Teaser Excerpt from The Paleo Approach: Ketogenic Diets

October 21, 2013 in Categories: , , , , , , by

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The Paleo Approach by Sarah BallantyneThere are many topics that I researched extensively for The Paleo Approach that I’ve been meaning to write about for the blog for ages. I have decided take some of these topics (especially the more blog-sized ones) and publish them as teaser excerpts for the book (also because I think this information should be here too).

This excerpt is from Chapter 5, the chapter that details exactly what to eat including comprehensive food lists. Chapter 5 also talks about a variety of food quality and safety topics as well as practical implementation topics like variety, where to source the best quality food, and both tips and priorities for tight budgets.

I’ve decided to break the section on macronutrient ratios into two teaser excerpts. The first excerpt discussed the optimal proportion of our diets that come from protein, fat and carbohydrates in more general terms and can be found HERE. This post specifically discusses ketogenic diets.  I’ve also included a relevant testimonial.

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There is a great deal of passion both for and against ketogenic diets. These very low-carbohydrate, moderate-protein, and high-fat diets were developed in the 1920s as a treatment for epilepsy that was not responding to other treatments. Ketogenic diets alter metabolism by increasing the level of ketone bodies in the blood while decreasing glucose, mimicking the biological changes caused by starvation. A proven therapy for epilepsy, short- to medium-term nutritional ketosis (from a few weeks to a few months) can be beneficial for a variety of neurological disorders, and those with autoimmune diseases that affect neural tissues may want to experiment with a ketogenic diet (in addition to my other recommendations). Ketogenic diets were beneficial in animal models of multiple sclerosis (no human studies have been done) and have decreased epileptic seizures even in children with both epilepsy and type 1 diabetes. However, evidence supporting the use of ketogenic diets in humans with neurological autoimmune diseases (or any autoimmune diseases, for that matter) is lacking.

In patients with rheumatoid arthritis, a short-term (seven-day) ketogenic diet did not reduce inflammation or any clinical or laboratory measures of disease activity, but a short-term fast did (see page ##). And while the ketogenic diet did result in lower blood-leptin levels, it did not decrease the numbers of total or activated T cells. Of significant concern, the ketogenic diet caused an increase in cortisol (see page ##). Also, nutritional ketosis (or even simply very high fat consumption in a single meal!) has been shown to decrease insulin sensitivity (see page ##). Following a ketogenic diet over the long term may cause nonalcoholic fatty liver disease (at least it does in mice). Furthermore, when vegetables are so strictly limited, you are missing out on some very valuable vitamins, minerals, antioxidants, and fiber.

Studies evaluating the effects of ketogenic diets are limited, and even more limited in the context of autoimmune disease. There just isn’t sufficient data suggesting that ketogenic diets, especially long-term ones, are beneficial or even safe for those with autoimmune disease. If anything, the arthritis studies indicate that nutritional ketosis may do more harm than good by raising cortisol levels.

Testimonial by Nataliya

“I have suffered from alopecia areata since the age of 15–so for 17 years now, with 4 major flare ups and also periods of 100% hair in between.  The first two flares were triggered by extreme stress and a high sugar diet during those weeks to emotionally cope with stress.

The most recent outburst happened very unexpectedly when I saw many female friends successfully losing weight with ketogenic  diets. I have always had problems eating too much protein–I am immediately constipated and have a heavy stomach.  Still, in the search for beauty, I tried after a strict nutritional ketosis protocol (20 grams of carbs and 5 small protein intense meals daily).  After only 5 days, I had the second worst flare of my life.  I had to help my digestion with enemas for those 5 days and only after going back to more vegetables, fruit etc. digestion regularized.  My hair was falling out for over 4 weeks after this diet.  It took me 6 painful months of clean eating, doing acupuncture & numerous hair masks & UV treatments to fill in the patches.

Interested in learning even more about The Paleo Approach? This video from my YouTube Channel is just a quick tour (the book is so big that giving you a broad overview takes 13 minutes!) but you get to see just how comprehensive and detailed this book is.

