I am writing this article about Keto for you if you cannot lose weight no matter how well you eat or how much you exercise, if you have uncontrollable food cravings and/or food addictions, if you suffer from bulimia or binge eating disorder, if you have high blood sugar or insulin levels and/or if you have inflammatory conditions that do not resolve.
Several years ago I took a supplement (Red Rice Yeast Extract) at the suggestion of a physician who believed that my LDL cholesterol was too high. The supplement, used in place of a statin to lower cholesterol levels, raises blood sugar (glucose) and insulin levels. After a year or so on the supplement, I ended up being pre-diabetic.
At this point I became interested in the ketogenic diet, as I was on a mission to correct my glucose and insulin problem. Specifically, the diet causes the body to use fat (rather than carbohydrate) as its principal energy source and as a result, can lower blood sugar and insulin levels. While you are on this diet, you consume 75% of your daily calories as fat, 20% as protein and 5% as carbohydrate.
The body is forced into a state of ketosis by significantly reducing carbohydrate intake and lowering protein, while replacing them with healthy fats. The benefit if you are diabetic or pre-diabetic, is that it lowers glucose and insulin levels and improves A1c’s (an indicator of healthy glucose metabolism.)
If you are trying to lose weight, the ketogenic diet can also result in significant weight loss as the body is now burning fat stores. In addition, as you eliminate simple carbs, you significantly reduce the inflammation caused by too much sugar. Regarding the latter, this is a boon to overall health, as sugar causes inflammation in joints, is now viewed as the primary energy source for cancer, and has been implicated in Alzheimer’s.
Trial and Error on Keto
This is not a diet to do on your own. Nor is it a diet for everyone. I recommend that you only do it with the help of an expert in the wellness field who is well-versed on the in’s and out’s of keto. I also think it is advisable to work with someone that has had personal success on the ketogenic diet. If you suffer from an eating disorder, such as bulimia, binge eating, or if you are obese, I recommend that you work with someone who has expertise in these fields as well. I do not recommend this diet, or any diet, for someone suffering from Anorexia. It may also be contra-indicated for those of Asian decent.
I am a wellness researcher and writer with extensive experience in the treatment of eating disorders and obesity, and I had researched the ketogenic diet for a year or so before trying it but still had difficulty getting it right the first time out. Indeed, I ended up with more food cravings, and no change in my blood sugar or insulin levels. I also gained weight, something I normally do not have to be concerned about. I had to go back to the drawing board, consult with a few more experts and try it again.
My second keto experience was life changing. I have also been able to help patients reap the amazing benefits. I have coached 4 patients with either bulimia or binge eating disorder, all 4 of whom are currently symptom free, and 3 of whom have lost the weight they needed to lose but previously were unable to lose.
Carbohydrates and Keto
Without getting too scientific about it, one of the most important discoveries I made in my journey is that if you achieve ketosis and remain in ketosis for long enough, you become keto-adapted. What this means is that because you are burning fat instead of carbohydrates, food cravings are a thing of the past, body fat goes down, and you are building muscle as long as you are eating clean foods. (Notice I said, you build muscle if you eat “clean” food, more on that below.) It turns out that muscles prefer fat as a fuel and only need a little bit of carbohydrate, usually right after a strenuous workout.
As to the disappearance of food cravings, I believe this happens because you no longer need as many carbs. Your body is using fat to fuel muscles and for energy, so it no longer drives the need for carbs. Of course, you have also eliminated simple carbs altogether on the ketoketogenic diet, most of which are very addicting, so you have also extinguished the addictions to these foods if you stay on the diet long enough. I have found that a 1 to 2 month period is adequate for most people to extinguish their addiction to sugar and simple carbs and to become keto-adapted.
Based upon my research, it isn’t a good idea to stay on the diet indefinitely as insulin levels seem to adapt and may even begin to rise again if you stay on the diet continuously. The current wisdom seems to be that it is better if you cycle on and off of the diet.
