Challenges and Rewards of a Ketogenic Diet

SOURCE: Wellness Farmacy

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The Keto or Ketogenic diet has become popular lately but was invented in the 1920's. It was used for short term weight loss and the treatment of epilepsy. More recently it is being investigated as a treatment for a host of neurological disorders. This diet has been incorrectly labeled everything from re-branded paleo to atkins light but it has a unique place among other diets. I have been using the keto diet as part of a treatment for the neurological autoimmune disease, Multiple Sclerosis with excellent success. It is an extremely strict diet and is not for the feint of heart but offers many rewards. My inner geek loves that this diet is also a true bio-hack.  

Keto As a Bio-hack
There was a movie in the 80's called “The Abyss” that showed humans ingesting a gel called “Breathing Liquid” that stored oxygen and allowed them to breath under water. Keto is a similar type of hack, allowing your body to become more versatile in how it processes food.

• Genetic codes - Keto forces your body to activate a very old system of food processing that is generally turned off.
• Fat as energy - Once acclimated, your body starts to burn fat instead of glucose for energy
• Changing cell structure - Cells use fat to keep their shape, but since you are burning fat, your cells substitute water instead.
• Instant brain power - You can gain temporary brain power, will power and emotional control and processing speed by eating small amounts of fat.   

Some Advantages of Keto
A Ketogenic diet offers a host of blessings in weight loss, health, and neurological advantages.

• Enhanced brain power – We're not talking about becoming Professor X but improved memory and cognitive abilities have been reported.
• Increased density in mylin sheathing – When the brain sets a routine (think starting your computer with a password), it coats the nerves for that in mylin sheathing. The thicker that is, the more insulated and protected the process is. A denser mylin sheathing leads to faster and more accurate repetition of that process. 
• Say goodbye to “Hangry” - The brain needs fuel to regulate emotions. That fuel is normally glucose, which is inefficient. Fat is easier to get to the brain and works in smaller quantities.
• Fat is flavor – This is a diet that requires a high quantity of fat and every chef knows that fat is delicious.
• Fast Weight Loss – Most people start keto to lose weight and because it forces your body to use fat as fuel, the weight loss is very quickly noticeable.   
• Overcoming Fear
  There is a good bit of fear that comes with this diet. Despite its advantages, it is a very precise and difficult to manage course of treatment. At its best it requires extensive record keeping and diligence and if not treated with respect, it can be dangerous. It also calls for a complete re-calibration of a lifetime of nutrition advice.
  ​What am I supposed to eat?
  The keto diet can fill your mind with images of a plate full of fat trims, or bowls full of lard. That might be titillating in a cultural taboo kind of way, but they are not something most of us get excited about eating. Good news though. This is an area where keto can feel less like a diet and more like some kind of genetic loophole.
  ​What do I need to stay away from?
  So far this doesn't seem like such a hard diet, right? I mean, it involves cheese and bacon. What's the downside? There is a very popular food category missing from the above list and it is one of the most addictive food categories in the world. Carbohydrates are mostly forbidden on the ketogenic diet. Carbs break down into glucose, which is the standard fuel for our bodies. On the keto diet you change your body to use fat for this fuel, but if you keep feeding it carbs, it happily returns to its default and stops burning fat. You get to choose the fuel you burn but you can't do both. Carbs are everywhere and you will have to get very good at rooting them out. Where are carbs hiding in your pantry?
  Staying Safe
  It can't be overstated that this is not a diet for the lazy or undisciplined and that if you do it wrong, you could increase your risk of more serious conditions. If you have been unable to successfully lose weight because you couldn't resist a doughnut, this is not the diet for you. 
  My Kingdom For a Bowel Movement
  Fiber is king when it comes to staying regular and most fiber is found in foods with high starch or carbohydrates. Since those aren't part of the keto experience, a common complaint is constipation. Once acclimated to keto and when your macros are in order it is common to have only one bowel movement every few days. This is often not the epic movement you might expect after three days, but that is normal. The ketogenic diet makes your body more efficient and the foods you aren't eating are what cause much of the bulk waste in those movements. Your body will be running on better gas, so don't be alarmed if your parts don't get gunked up. Constipation is something to watch out for though, and there are several things that can be done to help make sure your new normal stays regular.
