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Ketogenic Diet Q&A

Ketogenic Diet

Which sweeteners are best on ketogenic diet?

One key to the longevity of a ketogenic diet is to incorporate foods that are satisfying. If individuals choose to make keto-friendly desserts, learning which sweeteners permit one to remain in a ketogenic state is essential. Ideally, we encourage natural sweeteners like Stevia, monk fruit, erythritol, and allulose in moderate amounts.

How important are strict ketogenic macronutrient ratios?

Depending on an individual’s current metabolic state, activity levels, and goals, macronutrient profiles will vary among individuals. In general, we recommend that a beginner adopts a macronutrient ratio around 70/25/5 (fat/protein/carbohydrate) and then customize from there. For more help, check out our Keto Calculator.

Can I have too much fat?

Yes. Calories are still of importance, even on a ketogenic diet. Simply eating unlimited fat will not guarantee results.

What do I do if I hit a plateau with fat loss?

Hitting a plateau on a ketogenic diet is possible regardless of one’s goal. Below are actions to consider taking to continue losing fat:

  • Track macros
  • Check calorie consumption
  • Weigh food
  • Alter meal frequency
  • Implement a fasting period
  • Ensure adequate sleep
  • Include exercise
  • Determine food sensitivity by testing blood glucose responses

Can I have fruit?

Some fruits, such as berries, have a low glycemic index and are also lower in carbohydrates. If incorporating berries, try and opt for the fresh, organic, frozen berries. Don’t forget: avocados are the best fruit out there and well suitable for a ketogenic diet.

Can I have dairy?

As with other customized properties of the diet, the consumption of dairy is individualized. If digestive or glycemic problems develop due to the lactose and casein in dairy, then dairy may need to be avoided. If you can tolerate it, opt for lower carbohydrate dairy like cheese, heavy whipping cream, and butter, rather than higher carbohydrate products like milk.

Can I have coffee?

Yes! In fact, caffeine may increase endogenous ketone production. However, as usual, be careful about consuming caffeine late in the afternoon, as it may affect your sleep.

Do I need to exercise to see results?

Not necessarily. Positive results can be seen on the ketogenic diet without exercise; however, exercise will maximize the benefits of the diet. In addition, exercise may help accelerate the adaptation process and allow your body to utilize ketones better.

Can I have as much protein as I want?

Tracking protein is important for anyone who has adopted a ketogenic diet. Depending on activity level and other metabolic factors, some individuals may be able to tolerate more protein. As mentioned above, at a certain level protein can be glucogenic; so tailor it to your needs. However, we would say to lean towards more, not less, especially for older individuals trying to preserve muscle mass.

Should I track “net” or total carbs? suggests tracking total carbohydrates (fiber + non-fiber carbohydrates) in the initial stages of “keto-adaptation;” however, once adapted, one may be able to track “net” carbs (non-fiber carbohydrates – fiber).

Are there fats I should avoid?

Not all fats are created equal! Omega-6 fatty acids, as well as “trans” fatty acids, should be limited or completely avoided if possible. Rather, one should focus on a diet rich in Omega-3 fatty acids, which have anti-inflammatory properties. Make sure you are limiting vegetable oils!

What are medium-chain triglycerides (MCT)?

MCTs are fatty acids that are structurally shorter than long-chain triglycerides, which require processing from the gallbladder. As such, MCTs are rapidly digested and directly used for energy, with a lower propensity for fat storage. These fats are a staple on the ketogenic diet, in which they can be converted to ketones!

Will I be hungry?

At first, you may experience intense hunger; however, if your diet is well formulated, hunger tends to subside once your ketones become elevated and your blood glucose stabilizes.

What are exogenous ketones?

Exogenous ketones are molecules that, upon consumption, behave similarly to the endogenous ketones that the body produces due to carbohydrate restriction.

Will I lose muscle?

Among the many benefits of being in a ketogenic state is muscle preservation. Research has demonstrated that ketones prevent muscle catabolism. Furthermore, muscle anabolism may actually occur once “keto-adapted.” For these reasons alone, the ketogenic diet still would allow you to maintain or increase muscle mass.

What is fat-fasting?

Fat-fasting is the consumption of only the macronutrient “fat” during the fasting period. An example is drinking coffee all day, with fats like heavy whipping cream, butter, or coconut oil added in. Some research has shown that since this doesn’t increase insulin, it mimics a fasting state.

What is fasting?

