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CHAPTER 1

UNDERSTANDING KETO

HOW DOES KETOSIS WORK?

Short Answer: Ketosis occurs when carbohydrate intake is restricted enough to cause low blood sugar and insulin levels, which stimulates the burning of stored fat and the production of ketones in the liver.

Thus far we have really driven the point home that ketosis is what makes a keto diet unique. Understanding how ketosis works can be a great way to understand the changes that are going on in your body. However, to understand how ketosis works, we have to first discuss how carbohydrate metabolism works. When you consume carbohydrates, those carbohydrates are broken down to glucose and released into the bloodstream. Glucose is a type of sugar, and in this case is what we know as blood sugar.

This increase of blood sugar, from the breakdown of carbohydrates, causes the pancreas to secrete a hormone known as insulin, which binds to cells in the body to open the door for glucose to enter the cell and go through a process known as glycolysis. Glycolysis further breaks glucose down into a substrate that can be used by the cell to produce energy or scientifically speaking, ATP (adenosine triphosphate).

Since carbohydrates can be broken down very quickly, whenever they are present (which for a lot of people is all the time), they are the primary fuel source for the body.

However, if we restrict our carb intake enough, as we would on a keto diet, we see a decrease in blood sugar, which means that the need for insulin decreases, so insulin levels also lower. When we have low levels of glucose and insulin, our pancreas secretes another hormone known as glucagon. Glucagon has many functions, one of which is to interact with our adipose tissue or fat cells to release stored fat into our bloodstream where it can be used by cells for energy. But that’s not quite enough.

Interestingly, while most of our body can run on fat for fuel, the brain cannot. This is why we possess this unique metabolic mechanism of ketosis. The liver can break down fat and use it to make little energy molecules known as ketones or ketone bodies. However, the liver does not possess the necessary enzymes to use ketones for fuel, so these little energy soldiers are shuttled out of the liver and into the blood, where they are able to travel to cells and tissues and be taken in and used for energy.

Research has found that many cells in the body will skip using ketones for fuel and use fat instead, allowing the ketones zooming through the bloodstream to be taken in and used by the brain.3 Remember, the brain can’t effectively use fat, which is why this adaptation of the body is crucial.

Your body being in a state of ketosis is what differentiates keto from other low-carb diets and makes it superior. One of the problems with other low-carb diets is brain fog and lack of energy. This is because these diets do not allow enough carbs to meet the demands of the brain and body, yet do not restrict carbs enough to stimulate more fat burning and trigger ketone production to meet the needs of the brain.

Most people think that eating fat is required to stimulate ketone production, but that isn’t necessarily the case. Here’s a brief science lesson. Note that there is a difference between the fat that we eat and the fat in our body. Ketones are made when stored fatty acids are mobilized and delivered to the liver. Ketones are not made from the fat you eat with the exception of MCTs,

The fat that we eat gets absorbed in our digestive tract and packaged into little carriers known as chylomicrons. Chylomicrons travel through our bloodstream and are roped in by muscle and adipose tissue where they can then dump off the fatty acids they are carrying into cells to be used for energy or stored for later use. However, chylomicrons only go to the liver to be disposed of after they have dumped their fatty acids, meaning they are not able to deliver significant amounts of dietary fat to the liver for ketone production. That means that the fat we eat will preferentially be used for energy by our tissues and not for ketone production. Do not fall victim to the misconception that eating more fat will get your ketones higher or that it is necessary to be in a state of ketosis.

MOOD

Besides the fact that always having low energy and being hungry is obviously going to cause you to be in a bad mood; the foods you eat also play an important role in your mood, which many people do not want to accept. We used a similar example earlier. If you drank five margaritas and felt like heck the next day, would you blame it on the margaritas? Obviously, yes. But don’t forget about the tacos you had with it! Everything you put in your body can affect the way you feel.

Additionally, the neurotransmitters (chemical messengers) that play a role in your mood are produced in your gut and can be impacted by the foods you eat. In fact, many mood disorders, such as depression and anxiety, are rooted in impaired gut function. If you are consuming a diet that is high in pro-inflammatory and highly processed foods, your gut health is being destroyed and this is a huge contributor to poor mood.

Your mood isn’t just about what you do put in your body. It is also about what you do not put in your body. Nutrient deficiencies, such as protein, cholesterol, fat, vitamins, and minerals, and energy availability also play a big role in our mood further emphasizing the importance of diet in our feelings of well-being.

HOW IS KETO GOING TO IMPROVE MY MOOD?

There is actually growing evidence for the use of the ketogenic diet for mental health disorders, including depression and anxiety, which we will touch on in greater detail later in the book. For now, it is important to know that the combination of improving your energy levels, reducing hunger, improving gut health, minimizing nutrient deficiencies, and improving body image are all ways that a ketogenic diet can improve your mood.

Of course, it is important to note that the quality of your keto diet is important here. As we will get into in the coming chapters, consuming low-quality foods will prevent you from seeing many of the benefits we just discussed.

BRAIN HEALTH AND FUNCTION

HOW DOES KETO IMPROVE BRAIN HEALTH AND FUNCTION?

Short Answer: Ketones provide more energy to the brain than glucose and do so while producing less oxidative stress, thus causing less inflammation.

The brain has a massive energy demand, around 20-23 percent of the body’s total energy demand.21 This is important because the brain has to utilize the energy that is available to it, and for most people not on a keto diet, this is primarily glucose.

However, when available, ketones are the preferred fuel source for the brain. In fact, research has shown that the brain’s uptake of ketones is proportional to their availability in the blood.22 What is interesting to note about ketones versus glucose metabolism is the push-pull method that has been so brilliantly explained by one of our favorite keto researchers, Dr. Stephen Cunnane. Dr. Cunnane explains that glucose is pulled into the brain based on the demands of the brain. However, ketones are pushed into the brain based on their availability in the blood. Since ketones provide more energy compared to glucose, this means that ketones possess the ability to provide more energy to the brain to assist in brain function.

It’s not just about what ketones are doing, it’s also about what they aren’t doing. Metabolizing glucose can be oxidative (requires oxygen), meaning it can cause oxidative stress. Over time, that stress can contribute to chronic systemic inflammation, which can damage our cells’ mitochondria, the organelles responsible for creating energy. The inflamed brain with damaged mitochondria is an unhealthy, impaired brain.

Ketones are a much “cleaner” source of energy, meaning that when they are burned, they do not promote inflammation. Additionally, since ketones can provide more energy compared to glucose, they are better suited for the brain due to its high energy demands. Ketones are also signaling molecules, and one thing they are able to signal for is greater antioxidant production—important for anti-aging in general, especially as it relates to the brain.

The health benefits of metabolizing ketones in place of glucose also plays a huge role in brain disease prevention and management, especially since research has found that the brain loses its ability to metabolize glucose as we age.23 Chronically fueling the brain with glucose is one way to accelerate this. Like all cells in our body, the cells of the brain can become resistant to insulin, causing the brain to struggle to access fuel, thus forcing an energy crisis. A starving brain is also not a healthy brain. In fact, research has shown that insulin resistance is a common driver of neurodegenerative diseases.24 Alzheimer’s has recently been described as Type III diabetes because it is becoming evident that as we age, our brain’s ability to metabolize glucose decreases. This can result in a slew of deficiencies that impair cognitive health. This and other indicators suggest that maybe our brain should not be only metabolizing glucose for fuel, especially for extended periods of time—which for many could be their whole life!

Neurodegeneration and other declines in brain health do not have to occur as we age, at least not to the degree that we are currently seeing. Switching to the metabolic state of ketosis can aid in preventing or slowing this. In fact, research in neurodegenerative individuals has demonstrated that keto can improve aspects of brain function such as memory.25 This is because the insulin resistant brain can still metabolize ketones despite its inability to effectively utilize glucose. This not only solves the energy crisis but also helps reduce neuroinflammation and improve insulin sensitivity, all markers for improving brain health and function.26

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Loss,” European Journal of Clinical Nutrition 67, no. 7 (2013): 759.

21 M. Bélanger, J. Allaman, and P.J. Magistretti, “Brain Energy Metabolism: Focus on Astrocyte-Neuron

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Metabolic Cooperation,” Cell Metabolism 14(6) (2011): 724-738.

22 Alexandre Courchesne-Loyer, Etienne Croteau, Christian-Alexandre Castellano, Valerie St-Pierre, Marie Hennebelle, and Stephen C. Cunnane, “Inverse Relationship between Brain Glucose and Ketone Metabolism in Adults during Short-Term Moderate Dietary Ketosis: A Dual Tracer Quantitative Positron

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Emission Tomography Study,” Journal of Cerebral Blood Flow & Metabolism 37, no. 7 (2017): 2485-2493.

23 Mayer B. Davidson, “The Effect of Aging on Carbohydrate Metabolism: A Review of The English Literature And a Practical Approach to the Diagnosis of Diabetes Mellitus in the Elderly,” Metabolism

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no. 6 (1979): 688-705.

24 Suzanne Craft and G. Stennis Watson, “Insulin and Neurodegenerative Disease: Shared and Specific

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Mechanisms,” The Lancet Neurology 3, no. 3 (2004): 169-178.

25 Maciej Gasior, Michael A. Rogawski, and Adam L. Hartman, “Neuroprotective and Disease-Modifying

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Effects of the Ketogenic Diet,” Behavioural Pharmacology 17, no. 5-6. (2006): 431.

26 Robert Krikorian, Marcelle D. Shidler, Krista Dangelo, Sarah C. Couch, Stephen C. Benoit, and Deborah J. Clegg, “Dietary Ketosis Enhances Memory in Mild Cognitive Impairment,” Neurobiology of Aging 33, no.

I HEARD THAT OUR BRAIN NEEDS CARBS FOR PROPER FUNCTION?

Short Answer: Your body can make all the glucose it needs for brain function without you eating a single carbohydrate.

Certain portions of the brain do require some glucose, but this glucose does not have to come from your diet, it can come from a process known as gluconeogenesis, or the production of glucose from non-glucose sources. The rest of your brain can utilize ketones for fuel, and in fact, the brain likely prefers ketones.

Remember, ketones are taken up via the brain in proportion to their availability in the blood. The liver can produce between 100 and 150 grams of ketones per day, which is more than enough to meet the energy demands of the brain. This means that the brain can derive all of the energy it needs from ketones and gluconeogenesis, removing the need for carbohydrate consumption. Combine this with the fact that burning ketones is a lot healthier for the brain, you should trust us in saying “your brain likes the ketones.”

It is true that your brain will not immediately start functioning better when you start keto. In fact, the opposite may be true initially. This is due to the keto-adaptation period

There are several reasons why you may experience this. Once you stop consuming carbs, it takes time before your body is producing a sufficient amount of ketones. This can result in a temporary fuel shortage and thus brain fog. This will quickly subside as your body transitions into ketosis and becomes keto-adapted. Second, dehydration and electrolyte deficiency are very common when starting keto if not properly combatted, and together these two can also be common contributors to brain fog.

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WHY DO I NEED TO SUPPLEMENT WITH VITAMIN D?

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Over 75 percent of Americans are deficient in vitamin D.78 This figure would be much higher if accounting for those who are not technically deficient but are still not at an optimal level. Being deficient in vitamin D can come with side effects, such as fatigue, depression, muscle pain, hair loss, and impaired hormone production.

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Vitamin D deficiency is actually the primary contributor to season affective disorder, which is characterized by depression during months when exposure to sun is limited. This means that those living in states where getting outside in the winter months is difficult, the need for vitamin D supplementation is increased.

IS CONSUMING MORE FAT EVEN SAFE?

Short Answer: Yep! A great deal of our body is made of fat and needs fat to thrive.

Despite what you have been told your whole life, eating fat is not bad. In The Big Fat Surprise by investigative journalist Nina Teicholz, you can read a pretty detailed description of the history that has driven a lot of the recommendations we have against dietary fat today, most of which was a result of research from Ancel Keys. While it is easy to poke holes in his research, it did still make quite the boom, and now today we are still struggling to combat the bad name given to dietary fat in the name of his research.

