What Is A Ketogenic Diet?

I’m going to jump into the fray. What is a Ketogenic Diet? What is a Paleolithic Diet? What is a Low Glycemic Index Diet? How do the Atkins and the Modified Atkins Diets differ? Which diet do I choose?

I’m writing a series of posts to answer my own questions. I lost weight using a Ketogenic Diet, and I’m a fan. However, I want to refine my diet to improve my general health. I need to go deeper to make the right choice. If you’re asking the same questions and are equally confused, read on. I’ll give my best shot at answering the first question. How do these diets compare?

My Bias

Let me make my bias clear from the get-go. I come from a scientific background, and I believe that the scientific method provides the best information upon which to base a decision about the health and weight loss benefits of various diets. I’ll only discuss diets which are being actively studied to determine their health benefits.

When researching Low Carbohydrate Diets on the internet, you’ll see a mixture of terms. You’ll see terms used by scientists in peer reviewed journals. Some of these are Low Glycemic Diet or the Atkins Diet, the Classic Ketogenic Diet, and the Modified Atkins Diet. Then there are the made-up terms on the internet such as High Protein Ketogenic Diet, Cyclic Ketogenic Diet, Targeted Ketogenic Diet, etc. I won’t cover these.

See my credentials here. https://carbohydrateconfessions.com/about/

Macronutrients Versus Micronutrients

We’re going to compare the scientifically important diets based on their macronutrient composition. By this I mean the amounts of carbohydrates, fats, and proteins, etc. which make up the diet.

Understanding the macronutrients in each diet is just the beginning. Your final diet choice will hinge on micronutrients– the type of carbohydrate, the quality of protein, and the type of fat. We’ll look at micronutrients in another post or two or three.

Understanding Weights

Unfortunately, it’s hard to translate scientific Ketogenic Diet standards into practice for two reasons. First, scientists have yet to agree upon what is meant by a Ketogenic Diet. In recent research, scientists seem to have settled on the Atkins, the Modified Atkins, and the Classic Ketogenic Diet. The second problem is units of measure. For us in the United States, we think in ounces not grams, but scientists think in grams, not ounces.

We must convert grams into ounces. To convert ounces to grams, use this formula. Ounces = grams multiplied by 0.035374. So 15 grams of carbohydrates is equivalent to .53 ounce or about ½ ounce. This calculation is a bit of a pain, so you can use this website https://www.metric-conversions.org/weight/grams-to-ounces.html

What Scientists Measure

Making life even more fun, the diets are presented in scientific journals as grams per kilogram of body weight. The metric scale is the standard used in most international journals. You can use the website above to convert your body weight from pounds to kilograms. If you weigh 215 pounds that converts to 97 kilograms. Carbohydrates, when limited as they are in the Atkins Diet, are usually presented in absolute terms. If the diet says 20 grams, this means 20 grams total not 20 grams per kilogram of body weight or 20 grams at each meal.

Proteins and fats, on the other hand, are calculated based on your ideal weight in kilograms. If you’re a larger person, you can eat more of these foods than can a smaller framed person.

If you’re already feeling annoyed and ready to switch to another website, be consoled. You only must do the body weight calculation once. Calculate your desired weight into kilograms when deciding on the amount of protein and fat to eat at each meal.

The Twentieth Century Food Pyramid Failed Me and It Will Fail You

Choosing a diet used to be easy. In the good old days of the previous century, we were told that eating a balanced diet composed of proteins, carbohydrates, and fats while counting our calories was the best choice. Hidden within this diet, however, was a bias toward eating carbohydrates and avoiding fats of all kinds. Fats had become “the enemy”.

U. S. Department of Agriculture Food Pyramid used to illustrate the high proportion of carbohydrates which are bad for our health.

I believed in the government’s food pyramid. The food pyramid shown here is the official government version from the U. S. Department of Agriculture. The food pyramid has been replaced with plates, but the idea is the same. At the bottom of the pyramid, we find carbohydrates. Above the carbohydrates we find fruits and vegetables. Above this, we see milk products and protein. Finally, at the top of the pyramid are fats from oils, foods, and seeds.

Who Do You Trust To Tell You About Diet And Health?

I believed in this fictional pyramid because I’m a trusting person. I trusted government policy makers to be working in my best interests. I should also note that I believed in Santa Claus for years longer than my friends.