One thing to keep in mind when it comes to carbohydrates, is that you cannot eliminate them suddenly without feeling the effects in a process called keto flu. Your brain is used to burning carbohydrates and needs time to adapt to burning ketones. This was another discovery that I made the hard way. Initially, I was being very careful with the carbs, erring on the side of too little at times, rather than too much. Bad idea. Turns out my brain was having a hard time switching over to the new fuel and that meant it felt like I was starving my brain of the fuel it needs. It was as if I had dementia. It was terrifying. So I upped the carbs from 5% to 6% while reducing the calories from protein, (not from fat) and my cognitive functioning eventually returned to normal.
When I am coaching someone on the diet, I am mindful of helping them sort through the “keto flu” which is the body’s natural reaction to having significantly less carbohydrate versus having too little carbohydrate. After you have been in ketosis for a while, your brain can use ketones for fuel, a process known as beta-oxidation. Today, several months out from the end of my second keto diet, I’d say that my cognitive functioning is better than it has been in many years. This is likely also a result of eliminating sugar completely from my diet.
Protein and Keto
The other discovery I made after a bit of trial and error, is that protein also raises insulin levels, though not as much as carbs. Since the goal was to keep both glucose and insulin levels in check, this was counterproductive. I did not initially understand this phenomenon so that the first time I tried the ketogenic diet, I didn’t decrease protein enough. As a result, I was having a hard time staying in ketosis. In other words, I was limiting carbs a bit too much, and not limiting protein enough.
It is easy to understand why carbs raise blood sugar and ultimately insulin levels, but people often are very surprised that too much protein can raise glucose and insulin, too. It is a very complex metabolic process, but in essence, in the absence of carbohydrates or when you are fasting, the liver converts protein to glucose in a process called gluconeogenesis. It was a life-saving function back when we were hunter-gatherers going through regular cycles of feast or famine. Now, however, it can still drive high blood sugar or weight gain in people who are insulin resistant.
This is why keto focuses on high-fat, low-protein dairy foods (like butter or cream cheese), not high-protein, low-fat dairy foods (like Greek yogurt or even cottage cheese). Turns out, it’s all about reducing the insulin spike along with blood sugar when you are on keto, as you can only stay in ketosis when you do both.
At the end of the day, what is clear when it comes to protein, is that if you want a diet that minimizes insulin production, you also want to reduce protein. That said, you cannot reduce protein as much as you can reduce carbohydrates, as the body needs protein and the nutrients we get from protein, for other things. It seems to work best if you keep protein to around 20% of total calorie intake while you are on the diet. This helps to insure that you will remain in ketosis long enough to become keto-adapted.
When you come off of the diet, you can up the protein. I recommend keeping the carbs just high enough to get 5 to 7 servings of fruits and vegetables, say from 15 to 20%, keeping the good fat as high as possible, say from 50 to 60%, and upping the protein to 30% or 35%.
Clean Food and Keto
Keep it grass-fed, people.
I cannot say enough about how important the “clean food” issue is on this diet. I do not think that it is emphasized enough by proponents of the ketogenic diet. I say this because a lot of people contact me who do not lose weight on the diet and I believe that the quality of the food they eat may be one of the primary reasons.
First of all, if 75% of your calories are coming from fat, they really need to be the healthiest fats possible. I think people who go on this diet and eat bad fats are putting themselves in danger. By “bad” fats I mean hydrogenated vegetable oils, canola oil, soybean oil, corn oil or any refined oil. (email me at email@example.com for an awesome fat handout.)
Good fats, on the other hand, are like medicine for the body. By “good” fat, I mean fat from 100% grass-fed animals, unrefined coconut oil, avocado and avocado oil, raw grass-fed butter, grass-fed sour cream and cream cheese, real olive oil, ghee, omega 3’s from wild-caught fish and bacon fat (from a pastured organic pig.)
