Problem Solving a Ketogenic Diet

– I wanna take a little bit of timeto talk about troubleshooting problems that commonly occur on a ketogenic diet.The first problem that people have is that they just struggle with either having low energy after a few weeks, or longer, so they should be through the initial adaptation phase and they still don’t have energy or they can’t get their blood ketones up in a desirable range, that it is above .5 millimolar. The most common cause of that if people are holding their carbs in a restricted ranges that they’re eating too much protein. Now why would people eat too much protein?

A Keto Diet Problem Solving

Well, one thing is, many people refer to a low carbohydrate diet as a high protein diet, and that’s a mistake. People should think of this as a moderate protein, high fat diet, and the second is, that people have been taught to fear fat so much told that fat causes heart disease, eating fat makes us fat, blah, blah, blah, that they just have a very hard time putting that much fat on their plate and eating it.And besides, protein’s much more expensive than fat and so environmentally and financially getting your protein dose right, not too high, is important.

So what is the right amount of protein? Well when we map this out on a graph where we show carbohydrates on the vertical axis and protein on the horizontal axis if you look at the Standard American diet we eat about 50% of our calories as carbohydrate then a minority of our calories are going to be coming from fat. But when we switch to a well-formulated ketogenic diet where the carbohydrate intake is in the five to 10% range, if you hold protein in the moderate range of about 15%then clearly the majority of one’s calories have to come from fat. We cannot satisfy our need for energy by holding carbohydrates low, holding fats slowly, and then eating the rest as protein. Protein in moderation, and the majority of calories, they need to come from fat. Easy to say, but for many people, that’s hard to do. How would you do that in a practical way? Well this is a menu basically of what somebody my age, a male my height and weight would eat in a day. I’m a pretty high activity guy; my daily calorie need is in the range of 27 or 2,800 calories per day. For me, the majority of my calories, probably in the range of 75%, typically come from fat, and I do that by having, maybe, a high fat food for breakfast, some days.

Daily Ketos Dieting

it’s ham and cheese, some days it’s eggs. On a typical day it might be four modest size sausage links, that’s real sausage, not a processed meat that looks like sausage. For lunch I might have a couple cups of chopped green vegetables in a salad with six ounces of poultry, or meat, in this case, it would be a six ounces of water packed tuna. And again, we use water packed because we don’t want the fats that tuna is normally packed in when they pack it in oil that would be soybean oil, we don’t want that, and we’ll come back to that in a few minutes. And then to add the fat, I add black olives, I may add some cheese, and I’ll typically make a dressing, in this case. It might be a blue cheese dressing that has a lot of olive oil added to its it ends up being a high fat meal with very little carbohydrate. Snacks could be nuts in broth, nuts being a high fat food, or it could be a couple ounces of cheese spread on some vegetables, and then dinner might be a cream tomato soup made with homemade broth. A modest amount of meat, it could be steak, or pork, or fish, and then two servings of vegetables, both of which are cooked or prepared with fats, like buttered green beans and mushrooms sautéed with a little bit of garlic and olive oil.

Ketos Diets in Weight loss

And when one’s in maintenance, that is, you’re trying to eat as many calories as you’re burning, you can also add fat in the form of high fat desserts and one can make really delicious homemade ice cream with heavy cream and non-table sugar sweeteners, and there are varieties of those that could be used. And so this gives you the idea of the range of food someone can have, this looks like real meals, it’s all made with real food. The other point I make about this menus it looks like there’s a lot of protein in here but notice the portion sizes are quite modest for a male my size. But those could be replaced with more dairy fat, with more eggs, if someone is a lacto-ova vegetarian, or they can be replaced with tofu, nut butters, and other vegetable sources of protein if one wants to do this as a vegan. Doing this as a vegan is a little more challenging but it’s not impossible, and it certainly is healthy if in spite of having a history of being a vegan if you’ve developed type two diabetes this is certainly a reasonable option to achieve metabolic health. The second problem that is very common for people when they’re trying to make well-formulated ketogenic diet works they end up choosing the wrong kinds of fat. Normal common sense assumption that we’ve had for decades is that we should avoid saturated fats and eat healthy fats, including polyunsaturates.That concept is turned upside down when you go on a well-formulated ketogenic diet because the polyunsaturated fats that we get from vegetable oils that were thought to be good because they, quote, are essential fats, ignores the fact that when you eat too much of them they can cause harm. You’ve probably heard of the Omega-3 fats, the so-called fish oil fats, and Omega-6 fats.

