There's emerging scientific evidence that a high-fat, low-net carb, moderate protein diet is an ideal diet for most people. However, compliance tends to be low for a number of reasons.
Discussing this is Randy Evans, who has a master's degree in nutrition and works with Dr. Jeanne Drisko at the University of Kansas Integrative Medical Center. I recently interviewed Drisko on her clinical use of nutritional ketosis.
Evans grew up on a dairy farm in Southern Iowa at a time when agriculture was largely still organic. "I actually grew up eating mostly real whole foods," he says, noting his interest in nutrition was an outgrowth of his upbringing. His interest in the ketogenic diet emerged when he began working with Drisko five years ago.
"Our goal with most patients is to push back on those low-fat guidelines we got in the '80s … and to encourage people to incorporate healthy fats in every meal … We're really just getting carbs from Mother Nature here," he says.
Getting Started on a Ketogenic DietThe nutrient ratio Drisko and Evans typically recommend for their new patients is a 1-to-1 ratio of healthy fats to net carbs plus protein. This means your grams of healthy fats will be about equal to your combined grams of non-fiber carbs and protein put together. This ratio, they found, is fairly easy for most people to achieve, and will get most people very close to nutritional ketosis.
"We shoot for that ratio first and then … we'll advance them to the ratio of maybe 2-to-1 or 3-to-1 or even 4-to-1. That's just more and more fat. That's when you actually start to restrict some of the starchy carbs and fruit more. But for most people, the moderate version gets them pretty close to trace ketones," he explains.
Consider MCT Oil - Adding medium-chain triglyceride (MCT) oil or coconut oil to meals is one way of increasing the amount of healthy fat in your diet. MCTs get their name from their chemical structure. Fats consist of chains of carbon molecules connected to hydrogen atoms. There are two basic types of MCT oil being sold:
The pure C8 oil converts to ketones more effectively than C10, making it a preferred choice, even though it's a bit more expensive. You'll want to start with 1 teaspoon of MCT oil and work your way up, adding 1 teaspoon at a time over the course of a few weeks. A typical dosage is 2 to 3 tablespoons of MCT per day, although you could go up to 5 or 6 tablespoons if needed. If you experience gastrointestinal (GI) distress or diarrhea, it would be necessary to cut back.
While it's not harmful to overdose on MCT, your body will rid itself of the excess by causing diarrhea, so starting out with 2 or 3 tablespoons would be asking for trouble. If you have trouble tolerating the MCT oil you could try the powder form, which tends to be easier on the stomach.
Advice on Implementing a Ketogenic Diet
To implement a ketogenic diet, the first step is to eliminate packaged, processed food items. If you have food allergies or sensitivities, you'll need to be careful to avoid those items as well. Aside from that, the No. 1 emphasis is to eat real whole food, plenty of healthy fats and as few grains as possible.
Evans recommends avoiding dairy, as it can be difficult to stay in ketosis if you eat or drink a lot of dairy products. The galactose in dairy is a carbohydrate and you can easily use up your entire net carb allotment by drinking a single glass of milk. The protein casein in dairy can also trigger or contribute to inflammation.
"We have essential proteins and we have essential fats. We don't have any essential carbs," Evans says. "They certainly can help us. [But] our goal is to always make sure we're emphasizing the food essentials.
When we go ketogenic, we're just making a slight shift in what the image of their plate looks like. It's easy enough to ask people to eat half portions. They kind of ease into this, to eat half portions of maybe beans, sweet potatoes, or the starchy veggies. Not many grains.
Grains are just too energy dense and we see so much sensitivity to that. I'd say more along the lines of the starchy veggies. Maybe cut back to half portion of fruit. At the same time, we always add a little of that oil in there."
The key to success on a high-fat diet is to eat high-quality healthy fats, not the fats most commonly found in the American diet (the processed fats and vegetable oils used in processed foods and fried restaurant meals).
Evans recommends getting two servings of healthy fat with every meal. For example, you could add one-half avocado and a tablespoon of olive oil to your salad.
Besides MCT oil, high-quality healthy fats include:
✓ Olives and olive oil (make sure it's third party-certified, as 80 percent of olive oils are adulterated with vegetable oils. Also avoid cooking with olive oil. Use it cold.)
✓ Coconuts and coconut oil (excellent for cooking as it can withstand higher temperatures without oxidizing)
✓ Animal-based omega-3 fat such as krill oil and small fatty fish like sardines and anchovies
✓ Butter made from raw grass-fed organic milk
✓ Raw nuts, such as macadamia and pecans
✓ Seeds like black sesame, cumin, pumpkin and hemp seeds
✓ Grass-fed meats
✓ Lard and tallow (excellent for cooking)
✓ Ghee (clarified butter)
✓ Raw cacao butter
✓ Organic-pastured egg yolks