I coach all of my patients to eat only grass-fed animal protein. The fat from a grass-fed animal, called Conjugated Linoleic Acid (ALC) is much higher in Omega 3 fat than the fat from a conventionally or grain-fed cow which produces mostly Omega 6 fat. This is important because it isn’t just how much fat, it is also the kind of fat that matters when it comes to maintaining a healthy weight and more specifically it is the ratio of Omega 3 to Omega 6 fat that drives excess weight gain. Foods naturally high in Omega 3’s are fish and flax seed. Foods high in Omega 6’s are animal protein and dairy, seed oils like soybean, canola, and corn oil.
The ideal fat ratio would be a 1:1 ratio of Omega 6 to Omega 3. For most Americans the ratio is anywhere from 15:1 to 30:1, Omega 6 to Omega 3. This causes all kinds of health problems, not the least of which is obesity and the type 2 diabetes that usually follows. The foods in nature that have a perfect 1:1 ratio of Omega 6 to Omega 3 are breast milk and raw 100% grass-fed cows milk. Enough said.
Just one other little factoid about how amazing fat can be: the only thing ever shown to reverse Alzheimer’s is coconut oil combined with exercise.
I also believe the quality of the protein you eat is very important. I had a patient that could not wrap his head around “clean” food. He, like many people today, saw organic fruits and veggies and grass-fed beef as a rip-off. So he followed the ketogenic diet to the letter, lost some weight and brought his blood sugar levels down as well as his insulin. Great, right? Nope. He lost too much muscle.
When we problem-solved it, he admitted that he had not taken my advice regarding the clean food. He was eating conventional meat, dairy and produce and worst of all hydrogenated fats. While I was concerned that he was eating fruits and vegetable doused in glyphosate, which is dangerous for many reasons and also fattening, it was the conventional animal protein that was the culprit regarding the loss of muscle.
As I mentioned above, grass-fed animals such as cows, goats and sheep provide us with a polyunsaturated fatty acid called conjugated linoleic acid (CLA). It is actually both a cis and a trans fat. But unlike the trans fats from hydrogenated vegetable oils, this is a natural trans fat that converts to muscle only and is not stored as a fat. As such, it is incredibly good for you, especially if you are on a ketogenic diet where you want to maximize fat burn and muscle development at the same time.
Conversely, grain-fed cows have a type of fat that stores as fat on the cow and also on us when we eat the cow. The research shows that those of us who eat grass-fed instead of grain-fed animal protein have higher levels of good fat in our cholesterol profiles. Unfortunately, there is not enough research comparing grain-fed and grass-fed beef, especially when it comes to obesity, heart disease and cancer.
My observation after years of treating thousands of patients with eating related illnesses is that it really matters whether or not you eat grass-fed or grain-fed in terms of degenerative diseases, especially diabetes and vascular disease. It also makes recovery from eating disorders more likely as grain-fed beef likely contributes to leaky gut and bloating, both of which are a nightmare if you are self-conscious about your stomach. This can lead to purging or restricting.
When I convinced my patient to eat grass-fed instead of grain-fed animal protein, his workouts began to produce results almost immediately, he lost more weight but developed more muscle. Now he is 54 pounds lighter, and he is, in his words, “ripped.” His blood sugar, insulin and A 1c’s are perfect. He no longer craves carbs and reports that he never feels “bingey” anymore.
Keto Combined With Clean Eating for Those With Eating Disorders and Obesity
I have recommended the ketogenic diet for 3 other patients, all of whom were bulimic and 2 of whom were overweight. All three were virtually symptom free in a matter of months and are still symptom free today. Like the young man mentioned above, 2 were also overweight and have lost weight that they have not gained back. I find that my approach to treating eating disorders, which incorporates clean eating, results in much faster recovery rates when compared to the conventional approach to the treatment of eating disorders. But the keto diet amps recovery even more for those with eating disorders (ED’s) and for those needing to lose weight.