By definition, fasting is the absence of caloric consumption for a distinct period of time. There are several different fasting strategies: intermittent, alternate day, and even several days.

Should I implement a carbohydrate refeed?

A carbohydrate refeed is not necessary on a ketogenic diet, as the keto-adapted biological and metabolic changes do not require dietary carbohydrates. There are certain circumstances, however, in which an increase in small carbohydrate influx may be beneficial; however, more research is needed on this topic, specifically with respect to variations of ketogenic diet including “cyclic” and “targeted” ketogenic diets.

Do I have to count calories?

Restricting your calories may be important for some individuals depending on their goals. Additionally, it may aid in the initiation of ketosis; however, not everyone will require calorie tracking to maintain a deficit. It is not uncommon for caloric-restriction to occur inadvertently as a ketogenic diet tends to be satiating, leaving individuals satisfied with fewer calories.

Can I have alcohol?

Certain alcohols, in moderation, may be well tolerated by some individuals. An example of a ketogenic-friendly red wine is Dry Farm Wines. Also, low carbohydrate beers may permit certain individuals to remain in a ketogenic state. Be sure to avoid sugary liquors and beer as well as sugar-laden mixers.

Do I have to stay keto forever?

Though it’s possible, studies have shown that once you are adapted, you could transition to eating low carb for a few days/weeks before going back to strict keto. However, it is important to understand that this flexibility should come after you are adapted and not just in the beginning.

What happens if I fall off the diet?

If you “slip up” on a ketogenic diet, it is not the end-of-the-world nor does it mean you should continue to be off the wagon. Unfortunately, having frequent “slip-ups” or “cheat days” may prevent you from becoming “keto-adapted.” However, an occasional “slip-up” for someone who is already “keto-adapted” may not be as detrimental. Get back on track and get back in your routine. Find support groups and alternative recipes to avoid these pitfalls and setbacks.

Can including a non-keto, higher-carb day at least once a month replenish flora in the gut micro-biome?

This is not necessary, as it is possible to have a healthy gut microbiome on a ketogenic diet. Including low-carbohydrate vegetables, small amounts of garlic and onions, fiber extract called “inulin,” fermented foods, and aged cheeses like cottage and Cheddar all help to promote a healthy microbiome. Also, eliminating trans fats and switching some meat protein for dairy protein (i.e., whey protein) will also promote a healthy microbiome.

How can keto help with Polycystic ovary syndrome (PCOS)?

Insulin resistance and weight gain, two serious health issues associated with PCOS, are typically improved by the incorporation of a very-low-carbohydrate ketogenic diet. Studies have also shown that women with PCOS following a very-low-carbohydrate ketogenic diet reduced circulating testosterone levels and improved their luteinizing hormone/follicle stimulating hormone ratio. Improvements in insulin resistance and hormone balance as well as weight loss may help reduce other symptoms of PCOS such as normalizing menstrual cycles, reducing excess body/facial hair growth, and reducing the risk for type 2 diabetes, dyslipidemia, and depression.

How do I break through weight-loss stalls and plateaus on my ketogenic diet?

Try intermittent fasting, varying your exercise regimen, and/or cleaning up your ketogenic diet. A common intermittent fast is to fast and consume only water for 16 hours and then consume your calories over the following 8-hour window. Some people opt to skip breakfast while others skip dinner. I personally find that skipping dinner helps me slim down more than skipping breakfast. I would try both to see what works best for you.

Also, if you have a typical exercise routine, try to vary it by adding more intense training. Or, if you already train at high intensities, try adding a lower-intensity day. If exercise is not included in your day, start with adding in 30-minute walks.

Last, take note of what you are including in your ketogenic diet. Search for areas that may be deterring ketosis and fat breakdown. This may be achieved by reducing or varying carbohydrate intake. For instance, sugar alcohols are typically not included in net carbohydrate intake. However, some sugar alcohols do raise blood sugar levels, which could hinder ketosis. If you are consuming high amounts of sugar alcohols, try reducing that content to determine if that may be the culprit attenuating your fat loss.

Are there any special blood tests that I should ask my doctor about? I have heard that there may be a better test for cholesterol than the standard lipid panel.

An NMR lipoprofile is a cholesterol test that is more revealing than a general cholesterol test. General cholesterol tests will only measure total cholesterol. An NMR lipoprofile will tell you not only HDL (high-density lipoprotein, or “good cholesterol”) and LDL (low-density lipoprotein, or “bad cholesterol”) levels, but also particle size and concentration of those lipoproteins, the size of which can be vital and substantial in contributing to understanding your heart health rather than knowing only your total cholesterol number.