I learned how misplaced my trust and faith had been when I developed a weight issue a few years ago. I turned to the experts I trusted. I followed the diet endorsed by the American Heart Association, over and over again. I avoided those nasty fats, and I ate every manner of carbohydrate. Carbohydrates were good for me or there wouldn’t have been so many of them on the food pyramid. I didn’t think of fruits as carbohydrates, so I ate large quantities of fruit and slurped down fruit juice. I had a vague sense that eating too much sugar was a bad idea, so I purchased low sugar fruit juice.

What Happened To My Weight?

What happened to my weight? I’d lose a few pounds only to put them back on. Also, the weight loss process was miserable for the first two weeks. My head hurt, my stomach growled all night, and I was crabby, crabby, crabby.

Totally adrift, confused, and carrying my excess pounds about like an unwanted anchor, I found a diet center which recommended a modified Ketogenic Diet. I didn’t trust them. They wanted me to eat sausage and bacon. That was when the miraculous transformation of my body began. The pounds disappeared without pain or discomfort. How was this possible? How could I eat sausage and eggs for breakfast and lose weight? Certainly, there must be a trick or a hidden pitfall.

Getting Your Terms Straight

To sail on the sea of information about ketogenic diets and related low carbohydrate diets, you gotta know the lingo. In other words, you must learn diet speak.

All we’ll be discussing here are Low Carbohydrate Diets. Low Carb diets differ from the standard Western diet eaten in the United States. We’ll compare the diets as pie charts.

The Standard Western Diet is composed of 50% proteins, 35% fats, and 50% carbohydrates. Compare those percentages with two Low Carbohydrate Diet– the Ketogenic Diet and the Modified Atkins Diet. Carbohydrate macronutrient foods are only 2 and 6% in these diets.

The Low Carbohydrate Diet Family

There are many Low Carbohydrate Diet options. Think of Low Carbohydrate as the diet family and the diets themselves as members of the Low Carbohydrate family.

Types of Low Carbohydrate Diet

The best research has been done with the Mediterranean Diet, the Modified Atkins Diet, the Ketogenic Diet, and the Paleolithic Diet. The Paleolithic Diet has the fewest supporting scientific studies of the Low Carbohydrate Diet group.

What Is The Ketogenic Diet?

What does Meriam-Webster say? The dictionary definition of Ketogenic Diet is the following: “A diet supplying a large amount of fat and minimal amounts of carbohydrate and protein and used especially in epilepsy to produce ketosis and alter the degree of bodily alkalinity.” https://merriamwebster.com

The Farlex Partner medical dictionary definition is more succinct. It states the following: “A ketogenic diet is a high-fat, low carbohydrate, and normal protein diet causing ketosis.”  https://medical-dictionary.thefreedictionary.com/ketogenic+diet

There are two elements which are usually present in a ketogenic diet. These are changing diet composition by reducing carbohydrates in the diet while increasing the amount of fatty foods in the diet, and changing the body’s metabolism from a sugar burning factory to a fat burning factory via ketosis.

Plates Versus Pyramids

Pyramids can be helpful for comparing diets. Look, for example, at the Modified Atkins Diet as compared to the standard diet pyramid. The Modified Atkins Diet essentially turns the U. S. Department of Agriculture pyramid upside down. The Modified Atkins pyramid, a Ketogenic Diet, is shown to the left. This diet has very few carbohydrates at the tip of the pyramid, but you are allowed high fat dairy, cheese, and nuts. You’re allowed avocados and berries, and an occasional apple. You can eat many, many green or leafy vegetables, and you can consume eggs and other proteins in larger quantities. Contrast this with the standard food pyramid. Wow! The difference is clear.

Pyramids don’t help us decide which foods to put on our plates. Pie charts do help us visualize our menu portions. To make this process work, take a salad size plate (not a dinner plate, sorry) and fill the plate with food groups to match the pie chart. It’s easy to see how much of what to eat without weighing or measuring.

Ketogenic Diet Is A Class Not A Type Of Diet

There are a number of diets which can induce ketosis. Thus, the term Ketogenic Diet refers to a class of diets, each of which induces a state of ketosis. The original Ketogenic Diet is now called the Classic Ketogenic Diet.

The Ketogenic Diet is a member of the Low Carbohydrate Diet Class. The main members of the Ketogenic Diet family are the Atkins Diet, the Modified Atkins Diet, and the Classic Ketogenic Diet.

