Ignore the Standard Keto Advice

Fake news is not just an issue that plagues global politics. The Internet is flooded with articles and blogs by journalists and amateurs perpetuating bad research and misinformation about health and diet. Without a deep scientific understanding and investigation of the latest science, these writers are doomed to be stuck in the echo chamber of advice.  

At Rivas Medical Weight Loss we are medical professionals who daily help our patients use the ketogenic diet to lose weight with healthy and sustainable habits. Our guidance is based on clinical experience, personal experience, and a thorough and holistic understanding of the research done by leading authorities on the ketogenic diet and low carbohydrate diets.  

As we will explain, it is often actually better to do the opposite of much of the Keto advice out there.

Let’s step back. What is Keto and how does it work?

The ketogenic diet has become very popular lately, and for good reason. When done right, it is a great way to lose weight, improve many health conditions, and even enhance athletic performance.

The ketogenic diet is a very low carbohydrate diet that turns your body into a fat burning machine. It focuses on eating real foods like meat, vegetables, and dairy.

Our bodies can run on two energy sources: sugar or fat.

A standard American diet is high in carbohydrates. Carbohydrates turn into sugar in the body and are most people’s primary source of fuel.  

Lowering Insulin levels is the key to burning fat

Eating carbohydrates prevents your body from being able to burn fat. Insulin is a hormone that shuttles excess sugar from your blood into fat cells for storage. When you eat carbohydrates your body releases insulin. When insulin levels are high, the body is going to keep fat stored rather than release it for use as energy. To use fat as fuel instead of sugar, insulin levels need to be low.

When you cut carbohydrates out of your diet your insulin levels stay low and your body will switch to burning fat. Your body will first burn fat that comes from your diet, and then stored body fat. When your body is using fat for energy, the liver makes a molecule called Ketones, hence the name of the diet. It is called “being in ketosis” when your body is producing ketones and primarily running on fat.

Mistake #1: Eating Carbohydrates

This may sound obvious, but often people simply don’t realize they are eating too many carbohydrates. This can hold back weight loss and the super charged power of the ketogenic diet.

Generally, in order to reach a state of ketosis, you must have less than 20g of carbohydrates a day. For a ketogenic diet these carbohydrates should come from vegetables, nuts, or dairy. They should not come from just a small quantity of starchy foods, sugary sauces, processed carbohydrates, or even most fruits.

That’s right, vegetables have carbs too.  One bell pepper can have 7-10g of carbohydrates. With a cup of macadamia nuts you already hit 19g of carbs. Based on our experience we successfully help our patients make tweaks to eliminate the hidden carbs in their diets and lose weight.

Mistake #2: Not Getting Medical Supervision

While the ketogenic diet improves many health conditions, for people with medical histories or chronic disease, there can be serious risks of proceeding without medical supervision.

For example, if you have high blood pressure or diabetes, your medications will need to be reduced as you lose weight and become healthier. Otherwise you may have unhealthy symptoms or more serious complications like hypoglycemia or ketoacidosis. For these conditions the medical supervision is simple but essential.

At Rivas Medical Weight Loss, we meet with our patients much more regularly than primary care physicians to ensure that their blood pressure and other symptoms remain normal.

Mistake #3: Limiting Protein

The prevalent advice to limit protein is based on a misunderstanding of how the body works. There is a myth that the body will turn the protein into sugar and hinder ketosis.

It is true that the liver can turn protein into sugar (specifically glucose), through a process called gluconeogenesis. However, this is not something to be scared of. It does not hinder weight loss.

Gluconeogenesis is only a backup plan

The liver will only convert protein into sugar if it needs the glucose for immediate use. It does not just convert protein into glucose whenever there is an abundance of protein. This glucose will be used and will not negatively affect your fat burning. If the body has excess protein and no need for glucose, it tends to burn it as heat.  

Don’t confuse blood sugar and insulin

The importance of keeping insulin levels low is being confused with keeping blood sugar low. Usually sugar and insulin levels go together because when blood sugar is high, the body releases high amounts of insulin to store the sugar as fat. However, when the body creates sugar from protein, it does not want to store it as fat, it wants to use it. Therefore insulin will remain low.