The truth is that it is actually more efficient for the body to metabolize fat than it is for it to metabolize carbs. We are not going to get overly complex with the biochemistry here, but what this means is that when your body is using fat and ketones as its primary fuel source, less oxidative stress is produced, resulting in reduced inflammation and improved cellular health. When your body is metabolizing primarily carbs for fuel, the opposite occurs.

If this is true, then why do we think fat is bad? Well, besides the easily debunked work of Ancel Keys, the problem is that a lot of studies that find that fat is bad are actually using low-quality fat in conjunction with high-carb consumption, just like the Standard American Diet (think burger and fries). Remember, when carbs are present the body will metabolize them first. This not only drives up inflammation, but also prevents fat from being metabolized and pushes it more toward storage. Additionally, the combination of high-fat and high-carb can promote a harmful shift in blood lipids and evokes a greater inflammatory response.

However, when carbs are out of the picture, the body preferentially utilizes the fat we eat for energy, cell structure, and various bodily functions, which is not dangerous. In simple terms, remove the bun and swap those fries for some greens and that burger meal becomes health promoting rather than a cheat meal.

DOESN’T EATING FAT MAKE YOU FAT?

Short Answer: There is a difference between the fat you eat and the fat in your body. When you consume dietary fat without carbs, your body uses that fat for energy.

Now that is a good question! Fat is fat, right? Eating more fat should cause you to get fat, right? Seems to make sense, and that is what we have been told for a long time now. However, this is not the case.

It is important to distinguish the difference between fat in the body and fat we eat. Just because we can consume fat does not mean that eating it will lead to a higher body fat percentage. Let’s take a look at how fat accumulation occurs:

Adipose tissue is what you are seeing when you are looking at things like your visceral or belly fat, but it is also found in many other places throughout the body. Many people think of adipose tissue as a sack of fat with no purpose other than making our pants not fit. However, adipose tissue actually plays a crucial role in communicating with other fat cells, immune cells, neurons, stem cells, and much more.

Adipose tissues are made up of adipose cells (adipocytes), and there are two different types of adipose cells: brown and white. Brown fat burns calories, while white fat cells are for storage, storing triglycerides until they are called on for energy production.

Remember that when we eat fat, it is packaged into chylomicrons and carried around the blood where it can dump off fatty acids to cells to be used for energy or stored for later use. When fat is consumed without carbohydrates, it is used for energy because it is the primary fuel available.

However, when we eat fat and carbs together the story goes a little differently. If you recall from Chapter 1, when carbohydrates are consumed the pancreas responds by secreting insulin. Insulin is commonly referred to as a storage hormone, because it drives energy-producing nutrients into cells to be used for energy or saved for later use.

Carbs are considered our body’s primary fuel source because it is very easy for cells to use glucose for fuel, thus, when available, glucose will be burned ahead of fat. That means that when carbs are consumed with fat, the insulin secreted will result in fatty acids being pushed more toward storage, since glucose will be the primary energy source lowering the demand for those fatty acids. Pair this with the fact that the overconsumption of carbs can stimulate fatty acid production (through de novo lipogenesis) and when insulin is elevated, fat burning is halted, and you can see that dietary fat is not the cause of obesity.

The moral of the story here is that over-consuming carbs and pairing a high-fat intake with high-carb intake can lead to a cascade of events resulting in adipocyte hypertrophy or the growth of our fat tissue. This can start the path toward inflammation due to adipose tissues’ ability to stimulate the release of cytokines and other inflammatory markers.

As we’ll discuss later in the book, this doesn’t mean you should eat an unlimited amount of fat on a ketogenic diet. Everything has its place and we’ll help you decide how much fat works for your goals later on.

OKAY, FINE ON THE FAT, BUT I’M SURE I SHOULDN’T EAT RED MEAT, RIGHT?

Short Answer: Many people think red meat is bad due to saturated fat; however, saturated fat also provides many benefits to the body and is not dangerous when consumed without carbohydrates.

Red meat is often thought to be harmful because first, it is an animal product, and second, it contains saturated fat. Saturated fat has received more negative press than any other fat, mostly because of misunderstandings or misrepresentation of research. There is no actual evidence in the research demonstrating saturated fat being dangerous. Additionally, it has been determined that saturated fat intake does not correlate with saturated fat levels in the body. All of the research that points toward saturated fat intake and any complications of health are just weak epidemiological studies based on correlation.

Correlation does not equal causation.

“Red Meat Consumption Increases Risk of Cancer”

Everyone likes to take this title and run with it. In most cases, if you take a look at the actual study you will find that they are observational studies. Observational studies occur when a population is measured or surveyed as it is. Many of these studies are conducted via dietary recall surveys where in the instance of the above example, a group of people diagnosed with cancer would be asked to recall their diet through very vague questions like, “Over the last year, how many meals containing beef did you eat per week?” If the data reported high to red meat consumption, then it could be observed that red meat consumption correlates with a higher risk of cancer.

Let me ask you a question. If you interviewed people who just got diagnosed with cancer and found out that many of them have cats, would we assume that cats cause cancer? No, you would not. A single factor that does not take anything else into consideration can hardly be blamed for the cause of something. In the example of the above study, what about the carbs? Did they ask if these men were putting the bun on those red meat burgers? Or if they were having potatoes with that steak? No, they didn’t, or at least they didn’t report it. That is why we cannot take these studies to heart.

Yes, saturated fat can become harmful but not because it is fat, and not because it is saturated. When you have a gut problem, as you would if you were eating a diet high in processed carbohydrates, your body takes carbohydrates and makes these things called lipopolysaccharides, or LPS. These tiny molecules can hitch a ride into your bloodstream, where they lead to a cascade of inflammatory problems. However, LPS can’t cause this mischief alone. It has to hitch a ride on saturated fat to get into your bloodstream, via those chylomicrons we talked about earlier.

So, the theme remains, saturated fat in the presence of carbohydrates and gut dysfunction leads to inflammation and all its associated chronic health problems. The root cause isn’t saturated fat alone so, again, when we cut out the carbs and restore our gut health, which begins to happen as a result of keto dieting, then saturated fats are able to be used as they should be and provide their benefits to the body.

Besides carbohydrates, another real way red meat could actually be a concern is the manufacturing process, which can lead to low-quality meat that has lost much of its beneficial nutrients and is loaded with more pro-inflammatory fats. That is why the source of your food is so important, which we will get into more later in the book.

If you actually take a look at the available evidence, like this review of forty-nine observational and randomized controlled trials did, you will find that there is no link between saturated fat consumption and heart disease or death.10 The truth is, saturated fat actually is essential in our body for numerous reasons, most notably for brain health and hormone production.

BUT SURELY, I SHOULD LIMIT MY CHOLESTEROL INTAKE, RIGHT?

Ah, we thought you’d ask that. That’s okay, Mr. Keys made all of this very confusing for us. Bear with us on these next few questions, because they are going to be a little more science-based as we take a deeper look at cholesterol.

Cholesterol is a type of fat (also known as a lipid) that is found in many animal foods like beef, lamb, pork, eggs, and sardines, and is also produced by your liver. Cholesterol, despite getting a bad reputation, is extremely important and required for numerous processes in the body. Cholesterol is used to support cellular membranes, it’s used to make hormones, it helps your body produce vitamin D, it is used to protect our intestinal tract, it is important to repairing damaged cells, it helps your body produce bile, and it plays a vital role in combating inflammation. Would you be surprised if I told you that cholesterol makes up 25 percent percent of your brain? Cholesterol is extremely important for proper brain function and low cholesterol levels may even contribute to neurodegeneration.

For most diets, carbohydrates are the primary energy source or fuel. On a ketogenic diet, carbohydrates are restricted to a degree that triggers a response in the body to find a different fuel source to replace carbohydrates. This different source of fuel comes from our stored fat and the fat we eat. However, the brain cannot use fat directly for energy, so under these conditions the body must produce another fuel source known as ketones or ketone bodies. Ketone bodies are produced in the liver from the breakdown of fat stored in the body. When the body is producing ketones, it is in a state of ketosis, putting the “keto” in ketogenic diet.

Interestingly, this metabolic state of ketosis is also what occurs when the body is under conditions of fasting or starvation. Under these conditions, this transition to using stored energy to meet the energy demands of the body exists for survival. However, on a keto diet, you are not starving. Instead, you are replacing carbohydrates with fat and protein, which allows you to still nourish your body but also achieve ketosis and mimic this state of starvation, which has so many proposed benefits.

A snapshot of a keto diet done properly (yes, there are improper ways to do keto) consists of meat, eggs, vegetables, nuts, few fruits, and healthy oils.

If you eat paleo, you generally eat at a pre-agricultural level. Rather than eating carbohydrate-rich foods that people would have farmed, such as grains and tubers, paleo means eating foods that our hunter-gatherer ancestors would recognize: animal products, vegetables, fruits, nuts, and seeds. This eliminates much of what causes insulin resistance, chronic inflammation, and preventable diseases: grains, trans fats, and vegetable oils, sugars, and other Frankenfoods.

WHAT ARE KETONES?

Short Answer: Ketones are energy molecules that are produced in the liver from the breakdown of fat. Once produced, ketones can leave the liver and travel to places like the brain to be used for energy.

The body actually produces three different types of ketone bodies. They are referred to as acetone, acetoacetate (AcAc), and beta-hydroxybutyrate (BHB).

Technically, BHB is not a ketone body, due to a difference in its chemical structure, but is considered one for the purpose of energy metabolism. That is because BHB is the primary ketone body that is the end product of ketogenesis in the liver, meaning it is also the ketone that we see circulating in the blood, ready to be taken in by cells and used to convert to energy.

When stored fat, mobilized by glucagon, makes it to the liver, it is broken down to acetyl-CoA. Acetyl-CoA can then either enter the mitochondria of the cell to be used for energy, or it can be shuttled through another process known as ketogenesis. If shuttled toward ketogenesis, acetyl-CoA then goes through several steps leading to the production of AcAc, which is further converted to BHB, with acetone being made as a by-product.

Then BHB is released into the blood, where it can circulate through the body, be taken up by cells, and undergo a reverse process of being broken back down to AcAc and eventually acetyl-CoA, where it can now enter the mitochondria and be used for energy.

While some research suggests that acetone could also be used for energy, it is common for this ketone to be excreted as a waste product in our urine or breath.4

IS KETOSIS SAFE?

IS KETOSIS HEALTHY?

There are two primary health-destroying aspects that keto targets, allowing the diet to provide such robust benefits: insulin resistance and inflammation.

You have probably heard of insulin as something that type 2 diabetics take to control their symptoms. However, it is actually a vital hormone secreted by the pancreas in all healthy humans.

Simply put, insulin’s job is to manage the nutrients you digest and absorb from food and plays a role in carbohydrate and fat metabolism. Remember, when you eat carbs, they are broken down into glucose and released into your bloodstream (known as blood sugar). Increases in blood sugar signal the pancreas to secrete insulin. Insulin interacts with the cells of your body to “open the door” for glucose to enter the cell into your cellular “gas tanks,” where it can be burned as energy right away or shuttled toward glucose storage called glycogen. The problem is that most people have too much fuel. If you are overeating carbs and/or don’t exercise and move your body, you’re going to constantly have a full tank of gas.

What happens when the gas tank is full and there’s still glucose in the bloodstream? The body has to convert the sugar to something else. This something else is fat, which occurs through a process known as de novo lipogenesis. The fat created during this process is fat that can actually cause damage in the body and contribute to fat storage.

This is essentially what most people do every day by eating the large quantities of carbohydrates included in the standard American diet. To stick with the car analogy, every single day they go to the gas station to fill up on fuel, but their tanks are full, so they fill gas can after gas can and load them into the trunk.

The worse news is that if this trend continues, the overconsumption of carbs causes your cells to stop responding to the signals from insulin. This is known as reduced insulin sensitivity or insulin resistance. Insulin sensitivity is how easily your body responds to insulin. You are considered insulin sensitive if your body only needs to secrete a small amount of insulin to deposit glucose into the cells. The more insulin sensitive you are, generally the healthier you are.

