Is a Ketogenic Diet Safe?

Is a Ketogenic Diet Safe?

Ketogenic diets are popular. If you like eating fat, which I’ll admit I do, the idea of being able to eat an 80% fat diet does sound appealing.

What are ketones?

After you’ve gone without eating for 6 to 8 hours your body enters a fasted state. As this continues for the next 10 hours, you will have low blood sugar levels and further will have depleted your liver’s store of accumulated energy, called glycogen. Glucose is therefore not available to be utilized as fuel. At this point your body produces ketones. Ketosis is the state of the body whereby fat is being burned as energy.

Therefore you can achieve ketosis initially through fasting, but you can maintain that state by eating an 80% fat diet, one extremely low in carbohydrates.

Research into the benefits of a ketogenic diet is mostly associated with neurological diseases such as Parkinson’s disease, epilepsy, and some brain tumors.

Ketones are believed to increase the production of glutathione, our most powerful anti-oxidant – more on that topic a little later.

Okay, so those are the facts of what ketones are and how they are produced – so far so good.

Now we get to the million-dollar question:

Should you follow a ketogenic diet?

I’ll be honest; researching for this blog wasn’t easy. There are many, many claims made that completely contradict one another. Worse yet, these are by clinicians in my field of functional nutrition whom I really respect, and they have completely opposing views.

So let’s look at some more facts and see if we can come to a decision we feel good about.

Recall that earlier I mentioned ketones are believed to protect our mitochondria, the power plants of our cells, by increasing production of glutathione, our most powerful antioxidant. No one will argue the point that it’s a benefit to have healthy happy mitochondria and strong levels of glutathione.

Mitochondria have been likened to furnaces within our cells that convert the food we eat into useable energy. The combustion, as it were, that takes place inside the mitochondria can transform the oxygen you breathe into something called superoxide, a substance that causes oxidation, damaging our cells and speeding our transition into heart disease and cancer. Aging, too, has been related to oxidation and it can be seen, like wrinkles or brown spots of the skin, or felt, in less brainpower and worsened memory.

Is there a way to protect mitochondria without putting your body into ketosis?

You can eat antioxidants in the form of fruits and vegetables, but too often, antioxidants cannot penetrate through to the mitochondria themselves, so aging occurs unfettered. But, don’t give up so fast, Mother Nature thinks of everything – there is an enzyme called superoxide dismutase that turns the superoxide back into oxygen – now we’re talking.

The enzyme superoxide dismutase is such a hero that it is considered to be anti-cancer, tumor suppressing, brain protecting and more. Women, by the way, generally speaking have higher levels than men, perhaps why they tend to outlive them.

Therefore, if you want mitochondrial protection, which we all do, you will then need robust superoxide dismutase levels. Interestingly, researchers, upon comparing the enzyme’s activity found a big difference between individuals eating different diets.

Specifically, vegetarians had 300% greater activity of the enzyme as compared to meat-eaters. The researchers wondered if this was why vegetarians tend to live longer and have less degenerative disease, such as heart disease and cancer.

It’s not simply due to consuming greater amounts of fruits and vegetables, beans, and legumes, although that most certainly helps, specifically, the vegetarian diet upregulated or increased the production of, this longevity enhancing enzyme.

Hmm, so there IS a way to protect mitochondria without a high-fat diet…

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As I further researched the topic of enhancing mitochondria production I came across data regarding a nutrient that isn’t well known – it’s called Ergothioneine, and it’s a very powerful antioxidant. Ergothioneine is an amino acid the body is unable to produce itself; it must be gotten from your diet. While it’s not well known, knowledge of its identity is not new; research exists going back over a century. Recent research discovering that it has a dedicated transporter molecule designed to pull the amino acid from our diet and into needed tissues of our body took the amino acid from a level of obscurity to one of fascinated curiosity. Here was a powerful antioxidant with its own transporter molecule – clearly your body thinks it’s important enough to ensure it arrives at some vital organs such as your brain, heart, joints, and eyes.

Its major strength appears to be in the arena of anti-aging, along with the protection of the heart, brain, eyes, skin, enhanced athletic performance, and joint health. Researchers discovered that starving cells of ergothioneine was not a pro-survival activity. That datum along with the fact ergothioneine cannot be produced inside the body, had researchers yearning to coin it as a new vitamin.

