Wednesday, January 23, 2019

Keto Sacred Cows - Busting Common Keto Myths

In the realm of the Ketogenic way of eating, there is no shortage of misinformation.  This is to be expected for people on the outside that have not taken the time or performed the research, but there is also a pile of "Keto Legends" that are pervasive inside the Keto community as well.  This will cover the latter.  Some of these myths are fairly harmless and at worst will slow down your weight loss progress while others may have somewhat more serious consequences if unchecked.  So, let's take a walk through these.

All of these will be in reference to the Ketogenic protocol advised by Dr. Eric Westman.  Here are our food list and protocol which mirrors Dr. Westman's.

  1. To lose weight on Keto, you MUST meet ALL your macros
Keep in mind that people adopt the Ketogenic way of eating for different reasons.  People often assume that people only do so for fat loss, but a certain group does so for therapeutic reasons such as epilepsy, traumatic brain injury, Alzheimer's Disease or certain types of cancers (Therapeutic Ketosis).  These people are generally under medical care and will need to stay very close to the prescribed macros.  However, the overwhelming majority of people following a Ketogenic regimen are doing so for purposes of fat loss and/or to reduce inflammation (Nutritional Ketosis).

The people that are following the Ketogenic regimen for nutritional purposes, the only macronutrient of concern is carbohydrates.  The magic number for carbohydrates is 20.  Per the research and practice of Dr. Eric Westman (his database has more than 50K patients), his subjects/patients that consumed 20 grams total or less of carbohydrates per day, 100% achieved stable Ketosis.  Of his patients that consumed 30 g/day, 75% achieved stable Ketosis and of his patients that consumed 50 g/day, 50% achieved stable Ketosis.  The only macronutrient of consequence for entering Ketosis is carbohydrates.  Thus, it is not how much fat or protein that you eat, rather how many carbohydrates that you DON'T eat is what causes the magic to occur.  

Twenty grams of carbohydrates is minuscule compared to the average person's diet.  Americans eat in excess of 300 grams per day accounting for at least 50% of their daily caloric intake.  So, how in the world is a person expected to limit themselves to a mere 20 grams?  The Dr. Eric Westman approach is simply to eat fatty cuts of meats and non-starchy vegetables until you are full and not to eat when you are not hungry.  In essence, the protocol removes all grains, sugars, most fruits, and many vegetables from the equation.  Since there are only 3 nutritional macronutrients (Carbohydrates, Dietary Fat, and Protein) and you are minimizing your carbohydrates, the remainder of your calories will comprise of fat and protein.  By eating fatty cuts of meat, you are eating a nice balance of protein and fat, which provides the feeling of satiation.  There is not a need to worry if you are hitting specific numbers for protein and fat.  Quickly, your body learns to self-regulate.  By eating to satiety, it ensures that you are consuming the amount of protein needed for your health.  There is no reason to add additional fats to meet some magical fat macro target. Simple is better.

 2.  In order to burn fat you have to eat MORE Fat

The Ketogenic diet often seems counter to the traditional nutritional advice given by most of the "experts".  But there is still a universal truth.  Eating excessive dietary fat will be stored in your body.  This is especially true if you are eating excessive easy access fuel of sugars and carbohydrates.  Those carbohydrates will be utilized to meet your fuel needs first leaving your dietary fat on the hook to be stored in your body.  Even as you discover the path of Ketogenic regimen where you are burning fat instead of sugar for fuel, it is still true that if you consume more fuel (in the form of dietary fat) than your body requires, it will prevent your existing body fat from being consumed and even, potentially, result in weight gain.  I see so much BAD advice from people telling you that in order to be successful at Keto, you need to keep your fat macro at 75 or 80%.  