Note: this is just a problem with simple refined carbs without fiber tho right?

Insulin resistance occurs when your blood sugar is constantly elevated, so your pancreas continues to secrete insulin. Over time this chronic high level of insulin, or hyperinsulinemia, results in the cells of your body no longer responding to insulin, a.k.a. insulin resistance.

When you become insulin resistant, your pancreas continues releasing more insulin in the attempt to decrease blood sugar levels. This is a dangerous cycle that can result in numerous health complications, most notably, type 2 diabetes.

Diabetes is not the only disease caused by insulin resistance though. As mentioned, insulin resistance plays a big role in many of the most common chronic diseases we see today. It appears that as we age, our bodies lose their effectiveness at utilizing glucose. This trend seems to be accelerated by lifestyle factors, including the chronic overconsumption of carbohydrates. This is why we should stop neglecting nutrition’s role in the treatment and prevention of disease.

Another reason why insulin resistance is so damaging to our health is because when insulin is elevated, the body does not burn fat. In fact, under conditions of high insulin, fat consumed is shuttled toward storage in combination with the fat created from excess carbohydrates. Furthermore, insulin prevents the burning of stored fat, so if you are insulin resistant, stored fat burning is also going to be hindered. This not only leads to obesity, which is a huge contributor to poor health, but it also drives up inflammation and other contributors to poor health and disease.

it seems like a better idea is to cut the carbs and allow your body to transition to a different fuel source (fat and ketones) that will not lead to the same complications. Ketones can be taken in by cells through pathways that are independent of insulin, so despite any insulin dysfunction, ketones can still be utilized as fuel.

Another problem with insulin resistance is that it is a prime driver of the other factor that plays a key role in our overall health: inflammation.

As for inflammation, there are two kinds: acute and chronic. Acute inflammation is your friend. If you cut your hand trying to slice the perfect avocado, you want your acute inflammatory pathway activated immediately. This is your body’s way of sending reinforcements to take care of a problem. You may notice a little swelling, a little redness in the area—and this is normal.

Chronic inflammation is an entirely different animal. This is the low-grade response by your body to having to continually repair tissues or combat foreign invaders from your diet and environment. If you are slowly and constantly damaging cells, your body will be in a consistent, slow repair process at all times. This results in chronic inflammation, another great landscape for chronic disease to build on. Interestingly, consuming too many carbs and being insulin resistant can promote chronic inflammation, so going keto also breaks this cycle.

One of the best ways you can do this is by cutting out those carbs, especially processed carbs, and running on an entirely different energy system. This is what makes keto so special.

here are some of the foods you’ll be eating to both be in ketosis and be healthy:

Meat (beef, pork, poultry, etc.)

Fish

Eggs

Avocados

Leafy green vegetables

Nuts/Seeds

Minimal amount of cheese

Quality oils like MCT, coconut, and avocado oil

Few low-glycemic fruits such as blueberries

Many people consider keto to be a restrictive diet. We actually don’t see it that way, but for a vegetarian or a vegan it can be. Typically, the foods used to replace meat on a standard vegan or vegetarian diet contains carbohydrate replacements making them not keto-friendly. This means that the approved keto food list for vegans and vegetarians is a lot smaller and thus restrictive.

That makes following keto as a vegetarian or vegan a lot harder. You can still consume plenty of fats if you stick to healthy oils, nuts/nut butters, avocados, seeds/seed butters, and coconut as your sources, but making sure you get enough protein in can be a little more challenging. But that doesn’t mean it can’t be done, and in fact, there are numerous people reporting that they do follow a vegetarian keto diet.

CHAPTER 2

DEBUNKING NUTRITION MYTHS

As you now know, the body can replace the need for carbohydrates with fat and ketones. Despite this, the body does still need glucose, a product of carbohydrate digestion, which leads many to believe that carbs must be consumed to meet demand. But this thinking is a little flawed.

There are some cells in the body, such as red blood cells and even certain portions of the brain, that can only use glucose for fuel. Even on a keto diet, the need for glucose by these cells remains. The secret is, you don’t have to eat the carbs to fuel these cells!

Our body possesses a unique metabolic process known as gluconeogenesis (GNG), a word that some ketogenic dieters fear for reasons we’ll investigate later. GNG is the creation of glucose from non-glucose substrate, like amino acids from protein and even from the fat you burn for fuel. No, that does not mean that when you eat a steak high in protein that it turns into a donut inside our body. It means that your body has a regulatory process in place to ensure that these cells that consume only glucose have the fuel they need. This is a demand-driven process, meaning your body does this as it needs glucose, and doesn’t when it has enough.

carbs are not necessarily bad, but they are not essential, and people eat far too many of them and from bad sources.

It is often perceived that those in favor of low-carb diets think that carbs are bad. While many keto advocates do fall victim to this line of thinking, it should be noted that carbohydrates are not inherently evil (with the exception of processed carbs). The problem is that we consume way too many carbs, especially those fake food, processed carbohydrates.

If someone is insulin resistant, they no longer effectively utilize carbohydrates so consuming them does not make sense. Additionally, research has shown that as we age, we begin to lose our ability to effectively utilize carbs.6 Furthermore, as we addressed in the last question, our body can make all of the glucose it needs without carbohydrate consumption so while they may not be bad, they are not necessary. In fact, there is no such thing as an essential carbohydrate.

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6 Mayer B. Davidson, “The Effect of Aging on Carbohydrate Metabolism: A Review of the English Literature and a Practical Approach to The Diagnosis of Diabetes Mellitus in the Elderly,” Metabolism 28, no. 6 (1979): 688-705.

As we age our ability to effectively utilize carbs for energy can become impaired, which is accelerated by the chronic overconsumption of carbohydrates.

It’s true that some carb sources are better than others. Certain carbs may have a lower glycemic response, meaning they can be digested slower, leading to a milder increase in blood glucose. Certainly, some carb sources may also contain a lot more nutrients compared to others (that doesn’t mean you can access those nutrients, but we are getting ahead of ourselves again).

For someone who was raised eating only real foods, with strong exercise, sleep, and stress standards, eating “clean” or “good” carbohydrates may be well tolerated. The problem is quite a few of us have metabolic damage, excessive fat, and never-ending inflammation. If you are metabolically damaged and suffering from some degree of insulin resistance, you no longer effectively utilize carbohydrates whether they are “good” or “bad.”

Even fruit, whole grains, brown rice, and sweet potatoes are broken down to glucose and remember, having chronically elevated levels of blood glucose can lead to your health spiraling out of control. Furthermore, if your goal is to achieve ketosis, spiking blood sugar will prevent this so on a ketogenic diet, even the “clean” carbs have to go. This does not mean you will never eat these foods again, which we will discuss in greater detail later.

While fruit may contain some vitamins and minerals, it also contains a lot of sugar in the form of fructose, which in excess is not healthy and should be limited or avoided on a keto diet.

Fruit also contains a lot of sugar, so consuming it can keep you out of ketosis, negatively impact weight loss efforts, and hinder your ability to develop healthy habits. How?

The sugar in fruit causes a big increase in blood sugar, followed by a big crash in blood sugar, leading to a hungry and tired you. When you eat fruit as a stand-alone snack, you’ll probably feel full for half an hour. After that, hunger sets in again. Fruit doesn’t have enough fat or protein to keep you satiated. Although fruit does contain fiber, which can help keep cravings at bay, it’s usually not enough to prevent the inevitable blood sugar crash. Once that blood sugar starts crashing, the hunger and cravings begin to surface again.

Fruit doesn’t just contain any sugar; it contains a special sugar known as fructose, a sugar that most people refer to as a “healthy sugar,” because, well, it is found in fruit. Here’s the problem: fructose fails to trigger the release of hormones and neurotransmitters in your brain to signal that you’re full. Did you ever bring home a container of grapes or pineapple, eat a few pieces, and suddenly the entire container was gone? You’re not alone. The combination of sneaky fructose and blood sugar spikes (followed by dips) is a recipe for disaster. This inadvertently prevents weight loss for many people.

And thanks to the magic of agricultural research and development, today’s fruits are bigger and sweeter than ever. Have you noticed that some apples are the size of a baby’s head, and you can buy table grapes that seem almost as big as kiwis? They are just bags of wet sugar with little to no actual nutrition. Beware.

One last thought about the supposed health benefits of eating a lot of fruit comes from a meta-analysis looking at fruit and vegetable consumption in relation to breast cancer risk. Findings showed vegetable consumption was associated with a reduced risk of breast cancer—but not fruit.7 Why? Maybe because sugar fuels cancer,

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7 S. Gandini, H. Merzenich, C. Robertson, and P. Boyle, “Meta-Analysis Of Studies on Breast Cancer Risk and Diet: The Role of Fruit and Vegetable Consumption and the Intake of Associated Micronutrients,” European Journal of Cancer 36, no. 5 (2000): 636-646.

Many do not realize that while fruit does contain a lot of micronutrients, humans are not able to absorb these micronutrients very well. In fact, micronutrients found in meat are much more bioavailable, a term used to describe how well something can be absorbed, to humans compared to micronutrients of plant origin. For example, vitamin A has been found to be 15-20 times more bioavailable in meat compared to plant sources.8 Iron from meat origin is three times more bioavailable compared to iron from plant sources.9

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8 Marjory J. Haskell, “The Challenge to Reach Nutritional Adequacy for Vitamin A: B-Carotene Bioavailability and Conversion—Evidence in Humans,” The American Journal of Clinical Nutrition 96, no. 5 (2012): 1193S-1203S.

9 Lichen Yang, Yuhui Zhang, Jun Wang, Zhengwu Huang, Lingyan Gou, Zhilin Wang, Tongxiang Ren, Jianhua Piao, and Xiaoguang Yang. “Non-Heme Iron Absorption And Utilization from Typical Whole Chinese Diets in Young Chinese Urban Men Measured by a Double-Labeled Stable Isotope Technique,” PloS One 11, no. 4 (2016): e0153885.

Grass-fed butter can actually be rich in fat-soluble vitamins and other nutrients like conjugated linoleic acid (CLA).

Since research has now debunked many of the myths against animal fats, the lack of environmental sustainability is now the last thing that advocates for plant-based diets hold onto for justification. We have all heard it, right? “Animal meat production is not sustainable, and after all, cows release a lot of methane which is detrimental to our environment.” Wrong again.

You may be wondering, if cholesterol has so many purposes in the body, why is it so often feared? Besides the fact that cholesterol is a fat and fat is feared, high levels of cholesterol in the body have been associated with high risk for various diseases, particularly heart disease. The problem here is that when you are testing cholesterol in the blood, you aren’t actually directly testing cholesterol. Let us explain.

Earlier we talked about chylomicrons and how they had to carry fat from the diet through the blood. The same is true for all lipids that need to be transported in the blood. Unlike sugar and other components of the food you eat, which can mingle in your bloodstream, cholesterol is also a lipid and doesn’t mix well with the watery nature of your blood (you know what they say about oil and water). Therefore, for cholesterol to make its rounds throughout your body, it needs to climb into a “boat” to sail your bloodstream in style.

These vessels are known as lipoproteins. Lipoproteins, like they sound, are lipid-carrying proteins. One of the primary jobs of lipoproteins is delivering cholesterol to the cells and organs that need it the most. There are five different types of lipoproteins, but the ones you hear about most are low-density lipoprotein (LDL), frequently referred to as “bad” cholesterol, and high-density lipoprotein (HDL), which has been labeled a “good” guy.

To be clear, HDL and LDL are not actual types of cholesterol, only the lipoproteins that transport cholesterol throughout your body. This is important because when you are getting total cholesterol measured at your doctor’s office, you are just getting your lipoprotein levels measured or the combination of HDL and LDL. The problem with this measure is that HDL and LDL both have different functions in the body and lipoproteins carry other things besides cholesterol, including triglycerides, phospholipids, fat-soluble vitamins, and even various proteins. The amount of each of these contained within a lipoprotein varies and is dependent on numerous factors, such as the composition of your diet and your activity level.

