Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (31 page)

Again, test it for yourself to see how it works for you. Eating a ketogenic diet during the week and then raising your carbohydrate and protein intake on the weekends may be desirable for some people, but it may be counterproductive, since getting back into ketosis can take anywhere from a few days to a few weeks. Figure out what works for you to keep you optimally healthy and do that. If cycling in and out of ketosis periodically gives you the results you desire, then go for it. If not, then there is certainly no downside to staying in a constant state of ketosis.

Why do my muscles cramp when I eat a ketogenic diet?

Often when people begin a low-carb, moderate-protein, high-fat, ketogenic diet, they forget to take care of the electrolytes in their body and drink enough water, and an electrolyte imbalance can cause, among other problems, muscle cramps. (I used to get bad charley horses in my calves when I first started eating a low-carb, high-fat diet.) Especially early on, when you are making the transition from using glucose as your primary fuel source to using ketones, you need to be replenishing your body with salt and fluids. No, this doesn’t mean you have a Gatorade deficiency! (There’s way too much sugar in it anyway.) Instead, there are three very easy strategies you can use to avoid those painful and annoying cramps.

First, you need to get more potassium and magnesium. While you can certainly use supplements for both of these, there are ketosis-friendly foods that are rich sources of both potassium and magnesium. Unfortunately, if you ask most people how to increase the potassium in their diet, they’ll suggest eating bananas. But bananas are very high in carbohydrates (27 grams) and are not conducive for ketosis. A better option is avocados. One whole avocado contains twice the amount of potassium (975 milligrams) in a large banana (487 milligrams). As for magnesium, raw spinach, Brazil nuts, almonds, fish, and dark chocolate can provide you with this key nutrient.

Second, replenish your body’s salt stores by making a warm cup of broth out of beef or chicken bouillon cubes a few times a day. Unless you have high blood pressure and are salt-sensitive, or you have experienced heart failure, doing this should work well to eliminate cramps. It should even boost your energy enough to prevent the “keto flu” symptoms that can accompany the early days of ketogenic eating. Concerns about salt raising blood pressure levels is a non-issue in those who are not sensitive to salt.

Third, drink, drink, and drink some more. Water is a crucially important factor in preventing cramps, since it helps muscles relax and contract. Staying well-hydrated is especially important if you are exercising regularly. Keep a water bottle with you at all times and take a sip now and then throughout the day. Don’t be surprised if those cramps suddenly disappear. And the longer you do keto, the fewer cramps you’ll experience.

Although it’s unlikely, it is possible to drink too much water, which can deplete sodium and other mineral levels, so keep your water consumption under 800 milliliters per hour. But you’re far more likely to not be getting enough water than to be getting too much.

Can any supplements help me get into ketosis?

You should be able to produce ketones simply by manipulating the macronutrients (carbohydrate, protein, and fat) in your diet to your individual specifications, as we outlined in chapters 5, 6, and 7. That said, there are a few supplements that may help boost your ketone production.

To facilitate beta-hydroxybutyrate (blood ketone) production, we add either MCT oil or coconut oil.

– Dr. David Perlmutter

Medium-chain triglycerides (MCT) oil, found in smaller amounts in coconut oil and sold as a supplement in vitamin and health stores, will raise your ketone levels very quickly over a two- to three-hour period. Be careful using it, though, because it can cause gastric distress, stomachache, and diarrhea if consumed in excess. Introduce it slowly over a period of time until you’re able to consume higher quantities. Remember, MCT oil should not be a substitute for making the nutritional changes necessary to become ketogenic. But it could give someone who is struggling to produce ketones a much-needed psychological and physiological boost.

The major issue is whether the ketogenic diet provides the micronutrients from vitamins, minerals, essential fats, and antioxidants that are necessary to conduct the biology of life properly.

– Dr. Terry Wahls

In general, a ketogenic diet is incredibly nutritious and should provide you with most of the nutrients you need to be optimally healthy. Taking an iron-free multivitamin (unless you have low iron levels or are a premenopausal woman, in which case an iron supplement may be helpful) can help fill in the gaps here and there. Other supplements to consider include alpha lipoic acid, coenzyme Q10, L-carnitine, vitamin D, vitamin C, potassium bicarbonate, and magnesium. And if you still have strong carb cravings, try 1,000 mg of L-glutamine three times daily, taken on an empty stomach.

Do the ketones produced with MCT oil offer the same benefits as those produced through cutting carbs, moderating protein, and eating more fat?