While on an extended fast, can I have electrolytes? What will and what won’t break a fast?

Electrolytes (sodium, magnesium, and potassium) are needed on an extended fast and will not break a fast. There are mineral-containing supplements that can be added to water.  If you feel dizzy or fatigued during the fast, it is probably a sign that you need more electrolytes. You should consume more than the recommended daily amount during a fast. I would listen to your body while fasting; if you feel dizzy, tired, an elevated heart rate, muscle cramps, thirst, or headaches, then those are signs that electrolyte levels may be low. Typically, unsweetened water (with a little lemon, mint, and/or carbonation), coffee, and tea are allowed on a fast.

Does keto help individuals with ADHD?

It is possible that a ketogenic diet can help with ADHD according to research. A 2001 study at Johns Hopkins Hospital examined behavior in children with difficult-to-control seizures. They were placed on a ketogenic diet for one year, and behavior was observed before and after the diet. The children showed significant behavioral improvements in attention span and social functioning. This may benefit individuals with ADHD, as most have impairments in attention span and also experience social difficulties.

What happens to our bodies if too much fat is consumed on a ketogenic diet?

It is difficult to consume a lot of fat when it is not paired with carbohydrates, thus the ketogenic diet typically leads to a suppression in appetite and regulates hunger. However, some individuals may overly enjoy the amazing snacks such as fat bombs and great-tasting keto meals, which may lead them to consume too many calories from fat. If an excessive amount of calories is consumed by a non-athlete, fat-loss will not occur. An individual can gain fat mass on a ketogenic diet if too much fat is consumed. Also, just like a typical diet, excessive calorie intake may lead to metabolic issues as well. A way to ensure too much fat isn’t consumed is to reduce carbohydrate intake, including sugar alcohols; the sweet taste from sugar alcohols paired with fat may cause an individual to consume past satiety. Appetite is the psychological (mental) desire for food, whereas hunger is the physiological (body’s) need for food. Some individuals enjoy a ketogenic diet so much that hunger may be suppressed, but appetite may drive an over-consumption of calories. Therefore, determine what is driving your appetite for the over-consumption of fat and try to re-formulate your ketogenic diet a bit. Lastly, you may be missing a specific nutrient, driving you to consume too much fat. For instance, sometimes we overeat when we are dehydrated. Therefore, it is important to stay hydrated and replenish electrolytes on a ketogenic diet.

What effect does caffeine have on ketosis?

Caffeine probably does not affect ketosis. Research on the direct effects has not been conducted as of yet. However, it is plausible that caffeine may acutely increase ketones due to the enhanced fat breakdown that may occur after taking caffeine. Also, large doses of caffeine may cause hypoglycemia (low blood sugar), so if you are feeling fatigued after consuming caffeine, you may want to consider lowering the caffeine dose.

What are the effects of ketones on blood pressure?

Studies have shown a reduction in systolic blood pressure when using exogenous ketone salts. Also, markers and conditions related to high blood pressure improve with a ketogenic diet, including total cholesterol, HDL (good) cholesterol, and triglyceride levels, positively impacting type 2 diabetes and obesity.

How can you gain weight on a keto diet?

To gain weight on a ketogenic diet, eat plenty of calories and do not fast for prolonged periods. The ketogenic diet tends to suppress appetite; with that in mind, be sure to include plenty of fat and protein regularly into your daily diet. Also, a well-formulated ketogenic diet regulates body composition as it reduces fat mass and spares muscle protein. Increasing muscle protein will promote proper weight gain on a ketogenic diet. In addition to the protein-sparing nature of ketones, building muscle can be stimulated through strength training with appropriate protein-nutrient timing strategies. Also, well-researched, more affordable supplements such as creatine, whey protein, and BCAAs (branched-chain amino acids) may help promote weight gain through muscle building.

How much do ketone levels vary in a day?

Levels can fluctuate greatly based on several factors including your diet today, your diet yesterday, and whether you are currently in a fasted state (or plan to be today). For example, if you eat more fat and less carbohydrates than normal, you may see a larger increase in ketone body levels. Or, if you have been on a prolonged fast and eat a normal meal, you may see these numbers decrease more than usual. Ketone levels will typically be higher in the morning and lower at night. If they are staying above 0.3 mmol, which usually suggests a state of ketosis, there is no need for concern.