  Bonus Content
  When you have mastered the basics of a ketogenic diet and have your macros under control, you might want to start getting adventurous. Here are some hints that can help you feel like you are having a full culinary experience while you are in keto. Warning, if you try these before you get your macros and the basics under control, you are asking for trouble. ​
  A ketogenic diet is not for everybody and certainly no substitute for hard work and discipline. If you are willing to put in the effort, be careful, and treat it with the respect it deserves it can be the right choice for many people. It has certainly made a noticeable difference in treating my MS symptoms. I have also noticed an increase in mental and physical stamina. Dropping the extra weight I had been struggling with was a good bonus as well.
  • This is too much fat – We've been taught that fat is bad and one of the number one killers in this world. A ketogenic diet is a constant battle of nerves about cholesterol and heart disease.
  • Too much weight loss – 1 pound a week has been drilled into us as a healthy weight loss. When you are losing much more in a week it is easy to be worried that something is wrong.
  • Am I doing it correctly – It's often difficult to confirm you are doing the diet correctly. If you are not in ketosis and eating all of this fat your body could be in danger.
  • I'm not getting enough nutrients – getting your nutrients can sometimes require supplementation, the worst way to get your nutrients. If you are a purist, there can be very real concerns over whether your diet is balanced.
  • I'm not getting enough food – Fat fills you up much more than carbs and lasts longer. It can be weird to find yourself eating so much less food than you've eaten in the past and not feeling hungry.
  • Cheese and Dairy are full of fat – That's right, if you are in the 20% or so of Americans that are not sensitive to dairy, you have just been handed a free pass to eat the foods that doctors have been trying to get you off of for years. (Nutritional Therapist mandatory warning here: Dairy can cause and irritate inflammation so if you are dealing with health issues, this is not the fat you are looking for.)
  • Leafy Greens – Yes, even Kale has carbs, but leafy greens tend to be more nutrient dense than other vegetables and they lend themselves to being cooked with oils and fats.
  • Meat – The key with meat is getting small quantities that are high in fat, so bacon and prosciutto can be regular parts of your diet. Who doesn't like a diet that encourages bacon?
  • Fish – If you are a fish lover, you are in luck. The nutrients from especially deep water fish combined with the beneficial fats they provide make them a slam dunk for a Keto Diet.
  • Avocado – This excellent fat pulls double duty as a nutrient rich food as well and is very versatile. Did somebody say guacamole?
  • Eggs – High protein, high fat and no carbs make this a potent choice for this diet.
  • Mayonnaise – You either love or hate this and if you are in the group that loves it, this is your lucky day. Eggs and Oil, a fun combination of delicious fat and very few carbs.
  • Bone Broth - This is a great source for the minerals that your ketogenic diet might be lacking. It is also easy to prepare yourself or to find at stores. Use it to make soup or drink it it in the morning.
  • Fat Bombs – This little snack is a lifesaver. It is coconut oil, flavored with cacao and frozen. These little bon-bons are perfect for a couple hours of energy or brain power. If you are used to grazing all day, you'll be amazed how effective these are in keeping your hand out of the cookie jar. https://lastresortkitchen.wordpress.com/2018/01/08/almond-butter-fat-bombs/
  • Sugar – Where you find sugar, you will find carbs (like on a nutritional label. Start looking at those by the way)
  • Fruit – Fruits are basically sugar and fiber, so aside from occasional berries, you will be avoiding fruit on this diet.
  • Grains – Yup, I went there. I know you were thinking about deep frying all the things when we started talking about fat, but all of the coatings you are thinking about using are filled with carbs. If it includes a grain, say a fond farewell. (Fun fact, this is where some people get the idea that keto is a re-branded Paleo diet)
  • Corn – I know and you know that corn is a grain, not a vegetable, but this is a reminder for those other people, you know, the ones who aren't you.
  • Pastry – This goes with the above but you would be surprised how many people forget that pastry is made of sugar and grains. If you are going to do keto, be prepared to lose just about all of your delicious deserts.
