Any diet is what you make of it and the same is true with a ketogenic diet which can otherwise be thought of as a low carbohydrate, high fat, moderate protein diet. If you are new to the ketogenic world then you should know that this is a very strict way of eating that causes the body to burn fat as its main source of energy instead of glucose from carbohydrates. In order to enter a state of ketosis, a certain level of ketones must be present in the blood. This typically occurs within 3 to 4 days of adherence to the diet but can vary on an individual basis. Following a ketogenic diet is not easy by any means but if done properly, the benefits can be life changing for a person’s health and overall functionality. In order to adopt a nutritious ketogenic diet, keep my nine nutritional considerations in mind!
The ketogenic diet was initially used to help manage epileptic seizures in children and it has since evolved to be a neuroprotective intervention for those suffering with Alzheimer’s, Dementia and Parkinson’s Disease in addition to being used for the management of Type 2 Diabetes. Research is establishing these benefits but that doesn’t make the implementation any easier. As with all diets, it’s possible to eat poorly on a ketogenic diet and fall short on several key nutrients but a well-balance ketogenic is also quite possible. The difference with the ketogenic diet compared to a paleo diet or vegetarian diet is the extensive limitations regarding what is included and what is not. Because of this it can be difficult to meet proper nutrient needs and incorporate a variety of diverse colors and plants. But with the right balance of foods, an adequate intake of leafy greens and other vegetables, and a high quality multivitamin, it can be entirely possible.
Before we get into the nutritional considerations, please note that the ketogenic diet is certainly not for everyone. Common side effects of this diet include constipation, kidney stones, nutrient deficiencies, dehydration, fatigue, and nausea. If you are considering adopting a ketogenic diet it is best to first discuss with a Doctor and/or a Registered Dietitian, especially for those with diabetes. After leading a ketogenic dietary intervention for patients with Type 2 Diabetes in 2017, I observed firsthand the effectiveness of this dietary intervention but also the importance of proactively working alongside a physician and dietitian in order to adjust insulin and medication dosages as needed.
If you are considering going ketogenic or are already adhering to a ketogenic diet, there are many nutritional considerations to keep in mind. Read below for my top nine!
1. Count Net Carbohydrates Instead of Total Carbohydrates
In order to reach ketosis a person typically needs to limit their carbohydrate intake to a daily consumption of about 25-40 grams of net carbohydrates. Since fiber is not digested, net carbs are the amount of carbohydrates left after fiber is accounted for (total carbohydrates minus dietary fiber equals net carbohydrates). Some experts recommend counting total carbohydrates instead of net carbohydrates. The benefit of tracking net carbohydrate intake is that you aren’t punished for eating fiber (meaning it doesn’t count towards your carbohydrate intake). Inadequate fiber intake is all too common amongst ketogenic adopters so I absolutely encourage everyone to count net carbohydrates and to eat enough fiber.
Limiting net carbohydrates is often one of the most challenging parts of eating ketogenic considering how many foods contain even a small amount of carbohydrates. Healthy fats like grass-fed ghee, coconut/MCT oil, avocado, and organic eggs are desirable ketogenic additions because they tend to have a lower net carbohydrate count. As you can see in the table below, the net carbohydrate content from foods like broccoli, brussels sprouts, bell peppers, cashews, pistachios, and almond butter can add up quickly in the course of one day.
|Food||Total Carbohydrates||Dietary Fiber||Net Carbohydrates|
|½ avocado||8.6 grams||6.7 grams||1.8 grams|
|½ large red bell pepper||4.9 grams||1.7 grams||3.2 grams|
|1 cup brussels sprouts||3.7 grams||1.5 grams||2.2 grams|
|1 oz cashews||8.6 grams||0.9 grams||7.6 grams|
|2 tbsp almond butter||6 grams||3.3 grams||2.7 grams|
2. Strictly Measure Macronutrients
Part of the difficulty in going keto is needing to meticulously track carbohydrates, fat and protein intake. Very few people are able to reach ketosis and stay there without tracking macro intake. Once you’re tracking, the goal is to avoid too many carbohydrates (especially refined) and excessive protein while also eating significantly more healthy fats. Tracking is the only way to know whether you are meeting these intake goals.