The experts recommend lots of protein

The recommendations of the foremost experts in the Keto diet, Dr. Stephen Phinney and Dr. Jeff Volek, is not strictly limiting protein. For example, for a woman who is 5 ft 4 in tall they recommend eating 70-119g of protein a day. That is over 3 medium sized chicken breasts or over 3.5 cans of tuna. Clinically many low carb doctors have documented many people eating significantly higher protein diets who still remain in ketosis.

If you are concerned by the myths about the Mtor pathway or too much protein being bad for your kidneys…don’t be. Look into the work of expert nephrologist (kidney doctor) Dr. Jason Fung and the leading protein researcher Stuart Philips, PhD.

There are no negative effects of eating a lot of animal protein, but eating too much fat will slow weight loss.  

Mistake #4: Eating Excessive Fat

Keto articles will often advise you to eat more fat. This is totally backwards.

Eating too much fat keeps the body busy burning the fat that you eat, instead of the body fat you are trying to lose. The ideal approach is to prioritize protein. Protein from animal sources like meat, chicken, fish, and eggs include fat. Additional fats like cheese and butter can be used for flavor or variety, but they can slow your weight loss when used in excess.

Mistake #5: Chasing Ketones

It is a mistake to judge the effectiveness of your diet based on your level of Ketones. Many people on the ketogenic diet use ketone strips or meters to judge how “deep” their ketosis is. However, ketone levels do not indicate if you are burning dietary or body fat.  

For example, putting butter or MCT oil in coffee is a common Keto practice. This will raise your ketones, but only because you raised your fat intake. Chasing high ketone levels can head you right down the path of Mistake #4, eating too much fat.

Mistake #6: Eating too many vegetables

We give you permission not to eat buckets of spinach or kale. Limiting vegetables may make you healthier and will most definitely make your diet easier to maintain.

The health trade-offs of vegetables

Vegetables naturally contain toxins to defend themselves from getting eaten by animals. In low doses these toxins are good for you. What does not kill you makes you stronger, otherwise known as hormesis. However in large quantities there can be serious side effects. (Check out Dr. Georgia Ede)

For example, spinach and almonds both contain high levels of oxalates. Clinically we have seen multiple patients eating high levels of oxalates getting kidney stones. Kidney stones are actually made out of oxalates (calcium oxalates) and research has repeatedly found this link between eating oxalates and getting kidney stones. Cleaveland clinic

Vegetables are often praised for their relatively high levels of fiber. The push for high fiber diets originated from observing a tribe in Africa who had very regular bowel movements, and assuming it was due to their relatively high levels of fiber.(NCBI)What research and experience actually show is that digestion is more smooth and comfortable with lower levels of vegetables and fiber.(NCBI)

Many of the micronutrients that vegetables have to offer are primarily necessary to counteract the damage caused by a high carbohydrate diet. Don’t get me wrong, Vitamin C is good for you, but not as essential as you may think. For hundreds of years the Eskimos lived solely on animal protein without suffering from scurvy or other major health issues.

Fewer vegetables may be more realistic

Time, money, and will power are all limited resources that may be excessively drained by eating too many vegetables.

If you plan to grill tonight, preparing and cooking the vegetables will take much longer than the steak. Although meat may seem more expensive, you get more calories and nutrients per dollar.

Instead of using your will power to eat a head of broccoli, use it to resist the birthday cake at the office party.

Mistake #7: Not Eating Enough Salt

The symptoms people sometimes experience when starting a ketogenic diet are often caused by not eating enough salt. Without enough salt you may have headaches, get dizzy, or generally feel bad.

There are two reasons why people need more salt than they think they do when starting the ketogenic diet.

The body releases salt when you start Keto

When your body finishes burning sugar and transitions to burning fat, it releases a lot of water. This is the “water weight” people often lose when starting almost any diet. However, salt is also released and lost in this process.