  • Starchy Vegetables – Much like sugar, starch is an ugly step sister to carbohydrates. Some of them are super healthy, but not for your newly hacked body. Starchy vegetables can be identified as root vegetables or ones that tend to grow in colder climates. Bid adieu to your potatoes. If you need a minute to cry, go ahead and take it, I did.
  • All fats are not equal – Read your nutritional labels and try to use fats and oils that are derived from foods already in your diet. Your olive, avocado and coconut oils are vastly superior. You are looking for medium chain triglycerides (MCT's) in your oils.
  • Vegetables – You need vegetables in your diet, but remember that most of the traditional vegetables include a good bit of carbs. This is why you don't waste your carbs on the above foods. You need nutrient rich vegetables in your diet and they will consume most of your available carbs daily.
  • Food journaling is a must – It is imperative that you know everything that goes into your mouth and at minimum, the carbs/sugar, protein and fat content per serving.
  • Portion sizes are critical – You can't know what you are putting in your body if you don't know what a portion size is and what your portion was. On this diet, you are a scientist and your data points are everything. There is no such thing as free food. Even kale has an impact on your percentages.
  • Know your Macros – Your macros are one of the best tools for determining whether you are staying in keto or not. The percentages vary depending on your keto version, but you are aiming at between 70-90% fat, 7-20% protein and 3-10% carbs. There are many websites out there which track your food and calculate your macros. I use the free version of www.myfitnesspal.com
  • Calories still count – I've mentioned there is no free food. If you eat 3000 calories a day and burn nothing, you will still get fat on this diet. Your system will burn fat for energy, but if you aren't using any energy and have too much left at the end of each day, you will still store it and get fat.
  • Drink Water – You need water to live, but on a keto diet, the need for water is multiplied. Plan on drinking between 80 and 100 ounces of water a day. Remember, your body is using water instead of fat to keep the shape of its cells. This diet focuses on processing fat and that puts an extra strain on your urinary track, your kidneys, liver and gallbladder. Those need additional water to help the process along. Warning, people on this diet tend to get fewer minerals, so when drinking water, it is important not to guzzle or drink more than 100 ounces a day as that can flush the few minerals you get from your system. Drink water all day instead of trying to play catch up.
  • Ketone Urine Tests/Blood Tests – There are several lab and over the counter tests that can help you determine the presence of ketones in your system. These are most effective at the beginning of your journey and can become less accurate as you move forward. Use these to help you know that you have achieved ketosis but don't rely on them after having acclimated.   
  • Drink Water – it can't be overstated how much your system needs water and that is doubly true of your waste disposal. Not enough water means hard, lumpy bowel movements that can get stuck easily.
  • Poop Properly – Most members of the civilized world have forgotten how to properly relieve themselves. There is a lot of boring science behind why using a device like “squatty potty” in your bathroom will do you a world of good. It keeps your colon from pinching which makes it easier to have a successful movement and requires less effort. If you know you are going to have issues with constipation, give yourself an edge in the bathroom.
  • Eat avocados, nuts and dark leafy vegetables – These are your fiber champions for keto.
  • Avoid dairy – I know that's one of the bonuses of this diet (only if you aren't already sensitive to it) but if you are having issues with constipation, this is not your friend. Cut down or cut it out and find better, healthier fats.
  • Don't take a fiber supplement – These are full of carbs and will mess up your ketosis.
  • Coffee – This is a tricky balance. A little bit of coffee is a diuretic and can give you the winning edge in the bathroom, but too much of it will have the opposite effect. The name of the game here is sipping when needed.
  • Don't Panic – Stress makes it much more difficult to have a successful movement.
  • Breaded Foods – Using nut flours like coconut, almond and hazelnut, you can bread and fry your meats. This will have an impact on your carb counts, so it has to be taken into consideration but it makes for a fantastic change of pace that can leave you feeling less deprived.
  • Sweeteners – The best low carb sweetener I have found that doesn't leave me with an aftertaste and works well in baking is sweetened condensed coconut milk. It has three times fewer carbs than honey and is derived from one of the best keto foods there is, coconut.