The moral of the story here is that when we are measuring for cholesterol, we are essentially just correlating the number of lipoproteins in the blood with a predicted amount of cholesterol. That’s like trying to predict how many people are traveling a highway just by counting the number of cars. What about the number of people in each car? Now you can see why saying elevated levels of cholesterol in the body is the cause of disease seems a little fishy. How can we be certain?

Regardless of whether or not we can measure it well, most of us have been told that we need to avoid cholesterol, and this is what shapes our dietary recommendations. In fact, recently Chris’ grandpa’s doctor recommended that he eat no more than one egg per week to keep his cholesterol levels low. There are two big problems with this recommendation. The first is that the foods you eat only contribute to about 20 percent of the cholesterol in your body, the other 80 percent comes from your liver. The second is that cholesterol is important and necessary for a healthy, properly functioning body!

HDL and LDL, the two primary lipoproteins discussed in the previous question, are commonly referred to as good and bad cholesterol. The two primary problems with this label are that they are not actually cholesterol—they only carry it—and they both serve different and equally as important roles in the function of the human body. Furthermore, cholesterol isn’t bad, it just depends where it ends up in the body and this is regulated by the different types of lipoproteins and numerous other factors.

HDL is produced by the liver and is commonly referred to as the good cholesterol. HDL wears many hats as it relates to our human physiology, the most notable being its ability to scavenge the body looking for cholesterol to pack on board and deliver back to the liver, where it can be eliminated. Additionally, HDL particles have anti-oxidant, anti-inflammatory, anti-thrombotic, and anti-apoptotic properties.11 For this reason, higher HDL levels have been associated with superior cardiovascular health.

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10 Rajiv Chowdhury, Samantha Warnakula, Setor Kunutsor, Francesca Crowe, Heather A. Ward, Laura Johnson, Oscar H. Franco, et al. “Association of Dietary, Circulating, and Supplement Fatty Acids with Coronary Risk: A Systematic Review and Meta-Analysis,” Annals of Internal Medicine 160, no. 6 (2014): 398-406.

11 Kenneth R Feingold and Carl Grunfeld. “Introduction to Lipids and Lipoproteins,” in Endotext, K.R. Feingold, B. Anawait, A. Boyce, et al., ed. (South Dartmouth, MA: MDText.com Inc, 2000).

LDL, commonly referred to as the bad cholesterol, also wears many hats. In fact, LDL is the primary lipoprotein that carries cholesterol and triglycerides to the cells to be used for energy or other functions like cellular repair. The chylomicrons we have been mentioning are actually a type of LDL, are produced by cells that line our digestive tract, and is responsible for carrying fats and other components from the foods we eat. VLDL, another type of LDL, are particles that are produced by your liver to carry cholesterol and triglycerides, made by the body, to the cells. Once VLDL has deposited its triglycerides to be used for energy, it turns into LDL and is made up primarily of cholesterol. Nearly 70 percent of circulating LDL is cleared through the liver while the rest is utilized throughout the body based on demand.

Now are you a little confused on why people consider LDL to be such a bad thing? Does it sound like LDL is necessary to make sure our cells have everything they need for energy and repair? Does it sound like LDL levels may have to go up on a high-fat diet since fat is the primary energy source and needs to be transported? You are correct. Like most of the lipid-related topics we have discussed, LDL has been falsely accused for contributing to poor heart health. How did this happen?

LDL is perceived negatively because we see elevated levels of it in many chronic diseases, diseases characterized by inflammation and cellular degeneration—which is one of the reasons we actually see elevated LDL in these conditions. Remember, LDL functions to transport cholesterol, triglycerides, and other useful material to cells to provide energy and help repair damage. If you are suffering from a sickness, disease, or have cell damage occurring, it should not come as a surprise that you would see elevated levels of LDL; your body is trying to repair itself. Just because something is present doesn’t mean it’s the cause.

Remember though, LDL does carry cholesterol and, as we alluded to earlier in this question, cholesterol is only harmful if it ends up where it isn’t supposed to. Atherosclerosis, the hardening of our arteries, is a major contributor to poor cardiovascular health and disease. Cholesterol is one of the reasons why atherosclerosis occurs.

The lining of our blood vessels contains several layers of defense. When any of these layers become damaged, LDL will travel to the wreckage zone to help clean it up, primarily through the use of cholesterol. But LDL and cholesterol can get trapped inside our arterial cell walls. When this happens repeatedly, hardening occurs—atherosclerosis. Your next logical question should be, what causes the damage to the arterial wall and how does LDL get trapped inside? That’s probably the issue, right? Bingo!

Inflammation, especially chronic inflammation, is one of the primary reasons we see damaged arterial walls. This starts with the glycocalyx. (A mouthful, we know.) The glycocalyx is a thick, gel-like layer that lines the inner wall of our healthy blood vessels. The glycocalyx has many functions, one of its primaries being the first line of defense for the lining of our blood vessels. Inflammation and oxidative stress can destroy our glycocalyx. Interestingly, at Low-Carb Houston 2018, chemical engineer and nutrition expert Ivor Cummins showed a pretty shocking picture of what happens to the glycocalyx following a high-carb meal. It looked something like this:

As you can see after a single high-carb meal, the glycocalyx, our first line of defense, is completely destroyed. Now the first line of defense is down, and the endothelium is exposed. That means LDL can have access to this area for repair. If this is done through a process known as endocytosis, this is fine. This process means that the endothelium is taking in the lipoprotein, allowing repair, and spitting what’s left back out. The problem is that with chronic inflammation we see an increased occurrence of transcytosis, which occurs when the LDL goes a little deeper than it should and enters the intima proteoglycans, where something like 25 percent of it can get trapped and become oxidized by macrophages. It is this oxidized LDL that is the primary contributor to atherosclerosis.

Now, notice something. Consuming carbohydrates can destroy your glycocalyx. Also, worth noting is that a high-carb diet can result in smaller LDL particle sizes, more likely to get trapped in blood vessels. Chronically consuming carbs can dramatically increase inflammation, and inflammation can damage our arterial walls, requiring LDL to come fix things up. Here it can be trapped, leading to atherosclerosis. Seems like carbs may be more of the problem here, doesn’t it?

if you take a closer look, you will see that triglycerides are just fats found in food and in the body.

Triglycerides, just as they sound, are three fatty acids with a glycerol backbone. Triglycerides are the fats we find circulating throughout our body and can either be synthesized by the body or they can be acquired through the consumption of dietary fat. The point here is that triglycerides in and of themselves are not bad,

However, when it comes to measuring triglycerides in your blood, having very high triglycerides could be harmful. It is worth noting that recommended blood triglyceride levels may differ on a keto diet; however, we would still expect your triglyceride levels to lower overtime because the cells in your body should be soaking up these triglycerides for fuel rather than letting them circulate in your blood for a long time.

Of course, the time you test your blood matters. If you were to test your blood after eating a high-fat meal, we would speculate that your triglycerides would be higher since you just consumed fat. However, if you are measuring your blood fasted in the morning like you should, triglyceride levels should be decreasing on a keto because of better triglyceride usage. If this does not occur, it could be a result of too high carbohydrate consumption or consuming alcohol in the days leading up to your test.

How many people have you seen have health problems from consuming a protein shake? The reason many people think that protein could cause kidney damage is from increasing glomerular pressure and hyperfiltration. For those of you who don’t know what that is, it doesn’t matter. What matters is research has found no significant evidence for any harmful effect of high protein consumption on renal (kidney) function in individuals with healthy kidneys.12

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12 Michaela C. Devries, Arjun Sithamparapillai, K. Scott Brimble, Laura Banfield, Robert W. Morton, and Stuart M. Phillips, “Changes in Kidney Function do not Differ between Healthy Adults Consuming Higher-Compared with Lower-Or Normal-Protein Diets: A Systematic Review and Meta-Analysis,” The Journal of Nutrition 148, no. 11 (2018): 1760-1775.

Notice here that we are talking about the healthy population. For those suffering from chronic kidney disease, restricting protein consumption may be useful for preventing progression of the disease.

Low insulin levels, a positive benefit that comes with keto dieting, causes your body to excrete water and electrolytes like sodium. The side effects of sodium deficiency can range from brain fog to muscle cramps to heart arrhythmia—not something you want to or have to deal with.

It is also worth pointing out that your kidneys possess the power to very rapidly regulate sodium levels, preventing any concern about over-consuming sodium. This is one of the reasons why we have actually seen some governing bodies loosen their restrictions on sodium intake.14

CHAPTER 3

WELLNESS BENEFITS OF KETO

Ketones act not only as energy molecules, but also as signaling molecules. This means they tell other cells and pathways to do things independently of providing you with energy. Combined, this allows them to promote physiological adaptations that can contribute to many of the proposed health benefits of keto.

The length of time it takes to become adapted to keto is known as the keto-adaptation period and the length of time it takes for this to occur varies for everyone but typically between 2-8 weeks.

The length of time it will take you to see the benefits of keto varies. Some people report seeing improvements within just a couple of days, while others may take a week or longer. Much of this can depend on your individual body and how you were treating it prior to starting the diet.

There is a period of time between starting keto and experiencing its benefits known as the keto-adaptation period. During this period, which we will get into more in Chapter 7, the body is still becoming accustomed to the changes being thrown at it and this can take time. The length of this adaptation period can vary based on factors, such as the degree of insulin resistance or activity level. Someone who is more insulin resistant and less active may take longer to become adapted to burning fat for fuel and producing and utilizing ketones.

Unless you’re just flat out tired from lack of sleep, nutrition is the largest lever to pull here. Within nutrition, the easiest thing to control is the amount of carbohydrates you are consuming.

Consuming carbs leads to an increase in blood sugar (glucose). The good news is that if you aren’t extremely metabolically damaged, your body will sense this spike in blood sugar, and your pancreas will secrete insulin to rapidly shuttle glucose into your cells for energy or storage. The bad news is that this leads to a blood sugar crash, a primary driver of your fatigue.

When the blood sugar gets stored or burned, there’s no more available substrate for energy. Most people who are “carbohydrate burners” do not possess the ability to easily and effectively transition to burning fat for fuel once they have run out of blood glucose. This means that once their blood sugar crashes, there isn’t a whole lot of fuel available to transition to, leading to low energy levels and a need to acquire more energy the only way the body can in this situation—from more food.

Insulin resistance (IR), which we have mentioned numerous times already, can also be a common reason for a decrease in energy levels. Remember, insulin is secreted in response to elevated blood sugar. The purpose of insulin is to communicate with the cells in our body to allow them to take nutrients in for energy use or storage. However, if cells are chronically stimulated by insulin, the line of communication between insulin and our cells can become damaged or in some cases broken. This leads to insulin resistance and the body producing more and more insulin to drive glucose out of the blood and into the cells. This further contributes to the problem. This doesn’t just hurt energy levels, it also wreaks havoc on many aspects of your health since IR is considered a precondition to diabetes, heart disease, neurodegenerative disease, and cancer.

If you are insulin resistant but you are still eating a lot of carbs then your body is essentially starving, despite the fact that it has plenty of fuel available. The glucose is in the blood, but it is not efficiently getting into the cell. Furthermore, insulin actually suppresses lipolysis, or fat burning, meaning that someone who has chronically elevated insulin levels is not going to be an efficient fat burner, meaning they are unable to effectively tap into the body’s other source of fuel, fat.

One of the primary reasons a keto diet can improve your energy levels is because of its ability to circumvent exactly what we just described. For starters, when you are on a keto diet, you are not eating a lot of carbohydrates, so your blood sugar levels tend to be much more stable. Rather than having sharp increases in blood sugar followed by steep declines, you tend to see consistently level numbers, which can help prevent dips in energy levels.

Once you are adapted to keto, your body can easily tap into stored body fat, which is a much greater, and nearly endless, source of fuel since even the leanest people store plenty of energy in the form of fat. Even better is that fat provides more energy per unit compared to glucose—over double. This means that once you are keto or fat-adapted, you have access to a bigger on-demand fuel tank that is more efficient and produces more energy than blood sugar.