Equivalent terms:

  • Very Low or Low Carbohydrate Diet = Classic Ketogenic Diet
  • Low Glycemic Index Diet = Atkins Diet
  • MAD = Modified Atkins Diet

Ketogenic Diet Not Without Controversy And Confusion

A ketogenic language is developing. Although it’s hip to talk “keto speak”, the terms are tossed about and result in confusion.

The most confusing of these keto speak terms are the macronutrient ratios. If you’re in the know, you know what a ratio of 4:1 or 3:1 means. I wasn’t in the know, I didn’t understand these ratios, and I couldn’t translate these numbers into the foods I put on my plate.

When you read the ratio of 4:1, the ratio is saying that you’ll eat four times as many calories of fat as calories from carbohydrates and proteins combined. The Classic Ketogenic Diet used to treat epilepsy is a 4:1 ratio diet.

If you’re following a 3:1 diet ratio, you’re eating three times more fat than proteins and carbohydrates combined. If you’re following a 2:1 food ratio, you’re eating twice as much fat as proteins and carbohydrates combined. Research suggests that the ratio of carbohydrates and proteins must be at least 2:1 to obtain maximal health benefits (Weber et al., 2019). This estimate was based on the effects of a Ketogenic Diet on cancer.

Ketogenic Diet And Health

Ketogenic diets have been used to treat a number of illnesses from headaches to cancer. See a few references below. We also review some of the medical studies in our book. https://www.amazon.com/Confessions-Carbohydrate-Addict-Linda-Gummow-ebook/dp/B07QHRXD3R

See references at the end of the post.

Calories Versus Weight

These diet ratios are often presented as percentages of the diet made up of fats versus proteins plus carbohydrates. Take the Classic Ketogenic Diet ratio of 4:1. If you look at the ratio in terms of the weight of the food or size of the piles of foods on your plate, you will eat 4 grams of fat for every 1 gram of proteins plus carbohydrates. Percentage of fat = 80%

The picture looks a little different when you think of the diet in terms of calories. Food calories are used to calculate the percentage of the 4:1 diet which is made up of a particular food group. Use these estimates of calories.

  • fat = 9 calories per gram (4 x 9=36)
  • protein = 4 calories per gram
  • carbohydrates = 4 calories per gram (1 x 4 = 4) Total = 40

The total for the Classic Ketogenic Diet (4:1 ratio) total is 40. Of the 40 grams total, 36 will come from fat. The percentage of fat is 90%.

Is The Classic Ketogenic Diet For You?

Chances are pretty good that you’ll never follow a Classic Ketogenic Diet unless you have epilepsy, and your neurologist recommends this diet. Read more about fasting, the Ketogenic Diet, and epilepsy by following this link. https://carbohydrateconfessions.com/the-history-of-fasting-ketosis-and-the-ketogenic-diet/

If your doctor recommends a Ketogenic Diet, you may be hospitalized during the initial days on the diet, and your menus will be calculated by a nutritionist based upon your personal characteristics. The diet will be  monitored by your doctor and nutritionist. The Classic Ketogenic Diet is so difficult to follow that few people succeed.

The Modified Atkins Versus the Atkins Diet

You’re more likely to choose the Modified Atkins or the Atkins Diet. Dr. Atkins published his first book in 1972 (Atkins, 1972). His Ketogenic Diet recommendations are referred to as the Atkins Diet, but his work was updated by Westman et al. (2010) and is called the New Atkins Diet.

The macronutrient proportions of these Ketogenic Diets are similar. In the modified Atkins Diet or MAD, your diet will contain 65% fat and the remaining 35% is divided between carbohydrates and proteins. It is easy to visualize the food group proportions. The major difference between the diets is that the Atkins Diet allows approximately one half the amount of carbohydrates.

Two pie charts comparing the Modified Atkins Diet and the Atkins or Low Glycemic Index Diets.

Other Differences Between Atkins Diets

The Atkins Diet is designed to produce weight loss. Not only do you change the proportions of the foods which you eat away from carbohydrates to fat and protein, but you decrease the amount of food you eat. You must either count calories or weigh your food. For the Modified Atkins Diet, weight loss is not the goal. The goal of the Modified Atkins Diet is to improve health. There is good evidence that this diet does have health benefits.