If you are still early into your Ketogenic journey (less than 8 weeks), it may help you to adapt to burning ketones as fuel by eating a higher percentage of dietary fat, but once your metabolism is primed, the best advice is to find the right balance of proteins and fats that will result in your satiety.  Your body is smarter than the "experts".  By eating fatty cuts of meat until you are full, you do not need to concern yourself with adding more fat.  It self regulates.  So many people will tell you that you have to drink "BulletProof" coffee or add MCT oil or drench everything in butter in order to be successful.  I will admit that I do indulge in these items from time to time because of flavor enhancement.  But I do not consume these items with the goal of "upping my fat".  

On the other side of the coin, I am not recommending a "low fat" approach either.  Your body requires both saturated fat and monounsaturated as an energy source and for nutritional purposes.  The sources of those fats matter as well, but that is a different topic.  So, in short, follow the protocol.  Eat less than 20 g of carbs per day. Eat fatty meats and non-starchy vegetables until you are full.  Don't eat when you are not hungry.

3. You need to fast or intermittent fast on Keto

First of all, I do not want to discount the work and research of Dr. Jason Fung on fasting and intermittent fasting.  He has been able to take on some of the worst cases of Type 2 Diabetics that were about to have amputations or worse.  But, fasting (not eating for multiple days or more) and Intermittent Fasting (IF), also known as Time Restricted Eating, is not part of the Ketogenic Protocol.  Fasting is a separate discipline that does have some provable health benefits.

As stated before and will be done so repeatedly, the protocol that we recommend is to eat 20 grams total of carbohydrates per day.  Eat fatty meats and non-starchy vegetables until you are full.  Don't eat when you are not hungry.  Nothing in that protocol dictates that you should not eat between certain times, only so many times per day or even calorie restriction.  You may find that your appetite changes within the first few weeks and you are hungry less often.  You may even naturally find yourself eating only 2 or even 1 meal per day.  But, we don't recommend obsessing over when or how often that you eat.

Many people are able to think in terms of time-restricted eating without a problem, but there are some that may cause an unhealthy obsession with food.  Our goal is to repair our relationship with food.  By eating until you are full and not thinking again about food until you need fuel, you are repairing that food relationship.

Problems that I have seen related to Keto and fasting: 
  • Fasting shaming - I have seen people berate other people because they were not doing IF, telling them that they were not doing Keto right.  I have no patience for that.  We all need to have the flexibility to Keto our way.
  • Punitive fasting - When people report that they may have made a poor food decision (fallen off the wagon), I see people recommend that they fast for X amount of hours or even days in order to get back on track.  This sounds like a great idea (Can you feel the sarcasm building?). Suggest to a person that already feels like a failure to partake in an even more difficult task of not eating for an extended period of time.  So, now if or when they fail at that task, they have created a failure pattern.  Again, I have no patience for that kind of recommendation.  Let's support our Keto family members by encouraging them to just fix the issue the next time they put food in their mouth.  Then move on.
The Ketogenic protocol is considered a fasting-mimicking diet.  This means that many of the benefits that we would get from fasting, we also get by following a well-formulated Ketogenic diet.  Those benefits are as follows.
  • Stabilized and lower insulin levels
  • Stabilized and lower blood glucose levels
  • Normalized blood pressure
  • Autophagy (cellular self-repair)
  • Increased energy
  • Improved cognitive function
  • Decreased water retention
  • Reduced inflammation
  • Fat loss
  • Weight Loss

4. You need to buy certain Keto products to lose weight

Insert facepalm emoji here.  Keto falls under the same challenges as does every other health and wellness protocols: Charlatans that are looking to make an easy buck.  Let me make this statement (you will hear it again, I assure you).  You do not need to buy any product or supplement to lose weight while living on a well-formulated Ketogenic diet.  This includes exogenous Ketones, branded MCT oils, grass-fed anything, packaged electrolytes, supplements, shakes, smoothies, food bars, packaged foods, etc.  Do I make myself clear?  The key to success in Keto is not what you add to your diet, but rather what you don't eat.  By that, I mean that you DON'T eat the carbohydrates.  Let's break these down, shall we?

