Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (7 page)

Dr. Wortman obtained a Bachelor of Science in chemistry and biology from the University of Alberta and an MD from the University of Calgary, and completed his residency in family medicine at the University of British Columbia. His interest in diet research led to a position at the UBC Faculty of Medicine, where he studied the effectiveness of a traditional diet for treating obesity, metabolic syndrome, and type 2 diabetes in the Namgis First Nation. The study was the subject of the CBC documentary
My Big Fat Diet
. Dr. Wortman is a recognized authority on low-carbohydrate, ketogenic diets for the treatment of obesity, metabolic syndrome, and type 2 diabetes. He was the recipient of Nutrition and Metabolism Society Award for Excellence in 2010 and the National Aboriginal Achievement Award for Medicine in 2002. Dr. Wortman currently practices in West Vancouver, where he lives with his wife and young children. Learn more about Dr. Wortman at
DrJayWortman.com
.

These really are twenty-two of the top-of-the-line experts on the subject of low-carb, moderate-protein, high-fat, ketogenic diets for therapeutic uses. Additionally, my coauthor, Dr. Eric Westman, is a bona fide expert on this and will once again be sharing his thoughts and experience on this subject throughout the book in the “Doctor’s Note” entries scattered throughout the book. Here’s his first!

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: It’s a pleasure to assist Jimmy Moore in translating the science about ketogenic diets into plain language that anyone can understand.

The “Moment of Clarity” quotes, since they’re from doctors and experts, can use complex language, but don’t let that scare you off. The purpose of this book is to provide a basic explanation of what ketones are, how ketosis works, and what you can do to follow a ketogenic diet. I want to make these ideas so crystal clear that you will want to learn even more about ketosis. To that end, there’s a glossary of terms at the back of this book to explain any word or phrase that might trip you up.

Are you ready to gain some keto clarity? Oh yeah—let’s do this.

I believe a low level of ketosis is actually the natural and most optimal state of metabolism for humans. Historically, our genome evolved to express itself most ideally based upon food sources available for our consumption. Thus, from an epigenetic perspective, the very best way we can communicate with our DNA is to provide it with the signals [that], over millennia, it has come to expect.

– Dr. David Perlmutter

So what in the world is this whole keto, ketone, ketosis, ketogenic thing all about, anyway? It’s not a very common concept within mainstream health circles, and it’s definitely not often talked about in a positive light. If it is discussed in the media or by health authorities, it’s generally within a negative context (as we’ll cover in chapter 3). Ketogenic diets have been used since the 1920s to very effectively control seizures in refractory childhood epilepsy. This version of the ketogenic diet uses a four-to-one ratio of fat to combined protein and carbohydrate.

Its association with a century-old therapeutic seizure treatment, along with Dr. Atkins’ use of the “k” word in describing his low-carb, high-fat nutritional approach, have led some to label the ketogenic diet as an “extreme” diet. Nothing could be further from the truth. Beginning in chapter 16, you’ll see that this nutritional approach has been shown to produce some remarkably positive results for a wide variety of the most common chronic diseases today.

The ketogenic diet was also used as a treatment for epilepsy in the 1920s and 1930s, although the mechanism for its effectiveness has yet to be elucidated. It also fell out of favor with the introduction of the anticonvulsant medication Dilantin in 1937.

– Dr. Keith Runyan

Unfortunately, as is often the case, the general public has not been properly exposed to the truth about ketosis because of some deliberate scaremongering about the dietary changes that are required to induce it. Just as cholesterol is not the culprit in heart disease (as we explained in
Cholesterol Clarity
), ketones are not some kind of toxic substance in your body that you need to avoid at all costs. We will attempt to calm any lingering fears you may have about going keto by explaining in simple English what it really is and why it’s actually not a bad thing at all.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Even in the medical literature, ketones get a bad rap. A classic paper written by metabolism experts in 2003 was entitled “Ketones: Metabolism’s ‘Ugly Duckling.’”

A good starting point is to define exactly what ketosis is. Ketosis (pronounced KEY-TOE-SIS) is a metabolic state that happens when you consume a very low-carb, moderate-protein, high-fat diet that causes your body to switch from using glucose as its primary source of fuel to running on ketones. Ketones themselves are produced when the body burns fat, and they’re primarily used as an alternative fuel source when glucose isn’t available.