Ketos Diet help in Fats burn

And it is true that we humans need little bit of each of that category metabolically every day to help construct healthy cells but they don’t make good fuel, this is not fat that your body likes to burn for energy. When you’re eating a high fat diet you naturally will get enough of the Omega-6seven if you avoid the high Omega-6 oils. You get your Omega-3s by having fish three times a week, or, if you don’t eat fish, then maybe supplementing with a fish oil capsule. If you over eat the polyunsaturated, particularly Omega-6 fats, what happens is, that it upsets a person’s stomach and digestive system and people just don’t feel well after they eat and I’ve had so many people tell me, “I’ve been following your diet for a couple months “but I can’t keep on it “because I just can’t tolerate eating all those fats. “And I say, “Well, what fats are you eating? “And they say, “The healthy ones, “I get the corn oil margarine, “and I get the soybean oil mayonnaise. “And I say, “No, no, that’s not what you need to do “when you’re on a high fat diet. “You need to get most of your fats from monounsaturated, and to some degree, from healthy sources of saturated fats. Soybean, corn, the older versions of safflower and sunflower, peanut oil, all are high in the Omega-6 polyunsaturatesand what you want to do is have…Choose fat sources and oil sources where the great majority of calories come from monounsaturated and saturates. Probably the ideal source of fat for the human diet is olive oil because that’s very high in monounsaturated, has relatively little in the polyunsaturated category.

But even if you look at lard, which is relatively high in saturates, but also equally high in monosaturates, and has a low polyunsaturated intake, again, an excellent fuel source for humans. You can say the same for beef fat, for butter, and for coconut oil, again, they’re higher in saturated fats and that causes some anxiety in people. But as we mentioned in the previous video when you’re fully keto-adapted, your body more than doubles its ability to burn fat for fuel and one of the first fats that goes into that energy fires saturated fats, they don’t accumulate in the body, and they don’t cause harm. Now one of the questions I get over and over, they say, “Well, Steve Piney, you’re a doctor, “you got a good income, and you can buy that fancy olive oil “but it’s too expensive, “most people can’t afford olive oil. “And I would like to give you a little simple example of why that’s not true, and that is, if you go do your big box grocery store where they sell stuff in big quantities you can buy olive oil in a big jug like this and this is good quality olive oil, I’m not going to tell you which company it comes from so I’m not showing you this side, but this is true olive oil, it’s not the extra virgin stuff which has very intense flavor, this is a more mild flavor stuff. And you want to guess how much 1,000 calories of this costs? 53 cents.

Easy Ketos Diet Plan

That if you pour out 1,000 calories of this and you mix it in, make it into dressings and stuff, that 1,000 calories in your diet, in one day, cost 53 cents, where else in the grocery store can you buy 1,000 calories for 53 cents? I mean this is really good energy at a very low price. The other point is, people say, “Well that amount would last me 10 years. “No, if I eat 500 calories of this a day this bottle is going to last me a little over a month. So, it’s not an expensive source of energy. I have this little bottle, and in this bottle, I can put 700 calories, and if I have a salad for lunch, and the dressing is suspect, I don’t know what fat they put in the dressing, I just squeeze in some lemon juice, pour some of this over the top, take it home, fill it up the next day. And then the other thing is, if you want to use fat for frying, and fried foods are really good, as long as you don’t batter dip them, a good source of frying fat is a high monounsaturated oil and again, you have to be sure this is a safflower based oil but you have to read the label, and look down here, and if it says mostly…If the…mostly unsaturated, relatively few polyunsaturated. This is both a good food for cooking, you know, ingredients in food, but also a good oil for frying, or you can use coconut oil for frying, and it’s not expensive, as long as you buy it wisely, strategically, in bulk. The next problem is, maybe, the most common difficulty that people have when they ‘retrying to deal with getting the pieces of a well-formulated ketogenic diet right and that is they feel light-headed, they feel dizzy, they have a headache, they try to exercise, and they feel just really bad and they stop exercising. And, frequently, they have constipation. If you go on the web and look this up it’ll tell you that you have the keto flu. Now I don’t like that name because it’s not flu, it’s not an infection.