Atkins Diet Modified Atkins Diet
High fat foods allowed High fat foods encouraged
20 grams carbs first two weeks only 10-20 grams per day always
Weight loss is the goal Weight loss is not the goal
Count calories Eat all you want

There are several alternative weight loss plans based on the Atkins’s’ concepts. See the Atkins website for details and products. https://www.atkins.com/how-it-works/atkins-20

Modified Atkins Diet Example

Di Lorenzo et al. recommend the following Modified Atkins Diet to patients with cluster migraine headaches (Di Lorenzo et al., 2018):

  • Carbohydrate foods about 15 g per day with no more than 10 grams of carbohydrates per day for the first month and then 20 to 30 grams per day divided into three to five meals.
  • Normal/low protein about .7 to 1.2 g per kilogram per day.
  • Salad or leafy vegetables twice per day (up to 200 grams per portion) dressed with oil, mayonnaise, sour cream and vinegar without added sugars. Other vegetables limited.
  • Snacks are almonds, nuts, and oil seeds.
  • No rice, grains, cereals. Bread derivatives, pasta, crackers, cookies, legumes, or starchy vegetables such as potatoes corn and green peas, and fruits.
  • Dairy products are restricted to cream, cheese or butter (high fat milk products).
  • Each meal consists of a liberal combination of fat and protein in the form of fish, shellfish, poultry, red meat, eggs, low carbohydrate and high-fat cheese, and salads dressed with butter, heavy whipping cream, mayonnaise, olive oil, and other vegetable oils.

The Atkins Diet is designed to produce weight loss. Not only do you change the proportions of the foods which you eat away from carbohydrates to fat and protein, but you decrease the amount of food you eat. You must either count calories or weigh your food. For the Modified Atkins Diet, weight loss is not the goal. The goal of the Modified Atkins Diet is to improve health. There is good evidence that this diet does have health benefits.

I Was Wrong to Reject The Paleolithic Diet

I haven’t been fair to those who follow a Paleolithic Diet. I viewed the diet as pseudoscience based on the shaky assumption that what was good for the caveman was healthy for you and me. I was wrong. The Paleolithic Diet does have health benefits.

What Is The Paleolithic Diet?

The Paleo Diet mimicks the diet of our ancestors during the old Stone Age

The Paleolithic Diet is a modern diet with the following characteristics:

  • High consumption of fruits, herbs, spices, and vegetables
  • Moderate to high consumption of lean meats, organs, fish, and eggs
  • Moderate consumption of nuts and seeds
  • Exclusion of processed foods, legumes, grains, dairy products, and plant oils other than olive and coconut.
  • Exclusion of plants in nightshade family (eggplant, tomato, white potato). Seen in some but not all Paleo diets.

It is the exclusion processed foods, legumes, grains, dairy products and most plant oils which distinguishes the Paleo Diet.

The Paleo Diet has been shown to be superior to other health diets in small randomized trials. Following this diet could normalize the intestinal microbiota and may help control inflammatory diseases as well as inhibit cancer cell growth (Klement & Pazienza, 2019). Weber et al., @).ithic diet for most other diets and could be part of the explanation for the superiority of a Paleolithic diet over other healthy diets including the Mediterranean diet in small randomized trials. References 61 and 62. In particular, grains and legumes have been causally associated with disruption of intestinal bury integrity and the promotion of auto-immune and inflammatory diseases such as cancer and obesity. References 61, 63, 64. Indeed several protocols for treating autoimmune diseases exist which are based on a Paleolithic diet eating pattern, focusing on the elimination of several food groups typical of the Western diet. References 65, 66.

A very recent study investigated healthy Italians following a modern Paleolithic diet for more than one year. The dominating file of the gut microbiota were for firmicutes and bacteriodetes followed by proteobacteria, actinobacteria, amd verrucomicrobia. Compares the Italian hearing to the Mediterranean diet, the pen Neolithic diet microbiota diversity was much higher and comparable to that of the Hazada hunter gatherers. This study is important in showing that the loss of microbiota diversity in Western societies can be countered by returning to a modern Paleolithic diet composed of natural (also region-specific) foods but without dairy, grains, refined sugar, and other processed foods. The association with high microbiota diversity and are putatively anti-inflammatory properties would make Paleolithic diet interesting to investigate in future clinical studies as adjuncts to cancer therapy therapy. Recently, a Hungarian group published several case reports of a ketogenic version of a Paleolithic diet up appearing therapeutic against tumor growth (references 71 and 73, demonstrating the potential of this approach.