Exogenous Ketones may be useful for improving cognitive function, but for fat loss, they may actually be a barrier that you are introducing.  External Ketones would need to be consumed before the ones created by your liver.  In this case, the only thing getting thinner is your wallet.  

MCT oil does have the benefit of being easily converted to Ketones which is nice.  When first starting out on Keto it does give your brain a nice little boost while adapting.  But it still will be converted to Ketones and utilized before your own liver produced Ketones.  Do you see a pattern here?  I would put this under "nice to have", but not needed to lose weight.  

Grass-fed beef, butter, lamb, etc. may have a few minor micronutrient advantages, but they are not going to give you any weight loss benefits.  Everyone does not have access to these products but have managed to lose weight using a low carb diet for decades.  I would really prefer that grass-fed became the norm or, at least, more available. But, grass-fed is not necessary for success.

Electrolytes and supplements fall into a special category.  As your body becomes Keto adapted, you will lose electrolytes via urine as you will tend to urinate more often.  If your body tells you that you are in need of electrolytes (sodium, magnesium, potassium and calcium), you should first try to acquire these items in your diet via salt, meats or vegetables.  There are supplements that you can buy to acquire these as well and you can definitely go that route.  But, just be cautious not to fall into some multi-level marketing scheme for items that you could get from your diet or even over the counter.

Now let's talk about marketing hype.  Keto branded shakes, snacks, smoothies, protein bars, meal bars, and packaged meals are all the rage right now.  I lump these all under the category of Keto Junk Foods, AKA Keto processed foods.  Do you know why we are in the metabolic state that we are?  At least most of us?  We have an addiction to processed foods.  The reason that we use the Ketogenic protocol that we do is that it entirely consists of REAL foods.  These Keto branded junk foods will have sketchy ingredients and hidden carbohydrates that will impair your success - guaranteed.  Don't fall for the hype, Keto family.

5. If it fits your macros (IIFYM) AKA Keto Junk Food Part 2

While it is true that the protocol we follow stresses that you should consume 20 grams or fewer carbohydrates per day, there exists a food list for a separate reason.  There are foods (usually processed) that may technically fall under the threshold of 20 grams, but they may also contain ingredients that may still result in insulin spikes or increased inflammation.  The goal of this regimen is not only weight loss, but primarily, improved health.  Some examples would be "Low-carb" tortillas which are made with wheat flour (an inflammatory).  Keto snacks like Quest bars or chips.  These often use deceptive ingredients to reduce the number of (net) carbs and often contain inflammatory ingredients like palm oil, soybean oil or even trans fats.  They often also include small amounts of sugar or high-fructose corn syrup.  This can also be true for packaged "Keto" ice cream, pizza or just about anything else.  From time to time, these type of items may provide an outlet or treat to help you maintain the lifestyle, but my concern is that they might also begin a cycle of increased cravings.  My recommendation?  Be aware of what you may be getting into before partaking of these items.  If you feel that they may be a hindrance to your success, run away.

6. When on Keto you must consume x grams of fiber

Concerning fiber, there are is no shortage of "experts".  You will hear advice like this.
  • Eat 30 grams of fiber to stay regular.
  • Fiber will prevent insulin spikes
  • Lack of fiber causes colon cancer
  • Too much fiber causes colon cancer
  • You don't even need fiber
There is even one popular Keto Chiropractor that is recommending a MINIMUM of 7 cups of leafy vegetables every day. What is the correct answer?  That probably lies somewhere in the middle of the spectrum of advice.  Some of the most recent studies seem to be running counter to the traditional nutritional advice given by "experts".  These studies are showing that consuming fewer or even zero grams of fiber are resulting in less constipation and improvement of conditions like IBS, GERD, and even Chron's Disease.  But, we are all individuals.  We all react differently to different stimuli.  In my experience (and this applies only to me), I feel better and am not constipated or too loose when I eat little to no vegetables.  Admittedly, I only have a bowel movement every other day, but it is not painful and there is not much volume.  Theoretically, this is because meat is more efficiently digested and has far less waste product associated.  My wife has found that certain vegetables irritate her bowels, causing significant discomfort.  These include cabbage, Brussel's Sprouts and riced cauliflower.  So, she minimizes or avoids those vegetables.  For her, corn and grains were always a trigger, but are not on our food list.