It’s not just the burning of fat that contributes to better energy levels on a ketogenic diet. Ketogenesis, or the production of ketones, can also contribute to better energy levels. Ketones are little energy molecules that can be used by nearly all cells in the human body. This is even true for the insulin resistant person, which is why keto is the best option for someone like this.

Like low energy levels, carbohydrates being your primary source of energy can also stimulate hunger. When your blood sugar crashes after a carbohydrate-based meal and you are unable to tap into fat stores, hunger is stimulated, specifically carbohydrate cravings, to get you to eat and get that blood glucose level back up to provide energy to the body.

For someone who is following a high-carb diet, especially a high-glycemic, high-carb diet, the hunger stimulations will just lead to another carbohydrate-based meal that starts the cycle over again, leading to a perpetual blood sugar roller coaster. Not only can this eventually cause insulin resistance, it can also cause your hunger and cravings to come on quick and strong.

Appetite is much more complex than most people realize. In addition to unstable blood glucose, appetite signaling also plays an important role in hunger levels. Appetite signaling is regulated by the endocrine system (insulin, amylin, glucagon, pancreatic peptide), the central nervous system (NPY, AGRP, and POMC), and the digestive tract (ghrelin, PYY, somatostatin, secretin, and CCK). Together, all of these signals interact with the brain, particularly the hypothalamus, to regulate food intake.

These various signals are used for both short-term (after a single meal) and long-term (determined by the amount of fat stored in the body) to regulate appetite. In the healthy individual, appetite signaling works well. When there is not a lot of energy available, signals are sent to the brain to stimulate hunger. Conversely, when we have plenty of available energy, signals will be sent to the brain to promote fullness. The problem is that not everyone has proper appetite signaling. In fact, research has found that obese people in particular have impaired appetite signaling; one of the reasons for constant hunger and overeating.15

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14 Niels Graudal, Gesche Jürgens, Bo Baslund, and Michael H. Alderman, “Compared with Usual Sodium Intake, Low-and Excessive-sodium Diets are Associated with Increased Mortality: a Meta-analysis,” American Journal of Hypertension 27, no. 9 (2014): 1129-1137.

15 Jeffrey M. Zigman, Sebastien G. Bouret, and Zane B. Andrews, “Obesity Impairs the Action of the Neuroendocrine Ghrelin System,” Trends in Endocrinology & Metabolism 27, no. 1 (2016): 54-63.

There have been a lot of studies supporting that a keto diet can suppress appetite, especially when compared to other diets. In fact, one of the most commonly reported benefits of keto is reduced hunger, a great sign of being in ketosis. If you realize you didn’t eat for the last 14 hours, still have boundless energy and are not hungry, you are probably in ketosis.

This anecdotal evidence is supported by research like this 2008 study reporting that a keto diet, compared to a moderate-carb diet, led to greater reductions in hunger.16 This study was very practical because it allowed the subjects to eat as they felt necessary, referred to as ad libitum. Interestingly, the keto diet demonstrated a greater decrease in ad libitum food intake. The subjects on keto actually chose to eat less, which supports the reported reductions in hunger.

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16 Alexandra M Johnstone, Graham W. Horgan, Sandra D. Murison, David M. Bremner, and Gerald E. Lobley “Effects of a High-protein Ketogenic Diet on Hunger, Appetite, and Weight Loss in Obese Men Feeding ad libitum,” The American Journal of Clinical Nutrition 87, no. 1 (2008): 44-55.

A big mechanism is the stability of blood sugar experienced on a keto diet. Not consuming carbs means not having drastic fluctuations in your blood sugar to stimulate hunger. Furthermore, when adapted to keto, under conditions of low blood sugar your body will transition to burning fat. Since your body has a nearly endless supply of fuel available from fat (the body stores plenty), there is no need for the body to stimulate hunger because it has all of the fuel it needs available. Even further contributing to this effect is ketones since they (and fat) actually provide more energy compared to glucose.17

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17 Richard L. Veech, “The Therapeutic Implications of Ketone Bodies: The Effects of Ketone Bodies in Pathological Conditions: Ketosis, Ketogenic Diet, Redox States, Insulin Resistance, and Mitochondrial Metabolism,” Prostaglandins, Leukotrienes and Essential Fatty Acids 70, no. 3 (2004): 309-319.

While blood glucose levels have traditionally been thought of as the primary regulator of appetite (the glucostatic theory), research has found that fatty acids can also play a role. Having elevated levels of fatty acids in the blood, like you would on a keto diet, can actually stimulate fullness due to many factors including their impact on insulin and hunger hormone, NPY.18

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18 Tanya J. Little, Antonietta Russo, James H. Meyer, Michael Horowitz, Douglas R. Smyth, Max Bellon, Judith M. Wishart, Karen L. Jones, and Christine Feinle–Bisset, “Free Fatty Acids Have More Potent Effects on Gastric Emptying, Gut Hormones, and Appetite than Triacylglycerides,” Gastroenterology 133, no. 4 (2007): 1124-1131.

In addition to the fat found inside our body, further contributing to fullness on a ketogenic diet is dietary fat. Fat is more satiating (another term for being full) than carbohydrates, in part due to containing over double the amount of energy compared to carbohydrates. It is also worth mentioning that protein, also consumed on a keto diet, has also been shown to possess satiety-promoting effects.

Changes in satiety signaling on a keto diet further add to the hunger reducing benefits of the diet. Research has found that being in a state of ketosis can suppress ghrelin, a hormone that is responsible for stimulating appetite.19 The ketogenic diet has also demonstrated greater production of cholecystokinin (CCK), a hormone produced during fat metabolism, which can further suppress appetite.20

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19 Antonio Paoli, Gerardo Bosco, Enrico M. Camporesi, and Devanand Mangar, “Ketosis, Ketogenic Diet and Food Intake Control: A Complex Relationship,” Frontiers in Psychology 6 (2015): 27.

20 P. Sumithran, Luke A. Prendergast, Elizabeth Delbridge, Katrina Purcell, Arthur Shulkes, Adamandia Kriketos, and Joseph Proietto, “Ketosis and Appetite-mediating Nutrients and Hormones after Weight Loss,” European Journal

CHAPTER 4

BODY COMPOSITION BENEFITS

When you are following a ketogenic diet, you are putting your body in an optimal fat burning state, the reason why fat loss is so robust on the diet.

When you are no longer providing glucose from carbohydrates, the body must adapt by finding a new fuel source. Fat is this new fuel source and the fat can come from our diet or from our stored body fat. When it comes to burning fat, insulin is of particular importance since this hormone actually inhibits lipolysis or the mobilization of stored fatty acids. However, when glucose levels are low, insulin levels are also low, and the pancreas secretes a hormone known as glucagon instead. Glucagon behaves the opposite of insulin and is able to interact with adipose tissue to stimulate the release of fatty acids into the bloodstream, where they can then be used for energy by various cells in the body and for ketone production.

When you are in ketosis, you literally change your cellular machinery so that it can more effectively burn fat for fuel. Different cell membrane transporters and pathways are activated so your body will more readily use fat instead of sugar for fuel.

Many diets that severely restrict calories can lead to a loss of muscle mass. When our body does not have sufficient fuel coming in and is not adapted to burning fat and producing ketones, it resorts to breaking down muscle proteins, resulting in a loss of muscle mass. However, a ketogenic diet has actually been shown to preserve muscle mass.

You may be able to extrapolate that since on a keto diet you are fat-adapted, you can pull energy from your fat stores, resulting in the preservation of muscle tissue. This theory is supported by the numerous studies we highlighted reporting that while weight loss may be similar on a keto diet compared to other diets, we tend to see a greater percentage of that weight being lost as fat on keto suggesting that more muscle is being preserved on the diet.

A study looking at the infusion of ketone bodies found their ability to spare the breakdown of leucine, the primary muscle protein,43 demonstrating that it may be ketones that are responsible for the muscle sparing effect of a ketogenic diet.

From an evolutionary perspective, this makes perfect sense. If access to food is limited, especially for a long duration, it would be advantageous to be able to produce and use a fuel source that prevented breaking down precious muscle.

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43 K. Sreekumaran Nair, Stephen L. Welle, David Halliday, and Robert G. Campbell, “Effect Of Beta-Hydroxybutyrate on Whole-Body Leucine Kinetics and Fractional Mixed Skeletal Muscle Protein Synthesis in Humans,” The Journal of Clinical Investigation 82, no. 1 (1988): 198-205.

Research has also demonstrated that ketones may be able to stimulate protein synthesis or the biological production of muscle proteins.44 Since maintaining an appropriate balance of protein synthesis to degradation is important for maintaining muscle mass. This is another mechanism that can allow us to refer to a keto diet as a muscle-preserving diet.

Carbohydrates can help with muscle gain, but they are not required. Remember, ketones offer a unique ability to prevent the breakdown of muscle, and they also have an ability to stimulate protein synthesis, offering up a combination that could lead to muscle gain.

There is not a ton of evidence in the research of increased muscle mass on keto. This is because the diets used in research are not set up to promote muscle gain. Here are three factors to help muscle gain on keto. As you will see, they are an extension of how not to lose muscle as well.

Eat adequate protein: This will range depending on your bio-individuality but should be between .8 grams to 1.2 grams per pound of lean body mass.

Eat enough calories: To effectively gain lean muscle mass you may need to eat more calories. If you are losing muscle mass or not gaining it, increasing calories will help.

Create the appropriate stimulus: Exercising is important for muscle growth. This is no different on a ketogenic diet. Keto scientist Dr. Jeff Volek has demonstrated that the combination of resistance training and keto leads to muscle growth46 which has also been supported in other studies, including keto and CrossFit.47

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46 Jeff S. Volek, Matthew J. Sharman, Dawn M. Love, Neva G. Avery, Timothy P. Scheett, and William J. Kraemer, “Body Composition and Hormonal Responses to a Carbohydrate-Restricted Diet,” Metabolism-Clinical and Experimental 51, no. 7 (2002): 864-870.

47 Rachel M. Gregory, H. Hamdan, D. M. Torisky, and J. D. Akers. “A Low-Carbohydrate Ketogenic Diet Combined with 6-Weeks of Crossfit Training Improves Body Composition and Performance,” International Journal of Sports and Exerercise Medicine 3 (2017): 1-10.

CHAPTER 5

PERFORMANCE BENEFITS

The body can perform exercise just fine without the use of carbohydrates.

A hint to the answer can be found in a story of a two-year Arctic expedition that began in 1878. A group of explorers—four Caucasians, three Inuit families, and 44 dogs pulling sleds—set out from the west side of Canada’s Hudson Bay in search of the HMS Franklin, a British Royal Navy ship lost in the Arctic.48

The group set out with a month’s supply of food that consisted almost entirely of walrus blubber. After they ate that, they lived off the land and sea, eating what they hunted. In other words, for the duration of a two-year, 3,000-mile foot journey through the Arctic, they ate primarily meat and fat.

Every man and dog returned safe and sound, leaner and healthier than ever. This is a great example of the human capacity to perform exceptional physical feats on very few carbohydrates.

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48 Charles Francis Hall, Narrative of the Second Arctic Expedition Made (Cambridge University Press, 2014).

Nevertheless, conventional wisdom among the fitness and nutrition community is that carbohydrates must make up a high portion of your diet in order to maintain physical performance. If you had asked someone ten-to-fifteen years ago, they would have said you were crazy for thinking you could improve exercise without carbohydrates, especially endurance exercise. These beliefs mostly stem from studies in the last hundred years looking at muscle glycogen and its relationship to exercise performance.

Muscle glycogen is the stored form of carbohydrates found in our muscles that serves as an energy reserve tank. It is traditionally thought that having full glycogen stores is important to ensure enough energy is available to fuel the body for optimal physical performance. It is this understanding that has led to carb loading being the most popular strategy for improving physical performance. The problem is that research has not supported that carb loading before exercise actually improves performance.