Choosing Your Diet

Choosing a diet approach today, even if we accept the premises of a Low Carbohydrate or Ketogenic Diet, isn’t easy. First, we must commit to a small act of rebellion and abandon the wisdom of the government sponsored food guidelines. Second, we must ignore the diet advice of well-meaning family and friends who hop into the conversation with their explanations of what our bodies want and need. Third, we must set sail onto the ocean of information, misinformation, and disinformation which makes up the web. Finally, we must decide on a food formula and diet approach. There are an amazing number of choices out there.

What To Expect

First and foremost, you must give up processed foods, processed flour in all its forms, and sugars in all its forms. You must also give up many fruits. This ain’t easy, and it’s an ongoing struggle for me. To read of my struggles, see our book, Confessions of a Carbohydrate Addict. https://www.amazon.com/Confessions-Carbohydrate-Addict-Linda-Gummow-ebook/dp/B07QHRXD3R

Second, you will embark on the most amazing adventure of your life. My weight loss journey alternately surprised, confused, and delighted me. You won’t look at food the same way again.

Third, you will lose weight. You will keep it off. Your health might improve. There a few references on the health aspects of a Ketogenic Diet below.

To simplify your life and your choices, start out by tossing all keto speak terms except the ones used in peer reviewed scientific journals. Maybe you’ll work your way toward some of the “out there” concepts but start on solid ground.

Standards And Practices

Our standards and practices for introducing information onto the web are summarized here. https://carbohydrateconfessions.com/internet-information-jungle/

Title image is from https://pixabay.com

References

Atkins, R. C. (1972). Dr. Atkins Diet Revolution: Bantam Press.

Augustin, L. S., Libra, M., Crispo, A., Grimaldi, M., De Laurentiis, M., Rinaldo, M., Montella, M. (2017). Low glycemic index diet, exercise and vitamin D to reduce breast cancer recurrence (DEDiCa): design of a clinical trial. BMC Cancer, 17(1), 69. doi:10.1186/s12885-017-3064-4

Di Lorenzo, C., Coppola, G., Di Lenola, D., Evangelista, M., Sirianni, G., Rossi, P., Pierelli, F. (2018). Efficacy of Modified Atkins Ketogenic Diet in Chronic Cluster Headache: An Open-Label, Single-Arm, Clinical Trial. Front Neurol, 9, 64. doi:10.3389/fneur.2018.00064

Finsterer, J., & Frank, M. (2019). Low-Glycemic-Index Diet Relieving Migraine but Inducing Muscle Cramps. J Neurosci Rural Pract, 10(3), 552-554. doi:10.1055/s-0039-1698034

Gomes, J. M. G., Fabrini, S. P., & Alfenas, R. C. G. (2017). Low glycemic index diet reduces body fat and attenuates inflammatory and metabolic responses in patients with type 2 diabetes. Arch Endocrinol Metab, 61(2), 137-144. doi:10.1590/2359-3997000000206

McDonald, T. J. W., Henry-Barron, B. J., Felton, E. A., Gutierrez, E. G., Barnett, J., Fisher, R.,  Cervenka, M. C. (2018). Improving compliance in adults with epilepsy on a modified Atkins diet: A randomized trial. Seizure, 60, 132-138. doi:10.1016/j.seizure.2018.06.019

Park, E. G., Lee, J., & Lee, J. (2018). Use of the Modified Atkins Diet in Intractable Pediatric Epilepsy. J Epilepsy Res, 8(1), 20-26. doi:10.14581/jer.18004

Rezaei, S., Abdurahman, A. A., Saghazadeh, A., Badv, R. S., & Mahmoudi, M. (2019). Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: A systematic review and meta-analysis. Nutr Neurosci, 22(5), 317-334. doi:10.1080/1028415X.2017.1387721

Weber, D. D., Aminzadeh-Gohari, S., Tulipan, J., Catalano, L., Feichtinger, R. G., & Kofler, B. (2019). Ketogenic diet in the treatment of cancer – Where do we stand? Mol Metab. doi:10.1016/j.molmet.2019.06.026

Westman, E., Phinney, S., & Volek, J. (2010). New Atkins for a New You. New York, New York: Simon and Schuster.

Wheless, J. W. (2008). History of the Ketogenic Diet. Epilepsia Open, 49 (Suppl. 8), 3-5.

Zare, M., Okhovat, A. A., Esmaillzadeh, A., Mehvari, J., Najafi, M. R., & Saadatnia, M. (2017). Modified Atkins diet in adult with refractory epilepsy: A controlled randomized clinical trial. Iran J Neurol, 16(2), 72-77.

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