The reason conventional approaches to the treatment of EDs do not work particularly well is that they advocate that eating disorder (ED) patients should be able to eat “all things in moderation” irrespective of how damaging the food is to the body or the brain. This makes no sense to me. Why encourage an individual to eat foods that damage the gut, the brain and the vascular system just to get them over their fear of eating? It’s like encouraging someone with cancer to eat toxic waste to help them overcome their fear of the toxins that might be undermining their immune system. Why would you do that?
Clean food allows my patients to trust food again. It behaves in their bodies, i.e. it does not cause bloating, unneeded weight gain or inflammation. But The ketogenic diet seems to take this trust to a whole new level, in as much as they also lose their fear of fat (which is a really big deal for those with ED’s) and they develop a healthy skepticism for simple carbs. Regarding the latter, they come to recognize the role that simple carbs play in their impulse to binge or overeat.
The result for a select set of patients, who were carefully supervised, is that it shortened recovery time from bulimia and binge eating disorder even more. I believe it will also significantly reduce the likelihood of relapse for these patients, all of whom report this amazing freedom from food cravings. Although none of my patients were diabetic, I believe that for the diabetic or the pre-diabetic, keto is a much better alternative than medication. It certainly was for me.
Insulin Resistance = Weight Loss Blocker
The ketogenic diet is also a boon to the individual that has tried again and again to lose weight and failed. The inability to lose weight appears to be tied to insulin resistance in many individuals. As such, the ketogenic diet, which improves insulin resistance and in many cases results in the opposite, insulin sensitivity, shows real promise for those who are unable to lose weight. This is not a particularly well- understood or well known phenomenon and as such may not be on the radar of practitioners. Certainly the average person will not be familiar with this perspective. But I believe that until you deal with the insulin resistance, you are not going to lose weight no matter what you do.
The first thing I do when someone obese comes in for treatment is recommend blood work that tells us whether they are diabetic or pre-diabetic. About 90% of those who cannot lose weight and keep it off, are at least pre-diabetic if not diabetic. Unfortunately, taking medication to treat the diabetes does not treat the diabetes, it only treats the symptoms of the diabetes. This is another place where the ketogenic diet adds value, as it significantly reduces the body’s need for insulin since blood sugar levels are so well controlled. As such, it can reverse a chronic condition and open the door for lasting good health.
Inflammation and Keto
I have been reading for years about the many dangers of sugar and the inflammation that it causes. Dr. Axe, Dr. Mercola and many of my other favorite health guru’s have hit the topic hard from every angle, again and again. Convincingly. Yet I still rationalized that since I eat organic and almost no processed foods, I was ok to indulge in the occasional piece of bread (ok basket of bread) chocolate bar, whole grain crackers or a handful of organic chocolate covered almonds.
I ignored the arthritis in my hands and knees since the pain didn’t really slow me down. I coped with the cognitive fuzziness because I am, after all, old. But life without the joint pain and fuzziness is so much better. Although I would not be comfortable recommending that you give up all simple carbs, I am comfortable never eating them myself because the benefits far outweigh the costs. In addition, I absolutely love the food that I eat and I do not mind passing on the bread as long as I can have an extra lamb chop or some sweet juicy bing cherries or grapes for desert.
High Blood Sugar in the Morning, What?
After coming off of the ketogenic diet the second time around, I was shocked when I got the results of my first fasting blood sugar and insulin levels. I was expecting perfect blood sugar levels but instead my blood sugar was 117. It turns out that this is not uncommon when you are keto-adapted (burning fat and not carbs.) Instead of insulin resistance, which is the precursor to Type 2 diabetes, the ketogenic diet results in insulin sensitivity, which is a good thing.
However, the manner in which this shows up is counterintuitive, since when you test your fasting blood sugar levels in the morning, they are a bit on the high side. This can be very confusing and may even make some people think that the ketogenic diet did not work for them and that they are diabetic when they are not. It’s possible that many people end up on medication that they do not need as a result.