Furthermore, the fuel you rely on during exercise differs based on your diet. If you are following a high-carbohydrate diet, then yes carbohydrates will be fueling your physical performance. Don’t let this understanding lead to you thinking that carbohydrates are the best fuel source or that it is particularly good to have exercise primarily fueled by them.

In a study conducted on highly trained endurance athletes who were either keto or carb adapted, it was discovered that keto dieters burn a similar amount of glycogen during exercise and possess a unique ability to replenish glycogen at rates similar to carb-adapted athletes.49 All this despite consuming no significant amount of carbohydrates.

This tells us that when someone is adapted to a ketogenic diet, the role of glycogen may be diminished and the need for dietary carbohydrates to support glycogen levels may not be required. Thus, carbohydrates are not, in all circumstances, essential for physical performance.

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49 Jeff S. Volek, Daniel J. Freidenreich, Catherine Saenz, Laura J. Kunces, Brent C. Creighton, Jenna M. Bartley, Patrick M. Davitt, et al., “Metabolic Characteristics of Keto-adapted Ultra-endurance Runners,” Metabolism 65, no. 3 (2016): 100-110.

You may be wondering if the type of exercise matters. Conventional wisdom holds that carbs provide more fuel for the body to perform at higher intensities and fat is what provides more energy during exercise at lower intensities. Again, the fuel you rely on during exercise differs based on your diet. In Volek’s study, it was demonstrated that the athletes following a ketogenic diet burned mostly fat during exercise at up to 70 percent of their max intensity, while the high-carb athletes burned fat up to 55 percent of their max intensity. In other words, the fat-adapted athletes in this study demonstrate that the demand for carbs as fuel during greater exercise intensities can change under different dietary conditions. Thus, carbohydrates are not, in all circumstances, essential for physical performance.

However, it is true that carbohydrates may provide an ergogenic effect, meaning they can improve physical performance. Additionally, some elite athletes may require energy more quickly than the rate at which they can get it from fat, so more research is needed on this subject to fully understand the details. Regardless, none of these possibilities mean that carbohydrates are a superior energy source for exercise. Furthermore, the goal of optimizing physical performance likely only applies to elite athletes. The majority of us are not elite athletes and perhaps achieving the most optimal exercise performance shouldn’t be the primary focus. Instead, the focus should be on health, which when improved, can still contribute to greater exercise performance.

There is actually research demonstrating that simply swooshing carbohydrates around in your mouth can produce an ergogenic effect, without the need to actually consume the carbs. This phenomenon is known as the “Carb Rinse,” which could potentially have implications for keto athletes or athletes in competition who may experience upset stomach from carb intake.

As we briefly touched on earlier, there is a commonly held belief that carbohydrates are essential for exercise recovery due to the need to replenish glycogen after exercise. However, as you now know, under different dietary conditions, the bodies need for carbohydrates to provide fuel and replenish glycogen, is reduced. This debunks much of the perceived benefits supporting the use of carbohydrates during recovery from exercise.

Additionally, remember that consuming carbohydrates following a workout will increase blood glucose levels, thus stimulating insulin production to drive that blood glucose down. This can lead to lethargy, carb cravings, and brain fog during exercise recovery. Insulin can also halt fat burning and may even reduce the improvements in insulin sensitivity generated by exercise.

Finally, when the body is burning carbs, there is more oxidative stress and inflammation. This would be counterproductive for recovery. So maybe smashing tons of carbs post-exercise isn’t the absolute best approach.

There are two primary fuel reserves in the body: muscle glycogen and stored fat (stored in adipose tissue). What is the difference in these two different fuel reservoirs? Skeletal muscle and your liver can store up to 2,000 calories from carbs in the form of glycogen. Yet even the leanest of athletes can store 20,000 calories as fat in their adipose tissue.

You hear that you should load up on carbs prior to exercise to give you energy. However, when you run out of carbs, if you are not fat-adapted, your body cannot readily switch to burning your stored fat fuel supply. That means that despite the fact that you have a way larger stored fuel source available in stored fat, your body has to resort to burning glycogen for energy.

What happens when the carb-adapted athlete runs out of glycogen? They may start burning muscle and begin to experience fatigue. If they continue exercising, they “bonk”—their central nervous system, a.k.a. the brain, shuts down because there is not enough available energy. The common prescription to preventing this is continuing to refuel on carbohydrates to meet the energy demands of the body during exercise.

Is eating more carbs the best approach though? Or should we realize that carbs are inhibiting the use of fat during exercise and that the real reason why we suffer from fatigue during exercise is reduced carb availability combined with an inability to utilize a huge, latent fuel source in adipose tissue? If we looked at it like that, then we would understand that maybe finding a way to tap into this huge supply of fuel is the best strategy for improving exercise endurance.

Insert the ketogenic diet. Becoming keto-adapted means becoming an efficient fat burner, and fat burning during exercise is no exception. The study by Dr. Volek also found that athletes who were keto-adapted demonstrated the ability to burn up to 2.3 times more fat than the high-carb group during a three-hour run.

If that is not enough to get you on board with keto for endurance performance, then what if we told you that fat provides over twice the amount of energy compared to glucose, and ketones can fuel the brain to prevent bonking or any other kind of central nervous system fatigue that could limit performance?

Furthermore, becoming keto-adapted allows the body to sustainably provide fuel to our muscles without all of the added inflammatory side effects of eating carbohydrates. This could have huge implications on endurance performance and recovery.

Being able to list why a keto diet is better for endurance exercise is one thing. What does the actual research say on endurance performance while on a ketogenic diet? Those who do not have a lot of experience in endurance training can expect to see improvements in performance once adapted to the diet. A six-week study in untrained obese subjects found a 155 percent increase in treadmill duration time.50 However, when it comes to those who are more experienced in endurance exercise, the results are a little more mixed. A four-week study in endurance athletes found that keto did not impact aerobic performance,51 while another four-week study demonstrated a significant increase in markers of endurance performance and a decrease in markers of fatigue.52

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50 Stephen D. Phinney, Edward S. Horton, Ethan AH Sims, John S. Hanson, Elliot Danforth, and Betty M. Lagrange, “Capacity For Moderate Exercise in Obese Subjects after Adaptation to a Hypocaloric, Ketogenic Diet,” The Journal of Clinical Investigation 66, no. 5 (1980): 1152-1161.

51 Stephen D. Phinney, Bruce R. Bistrian, W. J. Evans, E. Gervino, and G. L. Blackburn, “The Human Metabolic Response to Chronic Ketosis without Caloric Restriction: Preservation of Submaximal Exercise Capability with Reduced Carbohydrate Oxidation,” Metabolism 32, no. 8 (1983): 769-776.

52 Adam Zajac, Stanisław Poprzecki, Adam Maszczyk, Miłosz Czuba, Małgorzata Michalczyk, and Grzegorz Zydek, “The Effects of a Ketogenic Diet on Exercise Metabolism and Physical Performance in Off-Road Cyclists,” Nutrients 6, no. 7 (2014): 2493-2508.

Based on these findings, it seems like there are many factors that may impact whether or not improvements in performance will be experienced by well-trained endurance athletes. A couple worth mentioning are the training stimulus, whether or not electrolytes are sufficiently replenished, and the adaptation time an individual requires

Regardless, we do not see many studies demonstrating that if sufficient time to adapt is allowed for, that endurance performance is impaired on keto. It is either staying the same or improving. Couple this with the greater benefits of a ketogenic diet and you have an ideal diet for endurance exercise, which is why more and more athletes are choosing the ketogenic lifestyle.

One of the studies we highlighted in the previous chapter found subjects following a ketogenic diet for six weeks while training CrossFit four times per week demonstrated improvements in strength to go along with improvements in body composition.53 We like this study because it is a very practical study using normal individuals, putting them on a keto diet and a training program, and seeing what happens.

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53 Rachel M. Gregory, H. Hamdan, D. M. Torisky, and J. D. Akers. “A Low-Carbohydrate Ketogenic Diet Combined with 6-Weeks of Crossfit Training Improves Body Composition and Performance,” International Journal of Sports and Exercise Medicine 3, (2017): 1-10.

However, not all research demonstrates improvements in strength. A 2012 study from keto researcher Antonio Paoli found that elite gymnasts put on a keto diet for twelve weeks did not demonstrate improvements in strength.54 However, they did not experience decreases in strength either. The point here is that even in highly trained athletes, keto will not impair strength if enough time to adapt is allotted for.

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54 Antonio Paoli, Keith Grimaldi, Dominic D’Agostino, Lorenzo Cenci, Tatiana Moro, Antonino Bianco, and Antonio Palma, “Ketogenic Diet does not Affect Strength Performance in Elite Artistic Gymnasts,” Journal of the International Society of Sports Nutrition 9, no. 1 (2012): 34.

Our take on keto for strength is that it depends on your training status. If you are a well-trained athlete, you will see decreases in strength at first, followed by a return to baseline strength and maybe improvements later. If you are an untrained or lightly trained person, the novel stimulus of exercise alone will lead to improvements in strength measures irrespective of diet.

Do not become discouraged if you lose strength initially; give your body time to learn to depend on its new source of fuel and you will find that your strength returns and, in some cases, even improves.

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CHAPTER 6

KETO FOODS

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Here are a few foods that would appear to be keto-friendly that you may need to limit or, in some cases, avoid:

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Dairy: Not everyone tolerates dairy well. Later in this book, we’ll get into the specifics on how to approach dairy to see if it works for you.

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Peanut Butter: Peanuts are actually not a nut, they are a legume. Besides containing a lot of carbs, they are pro-inflammatory and typically manufactured with the addition of pro-inflammatory hydrogenated oils.

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Lunch Meat: While lunch meat is technically keto-friendly, most lunch meats are low-quality and contain a lot of preservatives. In a pinch they may make a good option, but in general should be limited.

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Vegetable Oils: Don’t even get us started! Vegetable oils are going to get their own section, but for now note that these oils are extremely pro-inflammatory and should be limited at all costs. This includes sunflower oil, canola oil, corn oil, peanut oil, safflower oil, soybean oil, and any other partially hydrogenated oils (check the labels!).

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Processed and Prepackaged Foods: Avoid any foods that are highly processed or manufactured using poor practices. If it is packaged and has a long ingredient label, it probably falls into this category.

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Soy: Soy contains phytoestrogens, which can be problematic for your hormone levels. Additionally, many people react poorly to soy.

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While ideally you will eat mostly real unprocessed foods, here is a list of some of the most common ingredients to avoid:

Vegetable oils (soybean, canola, corn, grapeseed, peanut, sesame, sunflower, safflower)

Carrageenan

Citric acid

Potassium sorbate

Monosodium glutamate (MSG)

All syrups (high-fructose corn syrup, maple syrup, malt syrup, rice syrup, etc.)

Cane juice

Corn starch

All types of sugar (brown sugar, coconut sugar, cane sugar, beet sugar, etc.)

Most sugar alcohols (maltitol, xylitol, glycerol, etc.)

Artificial sweeteners (aspartame, sucralose, saccharin)

Other names used for sugar (dextrose, maltodextrin, maltose, lactose, fructose, monosaccharide, glucose, disaccharide, polysaccharide, etc.)

Agave

Molasses

Honey

Dates

Fruit juice

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Not all fats are created equally, and this is especially true for oils. In general, the best and most beneficial oils are:

Coconut oil

MCT oil

Palm oil

Avocado oil

Macadamia nut oil

Olive oil

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What makes these fats healthier is their unique fatty acid profiles, which allow them to contribute to a healthy and well-functioning metabolism.

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While these oils are healthy, if you treat these oils the wrong way, they can actually become unhealthy. To avoid this, understand the concept of “smoke point.” Smoke point is the temperature at which an oil begins quite literally to smoke. When you are cooking, you never want to cross this point, as the fats become very oxidized and thus damaging to your health.

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Lower smoke point oils are also a little less stable than other fats. Interestingly, lower smoke point oils don’t just become damaged through surpassing their smoke point; they can also oxidize by becoming rancid in storage.