You will need to determine your own needs and tolerances for dietary fiber, but don't let any person or app dictate to you what that amount is.

7. You must severely limit your calories on Keto

It is time to crank up the calorie in/calorie out (CICO) debate.  Standing by for the hate mail ... Once again, let's talk about our Ketogenic protocol.  Eat 20 grams of carbohydrates a day or less.  Eat fatty meat and non-starchy vegetables until you are full.  Don't eat when you are not hungry.  How many times did you see the word "calorie" in that description?  Maybe you should read it again to be sure.  Nope, not there.  

The beauty and simplicity of this protocol is that it causes the body to self-regulate.  It requests the fuel that it needs and informs you when it no longer needs it.  Undoubtedly, this is a result of food choice.  Here is a video for reference.  Does your body treat every calorie the same?  Are 1000 calories of angel food cake = 1000 calories of a ribeye?  Not likely. We now understand that sugar and carbs of the cake cause an insulin reaction in the body which will take the unused energy from the carbohydrates and stored it in your body as fat.  Whereas the nutrient dense ribeye is slowly digested and does not cause an insulin reaction and does not cause fat storage.  The lesson is that more insulin results in fat gain.  Less insulin does not result in fat gain.

Another factor is that when you reduce caloric intake, your body's metabolism slows, burning fewer calories.  This is especially true if adding liberal amounts of intensive exercise.  The best evidence of this is the famous Biggest Loser Study.  This was a group of people that were closely monitored to greatly reduce caloric intake and exercised intensively for up to 8 hours/day.  The result was that the subjects did lose significant weight, but also their at-rest metabolism slowed (even after 6 years) to a point that they were burning 800 calories a day less than the average person of the same weight.  The impact is that the majority of these people regain either most or all of their weight, some gained even more than they lost.  It has been found that a well-formulated Ketogenic protocol will lead to fat/weight loss without severely impacting a person's metabolic rate.  Of course, as a person loses weight, their metabolism will slow in relation to their original metabolism.  Don't forget, carrying less weight means that you are not having to work as hard to do simple things like breathe or walk.  If you have lost a considerable amount of weight using a Ketogenic protocol, it is best to remember that you are not necessarily a "skinny" person.  You are a reduced-size, obese person that may be susceptible to regaining weight.  Thus, it is best to treat the Ketogenic protocol as a lifestyle instead of a temporary dietary intervention.

8. Calories don't matter on Keto

I am going to frame this in reference to the Ketogenic protocol that I follow. Eat 20 grams of carbohydrates a day or less.  Eat fatty meat and non-starchy vegetables until you are full.  Don't eat when you are not hungry.  Using that methodology, you will naturally adhere to the Leptin that your body is producing and eat to satiety.  Your body will self-regulate and request the fuel that it needs.  Calorie intake becomes an unnecessary concern.  However, if you deviate from this protocol and begin eating processed foods or drinks or even high-fructose fruits, you will most likely become Leptin resistant and, as a result, have increased appetite.  Guess what?  You will eat more calories than your body can burn.  It is not just more calories, but less nutrient dense calories.  When you step outside the protocol, all bets are off.

But what about people following the carnivore diet that eat 2 pounds of ribeyes a day (3,000 calories) and still manage to lose weight?  I suspect that this is because all calories are not created equal.  Here is a video for reference.  Does your body treat every calorie the same?  Are 1000 calories of angel food cake = 1000 calories of a ribeye?  Not likely. We now understand that sugar and carbs of the cake cause an insulin reaction in the body which will take the unused energy from the carbohydrates and stored it in your body as fat.  Whereas the nutrient dense ribeye is slowly digested and does not cause an insulin reaction and does not cause fat storage.  The lesson is that more insulin results in fat gain.  Less insulin does not result in fat gain.