Excited about my book? You can support me by ordering here. Also check out the announcement of the companion cookbook to The Paleo Approach (aptly titled The Paleo Approach Cookbook) HERE!

Best of GraphicAnd don’t forget…

The Paleo Approach has been nominated as
*Most Anticipated New Paleo Book*
by Paleo Magazine!
Please support me by going HERE and voting for my book!

THANK YOU!

Citations

Afaghi, A., et al., Effect of low-glycemic load diet on changes in cardiovascular risk factors in poorly controlled diabetic patients, Indian J Endocrinol Metab. 2012 Nov;16(6):991-5

Badman, M.K., et al., A very low carbohydrate ketogenic diet improves glucose tolerance in ob/ob mice independently of weight loss, Am J Physiol Endocrinol Metab. 2009 November; 297(5): E1197–E1204

Brenta, G., Why Can Insulin Resistance Be a Natural Consequence of Thyroid Dysfunction?, J Thyroid Res. 2011; 2011: 152850

Chearskul, S., et al., Effect of weight loss and ketosis on postprandial cholecystokinin and free fatty acid concentrations, Am J Clin Nutr. 2008 May;87(5):1238-46

Dressler, A., et al., Type 1 diabetes and epilepsy: efficacy and safety of the ketogenic diet, Epilepsia. 2010 Jun;51(6):1086-9

Fraser, D.A., et al., Reduction in serum leptin and IGF-1 but preserved T-lymphocyte numbers and activation after a ketogenic diet in rheumatoid arthritis patients, Clin Exp Rheumatol. 2000 Mar-Apr;18(2):209-14

Fraser, D.A., et al., Serum levels of interleukin-6 and dehydroepiandrosterone sulphate in response to either fasting or a ketogenic diet in rheumatoid arthritis patients, Clin Exp Rheumatol. 2000 May-Jun;18(3):357-62

Ho, K.J., et al., Alaskan Arctic Eskimo: responses to a customary high fat diet, Am J Clin Nutr. 1972 Aug;25(8):737-45

Jennings, A.S., Regulation of hepatic triiodothyronine production in the streptozotocin-induced diabetic rat, Am J Physiol. 1984 Oct;247(4 Pt 1):E526-33

Kim do, Y., et al., Inflammation-mediated memory dysfunction and effects of a ketogenic diet in a murine model of multiple sclerosis, PLoS One. 2012;7(5):e35476

Lindeberg, S., et al., Determinants of serum triglycerides and high-density lipoprotein cholesterol in traditional Trobriand Islanders: the Kitava Study, Scand J Clin Lab Invest. 2003;63(3):175-80

McMillan-Price, J., et al., Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial, Arch Intern Med. 2006 Jul 24;166(14):1466-75

Reimer, R.A., et al., Satiety hormone and metabolomic response to an intermittent high energy diet differs in rats consuming long-term diets high in protein or prebiotic fiber, J Proteome Res. 2012 Aug 3;11(8):4065-74

Weigle, D.S., et al., A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations, Am J Clin Nutr. 2005 Jul;82(1):41-8

Hey, look which book is an Editor’s Pick on Amazon for October!!!!

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Comments

Hi Sarah,

Very interesting excerpt! Thank you for sharing it with us in advance of your book coming out. I had a few questions while reading it. During your description of nutritional ketosis you were very precise in describing it as low carb, high fat, and moderate protein. Coupling that with a general Paleo approach that would only include healthy fats would yield a very specific type of diet. I highly doubt that is what would have been attempted in the study you referenced in which inflation did not go down. I wouldn’t expect it to, if folks were still eating vegetable oils and other processed foods, right?

Also, in the testimonial, the person described her meals as all high protein, which is a big no-no for ketogenic diets. It’s a common misconception and leads many to issues. Also, does a ketogenic diet have to be low in veggies? My understanding is that if I keep my carbs to only non-starchy veggies (I avoid fruit and starchy veggies like sweet potatoes) and avoid overdoing the protein, and eat plenty of healthy fat, I can eat them to satiety without kicking me out of ketosis.