  • Pastries – If you've proven you have the willpower and discipline to succeed at Keto, then you might have the discipline to enjoy some keto rewards. You can make cookies, cakes, brownies and other treats with combinations of your low carb sweetener and nut flours. They freeze well and you can plan your day's food to still maintain your macros. If have the discipline to have one or two a day only, then you can experience the glory of a warm chocolate chip cookie or brownie with whipped cream. Make sure you follow your recipes and know what the impact of each desert is on your day.
  • Crock Pots – Keto often means cooking fresh meals and that can be time consuming and costly. To combat this, make a crock pot a week of your favorite dish (curry, pulled chicken, soup, etc.) and have those meals portioned and on hand. This is also a great way to never get caught out without appropriate food.
• Enhanced brain power – We're not talking about becoming Professor X but improved memory and cognitive abilities have been reported.
• Increased density in mylin sheathing – When the brain sets a routine (think starting your computer with a password), it coats the nerves for that in mylin sheathing. The thicker that is, the more insulated and protected the process is. A denser mylin sheathing leads to faster and more accurate repetition of that process. 
• Say goodbye to “Hangry” - The brain needs fuel to regulate emotions. That fuel is normally glucose, which is inefficient. Fat is easier to get to the brain and works in smaller quantities.
• Fat is flavor – This is a diet that requires a high quantity of fat and every chef knows that fat is delicious.
• Fast Weight Loss – Most people start keto to lose weight and because it forces your body to use fat as fuel, the weight loss is very quickly noticeable.   
• Overcoming Fear
  There is a good bit of fear that comes with this diet. Despite its advantages, it is a very precise and difficult to manage course of treatment. At its best it requires extensive record keeping and diligence and if not treated with respect, it can be dangerous. It also calls for a complete re-calibration of a lifetime of nutrition advice.
  ​What am I supposed to eat?
  The keto diet can fill your mind with images of a plate full of fat trims, or bowls full of lard. That might be titillating in a cultural taboo kind of way, but they are not something most of us get excited about eating. Good news though. This is an area where keto can feel less like a diet and more like some kind of genetic loophole.
  ​What do I need to stay away from?
  So far this doesn't seem like such a hard diet, right? I mean, it involves cheese and bacon. What's the downside? There is a very popular food category missing from the above list and it is one of the most addictive food categories in the world. Carbohydrates are mostly forbidden on the ketogenic diet. Carbs break down into glucose, which is the standard fuel for our bodies. On the keto diet you change your body to use fat for this fuel, but if you keep feeding it carbs, it happily returns to its default and stops burning fat. You get to choose the fuel you burn but you can't do both. Carbs are everywhere and you will have to get very good at rooting them out. Where are carbs hiding in your pantry?
  Staying Safe
  It can't be overstated that this is not a diet for the lazy or undisciplined and that if you do it wrong, you could increase your risk of more serious conditions. If you have been unable to successfully lose weight because you couldn't resist a doughnut, this is not the diet for you. 
  My Kingdom For a Bowel Movement
  Fiber is king when it comes to staying regular and most fiber is found in foods with high starch or carbohydrates. Since those aren't part of the keto experience, a common complaint is constipation. Once acclimated to keto and when your macros are in order it is common to have only one bowel movement every few days. This is often not the epic movement you might expect after three days, but that is normal. The ketogenic diet makes your body more efficient and the foods you aren't eating are what cause much of the bulk waste in those movements. Your body will be running on better gas, so don't be alarmed if your parts don't get gunked up. Constipation is something to watch out for though, and there are several things that can be done to help make sure your new normal stays regular.
  Bonus Content
  When you have mastered the basics of a ketogenic diet and have your macros under control, you might want to start getting adventurous. Here are some hints that can help you feel like you are having a full culinary experience while you are in keto. Warning, if you try these before you get your macros and the basics under control, you are asking for trouble. ​
  A ketogenic diet is not for everybody and certainly no substitute for hard work and discipline. If you are willing to put in the effort, be careful, and treat it with the respect it deserves it can be the right choice for many people. It has certainly made a noticeable difference in treating my MS symptoms. I have also noticed an increase in mental and physical stamina. Dropping the extra weight I had been struggling with was a good bonus as well.