Special Ketos

This is just a group of symptoms that occur when people are on a well-formulated ketogenic diet that they’re not eating enough salt. The reason why salt becomes a problem with a ketogenic diets that ketosis causes the kidneys to accelerate their excretion of salt. Now if you have…Retain salt, so you’re swollen, or if you have high blood pressure, and you get rid of that extra salt, that’s a good thing, but if you get rid of too much of it, it impairs your circulation, and you have this group of symptoms. If it inhibits exercise, and you feel lousy, you’re not going to continue to follow the diet. And so adding enough salt is the key to having basically a symptom-free experience. So the next question is, how much salt? And again, with the caveat, if you don’t have problems with high blood pressure or congestive heart failure where you have to take medicines for those problems, that number turns out to be five grams of sodium per day, that’s not five grams of salt, that’s five grams of sodium.

And the distinction is, salt has chloride as well as sodium and only 40% of the weight of the salt is sodium. So five grams of sodium per day translates to 12 grams of salt and that means about 2.5 level teaspoons of salt. Now do you have to spoon out almost…Yeah, 2.5 level tea spoons, and eat that every day? No, because, most people, when they eat a real food diet to satiety will eat about three grams of sodium per day. A place where that creeps into the diet in concentrated form is in dill pickles, in olives, in bacon, and other salty foods. So don’t avoid those, you can include them in moderation in your diet, and you’ll probably get about three grams of sodium per day from your diet. And then the way to get to our target of five grams per day is to add two cups of broth or bouillon. Don’t get the low sodium bouillon, get the regular one, this is about a gram. And if you make your own homemade broth and you add the proper amount of salt per the recipe, again, you’ll get about one gram per cup, and that’s not super salty, and it’s delicious, it’s…You can have it with cheese, or nuts, or something like that so it fits into your diet as a real food. So the question, then, is, you know,

if that avoids all these symptoms but it makes you die early from heart disease now what’s the rationale in that? You know, how can that be safe? In a study that was published a couple years ago at a highly reputable medical journal by a really good research team they looked at the salt intake and salt excretion from over 100,000 people from 17 different countries and then they followed them for almost four years to see how their health was maintained over the four years. In particular, they looked at whether they had a heart attack or whether people died, so the question is, at what level of sodium intake for these 17 different countries, at what level of sodium intake did they see the lowest mortality? The lowest point in the mortality curve here is at five grams of sodium per day. If you go down to the point of 2.3 grams, which is where the U.S. government says we should be eating sodium actually for that…those populations over in many different countries and different cultures, there’s a 50% increase in mortality if we were to follow those government guidelines. If you go the other direction you go much higher than five grams per day mortality goes up,

but much more slowly. Now these are people who live in cultures where they typically eat a lot of carbohydrate. If anything we would benefit from more rather than less but we find that five grams per day is plenty for most people to avoid all these symptoms but if they stay at three or go under that they’re going to have severe symptoms of fatigue, dizziness, constipation, things that we’d like to avoid and as a related some problem in that, again, if you go on the web, and you look at people’s complaints about the ketogenic diet you can find many, many bloggers who will tell you that if you stay on the ketogenic diet too long you will develop something called adrenal fatigue. Now that sounds like a medical diagnosis but nowhere in a medical textbook and nowhere in high quality scientific literature will you find this problem of adrenal fatigue as a diagnosis or as a problem of a ketogenic diet. What this adrenal fatigue refers toes the increasing symptoms that occur if people have this keto flu for weeks or months at a time. So if you follow a low carb diet and you stalwartly limit your salt intake you will have increasing fatigue and maybe even a drop in blood potassium levels and most of the bloggers will tell youth way to make it go away is eat carbs.

Well yeah, that’ll work, just, you know, you make the body stop excreting salt. The simple way is, give the body just enough sodium that it doesn’t have this problem with impaired circulation and that’s the secret to this, it’s not eating carbs, it’s avoiding sodium inadequacy. And again, salt is cheap, it’s harmless, if you don’t have hypertension or congestive heart failure. And the other important point is it has to be taken consistently. The salt you ate yesterday or the salt you ate last week isn’t going to help you today because the body doesn’t have big reserves of salt, you have to be consistent, so think of salt a little bit like you think of oxygen or breathing, you know, to have the right amount today, you got to consume it today, you can’t rely on what you had yesterday.