Science has not yet settled this question. Many people enjoy using MCT oil because its effect on ketones shows up quickly on a blood ketone meter. But why not induce ketosis nutritionally and naturally by consuming a high level of dietary fat (it doesn’t necessarily have to be from coconut oil or MCT oil), reducing carbohydrates to your personal tolerance level, and moderating protein to your individual threshold? If you do this, then there’s really no reason why you can’t have all the ketones you’ll need to experience their health benefits. If consuming MCT oil helps you feel good about the changes you are making in your diet, then go for it. But it’s certainly better if you try to induce ketones naturally through diet and the strategic use of spontaneous intermittent fasting.

Don’t forget to include some MCTs from fats like coconut oil—what I like to refer to as the cheater’s way to stay in ketosis! When you do this, it allows you to liberalize your carbohydrate intake without necessarily throwing you out of ketosis.

– Dr. Bill Wilson

What happens to my gut microbiota when I eat a ketogenic diet?

This is one of great controversies in the online health community. I asked nutrition researcher Dr. William Lagakos for some insight about this one. He notes that the composition of the gut microbiome is primarily regulated by diet, especially the types and quality of dietary fibers, but there is currently a lack of research studies on ketosis’s impact on gut microbiota. However, a study published in the January 23, 2014, issue of the scientific journal
Nature
found that ketogenic dieting increased microbes of the genus
Bacteroides
and decreased
Firmicutes
. This may be of clinical relevance for many reasons. For example, the opposite pattern—an increase in
Firmicutes
and decrease in
Bacteroides
—has been associated with obesity and an increased ability to harvest energy from food in animal and human studies. Furthermore, the microbial alterations induced by the ketogenic diet were associated with reduced levels of inflammation in a human study.

Cardiologist and
New York Times
bestselling author of
Wheat Belly
Dr. William Davis notes the critical importance of adding indigestible fibers to the diet for optimal gut health. He said that “they cause proliferation of healthy bacterial bowel flora species, such as
Lactobacillus
and
Bifidobacteria
. . . while also allowing [the] conversion of such fibers to fatty acids, such as butyrate, that nourish intestinal cells, thereby reducing colon cancer risk and even triggering a cascade of metabolic events that result in reduced blood sugars, reduced triglycerides, higher HDL, reduced blood pressure, and reduced visceral fat.” Enriching the gut flora with more
Lactobacillus
is critical for preventing bile acid from being reabsorbed, causing it to instead be discarded into the stool.

Here’s what Dr. Davis says is the key to obtaining all the benefits of ketosis while consuming the indigestible fibers that provide a prebiotic function: limit carbohydrate-rich legumes and tubers to no more than 15 grams net carbohydrates (total carbohydrates minus grams of fiber) per six-hour digestive window, while increasing your consumption of indigestible fibers that do not convert to blood sugar. This translates to half of a raw sweet potato daily, an unripe banana or plantain, or even a product like a Quest bar, all of which provide the fructooligosaccharides that feed your gut flora.

Unfortunately, this is far from settled science, and so much about it remains unknown. It is possible that eating certain foods on a ketogenic diet may feed gut flora. One study has also shown that body type and genetic predisposition seem to exert a bigger influence than diet. Regulation of the gut microbiome is complex and involves both dietary and nondietary components. There is no reason why gut health should not flourish on a ketogenic diet, and preliminary data suggest the gut microbiome may actually be improved by this way of eating.

Will drinking caffeine prevent me from getting into ketosis?

This is a question I have heard for many years from people who are struggling to get into ketosis. Dr. Atkins mentioned in his book
Dr. Atkins’ New Diet Revolution
that “excessive caffeine has been shown to cause a hypoglycemic reaction” in some people—in other words, that it can cause blood sugar to drop. That may lead in turn to food cravings (usually for carbohydrates) and then to the consumption of excess carbs or protein, which would kick you out of ketosis. He recommended that people who experience hypoglycemia from consuming caffeine give it up or “consume caffeine only in moderation.”

Jackie Eberstein, a registered nurse who worked with Dr. Atkins in his medical clinic in New York City for nearly three decades, says that there have been no scientific studies looking at caffeine and ketosis, but that the negative effects of caffeine on blood sugar could impact ketone levels.

“Some people are more sensitive than others, and of course the amount of exposure matters,” Eberstein explained. “Other factors [also] matter, such as having caffeine when the blood sugar is more stable after eating a low-carb meal, [when caffeine] may have no or only limited negative effects. For some of us, [consuming] caffeine when we are stressed for other reasons can provoke [carb cravings].”

That’s why she encourages people to “determine their tolerance,” and if their blood sugar is unstable, to avoid caffeine altogether. For everyone else, limiting consumption to, at most, three servings daily is probably a good idea. I have personally never had any problems from consuming caffeine, and neither has my wife, Christine, who drinks a latte made with heavy whipping cream almost every day. It’s something you’ll need to tinker around with to see how it affects your body. Self-experiment and see what happens.