So, basic tip: If you’re not cooking with an oil, don’t worry about the smoke point. If you are cooking with an oil, choose one that has a higher smoke point. Here are common keto cooking oils, ordered from highest to lowest smoke point:

Coconut oil

Palm oil

Avocado oil

Olive oil

Olive oil is one of the most ubiquitous oils in the kitchen. Everyone knows this is a healthy addition to any meal and a “heart healthy” fat. But with that comes caveats.

Olive oil can turn rancid a little quicker than other oils. Olive oil should be stored in amber or green glass (or tin) and out of sunlight. Many of the main brands of olive oil aren’t olive oil. They use blends of other oils that are inflammatory and oxidized. The good stuff should be a light green in appearance and almost fruity and nutty in taste. Once you use high-quality olive oil, you’ll notice all the garbage that most people call olive oil.

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After cutting sugar, if you were to make one giant change that would impact your health radically, it would be cutting out vegetable oils. Frighteningly enough, these are the oils we have been guzzling for decades in the Western world. These include:

Canola oil

Soybean oil

Corn oil

Peanut oil

Vegetable oil

Sunflower oil

Safflower oil

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Vegetable oils may be just as harmful to your health as refined and processed carbohydrates. Despite this, many people think that vegetable oils are healthy.

When we demonized animal fat, we opened up a market in which an oil called “vegetable oil” could thrive. We have seen a sharp increase in the use of vegetable oils since the low-fat diet recommendations were made. This increase in vegetable oil usage correlates with our increased prevalence of many different diseases.

Another reason why vegetable oils are used so often is they are cheap. These oils come from agricultural wastes and the methods of extracting the oil are inexpensive and damaging to the oil. Think about this for a second. Where does the oil come from in corn? Or a soybean? There is hardly any oil in corn or soy, right? Producers use high heat extraction methods that result in an oxidized, pro-inflammatory oil—a recipe for disaster for your health.

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Here is a list of approved nuts/seeds on a keto diet:

Almonds

Macadamias

Hazelnuts

Hemp hearts

Brazil nuts

Pecans

Pistachios

Walnuts

Sunflower seeds

Pumpkin seeds

Flaxseeds

Chia seeds

Almond butter

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WHAT ABOUT NUT BUTTER?

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What’s wrong with peanuts and peanut butter? They are not a nut and are quite pro-inflammatory. Peanuts also have a higher carb content compared to other nuts. If you are going to be indulging in nut butters, avoid peanut butter and opt for choices such as:

Almond butter

Macadamia nut butter

Walnut butter

Brazil nut butter

Coconut butter

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WHAT ARE THE BEST KETO VEGETABLES?

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Reminder: Whenever possible buy organic, in season, and local produce.

Leafy Greens

Spinach

Arugula

Swiss chard

Romaine lettuce

Iceberg lettuce

Dandelion greens

Watercress

Beet greens

Endive

Bok choy

Cruciferous Veggies

Broccoli

Cauliflower

Cabbage (red and green)

Brussels sprouts

Collard greens

Other Produce

Avocados

Coconut

Mushrooms

Zucchini

Summer squash

Asparagus

Green beans

Broccolini

Cucumbers

Leeks

Spaghetti squash*

Onions*

Green Onions

Okra

Eggplant

Artichokes

Sprouts

Lemons

Limes

Peppers*

Tomatoes*

Berries*

Fermented Vegetables (promotes gut health)

Sauerkraut (no added sugars)

Kimchi

Natto

*Limit because of carbohydrate content

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Much of the soil in this country, especially on farms that mass produce vegetables and fruits, is depleted of minerals and the necessary compounds for plants to achieve their highest levels of nutrition. Pesticides and herbicides also destroy the natural ecosystem in the soil upon which the plants depend. A farmer who wants to maintain truly healthy soil rotates his crops, planting different species over the years. He also introduces animals to the land. Their presence helps till the soil, mix in manure, bring bugs to the surface, increase the overall mineral composition, and improve the overall health of the soil. Healthy soil makes for healthy plants. Healthy plants make for healthier humans.

What is the takeaway here? Shop locally. Go to the farmer’s markets in your area. Ask questions. Ask if they rotate crops. Ask if they use fertilizers. Ask if they use pesticides and herbicides. The more they know, typically the more you can trust their methods.

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Another reason why shopping locally is important is transport time. The second you pull a plant out of the ground, off a stem, or from the tree, it starts oxidizing and losing flavor. This means the longer it takes to get to you, the less healthy and flavorful the plant is going to be. There is an inverse relationship between the transportation time of plants and how many micronutrients are left in them:

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The loss of flavor corresponds to a loss of nutrients. To eat the most nutritious plants, you have to get those plants cultivated closer to you. This means going to the farmer’s market and eating what is local and in season. If you’re eating pineapple in Alaska in the middle of winter, chances are you’re not getting a very fresh fruit. Eat seasonally—that is, eat what is in season in your region. Some areas may be trickier than others, but when you eat seasonally, you are going to get the healthier vegetables and fruits by default. Another perk of eating with the seasons is nutrient variety. Your body likes to shift from one thing to another to avoid processing the same nutrients constantly, so tweaking your diet according to the seasons will help you achieve this.

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If you do not have access to a farmer’s market, understanding labeling on produce will be crucial to ensuring proper food quality. Here is an explanation of many of the common claims you will likely encounter at a store or market.

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NON-GMO

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Genetically modified organisms (GMOs) are foods that have their genetic code manipulated to give us a desired trait. Many people think that these plants are just modified to be tastier; however, some modifications make plants genetically resistant to pesticides. This allows farmers to overspray crops with pesticides and herbicides—chemicals that are designed to kill things that live. You are alive. So, it’s probably not a great idea to eat these things in any amount. But pesticides can arguably be washed off, cooked down, and removed from the plant. Or so we thought.

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Some GMO foods are manipulated to actually produce their own toxins that kill living things. Yes, that’s right. The plants themselves are making the pesticides, such as the common bacillus thuringiensis (Bt) toxin. If plants are genetically manipulated to produce compounds to kill living things, and you’re a living thing, do you think you should be eating those plants? This is insanely frightening for reasons beyond what you can even imagine.

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ALL NATURAL

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Foods containing the label “natural” customarily contains no artificial ingredients or preservatives but may still contain antibiotics, growth hormones, chemical preservatives, and GMOs. Safe to say, “all natural” is not the gold standard for produce quality.

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CERTIFIED ORGANIC

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Certified Organic means that foods are grown without antibiotic, growth hormones, pesticides, fungicides, herbicides, or food additives. Certified organic foods must meet the standards and regulations of the National Organic Program (NOP) and be non-GMO.

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Certified organic is among the healthiest food you can choose. But not everyone can afford or have access to organic, non-GMO produce. If you can’t, then prioritize. Every year, the Environmental Working Group puts out two lists to help consumers make smart food choices: The Dirty Dozen and Clean Fifteen. They research these lists and rank foods based on levels of toxin and pesticide contamination.

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CERTIFIED NATURALLY GROWN (CNG)

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Certified Naturally Grown is a third-party certification program utilized by small scale farmers who choose not to obtain the Certified Organic label, typically due to cost. CNG standards meet or exceed the standards for Certified Organic.

Once you have the produce, you are not out of the woods yet! The way you store your produce is important to their micronutrient profile. When exposed to oxygen, the micronutrients oxidize, reducing nutritional benefit.

How do we minimize this? Keeping produce in your crisper drawers is a great idea, but even better is opting for more airtight solutions. Glass Tupperware works well if you want a fresh vegetable or fruit to keep nutrients as long as possible. There are also microperforated bags that do a great job.

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some fruits have a lower glycemic index and can fit into a ketogenic diet in moderation. As you will see most berries are good to go. Berries contain a lot of antioxidants and polyphenols while being relatively low in carbs. While some non-keto fruits may be dense in various micronutrients, these micronutrients can be acquired through more keto-friendly foods. For example, avocados contain much more potassium than a banana.

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As with all foods, check the nutrition label or your nutrition tracking app to see the carb content on fruit before choosing which ones to consume. If you do opt to eat fruit, stick to moderate quantities of these fruits:

Avocados

Coconuts

Strawberries

Blueberries

Blackberries

Raspberries

Cherries

Cranberries

Mulberries

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Several of the foods on the list we provided are classified as fermented foods. Fermented foods are created when natural sugars from the food interact with various microbes and bacteria, leading to not only a chemically different food but also a more bioavailable food. Fermented foods are very dense in probiotics that can help populate your gut with good bacteria. A healthy gut is at the foundation of a healthy body.

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In addition to improved gut function, fermented foods can also improve the immune system and even improve cognitive function! The most popular fermented foods are:

Kefir

Kombucha

Sauerkraut

Pickles

Kimchi

Raw cheese

Yogurt

Natto

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Different protein sources also contain drastically different micronutrient profiles. For example, salmon is extremely rich in B vitamins while grass-fed ground beef is high in CLA.

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WHICH CUTS OF BEEF SHOULD I EAT ON KETO?

There are many different cuts of beef and as long as quality is maintained, all make great keto options.

Beef

Steak (ribeye, sirloin, T-bone, etc.)

Prime rib

Veal

Roast beef

Brisket

Loin

Beef ribs

Ground beef

Corned beef

Stew meats

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When choosing the best beef, it is important to ensure that the animals have been fed a diet that most closely resembles what they would have been eating in the wild.

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Ruminants are a classification of animals that include cows, lamb, goats, and bison. Rumination is not just about thinking! It actually refers to the process of chewing up, partially digesting, regurgitating, then rechewing a plant-based diet to aid in the animal’s digestion. Interestingly, it is this process that allows ruminant animals to obtain nutrients from plants that we as humans cannot absorb.

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Just as in humans, grain-fed, carb-eating animals have an extremely high amount of inflammation. This inflammation leads to a high amount of inflammatory omega-6 fats in the tissues of the animals, and these fats are transferred to us when we eat them. When animals eat the things they are supposed to, like grass, clovers, shrubs and other colorful things (how many colorful animal feed troughs can you think of?), they end up with a much higher density of nutrients.

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These include beneficial omega-3 fatty acids, conjugated linoleic acid (good for brain function, weight loss and cancer prevention), beta-carotene (good for eyes) and essential fat-soluble vitamins (good for many things), all of which make achieving ketosis and being healthy so much easier. The ratio of omega-6 to omega-3 fatty acids is 6:1 in grain-fed cows and closer to 1:1 in grass-fed cows. This is important since omega-6 fatty acids can promote inflammation if consumed in excess. The average American eats a 20:1 ratio of omega-6 to omega-3 fatty acids, a recipe for increased inflammation. Don’t be the average American.

Odd how when animals eat what they’re supposed to, the nutrition we get from them is what we actually need. To help you shop, these are the three types of meat you will find at the supermarket or butcher shop:

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GRAIN-FED (CAFO)

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The majority of beef you will find will be from concentrated animal feeding operations (CAFOs), although the marketing will never tell you that, because it’s not the sort of thing advertisers want to draw attention to. A large number of these operations aren’t only feeding these animals inflammatory grains, corn, and soy-based products, but also candy. Yes, candy. And plastic. Oh, and also the ground-up by-products of the sick animals that die in the feedlot. That, too.

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CAFO animals are also commonly fed antibiotics and growth hormones. Why is this necessary? Because the animals are kept in such close quarters and fed such an awful diet that they get sick very easily (just like humans). They are malnourished and they don’t grow as large, so they’re given growth hormones. These chemical compounds can be stored in the meat and passed down to the consumer.

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Chances are, if your label doesn’t say where the meat came from, this is what you’re getting. These are not healthy meats and are even more inflammatory if high in fat content.

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GRASS-FED, GRAIN-FINISHED

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This is one of many examples of sneaky marketing in the food business. A good portion of grass-fed meat is actually not worth the extra price. This is because the animal is grass-fed, then “finished” on grain, spending 30-60 days in a CAFO. When you buy red meat that is grain finished, you’re getting a runaround for your money. Most of these cows are stuffed with grains to plump them up. This plumping-up not only drastically increases the inflammatory omega-6 fatty acids, but can also destroy the previously high levels of omega-3, fat-soluble vitamins, and conjugated linoleic acid.

