Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (34 page)

My gall bladder has been removed, so how can I eat a high-fat, ketogenic diet?

The gall bladder stores digestive enzymes from the liver that break down fat and releases them after a meal that contains fat. Even so, most people who have had their gall bladder removed have no problems eating fat. My wife, Christine, had her gallbladder removed in 2008, and she had trouble consuming higher amounts of fat for about a year. But over time she has been able to slowly increase her fat intake to 60 percent of the calories she consumes. Some people who have had their gall bladder removed have found benefit in taking digestive enzymes or bile salts to replace the enzymes your gallbladder would be supplying.

Incidentally, Nora Gedgaudas, an expert on low-carb, high-fat, ketogenic diets, says that an underlying or preexisting issue with your gall bladder function can be a stumbling block towards keto-adaptation because of the role it plays in fat digestion. Addressing these issues is imperative to experiencing the maximum potential from being in nutritional ketosis. It may be possible to work with a health-care provider to restore your gall bladder’s function rather than resort to having it removed.

Removing the gall bladder doesn’t necessarily take away the underlying problem, Gedgaudas explains. “Getting your gall bladder out didn’t ‘cure’ you—it merely masked the symptom,” she says. Underlying thyroid issues and various digestive disorders are common causes of gall bladder problems. Plus, if you have been on a very low-fat, vegetarian, or vegan diet, you can be especially vulnerable to problems with your gall bladder. As Gedgaudas puts it, “If you don’t use it, you might just lose it.” Address any gall bladder issues before attempting a high-fat, ketogenic diet.

I’m a vegetarian. How can I eat a ketogenic diet without consuming meat?

While it is certainly easier to follow a ketogenic diet if you eat meat, it’s not impossible for a vegetarian to experience the benefits of ketosis. If you allow yourself to consume eggs as part of your lacto-ovo vegetarian diet, they are an excellent source of fat and moderate protein, especially when cooked in delicious coconut oil. Green, leafy salads with avocado, a squeeze of lemon juice, and olive oil can be an excellent lunch or dinner. And there are plenty of low-carb, high-fat nut options for you, including macadamia nuts, almonds, and walnuts. Yes, it can be more challenging trying to get into ketosis if you are a vegetarian (and even more so if you are a vegan). But it’s not impossible if you’re eating plenty of healthy, plant-based fats and not too many carbohydrates or protein.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Are humans herbivores, carnivores, or omnivores? There is much debate about whether humans are “supposed to be” mostly vegetarian or meatatarian, or if we should just “eat food, not too much, mostly plants,” as Michael Pollan suggests. I think this is the wrong question to ask. A better question is, “What are the health consequences of eating a certain way? If I am a vegetarian or meatatarian, what is my health now, and what will my health likely be in the future?” (If ketosis is your goal, however, you probably need to consider being a meatatarian—it’s difficult to get into ketosis on a vegetarian diet.)

What if I only want the health benefits of ketosis, not the weight loss?

The human body is an extraordinary machine that operates pretty efficiently despite the demands we place on it. Yes, a ketogenic diet is extremely effective at bringing about weight loss in people who are carrying around some extra body fat. But what about people who are thin and only want to experience the health benefits of ketosis? How can they do this without wasting away to nothing?

Nutrition expert Nora Gedgaudas says that “your weight may normalize” when you start eating a low-carb, moderate-protein, high-fat, ketogenic diet. Since it’s not a nutritional plan for weight loss but rather for vastly improved health, there should be no concerns about giving this way of eating a go for yourself. However, Gedgaudas warns that if you’re underweight or experiencing unwanted weight loss while in ketosis, you may have some tendency towards malabsorption or endocrine dysfunction (such as autoimmune thyroid issues), and if that’s the case, you’ll need to address the underlying issue before you can start putting on healthy weight. Start by finding a health-care professional who’s knowledgeable about ketosis.

When you’re on a ketogenic diet, if your body needs to shed some weight, then it will. But if you are perfectly lean and begin eating a low-carb, moderate-protein, high-fat, ketogenic diet, don’t assume you are going to lose weight— you don’t have any to lose. However, if you are concerned about weight loss, then consider adding in small amounts of sweet potatoes or white rice, so long as they don’t raise your blood sugar or lower your ketone levels.

A ketogenic diet isn’t like the curse in the classic Stephen King horror story
Thinner—
you won’t just waste away on it.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: The ketogenic diet is not a weight-loss diet—it’s a fat-burning diet. If you have excess fat stores, the body will use them up. If you don’t have excess fat stores, your body will use the fat you eat for fuel, and it will let you know when you need to eat more fat by making you hungry.

Every time I go on a ketogenic diet, I feel like crap. Why doesn’t this work for me?