  • This is too much fat – We've been taught that fat is bad and one of the number one killers in this world. A ketogenic diet is a constant battle of nerves about cholesterol and heart disease.
  • Too much weight loss – 1 pound a week has been drilled into us as a healthy weight loss. When you are losing much more in a week it is easy to be worried that something is wrong.
  • Am I doing it correctly – It's often difficult to confirm you are doing the diet correctly. If you are not in ketosis and eating all of this fat your body could be in danger.
  • I'm not getting enough nutrients – getting your nutrients can sometimes require supplementation, the worst way to get your nutrients. If you are a purist, there can be very real concerns over whether your diet is balanced.
  • I'm not getting enough food – Fat fills you up much more than carbs and lasts longer. It can be weird to find yourself eating so much less food than you've eaten in the past and not feeling hungry.
  • Cheese and Dairy are full of fat – That's right, if you are in the 20% or so of Americans that are not sensitive to dairy, you have just been handed a free pass to eat the foods that doctors have been trying to get you off of for years. (Nutritional Therapist mandatory warning here: Dairy can cause and irritate inflammation so if you are dealing with health issues, this is not the fat you are looking for.)
  • Leafy Greens – Yes, even Kale has carbs, but leafy greens tend to be more nutrient dense than other vegetables and they lend themselves to being cooked with oils and fats.
  • Meat – The key with meat is getting small quantities that are high in fat, so bacon and prosciutto can be regular parts of your diet. Who doesn't like a diet that encourages bacon?
  • Fish – If you are a fish lover, you are in luck. The nutrients from especially deep water fish combined with the beneficial fats they provide make them a slam dunk for a Keto Diet.
  • Avocado – This excellent fat pulls double duty as a nutrient rich food as well and is very versatile. Did somebody say guacamole?
  • Eggs – High protein, high fat and no carbs make this a potent choice for this diet.
  • Mayonnaise – You either love or hate this and if you are in the group that loves it, this is your lucky day. Eggs and Oil, a fun combination of delicious fat and very few carbs.
  • Bone Broth - This is a great source for the minerals that your ketogenic diet might be lacking. It is also easy to prepare yourself or to find at stores. Use it to make soup or drink it it in the morning.
  • Fat Bombs – This little snack is a lifesaver. It is coconut oil, flavored with cacao and frozen. These little bon-bons are perfect for a couple hours of energy or brain power. If you are used to grazing all day, you'll be amazed how effective these are in keeping your hand out of the cookie jar. https://lastresortkitchen.wordpress.com/2018/01/08/almond-butter-fat-bombs/
  • Sugar – Where you find sugar, you will find carbs (like on a nutritional label. Start looking at those by the way)
  • Fruit – Fruits are basically sugar and fiber, so aside from occasional berries, you will be avoiding fruit on this diet.
  • Grains – Yup, I went there. I know you were thinking about deep frying all the things when we started talking about fat, but all of the coatings you are thinking about using are filled with carbs. If it includes a grain, say a fond farewell. (Fun fact, this is where some people get the idea that keto is a re-branded Paleo diet)
  • Corn – I know and you know that corn is a grain, not a vegetable, but this is a reminder for those other people, you know, the ones who aren't you.
  • Pastry – This goes with the above but you would be surprised how many people forget that pastry is made of sugar and grains. If you are going to do keto, be prepared to lose just about all of your delicious deserts.
  • Starchy Vegetables – Much like sugar, starch is an ugly step sister to carbohydrates. Some of them are super healthy, but not for your newly hacked body. Starchy vegetables can be identified as root vegetables or ones that tend to grow in colder climates. Bid adieu to your potatoes. If you need a minute to cry, go ahead and take it, I did.
  • All fats are not equal – Read your nutritional labels and try to use fats and oils that are derived from foods already in your diet. Your olive, avocado and coconut oils are vastly superior. You are looking for medium chain triglycerides (MCT's) in your oils.
  • Vegetables – You need vegetables in your diet, but remember that most of the traditional vegetables include a good bit of carbs. This is why you don't waste your carbs on the above foods. You need nutrient rich vegetables in your diet and they will consume most of your available carbs daily.