To enhance mitochondrial protection, ensure you get enough Ergothioneine

Where can you find this powerful antioxidant and mitochondrial protector? It turns out it is not only unable to be produced by the human body, but it also isn’t made by animals nor plants. Uh oh – what does that leave? Microbes in the dirt of course! Microbes are the only source, but no worries, you don’t have to start eating dirt. The roots of plants take the ergothioneine up into the plants themselves and therefore into those who then consume the plants – thereby plants and animals alike possess the amino acid, to a degree…

What’s the best source of ergothioneine in our diet? Research into a variety of foods yields the following results:

• Dairy products – zero
• Fruit – zero
• Fish – 0.07
• Eggs – about 0.7, yolks 1.4
• Nuts and seeds –1.4
• Vegetables – up to 3.0
• Grains – up to 4.0
• Organ meats (eating the kidney and liver of animals) – up to 10.0
• Beans – up to 13.0
• MUSHROOMS (fungi) – over 200!!!

Gotta love those fungi! These are an inexpensive way to support mitochondrial function with low calories (15 calories for an entire cup) and next to zero fat. Kind of debunks the concept that mitochondrial support needs to come from ketosis.

Let’s take a look at what Dr. Mercola, author of the recent book “Fat for Fuel” has to say. Dr. Mercola is a BIG advocate of the ketogenic diet. He says:

• “processed grains and sugars (particularly fructose) are the primary culprits behind our skyrocketing obesity, diabetes, and chronic disease rates” – AGREED
• “two-thirds of the American population is overweight or obese; 1 in 5 deaths is obesity-related, half have pre-diabetes, diabetes or other chronic illness, and 1 in 3 women and half of all men will develop some form of cancer in their lifetime.” – AGREED
• “There’s an answer to all of these terrible health trends, and it all starts with … your diet. Most … eat far too many processed foods, … carbs and too few healthy fats, and too many unhealthy fats, which results in gaining and retaining extra body fat and becoming increasingly insulin resistant.” – AGREED
• “Most also eat too much protein for optimal health and, while exercise cannot compensate for the damage done by a high-carb, low-fat diet, most do not get enough physical movement either.” – AGREED
• “Your mitochondria generate the vast majority of the energy (adenosine triphosphate or ATP) in your body. Were all mitochondria to fail, you’d be dead in seconds.” – AGREED
• Your mitochondria are nourished by certain nutrients and harmed by others. So, a healthy diet is a diet that supports mitochondrial function and prevents dysfunction,” – AGREED “and having the metabolic flexibility to burn fat is the key.” – NOT CONVINCED ON THIS LAST POINT.

Is the ability to burn fat THE KEY to nourish your mitochondria? Apparently it’s not the only key if you believe the research cited above regarding the enzyme superoxide dismutase and the amino acid ergothioneine.

Let’s say we want to try a ketogenic diet, what exactly would that entail?

First, it’s important to understand that ketosis is NOT something you want to maintain on a daily basis. Dr. Mercola and Dr. Perlmutter, avid advocates of a ketogenic diet, are in complete agreement on the point that remaining in a ketogenic state is not healthy. Instead, a ketogenic diet (80% fat) must be “pulsed” with a higher carbohydrate and protein diet. 

Note that “carbohydrates” can entail good complex, high fiber carbohydrates – what you need! Or “carbohydrates” can mean refined sugar and flour and processed foods – most definitely NOT what you need. There is a great deal of confusion about carbs, per se, and those that vilify them are speaking about the types of carbohydrates that SHOULD be vilified, the refined ones that have little to any fiber. However, and this is a BIG however, the beneficial carbohydrates in the form of whole fruit, vegetables, beans, legumes, and whole gluten-free grains are a MUST in any healthy diet. And this is something advocates of the ketogenic diet agree upon, as do I.

Why you can’t STAY on a Ketogenic Diet

It is not safe to remain on a ketogenic diet. Both Dr. Mercola, author of the recent book “Fat for Fuel” and Dr. Perlmutter, author of “Brain Maker” agree. In fact, while Dr. Mercola’s book was published a mere 2 months ago, it had likely been completed close to a year prior, if not more. Just a few days ago, however, Dr. Mercola had this to say on his site: On a personal note, I engaged in long-term (six months or so) chronic nutritional ketosis. But then I started noticing some adverse effects. I think these effects may be related to the action of insulin, which many aren’t aware of.

Remember earlier we discussed fasting and how it lowered your blood sugar and depleted your liver of its glucose storage? Insulin production is suppressed in this scenario because of the dramatically lowered blood sugar, but the insulin suppression doesn’t continue to keep your blood sugar suppressed, quite the opposite! What? That doesn’t make sense.