Most of my clients come to me with some kind of health issue that is blocking their progress. They are typically dealing with low energy, metabolic damage, high body fat, stress, gut issues, poor sleep quality, food issues, exercise frustrations, and whacked out hormones, and the dreaded doctor visits with looming test results scare the poo out of them. As a result, these poor people struggle to enter into a state of ketosis. The body won’t work unless you fix these underlying issues!

– Stephanie Person

It sounds like you never fully got keto-adapted. As we stated earlier, the “keto flu” symptoms shouldn’t last for more than a few weeks. Test your ketone levels and make sure you are producing enough to receive the therapeutic effects they have to offer you. Then be patient as your body adjusts from being a sugar-burner to becoming a lean, mean, fat-burning machine.

It is also possible that you aren’t getting enough salt in your diet. Low-carb researchers Dr. Stephen Phinney and Dr. Jeff Volek estimate that most people need 5 to 7 grams of salt every day when they are following a ketogenic diet.

I’m showing great blood ketone levels, but I’m not losing weight. Why?

The level of ketones in circulation does not accurately reflect the degree or speed of weight loss. The mere presence of ketosis and an energy deficit, but not the depth of ketosis, per se, seem to be the primary mediator of weight loss.

– Dr. Bill Lagakos

This common question gets to the heart of an important lesson about ketosis. Yes, one of the great side effects of a ketogenic diet is indeed weight loss. But producing adequate blood ketones does not automatically mean you will lose weight quickly. I realize this can be discouraging for people who are using keto for that purpose, but there are plenty of other reasons to keep at it despite the slow or stalled numbers on the scale: reduced hunger and cravings, stabilized blood sugar, lower blood pressure, better sleep, more energy, mental clarity, and much more.

Perhaps you need to tweak your diet by adding in more fat and making sure your carbs and protein are where they need to be. But beyond that, know that weight loss (and, more accurately, fat loss) is an extremely complex issue. Yes, a ketogenic diet gives you a fighting chance in the battle against the bulge. For some people it can be a slog, but it’s a fight worth getting into if you’re willing to go the distance.

Dr. Zeeshan Arain, a general practitioner from South Yarra, Victoria, in Australia, follows a ketogenic diet himself and recommends it for his patients. He notes that it is a common misconception that higher levels of blood ketones (beta-hydroxybutyrate) automatically result in weight loss.

It is possible, he explains, for ketones to be produced in one of three ways: by burning dietary fat alone, by burning stored body fat alone, or by burning a combination of the two. The trick to weight loss is to burn at least some of the fat stores in your body. The best way to monitor that is by testing your ketone levels as often as possible to make sure you are on the right track with your ketogenic diet, especially if something has changed in your routine, such as food intake, exercise, or stress levels. But remember, higher ketone levels don’t mean more weight loss will automatically happen.

As Dr. Arain says, “Being too fixated on the numbers can be counterproductive to weight loss [because of the] anxiety generated.” Focus instead on doing the things you need to do to lose weight, including feeling good about your efforts, maintaining high energy levels, and keeping stress in your life to the bare minimum. These things will all serve you much better than if you are constantly worrying about whatever your ketone level happens to be.

Be encouraged that sooner or later you will find success. And don’t forget that while you may not be losing weight on the scale, your clothes may very well begin to start fitting better. And that’s always a good thing.

Why do others get to eat more carbohydrates and protein in their diet than I do? This just doesn’t seem fair.

Ketosis, like most things in nutritional science, has an incredible degree of individual variability. Is the person overweight with insulin resistance or diabetes? What is the age and sex of the ketogenic dieter? Is the person suffering from epilepsy or a chronic neurological disorder? Perhaps the patient is an endurance athlete simply looking for a more efficient fueling strategy. Armed with this information, it is easier to determine the levels of macronutrients that are appropriate for helping them get into a state of nutritional ketosis.

– Dr. Zeeshan Arain

We like to compare ourselves to our friends, family, and coworkers, don’t we? I suppose it’s human nature, but we’re only setting ourselves up for disappointment and discouragement if we expect to be able to eat what others eat and have it work exactly the same way for us. If there’s one message we want to communicate loud and clear, it’s this: we are all different and have unique metabolic needs based on our genetics, our environment, and other factors.

We’re not all robots with a built-in program that produces identical results in everyone. We are unique snowflakes, and there is an incredibly wide range of variables involved in making our bodies operate the way they should. Some people need to consume less carbohydrate and protein than others. That’s okay. It’s how our bodies have developed, and we must accept the situation we are currently in.

The good news is that you are still in a fantastic position to optimize your health and run your body quite efficiently on ketone bodies, no matter how metabolically damaged you may be. Although I cannot consume more than 30 grams of carbohydrate and 100 grams of protein daily, that doesn’t deter me from doing the things I have to do to be healthy. Who knows? Over time I may be able to add in more carbohydrate and protein as my body heals from the decades of damage I did to it eating the Standard American Diet. That’s true for you, too.