fat ass." I'm 31 years old. I'm 5'11", started eating low carb on Sept. 21, 2010 at 264lbs. I'm currently 171lbs. I went from wearing size 44 jeans to size 32 and a 3xl shirt to a medium.

4D. vgisverbose 

Weight Change: 538lbs -> 269lbs

Story: here.

V. Useful Resources and  Websites for the Keto-Minded

5A. The Cook's Thesaurus 

The Cook's Thesaurus Enter in any specific food or food type and this website will give you back "synonyms" or substitutes of that food/food type. This might be very helpful when devising your own recipes.

5B. Restaurant Nutrition Facts 

Fast-food and Restaurant Nutrition Facts Nutrition data on all major restaurants and fast-food chains.

5C. Keto Macro-Nutrient Calculator 

Macro-Nutrient Calculator Easily figure your B.M.R., daily caloric allotment, and calorie breakdown in terms of the ketogenic diet. Alternatively, you can use Man2kx'scalculator download which can be found here: CKD Calculator for Dummies, by Man2kx.

5D. Keto Goods Online 

All Bulk Foods Bulk Foods Nutty Guys These sites are great for buying nuts, seeds, flours, and oils in bulk.

Netrition This site is great for any type of keto snack or food. They have loads of keto-friendly pasta, breads, chips, cookies, flours, etc.

Low Carb Shop and Cafe I haven't actually bought anything from this site so I can't vouch for the validity of it, but it has a nice database of various keto foods and companies.

Julian Bakery Pepperidge Farm's Carb-Style Bread Great keto-friendly bread.

Dreamfield's Pasta Tasty keto-friendly pasta.

Tova Industries Carbsmart Penzeys Sweetzfree These sites are great for keto-friendly sweets, sugars, syrups, powders, and baking goods.

5E. Recipes Galore  

Linda's Low Carb Menus & Recipes One of the best keto recipe sites out there. It is very organized and she rates each recipe honestly.

Bodybuilding.com's Archive of Keto Recipes An organized archive of the keto recipes that have been posted at bodybuilding.com

The Low Carb Cafe Loads of recipes.

Dyan's Low Carb Recipes Very good organization and recipes.

Low Carb Eating Recipes Keto recipes.

Cooking on Keto! Cooking on Keto! (Part II) Creative and fresh recipes for keto.

Keto Recipes Forum A forum dedicated to posting keto recipes.

5F. Further Information 

The ketogenic diet: a complete guide for the dieter and practitioner The original book written by Lyle Mcdonald which popularized keto.

The Big Fat Fiasco Speech Tom Naughton explains some of the politics and science of fat.

Low Carb Megathread 3: We go against the grain A keto thread at the somethingawful forums

Sugar: The Bitter Truth Robert Lustig explores the damage caused by sugary foods.

Sugar Free Sheila Great site with good information. Her printout grocery list is great.

Fathead Movie Watch Fathead Online for Free This is a documentary about the ketogenic diet and fats. I haven't watched it, but I've heard good things.

Fatty Acid Metabolism Goes into greater detail than I did about fat metabolism.

Arguments in Favor of Ketogenic Diet Awesome article on ketosis.

VI. Keto FAQ

6A. What is the ketogenic diet in simple terms? 

A ketogenic diet can be thought of as training your body only to use fats as energy by reducing your consumption of carbohydrates. If your body is trained only to use fats as an energy source, then when there is no dietary fat floating in your blood-stream your body will extract your body-fat and use that as energy.

6B. Is the ketogenic diet unhealthy? 

No. The ketogenic diet is actually so extraordinarily conducive to real human health that it quickly and readily reverses the diseases and malformities that a diet high in grains/sugars and low in fats will inevitably bring about. The idea that fat is bad for you is a complete and utter myth that never had any scientific backing whatsoever, and it is frankly a laughable notion considering how prevalent and important fats and cholesterol are in our bodies. Most vital hormones and steroids stem from cholesterol. Every single one of your cells are covered with and contain lipid membranes that are incredibly important to the functionality of the cells. Do not fear for your health when entering a ketogenic diet, because not only will you quickly rid yourself of body-fat, but you will experience numerous health benefits.

6C. Is the ketogenic diet unnatural? 

No. The ketogenic diet is far more natural for human beings than a diet high in grains and refined sugars. The current diet based on grains and sugars is completely foreign to the human body, and may be responsible for most of the diseases and ailments that we face today (diabetes, heart disease, depression, ADD, obesity, alzheimer's, cancers, etc etc etc).

Quote:
Quoted from Joaquín Pérez-Guisado

Humanity has existed as a genus for about 2 million years, and our prehuman hominid ancestors, the australopithecines, appeared at least 4 million years ago. This phase of evolutionary history made definitive contributions to our current genetic composition, partly in response to dietary influences at that time. The development of agriculture 10000 years ago has apparently had a minimal influence on our genes and markedly altered human nutritional patterns. In the hunting society of our ancestors protein contributed twice to nearly five times the proportion of total calories that it does for nowadays Americans.