9. In order to lose weight on Keto you mush exercise vigorously

I am a big proponent of moderate exercise.  Exercise has plenty of benefits: Normalized glucose/insulin levels, normalized blood pressure, improved mental health and more, but one of the benefits is NOT sustained weight loss.  It has been said that you cannot outrun a bad diet.  The advice of Eat less, move more is pervasive throughout the nutrition and fitness community.  The unfortunate result is that overweight and obese people are often judged because of their "lack of willpower".  This shaming causes people to avoid the doctor which cascades into them not getting the medical advice, treatment, and medications that they need to improve their quality of life.  As we have learned from the Biggest Loser Study, the combination of calorie restriction and vigorous exercise can damage your at rest metabolism for an extended period of time.  On the flipside, Dr. Eric Westman has worked with many disabled patients that are unable to include cardiovascular exercise because of physical limitations but manage to lose substantial weight and maintain for several years.  There are, of course, professional athletes that practice various forms of the Ketogenic protocol.  Most of these athletes are not coming from a previously damaged metabolic system and enjoy metabolic flexibility.  In other words, they did not start Keto to lose 100 pounds.

10. Keto is a rapid weight loss diet

While it is true that some people have reported substantial weight loss in a relatively short period of time on a Ketogenic regimen, I would not say that it would be considered typical or normal.  A certain percentage of people will experience up to 10 pounds of weight loss in a few weeks, but that is generally attributed to a change in water retention.  Generally speaking, I consider the Ketogenic protocol a way of eating like Vegetarianism is a way of eating.  People don't usually become vegetarians or vegans for 3 weeks.  Either you are or you aren't.  If your goal is to quickly lose 20 pounds and return to your old way of eating, maybe you should try a juice fast or whatever the latest trend is.  If you are serious about being more healthy and getting your weight under control, then you should take your commitment seriously and I am glad to help.

The best way to approach health and weight loss using a Ketogenic protocol is to set realistic expectations (you didn't gain all of your weight in a week, don't expect it to fall off that quickly, either).  Also, remember that different people lose weight at different rates.  Joe's metabolism is not your metabolism.  Lisa's Insulin Resistance is not the same as your Insulin Resistance.  Betty might not be on the same medications that you are.  There are many factors that impact how people lose or gain weight beyond the food that they eat.  The best advice that I can give is to stick to the protocol and be honest with yourself as to how closely that you are following it.  Be mindful of "Carb Creep" or unintentional introduction of carbohydrates into your diet.  If necessary, track the food that you eat more closely.

Finally, the goal of the Ketogenic protocol is to improve your health.  As a result of your improving health, weight loss is a lagging indicator.  Using that method, you will also achieve sustained weight loss.

11. You need to plan cheat days or "carb cycle" in order to make Keto sustainable

We live in a society that feels entitled to instant gratification.  But, I will make the case that our propensity toward instant gratification is what has fueled the current obesity/Type 2 Diabetes epidemic.  I don't want to appear unsympathetic to the fact that people do need to deal with sweet and comfort food cravings.  But, I firmly believe and have practiced a method of consistent Keto success by not using will power, but by closely following the protocol.  However, I am coming from the unique perspective that I started this way of eating when I was morbidly obese.  As a result, I practice Keto as if my life depended on it.  I believe that it has saved and extended my life.  I have come a long way in repairing my metabolic health, so I don't have any interest in toying with my metabolism by cycling into and out of mild Ketosis.  I can honestly say that I have not deviated from the protocol for 5 months as of this date.  The one time I did 5 months ago, a slice of key lime pie, I found no pleasure in eating it.  It was then that I realized that sugary sweets no longer had power over me.  That was a moment of feeling extreme liberation and empowerment.  Will I ever indulge in a full carb sweet or processed food again?  Perhaps.  I don't have it on my radar to do so.  I just don't feel the need to.  I sure don't plan to have a cheat day.  My relationship with food has changed enough that I do not feel the need to celebrate with a particular food.  Why is that?  It is because I enjoy delicious, decadent food every single day.  