3. Measure Ketones in the Blood
Tracking ketone levels in the body is the best way to ensure that you’ve reached ketosis. This can be done by collecting blood or urine but the most effective test is a blood meter. This finger-pricking process is similar to the way that a person with diabetes checks their blood glucose levels. While urinary tests don’t involve finger pricking they also don’t provide the most precise measurement since urine levels can be impacted by factors such as hydration status.
4. Avoid Eating Too Much Protein
The ketogenic diet is commonly described as low carb or high fat but it’s less common to hear any mention of protein intake. This moderate-protein diet is generally limited to no more than 20% protein intake, meaning that it can be just as difficult not to go overboard on protein as it can be for carbs. Too much protein can also sabotage ketosis efforts. If your protein intake exceeds your needs, a process called gluconeogenesis kicks in and small amounts of protein are converted to glucose. Essentially, if you are consuming too much protein, your body can revert back to using glucose as its main source of energy and it will disrupt a ketogenic state.
5. Buy Full-Fat Everything
It’s always a good idea to avoid low-fat products but this is especially true when eating keto! It’s nearly impossible to consume enough fat if you are not buying full-fat cheese (grass-fed & organic is always preferable), full-fat coconut milk, and full-fat dressing instead of low or reduced fat. Ramping up the fat intake can be a major change for many (including myself)! It requires heavy pours of extra virgin olive oil and very generous servings of guacamole. The side benefit of ramping up the fats is that it helps dramatically reduce overall cravings, specifically sugar cravings. This is great considering a recent study found that rats that were fed a high sugar and low fat diet were at risk for liver damage, brain inflammation and obesity.
6. Incorporate MCT Oil
Adding MCT oil into your diet can be extremely helpful for staying in ketosis. MCTs or medium chain triglycerides are exactly what they say they are–medium chains of carbon molecules that are structurally different than other fats which are generally long chain fats. MCTs are abundant in coconut oil but are also found in 100% MCT oil. These triglycerides are burned differently in the body–they are used as fuel instead of stored as fat and they are healthy for the brain. Dr. Dale Bredesen includes MCT oil in his prevent and reverse Alzheimer’s Disease protocol which has demonstrated improved clinical outcomes.
7. Call on Electrolytes
It is important to pay special attention to your electrolyte intake while eating keto. Some individuals may lose water weight while on the ketogenic diet which can result in a loss of electrolytes such as sodium, potassium, chloride and magnesium. The best foods for replenishing electrolytes include bone broth, nuts, avocados, salmon and leafy greens. Magnesium and potassium are especially difficult to get enough of when following a ketogenic diet. Be sure to incorporate magnesium rich foods like spinach (also high in potassium), kefir, and almonds in addition to potassium rich foods like cauliflower, pumpkin, and avocado. You may also want to consider an electrolyte replacement or a quality supplement.
8. Get a Minimum of 25g of Fiber
Lots of traditionally healthy, high fiber foods like lentils, oatmeal, apples, and sweet potatoes are not included on a ketogenic diet. The loss of these fiber-rich food sources can make it difficult to incorporate sufficient amounts of total daily fiber. But it’s important to track because fiber is a critical nutrient for optimal digestion, detoxification and heart health. If you experience constipation on a ketogenic diet it might be due to too little fiber intake. If this is the case, you’ll want to track your fiber intake to ensure you’re getting at least 25 grams and ramp up on water. Also incorporate at least ½ avocado and a few tablespoons of chia seeds. major benefit to ensuring adequate fiber intake is the reduction in overeating as well as cravings.
9. Consider Intermittent Fasting + Ketogenic
Several studies have confirmed notable benefits associated with intermittent fasting including a reduced risk of chronic illnesses such as Cardiovascular Disease, Cancer, Type 2 Diabetes and Obesity. Additional benefits include higher levels of energy, cognitive sharpness, anti-aging and an optimized state of ketosis. There are a few different ways that you can go about doing intermittent fasting but the most common is setting a designated number of hours for eating and for fasting in one 24 hour day. Fasting adopters will try to fast for 12-16 hours, which includes the hours you are asleep and then only eating within an 8-12 hour window. Consider incorporating this fasting framework with or without a ketogenic diet to see if you experience any health benefits!
Comment below with any other questions or nutrition challenges that you’ve experienced with the ketogenic diet!
Contributors: Madeline McDonough and Brynn Scheinberg