Since then, the human diet has changed drastically: protein intake has been reduced to 10-15%; glucid intake has increased to 45-60% through eating more grain and starch products instead of vegetables and fruits available according to the seasonal conditions; polyunsaturated fat has been reduced and saturated fat has increased (lower polyunsaturated-to-saturated fat radio). So we can affirm that healthier fats like monounsaturated and polyunsaturated fats (MUFA and PUFA) have been replaced by more pernicious fat like saturated and, above all, the artificial trans fats. Furthermore, carbohydrates consumed nowadays tend to have a higher glycemic index and glycemic load since they are based on grains, starch and refined sugars instead of vegetables and fruits. In such a short evolutionary period of time, human beings have been unable to adapt to this abrupt change in eating habits, and this has been a significant source of stress for our insulin metabolism.

The fact that the nutritional change from a hunter-gatherer diet to a carbohydrate-based diet has affected populations negatively has been revealed by archaeological findings in ancient Egyptian mummies, since tooth decay, cardiovascular disease and obesity were very frequent in those times. More recently, this problem has also been reflected historically by the change in eating habits of Inuit peoples in Alaska. Traditionally, their diet contained 3-5% carbohydrates (since it was based on fish, marine mammals, moose and caribou), obesity was virtually nonexistent and type II diabetes was rare. Since 1961, a growing tendency in type II diabetes and obesity problems has been observed due to a progressive substitution of the traditional protein and fat-based diet by a diet with higher carbohydrate content. This increase has been so dramatic that in 1978, carbohydrates represented 50% of the total calorie contribution in their diet. Another historical fact worth considering when analyzing the nutritional habits of American society is their increased consumption of carbohydrates, either through eating more food in general or by replacing fats with carbohydrates. This leads to an increase in obesity and atherogenic markers such as triglycerides and VLDL].

Most hunter–gatherers, for example, are not obese when they live their traditional lifestyle based on a low carbohydrate diet. Many hunter-gatherers consumed a predominantly plant-based diet, which was supplemented with meat when available, and others such as the Inuits consumed a high fat-protein diet. When such people are exposed to high, refined carbohydrate intake, however, they develop truncal obesity and a much higher risk of diabetes, up to 50% in some populations. This high waist-hip ratio and carbohydrate intolerance is shared by all hunter–gatherer populations throughout the world: Canadian Inuits, Native Americans, Mexican Indians, Pima Indians, South American Indians, Middle-Eastern Nomads, African Pygmies, Australian Aborigines, Maoris, South Sea Islanders, etc.

Nevertheless, many factors are responsible for the health and metabolic disturbances currently experienced by modern hunter–gatherers like the Inuits. It is important to remember that millions of people worldwide from different countries have predominantly carbohydrate-based diets and the prevalence of obesity is very low in these countries. Hence other risk factor factors, such as sedentarism and high calorie intake, are clearly relevant in addition to the macronutrient composition of the diet.

Thus, all these data might suggest that it could be wrong to consider carbohydrates as the basis of the human diet.

Taken from Arguments in Favor of the Ketogenic Diet

6D. How can you lose fat if you eat fat? 

Eating fat is actually the most effective way of losing body-fat. Basically you are training your body to only use fat as energy, so when there are no dietary fats floating around in your blood-stream your body will take out some of your body-fat stores and convert that into energy.

6E. Is it best to bulk (build muscle-mass) on keto or on a normal diet? 

If you like the idea of ridding yourself of excess fat while you gain muscle then probably keto is right for you. Ketosis has also been shown to increase testosterone levels which would of course be conducive to a muscle-building regimine. The only drawback is that insulin activity is reduced under ketosis. Insulin controls the synthesis of muscles by regulating the uptake of amino acids. Since insulin spikes in activity after the ingestion of fast-metabolizing substances such as glucose or medium-chain triglycerides, it is these substances that should be ingested in accordance with protein (whey perhaps) after weight-training in order to increase muscle-mass whilst under ketosis. Coconut oil contains medium-chain triglycerides.

Quote:
Originally Posted by Kinetics and thermogenesis ...
There was an eightfold increase in plasma β-hydroxybutyrate and acetoacetate concentrations and a threefold increase in serum insulin levels during MCT/LCT infusion, but no significant change in ketone bodies and insulin from basal values was observed during and after Sb infusion.
  1. Kinetics and Thermogenesis of Medium-Chain Monocarboxylic and Dicarboxylic Acids in Man: Sebacate and Medium-Chain Triglycerides

6F. Are ketostix reliable? 

Ketostix detect the presence of acetone in the urine. Acetone is a volatile compound with a very low boiling point, so it is readily exhaled from the body as gas and thru the urinary tract. It is possible to be in a low level of ketosis in which acetoacetate primarily synthesizes beta-hydroxybutyrate, and does not fall to forming acetone. It is also possible to use up all of the blood-ketones thru extreme exercise so that there is no excess acetone to escape into the urinary tract. Another possibility is that the urine is so dilute from excess water consumption that acetone doesn't register on the strip even if it is there; if your urine is clear and you aren't registering for ketosis, then this is a very good possibility.

Ketostix are a decent detector of ketosis, but just because your urinalysis doesn't register the presence of acetone doesn't necessarily mean that you aren't actually in ketosis.

6G. Please leave any questions in the comments. 

I've made it so that anyone can post a comment. You don't need an account or anything, so if you have a question, suggestion, or if you found an error in the guide then please let me know.

Thanks for reading.