In other words, your body changes from a sugar-burner to a fat-burner. Depending on your current diet and lifestyle choices, becoming keto-adapted can take as little as a few days and or as much as several weeks or even months. So “being in ketosis” just means that you are burning fat. Patience and persistence are an absolute must as you pursue ketosis.

Let me be very clear about something I know you’re probably already thinking about: yes, this is a completely
normal
metabolic state. In fact, according to pediatric physician Dr. Mary Newport, newborn babies who are exclusively breastfed will go into a state of ketosis within twelve hours of birth, and ketones provide about 25 percent of their energy needs. Actually, 10 percent of the fats in full-term human breast milk is composed of medium-chain triglycerides (MCTs), which the liver converts to ketones. This is one reason why virtually every infant formula sold on the market today contains MCT oil and coconut oil, which “mimic the fats in breast milk.” Dr. Newport says this is a clear indication that “from birth, and possibly before that, ketones play an important role.”

If you have ever fasted by skipping breakfast after a good night’s sleep, then you likely have begun producing trace amounts of ketones in your blood. If you consume a diet with very few carbohydrates, moderate levels of protein, and plenty of healthy saturated and monounsaturated fats, then these ketones will begin to increase until they dominate the way your body is fueled, to the point that very little glucose is needed to function. This book will clearly explain why this is a very good and even preferable state for your body to be in. And it makes sense that we were designed to eat this way, just as our hunter-gatherer ancestors once did.

The superiority of ketone bodies over glucose fuel is clear from the large amounts of sustained energy you experience all day, every day.

– Stephanie Person

Dr. William Wilson, a family practitioner and expert on nutrition and brain function, explained that “throughout most of our evolutionary history, humans used both glucose and ketone bodies for energy production.” He said that our Paleolithic ancestors used glucose as their body’s preferred fuel when non-animal food was available, but during periods of food shortage or when animal-based foods were their primary source of calories, want to take a wild guess at what was sustaining them? You guessed it—ketones! “Thus, our ancestors spent most of their time in a state of ketosis,” Dr. Wilson concluded. He added, “If our early ancestors hadn’t developed a way to use ketones for energy, our species would have ended up on Darwin’s short list eons ago!”

The Inuit are a perfect example of a ketogenic people that have, for thousands of years, consumed a diet that is very high in fat and very low in carbohydrates while maintaining full energy and stamina. In 1879, Frederick Schwatka, a US Army lieutenant, doctor, and lawyer, embarked on an Arctic expedition to look for records left by two Royal Navy ships that were lost in 1845. Schwatka began his journey in April 1879 with eighteen people, including several Inuit families; enough stored food to sustain them for one month; and ample amounts of hunting equipment. He learned that after a period of adaptation, consuming an Inuit diet with plenty of animal fat would sustain him even during hours of strenuous walking. This was one of the first understandings of keto-adaptation, and today, the process of transitioning from burning sugar to burning fat is known as the “Schwatka Imperative.”

Ketone bodies provide an alternative fuel for the brain, heart, and most other organs when serum glucose and insulin levels are low—i.e., on a very low-carbohydrate diet. Ketone bodies are preferred over glucose by the heart and can be used as efficiently as glucose by most portions of the brain. There is a growing body of research supporting their beneficial effects on aging, inflammation, metabolism, cognition, and athletic performance.

– Franziska Spritzler

What Schwatka discovered, before the technology even existed to measure it, was that his body was increasing its production of ketone bodies, which appear in the blood primarily as beta-hydroxybutyrate (BHB). (We’ll talk more about the various technologies for measuring the presence of ketones in 
chapter 8
.) BHB is synthesized in the liver and can be used as an energy source by just about every cell in the body, including brain cells. So think of ketones the same way we currently look at glucose, as an energy source. In fact, look at how amazingly similar the molecular formulas for ketone bodies and glucose are. (This is a bit geeky, but it is important for you to see with your own eyes why ketones are used by the body as another fuel source when glucose is not present.)