You’re correct. It IS counterintuitive, but the body has many ways of continuing to operate when the environment gets harsh – think little to no food. We were always taught that insulin’s sole action was to drive sugar (glucose) into the cells. But it turns out that insulin’s major action is to prevent the liver from producing more glucose. The process, a big word, but an interesting one, is gluconeogenesis – which simply means generating glucose newly from a non-carbohydrate source (typically a protein) – an action performed by your liver during times of fasting, starvation or when little to no carbohydrates are being ingested. Yes, you can have NO carbs, no sugar coming into your body, and your clever liver will STILL make glucose. It’s a survival mechanism.

Therefore, if you have chronically low levels of insulin what’s going to happen? The insulin can’t suppress the liver from making glucose and you’re going to produce it, and a lot of it, despite no carbohydrates coming in.

That’s why chronic (done every day) ketogenesis is so dangerous. You’re eating a no carbohydrate diet and producing high blood sugar despite your efforts. This is beyond counterproductive, not to mention moving you toward obesity and degenerative disease, the exact diseases you were trying to avoid.

Of course, you’re trying to keep your glucose levels low, but if you restrict carbohydrates too much, you’re going to get high glucose. This is important to understand, which is why I’m trying to say it in a few different ways. This was what Dr. Mercola ran into when he himself followed a ketogenic diet for 6 months straight – he noticed adverse effects on his health. And yes, he’s the author of a new book explaining why ketogenesis is so healthy.

You have to give him credit for admitting where he went wrong and sharing the importance of not remaining chronically on a ketogenic diet. As clinicians in the field of nutrition and functional medicine, we have come to realize that change is always upon us as we continue to learn and remain on the cutting edge. I will never fault anyone for sharing data at a given point in time and then changing it later as more is learned on the subject.

The takeaway therefore is, at the very minimum, you need to cycle or “pulse” a ketogenic diet to avoid ill health repercussions.

Needless to say, this is where I have major concerns with a ketogenic diet. It’s not something we are recommending for patients, but frequently patients arrive in the clinic on a ketogenic diet. They’ll mention how long they’ve been following it but rarely does anyone mention they are “pulsing”, “cycling” or taking days off from ketogenesis – a rather important oversight considering the strong negative ramifications associated with failing to do this.

Here’s my second concern: The experts caution there is no way to guess at the amount of fat, “net carbs” (amount of carbs after subtracting the fiber in a food), and protein you are eating without strict measuring. You need to purchase:

• A kitchen scale to weigh food before you eat it
• Measuring cups to measure your food before you eat it
• Plus, download a nutrient tracker (no cost for this one) whereby you enter in data to help you keep track of your ketosis.

Now you may be surprised to hear me say this when I’m a self-proclaimed highly disciplined person, but the thought of weighing and measuring all my food PLUS entering it into an app is getting to a level of complexity I balk at.

The benefits of ketosis are stated as:

• No more sugar cravings
• Weight loss
• High energy
• Mental clarity

Those are all great, no argument, but we achieve that for patients regularly without having to follow an 80% fat diet. In fact, we do it with closer to an 80% plant-based diet, which includes complex carbohydrates such as fruits, vegetables, beans, legumes, healthy fats, and plant-based protein.

How do you feel about this? My conclusion is that a whole food plant-based diet can get the job done rather effortlessly. With a plant-based diet, you are consuming foods known to boost mitochondrial function, are anti-inflammatory, and completely brimming with the magical antioxidants and resistant starches known to optimize all aspects of health – they are proven to protect heart health, are anti-cancer and can reverse diabetes and improve the autoimmune disease.

For whom would I recommend a ketogenic diet? Those suffering with, or at high risk for certain neurological diseases, based on the books written by Dr. Perlmutter, for whom I have great respect, could benefit from a properly executed ketogenic diet. But generally speaking, I think the average patient we see who is suffering from digestive complaints, pain, fatigue, headache, weight gain, stress, and autoimmune disease, appear to respond very well to a plant-based diet that includes healthy fats.

The only ketogenesis we recommend on a daily basis is that associated with a mini fast – having your first meal of the day anywhere from 12 to 16 hours after your last one, and that is not recommended for everyone, especially pregnant women and those with unstable blood sugar.

I’ll be discussing this more in a follow-up blog.

If you are following a ketogenic diet, are you pulsing it properly?

Are you doing well on a ketogenic diet? I’d like to hear from you.

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