Ketogenic Diets have been shown to work well for Type 2 Diabetics or anyone who wants to lose weight. But what is a Keto Diet, what does Ketosis mean and how can you tell if a Keto Diet is actually working for you? Here is a simple guide and introduction to these important topics.
What Do All of These Keto Words Mean?
A Ketogenic Diet (or for short, just Keto Diet) is not a diet that restricts how many total calories you can eat but instead restricts specifically what types of food you can eat. A Keto Diet is really more of a long-term lifestyle instead of a short-term diet and typically involves eating a very low amount of carbohydrates (all kinds including sugar, starches, simple carbs or complex carbs), a moderate amount of protein (avoid too much protein as Keto is not the same as the Atkins Diet), and then making up the rest of your diet with healthy fats in order that you fill full.
Ketosis is the goal of a Ketogenic Diet. Ketosis is a state when your body becomes adapted to burning fat as a primary energy source compared to burning sugar and other carbohydrates.
The term, Ketosis, sounds pretty ominous. To make matters worse, Ketosis sometimes gets confused with a very different term - and a very serious condition generally only Type 1 Diabetics can get - called Ketoacidosis. It is rare for someone with Type 2 Diabetes who is producing some insulin or for anyone without any type of Diabetes to get to a state of Ketoacidosis. Ketosis on the other hand, is a generally great state for everyone else including most Type 2 Diabetics and Ketosis is a pretty easy state for your body to get into if you are following a Ketogenic Diet.
Almost all people will lose wight while in Ketosis. This is helpful for Type 2 Diabetics as losing weight plays a huge role in slowing the progress of (or even reversing) Type 2 Diabetes.
Another benefit of living a Ketogenic lifestyle is that in order to get into a state of Ketosis, you must consume far fewer amounts of sugar and carbohydrates compared to a standard American diet or even the nutritional guidelines recommended by the American Diabetes Association. There's no way around it - eating less sugar and carbs (even complex carbohydrates) leads to lower blood glucose levels and lower insulin levels. As you could guess, lower glucose and insulin levels are what most Type 2 Diabetics desire most.
Before we talk about how to know if you are in Ketosis, one key concept to learn about when on a Keto Diet is a new word - Ketones. Specifically, it helps to know just the simple basics of what Ketones are, how they are made, and why they are a key to losing weight on a Keto Diet.
When we eat a standard diet containing traditional or recommended amounts of sugar, starches or carbohydrates of any kind (and even when we eat too much protein), all of these items will end up in the blood stream as glucose. When there is plenty of glucose around, our bodies will use that glucose as a primary energy source. So our brain, muscles, and cells of all types will take the glucose and use that to create the energy we need. When there is a high excess of glucose around, we make more insulin that triggers the excess glucose to be stored as fat for later if needed.
If we go for more than one day or so without much glucose in our bodies, then that triggers some of our stored body fat to be released and converted into one of 3 different Ketones. This process is what most people are actually referring to as "burning fat" - the fat is just getting converted into Ketones. This is why a Keto Diet both helps lower your blood sugar while burning fat - you are eating less sugar to trigger Ketosis and this triggers fat to be released or burned.
But Wait, Don't We Need Glucose?
Yes, but what people don't realize is that you don't need to eat carbs or sugar.
It is a very common misunderstanding that we must eat sugar and carbs to survive. Anyone who tells you that you need to eat at least a small amount of carbohydrates is either not current on the latest research or doesn't have an understanding about basic human physiology.
The really cool thing to know about burning fat is it turns out that Ketones are fairly similar in structure to glucose. In fact, your brain and body can use Ketones as an energy source just fine instead of using glucose. In short, Ketones mostly replace the need for glucose in our bodies.
Additionally, your body is capable of internally making any glucose it needs if certain systems can't use Ketones for energy production.
When you live a Keto lifestyle you'll end up with lower blood glucose levels and also with lower insulin levels - both are extremely beneficial to most people with Type 2 Diabetics or people who have insulin resistance.
It can often take one or more weeks of staying on a strict Ketogenic Diet before your body becomes use to using Ketones instead of glucose. We call this transition period going from a glucose-adapted state to a fat-adapted state - and it can take some time before your body gets good at turning fat into Ketones. This is one of the many reasons you need to stick with Ketogenic Diet for a few weeks before you may be able to tell if it is working or not.
Is this Keto Diet I'm On Working or Not?
One challenge that all people on a Ketogenic Diet face is trying to determine if the new lifestyle is actually working. So how can you tell if you are in Ketosis?