The next problem is a little bit more complex and that is, how do you manage the diet compositions you go from starting on a ketogenic diet where, frequently, people want to lose weight to progressing through the phases of a ketogenic distill they get to long term maintenance? And many people ask me, “Well, so, what should my macros be when I’m on your diet? “Well, macros means, how much of the macronutrients, what percent of carbohydrate, protein, and fat should I be eating? And I say, we don’t want to deal with macros because they’re going to change over the course of your progression on a well-formulated ketogenic diet. So when I started on a ketogenic diet and I was…Had gotten to a point where I had a fair amount of weight and a problem of high blood pressure to lose. And I ate to satiety, getting the right amount of protein, I was only eating about 14 or 1,500 calories a day but my body was burning twice that.

And the other half of those calories were coming from here but that didn’t show up on the macros on my plate. So my point is, the amount of protein you need from day to day doesn’t change, whether you’re in the initiation phase or when you’re in the maintenance phase or anything in between, and that should be in the range of 10 to 15%,at most 20%, of your daily energy expenditure. You want to keep carbohydrates at your personal level that keeps you in nutritional ketosis and that could be in the range of five to 10%and that probably won’t change much although when people lose a lot of weight and get rid of diabetes their tolerance for carbs may go up a bit, they can add a broader range of food, but not a lot of cabstand what changes as you go from the adaptation phase to maintenance phases to get to maintenance, eventually, you’re going to be eating a lot more your calories as fatso the macros will change but the protein and carb intake stays pretty constant and all you do is you adjust your fat intake just by your perceived need to achieve satiety, you adjust your fat intake to the point that you’re going away from your meals satiated and not feeling hungry until the next time it comes around to meal time.

The last problem I want to talk about is one that has cropped up in the last year or two and that is, it seems that on the web that people interested in the ketogenic dietary having a love affair with fasting and that fasting might be quote intermittent fasting or it might be prolonged periods of fasting and some people will recommend that if you want to lose weight and get your ketones high you might fast for a week or even a month. Now the human body is very well adapted to fasting from an evolutionary perspective as when…You know, people ran out of food and had to wait a week, or two, or a month till the next harvest, or the next successful hunt, being able to get by on body energy stores is a good idea. But the misunderstanding here is that when humans fast beyond one day they don’t just live on body fat they also break down muscle. And sometimes…And some people misrepresent the muscle loss as being minor but in reality, in the first month of total fasting, and even in the first week of total fasting, at least half of the weight loss that you see on the scale isn’t coming from body fat, it’s coming from lean tissue. This is not new information.

There’s been really top notch research done even 50 years ago that looked at the composition of weight loss with fasting. And this has been demonstrated over and over again this is not controversial information, there’s not solid data on the other side of the argument, but, for whatever reason, you know, people say, “Well fasting’s cheap and it’s easy, “so why don’t we just do it? “But the issue then is you lose lean tissue, and as we learned from The Biggest Loser Study, you know, the group of people that went on that TV show and did radical amounts of caloric restriction and exercise, attempting to lose huge amounts of weight, is when they came back and studied them five years later that extreme combination of exercise and fasting resulted in a permanent reduction in resting metabolic rate. So not only did they turn their thermostat down during the time of privation, years later, even after many of them have regained much of all their weight, they still have a depressed resting metabolism.

So, the solution for this, from our perspective, is doing go for short-term quick weight loss. Nutritional ketosis is by…In and of itself, an extremely powerful tool, and if you get the composition of your diet right with moderate protein, low cabman eating fat to satiety, and you get into nutritional ketosis, and you maintain that consistently so your body is not alarmed by a famine, you know, being caused by fasting, then that will give you the greatest benefit over a long period of time and that’s much more likely to be sustainable in the long term. The other reason not to go through prolonged fasting is pretty much anybody who’s done it for an extended period of time when they’re told, “Okay, you can eat now,

“there is a very strong propensity to binge on carbohydrates. And carbohydrate binging after fasting leads to, oftentimes, major episodes of fluid retention if you shut off the kidney’s salt excretion, and in some cases, it can lead to something calledRefeeding Syndrome, which can be fatal, and therefore, is something that we would advise people to be very careful to avoid. Again I want to emphasize that this is not just my opinion but this is data from many well-done studies, some of them going back as far as 50 years, and study after study demonstrates that, yes, weight loss was fasting as rapid, but, the cost in terms of losing lean tissue is too great for this to become something which is scientifically or medically defensible. I hope those answer some questions you might have and helps you avoid problems going forwards, thank you