Ketogenic Diet, Part 2

I was asked by a patient of mine who has had really amazing success with this lifestyle modification to do a post that has a bit more information about keto and my stance.

I had previously posted a very broad statement. As I told her, it’s hard when you’re doing a public blog to get across how open you are to whatever your patients are willing to do to get on the road to a healthier version of them.

So, she gave me permission to give you a glimpse of her story.

She approached me, wanting to lose weight, and wondering if I would oppose to her trying Keto. So many doctors immediately rebuke patients for wanting to try this lifestyle modification for differing reasons.

Some simply don’t know the data: keto has been shown to reduce insulin resistance, and if done appropriately can improve fatty liver disease, and lipid panels (cholesterol) over time. What we have seen with different diet modifications for weight loss is whatever you feel you can do consistently is something that will work for you.

Some have huge reservations about the amounts of meat: again, I say that we don’t have enough data. I do council my patient about the risk, but I also say that a patient that is going to continue to worsen their insulin resistance by continuing to eat meat AND high carb diet is likely harming themselves worse. I am willing to get behind a behavior that is an improvement in any direction. Additionally, there are ways to enter ketosis that would not necessarily be high in the animal products—in fact, you can be vegetarian or vegan, and be keto.  

So, anyway, I was completely supportive of her decision. I counseled her on the risks of eating too much bacon/butter—we know that studies show that these things are tied to heart disease, but there will also be some offset risk with significantly decreasing her intake of unhealthy carbohydrates—her body will process these fats differently, but she shouldn’t overdo it.

And SHE ROCKED IT!

She went, and she researched, and she became so much more knowledgeable than me about the lifestyle. She didn’t cheat. At 6 months, her cholesterol looked just as I expected, and it’s the other reason some docs freak out about this lifestyle—it was  WAYYYY up. But guys, this happens in weight loss outside of keto. Your body is breaking down fat, and it’s floating around, and I’m catching it before your body has had a chance to get balanced. In keto, we do see things go higher—because you’re eating way more fat than most, and your body is mobilizing fats like crazy. I expected that by 1 year, we were going to see things normalize.

And that’s exactly what happened. Her labs made my month! And her weight was down tremendously. And, of course, she was happier than I was—it was her life, her choice, her way! She hadn’t really cheated in the year, and I really do credit this to why I was seeing this level of success.

The safety of living in ketosis isn’t studied in trials long term (past 1 year) in mainstream medicine, so I always give my patients this information.  However, if a patient is willing to accept the risk for themselves, I am willing to engage in their journey in a non-judgmental way, and I get so much joy as I remove medications from medication profiles!

It has been 18 months, and she’s going strong. She’s added more unhealthy fats than I’m generally comfortable with (HELLO LARD!!), but she feels better and has more energy. Again, she’s drawing energy from fats, so this is new territory for me. And guess what!! Her cholesterol still looks amazing. Her weight is still decreasing. Her A1c looks great. She’s happy, and I’m happy.

She introduced me to a Houston Keto group on Facebook that has support and information for anyone interested in keto. Like any lifestyle modification, it requires LOTS of research. The more you know and prepare, the more likely you are to succeed. Like any lifestyle modification, it won’t be for everyone. But if you know you aren’t going to do vegan or vegetarian, moderation isn’t something you do well, and you are continuing to see your health decline, you need to do something. Keto is a reasonable option that I have seen work. Consider it!

Resources for Keto

(Disclaimer: I may or may not necessarily agree with everything that is written in these blogs or said on the videos, but these resources were recommended as helpful by people I know successful with keto)

Keto for Beginners

Keto Diet Food List

3 Keto Diets Explained

Dr. Ken Berry—What is the Ketogenic Diet

Ketogenic Diet

The ketogenic diet is essentially a very low carbohydrate diet. You cut your carbohydrates so low, that your body begins to burn fat for energy. NO, your body doesn’t NEED carbs. Our bodies are AMAZING and they have been designed such that they can adapt to the absence of carbohydrates by making the sugar our brain needs from fat or ketone bodies by a process called gluconeogenesis from lipolysis or ketolysis (please see figure below if you really want to get super scientific).

Ward, Colin. Metabolic pathways [internet]. 2016 Jan 19; Diapedia 5105765817 rev. no. 25. Available from: https://doi.org/10.14496/dia.5105765817.25

All that being said, as I tell my patients, I AM NOT a fan of the way it is marketed, as the diet where you can have all the bacon and butter you want. There are far too many studies that show us that these animal based saturated fats are unhealthy for us. Sure, if you have cut out all processed, refined carobohydrates and sugars, then you will tolerate more of these fats than the average individual. However, I tend to advise my patients who decide on this diet to choose healthier sources of fat as a go to.

The include: avocado and its oil, grapeseed oil, nuts and nut butters, salmon, olive oil.

Sure, it makes it less “fun,” but the goal is health, right?!

Keto has many benefits including immediate improvement in glucose control, because you are decreasing the very thing that increases sugars—carbs. However, if you are someone who is taking medications for your blood sugars, you should discuss how these medications should be adjusted before starting this type of diet. If you have a history of pancreatitis, liver disease, issues with fat metabolism, malabsorption—you should really consider another type of diet. Most people on this diet will need a multivitamin.

With most diets, you will see an increase in the cholesterol transiently when you begin, but with this one, you REALLY see the numbers increase, but they typically go down after a few months of dedicated lifestyle change. Also, people tend to find that in the first few weeks, they get what’s known as the “keto flu.” The biggest problem with this diet? People actually sticking to it long enough for me to see the benefit. People are typically doing the unhealthy version of this, and they are cheating too often for me to see the benefits actually come through. It generally takes 6-12 months of dedication, but if you stick to it, I see the results, physically, and metabolically. Also, while the short term safety has been shown for most, sticking to this diet hasn’t been shown to be safe past 24 months, so it’s generally recommended that after 12 months, you begin to transition to a more long term plan.

I don’t have any links for you guys, because I have yet to find recipes that I have deemed appropriate for long term use—again too much butter and bacon. But as I find them, I’ll try to link them for your use.

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