Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (39 page)

Studies suggest that keto-adaptation, in which the impact of glycogen depletion is no longer relevant as the body is capable of running on ketones, appears to take approximately three to four weeks in most people.

– Dr. Bill Lagakos

They say that “patience is a virtue,” but whoever said that must not have tried to get into ketosis! After all, if I’m doing what I’m supposed to do, then I should see the results that come from those efforts, right?

That’s right, you absolutely should. But keep in mind that everyone is different, and it could be that you just haven’t given your body enough time to make the switch from being fueled by glucose (sugar and carbohydrates) to being fueled by ketones and fatty acids. Becoming keto-adapted can take as little as a couple of days (if you already eat pretty low-carb, it doesn’t take long) to as much as four to six weeks (especially if you are coming off of the Standard American Diet, which is very high in carbohydrates). You know how they say “time heals all wounds”? That definitely applies when you are courting ketosis.

In your pursuit of ketosis, letting a little bit more time pass may be just what you need to find success. But there’s one more thing about the passage of time you need to be aware of: as your body becomes more efficient at using blood ketones as fuel, they may eventually show up less and less when you test. Don’t let this upset you unless your ketone level dips below 0.5 millimolar. It’s just your body running like a well-oiled, ketogenic, fat-burning machine!

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Much of what I do in my clinic is what I call “recalibrating expectations.” Not everyone will lose ten pounds in a week, as the gimmicky marketing for so many diet programs and products boldly proclaim. Remember how long it took to gain the weight, and then realize that one to two pounds of weight loss each week is a very healthy pace.

5. You’re exceeding your carb tolerance and
protein threshold.

As a general guide based on anecdotal evidence, restrict carbohydrates to approximately 50 grams per day and protein to 1 to 1.5 grams per kilogram of lean body mass, and consume fat to satiety. For most individuals this will result in serum BHB levels between 0.5 and 3.0 millimolar per liter. Those who are severely metabolically damaged may need to restrict carbs and protein even further.

– Dr. Zeeshan Arain

This one is so important that we have already dedicated two entire chapters (chapters 5 and 6) to it. But the underlying lesson here cannot be emphasized enough—you should not expect to be able to create adequate ketones until you know how many carbohydrates and how much protein is right for you. If there were a one-size-fits-all equation to get everyone into ketosis, I’d share that with you. Unfortunately, there is not. So if you’re not seeing results on your ketogenic diet, try tinkering around with your carbohydrate and protein intake to find your personal sweet spot for success.

Watch out for hidden ways you may be consuming too many carbohydrates and protein and be mindful of everything that goes into your mouth. If you are consuming low-carb products such as protein bars and shakes, trusting that the “net carbs” will stay below your threshold, then you’re probably getting a double whammy—extra carbohydrates that you didn’t think you needed to count as well as an increased amount of protein. Remember, you can’t eat high-protein on your low-carb diet if you want to be creating ketones.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: There is often confusion between counting “net carbs” and “total carbs.” “Net carbs,” determined by subtracting the fiber grams from the total grams of carbs, works well for those who are not very metabolically sick or who don’t have much weight to lose. But because some of the fiber is absorbed as glucose and your goal now is to become ketogenic, the more prudent approach is to
not
subtract even the fiber grams from the total grams of carbs.

6. You’re not eating enough dietary fat.

One way to ensure adequate ketone levels on a daily basis is to maintain a relatively high intake of dietary fat—as much as 75 percent of calories or more. Fat is the metabolic precursor for the production of ketones, and it doesn’t matter if the fat is provided by the diet or adipose tissue.

– Dr. Bill Lagakos

As I shared in chapter 9, when I talked about my one-year n=1 experiment in nutritional ketosis, one of the biggest mistakes I realized I was making in my low-carb diet was failing to eat enough fat. Although I was consuming over 60 percent of my calories in the form of fat, it wasn’t until I bumped it up to over 80 percent that I was able to experience genuine ketosis. Eating fat to satiety, as discussed in chapter 7, is extremely important for getting into ketosis and staying there.

When you consume more fat, it satisfies your hunger and does not raise your blood sugar. Additionally, eating more fat keeps you from taking in more carbohydrate and protein, which could knock your ketone production down. You’re looking to get the biggest nutritional bang for your buck, and whole-food sources of fat provide that in spades.

The biggest criticism I hear the most about ketogenic diets are concerns about the high fat intake causing heart disease and heart attacks.

– Dr. William Davis

I know we’ve long been told to stay away from dietary fat because of a misguided notion that it will clog your arteries and lead to heart disease (it’s just not true) and that fat has 9 calories per gram, compared with 4 calories per gram in carbohydrate and protein. But nutrition is so much more complex than the simple mathematical equation that health experts have attempted to make it. The fat phobia that has dominated our culture for several decades will be coming to an end very soon.

So why not get a jump-start on everyone else and eat more whole-food sources of dietary fat? Don’t be surprised when you see your ketones soar.

7. A medication or combination of medications is taxing your liver.

Medications can “manage” chronic illnesses like diabetes and obesity, but they cannot prevent or reverse them. But following a ketogenic diet is a potent way to prevent or reverse these common chronic diseases. As a clinician, I like having safe approaches that work with my patients. If you start by focusing on your diet, then the rest will be merely window dressing.

– Dr. Bill Wilson

Both prescription and over-the-counter medications can be hard on your body. Yes, sometimes drugs are necessary, but they can add more toxins that your liver needs to flush out of your body. This is very important, since most medications, including common over-the-counter ones, can be damaging if taken long-term. They may help manage symptoms in the short-term, but that comes with a price if it becomes a maintenance drug you take for the rest of your life.

What does this have to do with ketosis? Well, the liver is involved in regulating insulin levels, and when it’s under strain from dealing with medications, your insulin can remain elevated. (This doesn’t mean you should necessarily stop taking your medications. If you’re concerned, please consult with your physician about the risks and side effects of the specific medication you are taking.) When insulin levels are high, this can knock down your body’s ability to create ketones.

If you are able to come off of your prescription medication or forgo taking an over-the-counter drug, you may see your ketones begin to rise. It’s certainly something you should be aware of if you are struggling to see results in your ketone testing.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: In diet and metabolism studies conducted in the early twentieth century, carbohydrates were called “the anti-ketogenic factor.” Eating carbohydrates raises insulin levels, and it’s the increase in insulin that turns off the production of ketones.

8. You’re consuming too few or too many calories.

Following a well-formulated ketogenic diet with adequate calories to support your needs is unlikely to cause problems over the long term.

– Franziska Spritzler

We haven’t discussed calories very much in this book, and for good reason. When you are eating a diet that is low in carbohydrates and moderate in protein, and you’re consuming real, whole sources of dietary fats to satiety, calories take care of themselves, without any need for you to become obsessed with counting them. But in the pursuit of ketosis, some people can run into trouble with consuming calories either well below or beyond satiety.

In chapter 12, we discussed ways to distinguish true hunger from other factors that prompt you to eat, because with the abundance of food in our society, we’re used to consuming a lot of food and eating for reasons other than hunger—making it difficult for us to know when to stop eating. And on the flip side, our society glorifies hunger as a good thing in the realm of dieting, which puts pressure on us to eat fewer calories than our bodies probably need. Both of these extremes can play a major role in your ability to produce therapeutic levels of ketones.