  • Food journaling is a must – It is imperative that you know everything that goes into your mouth and at minimum, the carbs/sugar, protein and fat content per serving.
  • Portion sizes are critical – You can't know what you are putting in your body if you don't know what a portion size is and what your portion was. On this diet, you are a scientist and your data points are everything. There is no such thing as free food. Even kale has an impact on your percentages.
  • Know your Macros – Your macros are one of the best tools for determining whether you are staying in keto or not. The percentages vary depending on your keto version, but you are aiming at between 70-90% fat, 7-20% protein and 3-10% carbs. There are many websites out there which track your food and calculate your macros. I use the free version of www.myfitnesspal.com
  • Calories still count – I've mentioned there is no free food. If you eat 3000 calories a day and burn nothing, you will still get fat on this diet. Your system will burn fat for energy, but if you aren't using any energy and have too much left at the end of each day, you will still store it and get fat.
  • Drink Water – You need water to live, but on a keto diet, the need for water is multiplied. Plan on drinking between 80 and 100 ounces of water a day. Remember, your body is using water instead of fat to keep the shape of its cells. This diet focuses on processing fat and that puts an extra strain on your urinary track, your kidneys, liver and gallbladder. Those need additional water to help the process along. Warning, people on this diet tend to get fewer minerals, so when drinking water, it is important not to guzzle or drink more than 100 ounces a day as that can flush the few minerals you get from your system. Drink water all day instead of trying to play catch up.
  • Ketone Urine Tests/Blood Tests – There are several lab and over the counter tests that can help you determine the presence of ketones in your system. These are most effective at the beginning of your journey and can become less accurate as you move forward. Use these to help you know that you have achieved ketosis but don't rely on them after having acclimated.   
  • Drink Water – it can't be overstated how much your system needs water and that is doubly true of your waste disposal. Not enough water means hard, lumpy bowel movements that can get stuck easily.
  • Poop Properly – Most members of the civilized world have forgotten how to properly relieve themselves. There is a lot of boring science behind why using a device like “squatty potty” in your bathroom will do you a world of good. It keeps your colon from pinching which makes it easier to have a successful movement and requires less effort. If you know you are going to have issues with constipation, give yourself an edge in the bathroom.
  • Eat avocados, nuts and dark leafy vegetables – These are your fiber champions for keto.
  • Avoid dairy – I know that's one of the bonuses of this diet (only if you aren't already sensitive to it) but if you are having issues with constipation, this is not your friend. Cut down or cut it out and find better, healthier fats.
  • Don't take a fiber supplement – These are full of carbs and will mess up your ketosis.
  • Coffee – This is a tricky balance. A little bit of coffee is a diuretic and can give you the winning edge in the bathroom, but too much of it will have the opposite effect. The name of the game here is sipping when needed.
  • Don't Panic – Stress makes it much more difficult to have a successful movement.
  • Breaded Foods – Using nut flours like coconut, almond and hazelnut, you can bread and fry your meats. This will have an impact on your carb counts, so it has to be taken into consideration but it makes for a fantastic change of pace that can leave you feeling less deprived.
  • Sweeteners – The best low carb sweetener I have found that doesn't leave me with an aftertaste and works well in baking is sweetened condensed coconut milk. It has three times fewer carbs than honey and is derived from one of the best keto foods there is, coconut.
  • Pastries – If you've proven you have the willpower and discipline to succeed at Keto, then you might have the discipline to enjoy some keto rewards. You can make cookies, cakes, brownies and other treats with combinations of your low carb sweetener and nut flours. They freeze well and you can plan your day's food to still maintain your macros. If have the discipline to have one or two a day only, then you can experience the glory of a warm chocolate chip cookie or brownie with whipped cream. Make sure you follow your recipes and know what the impact of each desert is on your day.
  • Crock Pots – Keto often means cooking fresh meals and that can be time consuming and costly. To combat this, make a crock pot a week of your favorite dish (curry, pulled chicken, soup, etc.) and have those meals portioned and on hand. This is also a great way to never get caught out without appropriate food.