You are eating less salt when you switch to a Keto diet

Before Keto, most people are eating processed foods and have much more salt in their diets then they realize. For example a small chocolate shake from McDonalds has significantly more salt than a small fries (260g vs. 160g). When you switch to a diet based on real foods, you are also dramatically reducing your salt intake without even realizing it.

Including salty soups, like chicken or miso, in your diet when you start Keto can be an easy way to avoid the uncomfortable symptoms while your body adjusts to burning fat.  

Mistake #8: Snacking

There are two problems with snacking: it is generally not a healthy habit and it encourages high fat intake.

Learning to eat meals rather than snacking all day is an important habit we encourage for all our patients. Humans are not grazing animals like cows and elephants who are designed to eat low energy foods all day. Because of our physiology and hormonal responses to food, our bodies are designed to eat high-energy food in consolidated meals.

The idea of eating many small meals throughout the day is a myth backed only by misinterpreted science. Actually, multiple studies show that it didn’t have any benefits and made people eat more. Small meals just open your appetite for more food. That is why restaurants have appetizers, to make you hungry for more.

When you are eating a low carb diet, generally your appetite decreases and it should be easier not to eat between meals. If you are still hungry between meals, you probably just need to eat bigger meals.

On a Keto diet specifically, snacks usually means fat bombs, salami and cheese or other high fat foods. This brings us right back to Mistake # 4 above, eating too much fat.

Mistake #9: Making Imitation Carbs

The Internet is riddled with recipes for Keto bread, tacos, cookies, and pizza.  There are several issues with making these imitation carbs a mainstay of your Keto diet.

Making Imitation Carbs is a lot of work and often not sustainable

The time and effort required to prepare, cook and clean from making imitation carb recipes is going to make Keto feel a lot harder than it needs to be. Making Keto bread is always going to be a bigger hassle than throwing a steak or chicken breast on a pan.

If these intricate types of recipes are a common part of your Keto menu, you are more likely to feel like a Keto diet is too hard to maintain.

We help our patients realize there are a lot of super simple yummy meal options that make keeping a low carb diet easier.

Imitation Carbs perpetuate a psychological dependence on carbs

Carbohydrates are completely non-essential nutrients, there is nothing your body needs them for.( Institute of Medicine, Dietary Intake Reference Intakes 2008)

“Carb Cravings” are caused by excessive insulin being released in response to eating refined carbohydrates. The extra insulin is looking for more sugar to store as fat, which is why you crave carbs. Carb cravings are not an indication of a biological need. Once you are off carbs and your insulin levels stabilize, the carb cravings go away.

Despite weaning the physical dependence, many people may maintain a psychological dependence on carbs. They think things like “How can I live life without bread and cookies?!” Removing imitation carbs can help heal this psychological attachment. It puts you back in the driver’s seat rather than letting food have power over you.

Imitation Carbs Contain Artificial Sweeteners

Many low carb imitations of high carb foods contain a lot of artificial sweeteners. Although artificial sweeteners don’t have calories, most will still raise insulin and slow down weight loss.

Clinically we have seen patients blast through stubborn plateaus just by cutting out artificial sweeteners. A patient in her 60s lost 14lbs in two weeks just by eliminating her diet soda.

She was drinking 6 diet Pepsis a day when she came to The Rivas Weight Loss Clinic.  We advised her to stop drinking them for 28 days. The result was amazing. She lost 14lbs bringing her to her goal weight. However, due to the addictive quality of diet sodas, by the follow up appointment she had gained back 7lbs because she had started drinking them again.

Imitation Carbs Encourage High levels of Fat

Many low carb imitations of high carb foods use lots of cheese and high fat ingredients. Good old Mistake #4 finding its way back again.

Let Rivas be your Resource

Hopefully this article has taught you that diet, especially the ketogenic diet, is a complex issue ripe with misinformation and bad advice. As medical experts up-to-date on the real science, we are here to help you sort through the details. Please feel free to reach out and book an appointment at www.Rivasweightloss.com