A simple method is by just measuring your weight at least once per week. Don't get upset by daily ups and downs as there are many reasons our weight can fluctuate a little day-by-day. Focus on overall up or downward trends week by week. Also, don't be surprised if you loose 5 pounds in the first week then slow down over the coming weeks. A Keto Diet can trigger some water loss in the first few days which may account for a large drop the first week. Remain patient and strive for a slow and steady drop of one or two pounds per week on average.
Another very helpful way to tell if you are in Ketosis is to actually measure the amount of Ketones in your body. You are only in Ketosis if your body is making Ketones by the burning of fat.
There are a few methods to measure Ketone levels. The two most common methods are by using either a urine strip test or a blood strip test.
Urine Ketone Strips:
By using inexpensive urine testing strips you can quickly tell if you are producing Ketones.
One downside to the urine strips is that they only measure the Ketones excreted through urine so readings can vary quite a bit depending on how much water you've had and other factors. The good news is that you don't absolutely need to know the exact level of Ketones in your body - the important thing to know is that you are making at least some Ketones.
I usually buy urine strips like these for under $10 for 100 strips.
Below is an example of what urine test strips typically look like.
They are easy to use. Just urinate in a cup, let a strip sit in the cup for at least 30 seconds then compare the color on the strip to the chart on the bottle. The strips change color from a light pink to a darker pink or purple as they detect higher Ketone levels.
Remember, as long as the strip changes colors you can know that you are at least making a small amount of Ketones. It isn't absolutely critical to know your exact Ketone levels.
Blood Ketone Meter and Strips:
If you want to get an accurate measure of Ketone levels in your body, then a blood Ketone meter is the best way to go. Blood Ketone levels are measured using a special type of meter and special strips - very similar to how you measure your blood glucose levels today with a finger prick but Ketones must be measured using a different type of meter and different strips (your standard blood glucose meters and strips will not work sadly).
The downside is that a blood Ketone meter and its needed strips are more expensive compared to the urine strips. Also your health insurance will likely not cover the costs.
Make sure and only go this route if you can afford it. A meter usually costs around $60-$70 and strips can cost at least $1 each (you do usually get 10 free strips when you buy your meter so that helps a little bit).
I have tried a few blood Ketone meters and find this one the best performing and the best value.
Below is an example of what my Ketone blood meter test looks like for me after 4 weeks of being on a Keto Diet. Generally a level of 0.5 mmol/L or higher indicates you are in Ketosis. The photo below shows a Ketone blood meter on the right and a traditional blood glucose meter on the left so you can see the difference in the way they look.
What Can I Do if I'm not Seeing Results?
Remember to be patient and remember that everyone is different when it comes to Ketosis. It can take some time and also can take some trial and error.
Try and get even a small amount of light exercise in 4 to 6 times a week (in whatever level your body can take without risking injury). Do as much as you can, but even a short walk or an easy-on-the-knees swim helps. Moving your muscles will force your muscles to absorb some glucose out of the blood stream and make it easier to get into Ketosis.
If you are not detecting any Ketones in your body and not starting to lose a little weight within a few weeks then take a hard look at every single nutrition label on all food you eat. Odds are that you are eating more sugar and carbohydrates that you may think. It's easy for a few too many carbs to sneak into your diet when you don't look at nutrition labels.
Gradually take your carbs down to zero. Some people can get into Ketosis and still have some carbs (some even with eating as high as 10-20 total grams of carbs per day). But some people have to drop total carb intake below 10 grams or even close to zero in order to trigger Ketosis.
Slowly work on dropping more and more carbs out of your diet until you can start detecting Ketones (and remember you need to usually change your diet then stick with that same diet for 1 - 3 days before you can tell if it is working or not so be patient and stay diligent. Don't forget that starchy vegetables like carrots, corn and potatoes get converted to glucose too. Green leafy vegetables are usually very much OK.
If you get your carbs down to zero but still can't detect Ketones, then the culprit is usually eating too much protein. If you eat too much protein some can get converted into glucose and will keep you out of Ketosis. Don't eliminate all protein (we do need some). But slowly try keeping track of your total daily protein intake and gradually try reducing consumption until you can detect Ketones. Remember that most nuts have more protein and/or carbs than you'd think. The safest 2 nuts are Macadamias and Brazil Nuts which are lower in carbs and protein and higher in healthy fats.
One last word of advice. Be careful eating out at restaurants. It is typically impossible to tell if restaurant salad dressings contain sugar. Also, croutons, tortilla strips, or nuts can have sugar or be deceiving. So order salads without the crunchy carbs and without salad dressing. Instead ask for only olive oil and lemon for a dressing.
Don't get discouraged! On a Keto Diet you don't have to starve yourself or be hungry all of the time! Just eat the right foods. If you eat something that kicks you out of Ketosis, don't let yourself get upset and just get back on your plan. Stay strong, the future you (and your blood sugar) will thank you!