Another perspective that I have is that I have is that I have put myself out there as a person that is helping others to improve their health using the Ketogenic protocol.  This includes creating a support group.  So, I feel the need to lead by example.  If I want to help others, I need to walk the walk not just talk the talk.  I have a strong opinion that people that brag about their cheat days or meals are looking for approval and validation.  If you want to indulge in a meal or a series of meals that are outside the Ketogenic umbrella, I really don't care.  You do what works for you.  But there are many people that could be on the tipping point of failure who are just looking for the excuse or justification to fail.  Carb addiction is not unlike drug or alcohol addiction in this way.  I never want to be the person that contributes to someone else's failure.

Carb cycling: I read and hear, far too often, people claiming to have lost a pound or a few pounds the day after indulging in a high carb meal or meals.  These people then will attribute their "breakthrough" to their "carb cycle".  Insert facepalm emoji here.  If you believe that a scale change today is because of something that happened yesterday, I have some Nevada beachfront property to sell you.  

On any given day, the bathroom scale can vary up to 5 pounds without a solitary change in your diet or physical activity.  Water retention or change in retention is generally the culprit.  That pack of Doublestuff Oreos was not what CAUSED you to lose 1.3 pounds.  But you did manage to shift to sugar burning temporarily.  Hopefully, you can swap back to fat burning mode pretty quickly.  For some people, this can take from a day to 3 weeks.  Congrats on pausing your progress.  If you are metabolically blessed, you may recover quickly, but then I would ask, "Why do you feel the need to carb cycle in order to break a stall?"

Let me put it this way.  Believing that if you eat a cherry Danish will cause you to lose weight is no better than superstition.

12. Overeating protein will knock you out of Ketosis (Make you not fat adapted).

If you spend any time surfing the Keto Facebook groups or Reddit, you will see a recurring theme of people telling others to not eat too much protein.  It is almost as if a skinless chicken breast is a metabolic equivalent to a jelly donut.  Now, don't get me wrong, I follow a protocol that stresses eating fatty cuts of meat as a general rule, but on the other hand, I don't have an irrational fear of eating an occasional lean cut under certain circumstances.  But, what about the claim of excess protein all but halting your Ketogenic success?  Well, I am not a medical professional or even a nutritionist, so I have to lean on someone that knows about this.  Here is a very in-depth article by Amy Berger from Tuit Nutrition.  Here are the laymen's highlights.

Can certain proteins be converted to glucose via Gluconeogenesis (GNG)?  Yes, they can, however, it is not an automatic process.  It happens on demand.  In other words, when you are not eating tons of carbohydrates and sugars, your body will require your liver to create glucose.  Your blood requires 4 grams of glucose at all times.  Thus, when required, GNG kicks in to handle the 30% fuel requirements of the brain.  The remaining 70% is fueled by Ketones and triglycerides.

Does protein cause a rise in insulin levels?  Well, yes, a little.  However, insulin does not just have a single job (store fat).  It also has another cool feature.  It stores protein into your lean muscle mass.  But protein does so much more. 

While it is true that as insulin levels slightly rise in response to the slowly digesting protein, it is busy building lean mass and all of these other tasks.  Also, the folks that reside over in the Carnivore tribe of the Keto family eat upwards of 2 pounds of meat every day, yet manage to stay in mild Ketosis.  
This leads to the final point.  We should not even be chasing Ketone readings.  We should be chasing fat adapted results.

Concerning protein, this is really the 50,000-foot view.  I suggest reading Amy Berger's article for more detail.

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