What I discovered with a bit of additional investigating, was that even though my fasting blood sugar levels were high in the morning, they were good throughout the rest of the day. In fact my blood sugar barely changes over the course of the day, even after a meal now, placing them in the “Excellent” range all day except for first thing in the morning.
Going From Insulin Resistant to Insulin Sensitive on Keto
According to Anne Mullens and Dr. Andreas Eenfeldt in an article Is Your Fasting Blood Glucose Higher on Low Carb or Keto? the reason for this early morning phenomenon is that every morning cortisol, growth hormones, adrenaline and the enzyme glucagon pulse to the liver to be converted into glucose through a process called gluconeogenesis. They use the analogy that it is as if the body is making itself breakfast.
The problem is that if we are keto-adapted, meaning that our muscles burn fat for fuel and not glucose, the muscles say no thank you and blood sugar levels go up. It is as if the liver is offering pancakes when all the muscles need is bacon. However, as mentioned above, what you will find if you continue to test throughout the day, is once the hormones subside the blood sugar levels look good.
How to Test to Determine Insulin Resistance Vs. Insulin Sensitivity
To be sure that you are not diabetic or pre-diabetic, Dr. Ted Naiman recommends testing both fasting blood glucose and fasting insulin. If your fasting insulin is good, even if your fasting glucose is high, you are likely to be insulin sensitive and not insulin resistant. You will probably have to ask for this test as most doctors do not do it routinely.
Dr. Naiman uses an equation, which shows that if you know your fasting blood glucose and your fasting insulin, you can tell how insulin sensitive or insulin resistant you are. For example, according to Dr. Naiman, if your fasting blood sugar is 5.7 (103) and your insulin is high too, over 12 μU/mL, you are insulin resistant and on your way to type 2 diabetes. If your blood sugar is 5.7 but your fasting insulin is under 9 μU/mL, you are insulin sensitive and likely in glucose refusal mode from a low-carb or keto diet.
I highly recommend the website Diet Doctor for help with the keto diet. Created by Dr. Andreas Eenfeldt it brings together low carb and keto experts from around the world, like Dr. Naiman, Dr.Jason Fung, Dr. Sarah Hallberg and more. It is loaded with good information, and recipes galore!
The only other thing to keep in mind when testing for diabetes is that the A1c test looks at the previous 3 months, so wait a few months after being keto-adapted to use that test as a measure of blood sugar health.
What You Can Expect When You Are Keto-Adapted
Just a few of the things that changed for me while I was on the diet the second time around:
➢ NO FOOD CRAVINGS
➢ Blood sugar, insulin levels and A1 c’s improved – no longer pre-diabetic
➢ From insulin resistant to insulin sensitive
➢ Significantly more muscle mass during and since
➢ Less body fat
➢ More stamina
➢ Arthritis/inflammation in near total remission
➢ Cognitive function improved significantly
While I do not recommend a keto diet for everyone, the health benefits are significant for someone who is being monitored/coached by a knowledgeable professional. It is particularly helpful for anyone wishing to bring bingeing and food cravings under control and for anyone trying to manage blood sugar and insulin levels and achieve a healthy weight.
Special Thanks: I would like to thank Dr. Arthur Craig for his insightful edits to this article.
Dr. J. Renae Norton is a clinical psychologist, specializing in the outpatient treatment of eating disorders such as anorexia, bulimia, bulimarexia, and binge eating disorder (BED), as well as obesity. Let’s Connect!
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Medical Advice Disclaimer: The information included on this site is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information on this website does not create a physician-patient relationship. This information is not necessarily the position of Dr. J. Renae Norton or The Norton Center for Eating Disorders and Obesity.
©2018, Dr. J. Renae Norton. This information is intellectual property of Dr. J. Renae Norton. Reproduction and distribution for educational purposes is permissible. Please credit ‘© 2018, Dr. J. Renae Norton. http://www.eatingdisorderpro.com/