Lastly, ketogenic diets tend to really dial down one’s appetite. Can a general lack of calories (as opposed to carbs, per se) be what causes some of the problems people notice when attempting this way of eating? I am trying to reconcile what I’m reading with my own experience, which has been almost every type of Paleo, from ketogenic to more of a Perfect Health Diet approach. My experience is that the lower I keep my carbs, the better I feel – hunger goes down, hormonal issues disappear, and my energy level goes up. Could this just be differences between individuals, differences in the way these dietary approaches are implemented, or some combination of both?

I always say if it works for you, you should stick with it. But there are some recurring problems with long-term ketogenic diets, like depressed thyroid function (which reduces testosterone, estrogen and progesterone), leptin and insulin resistance, and micronutrient deficiencies as well as increased risk of liver problems. Yes, there might be a way to implement a ketogenic diet that gets around these risks (maybe like the 50g/day carbs protocol in the Perfect Health Diet coupled with lots of supplements), but mostly what I see is some specific conditions (all neurological) where short term ketogenic diets are very powerful and no good rationale for their use beyond a few months in just about any circumstance (in refractory epilepsy, ketosis is usually implemented for 2 years).

I’ve read his page about the discussion about how much carb to include in one’s diet with the author or authors of The Perfect Health Diet. What’s there is convincing enough that for maximal life span goal, limiting carbs to a minimum shoud be used and that any level of carbs does some harm inside the body.

Thanks for sharing this bit about ketogenic diets in advance of your book. I’ve read a lot about them, but still am not quite sure that I understand exactly how they work. I’ve had good luck with the paleo diet thus far, and am going to stick to it but that doest stop me from being curious about the ketogenic diet.
I’m looking forward to checking out the book when it gets back from the printer!

Great stuff – can’t wait for the book! Quick copy editing comment – I believe the word ‘friends’ is misspelled as ‘fiends’ in the first line of the 2nd paragraph of the testimonial. I know you want it to be perfect (I’ve heard you talking about it on your podcast) for print. Not something a spelling or grammar checker would catch.

Hey Sarah, looking forward to the book! Regarding NAFLD, I’m curious what your thoughts are on these studies:

The effect of a low-carbohydrate, ketogenic diet on nonalcoholic fatty liver disease: a pilot study.
http://www.ncbi.nlm.nih.gov/pubmed/17219068

The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study.
http://www.ncbi.nlm.nih.gov/pubmed/21688989

Enjoyed this post a lot, looks like it will be a very well researched and cited book, like a “Perfect Health Diet” for autoimmunity.

Those studies are compelling. It would be nice to see their ketogenic diet head-to-head against low carb (but not ketogenic), paleo (which could be low and moderate carb), Mediterranean diet, etc. as well as measure how much of the liver regeneration is due to a ketogenic diet versus simple weight loss.

I think the discussion with ketogenic diets is very different if you’re talking about short term versus long term, and it’s very different depending oon the health of the person doing it and the goal. The mouse studies show that the long term detriment to the livers (the studies were much longer in terms of percent lifespan than the human studies) is also related to nutritional deficiencies (http://www.ncbi.nlm.nih.gov/pubmed/24009777) (the double whammy of the ketogenic diet and choline deficiency).

You’ve probably already figured out that I’m a big fan of nutrient density. What really makes me nervous about long term ketogenic diets is the difficulty in obtaining some very key essential nutrients. I like Perfect Health Diet’s way of doing it with 50g of carbs a day instead of 25g, just because that means quite a lot more vegetables, but even then, I’m worried about the long term effects of diet that is so low in vegetables (especially in light of all the recent research I’ve been doing on fiber). And, as I mentioned above, the evidence for benefit in autoimmune disease is completely lacking.

That being said, I’m also a huge fan of self experimentation and I would never tell someone that what they are doing is wrong if they are trying it and finding that it works for them. But, I think the research with ketogenic diets is very mixed and the bugs haven’t been worked out enough for me to recommend it over a low or moderate carb paleo diet.

As Amelia, I am follow a nutrient dense ketogenic diet and my experience is very different from what you write. I don’t think there is a problem with nutrition density if you include egg yolks, organ meats, fermented vegetables, bone broth, non-starchy vegetables and berries (none of these things have to be excluded on a ketogenic diet). You can add quite a lot of vegetables if you avoid fruit and starchy vegetables, getting those fibres and micronutriens. I also think a one week study is far too short to say anything about the long term effects on hormones etc since it takes up to a month for the body to adjust to ketones as fuel. I know a lot of people that follow a ketonic diet, and have been for several years (up to ten years), and their experiences are very different concerning overall health. So in this case I feel that the very limited science concerning this topic doesn’t go with my experience.

I went WAPF style paleo in 2004. Then I followed a ketogenic diet pretty closely for about 5 years starting in 2009, with some “cheats” off and on. I did limit plant foods at the beginning of that stint, but then added more back to about 6-10% energy from total carb. I ate homemade wild and cultured ferments throughout (twice weekly minimum), beef and chicken stocks based soups (twice weekly minimum), liver, heart, shellfish, eggs and other nutrient dense animal foods, and I focused on non starchy veg with nonsweet botanical fruits (like olives, avocados, etc). I allowed some small amounts of properly prepared legumes maybe once or twice a week max. I stayed in ketosis most of the time as I am highly active. My eyes and skin became dry recently. Fortunately some others on my forum who were very strict let me know that this could be related to a long term ketogenic diet. PHD website said as much. I now have what seems to be increased sensitivity to some foods (nightshades especially), and even had a full blown allergic reaction (first in my life) to erythritol (a sugar alcohol I tried in sugar free chocolates on Valentine’s Day 2014). So I added in some more starchy plants like carrots, winter squash, fruit, more lentils and beans (which I may rethink after I read more of the work here) and got rid of nightshades. So I would say that although very low carb might be therapeutic and may even seem ok for awhile, it may not be best for health long term. 15%+ or more energy from carbs, and some of those containing some starches is probably a good idea, ime.

Very thankful for the info here (especially nightshade and leaky gut). Look forward to reading the book which my NTP friend recommended. Cheers!

“Following a ketogenic diet over the long term may cause nonalcoholic fatty liver disease (at least it does in mice).”
That’s because a) the mouse keto diet is too low in choline and biotin for the demands on these nutrients (some infant formulas are similarly flawed), b) if a keto diet is restricted in protein this amplifies any deficiency of choline (the choline methionine deficient diet, MCD, is the standard animal model of fatty liver disease). Luckily most people like eggs – in any case a whole food diet that includes animal fats isn’t going to be deficient in choline, but an infant formula could be.
Ketogenic diets are used to clear fatty liver in humans preparing for surgery.

But some of us with autoimmune problems have trouble eating eggs. I can’t eat eggs on a keto diet unfortunately, as much as I would love to.

Hi Paleomom, I onder if you can help me. I have been trying a ketogenic diet for about a month now, and while it has had many benefits for me, there have been downsides too. My depression is getting worse, my sleep is very poor and my anxiety and stress levels have increased. I have also had another problem which has been slight yellowing of my hands, especially when I press into them. Could this be a liver problem? Maybe I have been overdoing the fat? My fingers also get very puffy and red at times.

I would like to transition back to a regular low carb way of eating that includes vegetables but I have so many sensitivities I am quite frightened to change things. I seem to do ok with vegetables like broccoli, cauliflower and courgettes in small amounts, but starchy or sugary veg like squash and carrots throw me out of ketosis and make me feel bad, and onions and garlic make me feel unwell too (possibly FODMAPS?).
I begin to wonder if ketosis has reduced my good bacteria and thus causing me more digestive problems.

This might not be the answer you want to hear, but I think you should get out of ketosis asap. All of those problems you mention could be serious and I would also recommend discussing all of this with a doctor.

Thankyou for your reply. I will be seeing my doctor for sure, but must admit I don’t really want to go back to higher carbs.

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