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Whether at a farmer’s market or a grocery store, if are you unsure about whether meat is grain- or grass-finished, just ask. At farmers’ markets you will very easily get your answer and usually the staff at Whole Foods and other similar stores will know where they get their meat and how the cows ate during their last few weeks.

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100 PERCENT GRASS-FED

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To get this label, the cow (or other animal) must be fed a natural grass diet up until the day they are slaughtered. When buying red meat that is 100 percent grass-fed you are getting the highest nutrient concentration possible, and definitely healthy meats. This is also known as grass-fed/finished.

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Stress on the animal plays a huge role in the formation of inflammatory fats. The stress hormone cortisol persists in cows just as it does in humans. This stress hormone leads to fat gain and chronic inflammation. In general, most grass-fed cows graze on pastures until they are slaughtered, leading to a reduction in cortisol, thus a reduction in harmful fats.

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The fat in grass-fed beef is also sometimes darker and more colorful (yellow to orange) than in their CAFO counterparts. This is a result of increased colors in their diet and resultant increased levels of beta-carotene (you want this) in the animal’s fat.

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There is a caveat with grass-fed, however. Unlike with chickens, there is no regulation regarding whether grass-fed or pastured animals can be injected with growth hormones, antibiotics or fed a bunch of GMO feed. This is another reason why asking questions about how the animals are raised is important

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If you can’t afford the higher price at farmers markets, Whole Foods, or other specialty stores, there are plenty of other options for beef, lamb, bison, goat, etc. Use Google to find cow-share programs in your area. Find local sources through resources like EatWild.com and LocalHarvest.com that feature local farms in your area that are easily accessible. Check Craigslist. Seriously. There are plenty of very small-scale farmers offering their cows on Craigslist. These farmers often allow you to visit the farm and ask further questions about how the animals are raised.

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Can’t fit a whole cow in your freezer? Find a few friends, co-workers, people at your gym, whatever, to split a whole, half or quarter of a cow. When you purchase meat this way, all of the cuts average out to $4-5/lb. This includes organ meats (you should be eating these), ground beef, New York strip, tenderloins, rib eyes, rib roasts—all of it! This quickly becomes exceedingly affordable, and usually much more so than even your general grocery store CAFO-based animal products.

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ORGANIC

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This is a strict term highly regulated by the USDA. Even though grass-fed meat is fantastic, the responsible thing would be to make sure the animals aren’t pumped full of antibiotics and hormones and given potentially dangerous GMO crops to graze on.

Is there organic, grass-fed beef? Yes. More often than not, these two things go together. When farmers take the time and care to raise their animals on fully organic standards, they are not going to ruin their insides with grains, corn, and soy-based products.

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Organic is worth purchasing to avoid any additives to the animals. Most of the toxins and inflammation concentrate in the fat of animals. This means if you can’t afford the 100 percent grass-fed, organic beef, go for the leanest cuts possible and at least look for antibiotic- and hormone-free. If you are able to purchase organic, grass-fed meats, spring for the fattier cuts.

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You may have noticed that we have organ meats on the food list. This is not a mistake. If you ask your grandparents, chances are they used to eat organ meat, especially if they grew up on a farm. Times were tough and food couldn’t go to waste. What your grandparents may not have realized is that these meats are extremely nutrient dense! Even better is that the nutrients in these organs are more bioavailable, meaning they are more readily absorbed by the body. This makes organ meat like a natural meat version of a multivitamin. This is one of the reasons someone can follow an all meat diet without having to suffer from nutrient deficiencies. We will get more into that later but for now know that organ meat, while it may take some getting used to, is a great food to include in an optimized ketogenic diet.

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If you were to rank all foods on a spectrum of nutrient density, organ meats sit unchallenged at the top. Yes, far above kale. Organ meats do not have to just come from cows, they can also come from pigs, lambs, goats, chickens, and ducks. Organs commonly consumed are:

Liver

Tongue

Heart

Kidneys

Brain

Sweet Breads

Tripe

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Pork is one of the most popular meat sources on keto. Think bacon. One of the problems with pork is that many sources contain a lot of additives or added sugar. This and source of your pork is just as important as it is with beef. Since pigs will eat nearly anything, the food typically fed to these animals is suboptimal and worth considering when sourcing pork. Again, asking questions from the source can help here.

Here are some of the pork options you may elect for:

Bacon*

Ground pork*

Sausage*

Bratwurst*

Pork rinds

Tenderloin

Pork loin

Pork shoulder

Ham*

Pork chops

Prosciutto

*Check ingredients for harmful additives and added sugar.

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Adding seafood to your keto diet helps bring variety to your diet, which also increases variety in your nutrient intake. Leaner fish like tuna tend to have a lower nutrient profile compared to fattier fish like salmon.

Here is a list of seafood options:

Tuna*

Salmon

Catfish

Trout

Halibut

Mackerel

Mahi-Mahi

Cod

Bass

Anchovies*

Sardines*

Haddock

Tilapia

Clams*

Oysters*

Mussels

Crab**

Lobster

Scallops

Shrimp

*Canned is fine; look for a no-BPA can and choose canned wild caught seafood.

** Do not eat imitation crab.

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Many people know about the benefits of eating fish—the oil, right? That’s one reason fish oil is one of the most popular supplements. Fish and fish oil contain omega-3 fats, particularly EPA and DHA. These two fats have been shown not only to help combat inflammation but also improve brain development and function.

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As we alluded to earlier, getting enough omega-3 fats in your diet is extremely important for maintaining an appropriate omega-6 to omega-3 fatty acid ratio. Consuming low-quality red meat containing a lot of omega-6, and not consuming seafood, is a recipe for a high omega-6 to 3 ratio and thus inflammation.

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The benefits of seafood go much further than healthy omega-3s and a quality protein. Antioxidants, such as astaxanthin found in seafood, can aid many different bodily processes and can protect the brain. Micronutrients like magnesium, potassium, selenium, zinc and B vitamins are also often found in fish.

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With beef and poultry, it is fairly easy to lump animals into better and worse categories. Grass-fed or pastured? Good choice. Grain fed/CAFO? Not a great choice. Unfortunately, categorizing seafood is not as simple. The same rules do not apply. Wild-caught sea creatures aren’t always the best option and farmed is not always a problem.

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While the benefits of fish are pretty robust, pollution is cause for concern in several large populations of fish. It is much less problematic with river and stream fish, but wild ocean fish can accumulate substantial levels of heavy metals such as mercury. Unfortunately, just as we are what we eat, so are fish, so the larger fish near the top of the food chain concentrate mercury and other toxins from the smaller fish they eat and the mercury (or any other metal) in the fish is passed along to the human who eats the fish.

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Farmed fish can sometimes be just as polluted, if not more. Artificial feeding is a problem for some fish, but not for others. It can be hard to know, so here is a breakdown for what to look for when buying seafood at your local market.

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SALMON

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Salmon is one of the best sources of omega-3 from an animal product. However, farmed salmon is akin to farmed chicken or beef. In the past, these fish were fed pellets of fish meal. But that’s far too expensive for modern farms, where fish are often fed pellets of corn and soy. Sounds like a familiar way to get fat and sick, right?

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Farmed salmon get so sick that up to a third of them die in the farms. They are so devoid of nutrients that their flesh is gray, and the salmon are fed coloring pellets to make their flesh a more recognizable pink color. The tanks are loaded with various chemicals like PCBs and flame retardants to keep them running smoothly. No thanks.

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Stick with wild-caught Alaska, California, or Oregon salmon. These fish are going to be a much deeper pink, will have lower levels of toxins, and a higher concentration of omega-3 than most any other healthy fish you can find.

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TUNA

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Tuna is a very large fish that lives in deep waters and eat many smaller fish. This means the tuna have concentrated the mercury and heavy metals contained in all of the fish they’ve consumed into their own flesh.

If you are going to eat tuna, try to avoid long-line-caught tuna, which tend to be very large. Pole-caught tuna are smaller fish, thus typically less contaminated with heavy metals and a better option for your body. If you are buying tuna and can’t determine any of this, it’s probably not a good sign.

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TILAPIA

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Tilapia is the real chicken of the sea. Similar to chicken breast, tilapia is a good source of protein, but not much else. It is a relatively lean fish, but because of what farmed tilapia are fed, the omega-6 to 3 ratio is high. Additionally, it is relatively tasteless and ends up mostly as a plate of mush when you cook it.

Tilapia are vegetarians. This means they love all of the corn and soy that gets thrown at them during farm feeding. They also enjoy all of the other garbage that other fish don’t eat. Skip tilapia if you’re trying to eat fatty fish and have healthy seafood be part of your diet. It was probably fed an awful diet and you’re not getting much of that healthy fish fat from it anyway.

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CRAB AND LOBSTER

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Who doesn’t love crab and lobster? Especially when dipped in some ghee or grass-fed butter, crab or lobster can be one of the best-tasting seafood options. Lucky for us, these creatures are like rats of the ocean.

This means there is no reason to farm them, so the crabs or lobsters you buy in the grocery store are wild. What’s more, these little sea monsters have organs called hepatopancreas that filters out and concentrates toxins and heavy metals, leaving the meat untainted. They are rich in magnesium, zinc, and antioxidants. Go crazy here if you can afford it.

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ANCHOVIES, SARDINES, AND MACKEREL

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Sardines are one of the best budget meals on a ketogenic diet. You can buy these fish fresh or canned, but canned is a great way to get tons of fatty delicious fish, usually soaked in olive oil. These tiny fish have very short lifespans, meaning they have very little time to concentrate any sort of heavy metals or toxins. They also rank exceedingly high in omega-3s, making them the common source for very high-end fish oils.

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SHELLFISH (MUSSELS, CLAMS, SCALLOPS, OYSTERS)

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Shellfish are the king of healthy seafood. You can’t force-feed it any garbage. Farming is just fine for this group. You can throw all the corn and soy in the water you want, and shellfish will filter it out and take only the nutrients out of the water that they need. Shellfish don’t concentrate anything in the water, passing what can’t be used. Furthermore, shellfish are extremely high in magnesium, selenium, zinc, iron, B12, and have very high amounts of omega-3 fats, about a 15:1 omega-3-to-6 ratio.

Go crazy on these shellfish no matter the source, as they are highly nutritious and extremely low in contaminants. Canned oysters are another way to provide a lot of bang for your buck on a ketogenic diet.

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SHRIMP

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Nearly 90 percent of the shrimp consumed in this country come from Asian or Latin American farms. These farms are entirely disruptive to ocean ecosystems and are chock-full of antibiotics and chemicals. The shrimp marinate in these chemicals and concentrate them pretty heavily. If the shrimp aren’t marked as being from some other source at the supermarket, assume that this is what you’re getting.

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Domestically farmed shrimp are regulated; farmers can’t use the antibiotics and chemicals that foreign farms are getting away with. This makes both domestic wild and farmed shrimp an okay choice.

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While poultry is a great source of protein, it is typically pretty low in fat and does not contain a ton of additional nutrients. For this reason, we do not recommend poultry being your primary source of protein.

Eggs, on the other hand, are a completely different ball game. Eggs are rich in protein, fat, and a wide variety of nutrients. The problem with eggs is sourcing, but we will get into that in a second.

Here are some of the best poultry sources on a keto diet:

Chicken

Quail

Turkey

Wild Game

Cornish Hen

Eggs

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Similar to beef, you’re not going to find much label information on these items. These are the average $1 per dozen eggs or run-of-the-mill economy-size package of chicken parts at your local grocery stores. You know all of those disgusting videos you see of sick animals crammed into large cages or warehouses being sprayed with antibiotics and covered in each other’s feces? Their unused parts get chopped up and turned into some bizarre slime and fed back to the animals or to young children as tasty little nuggets. Yes, that’s what you’re eating here.

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The animals’ living conditions matter not only in relation to what the animal ate (never mind the ethics of it all) but also because, remember, stressed animals have higher levels of cortisol. Like beef, this high-stress environment and shift in hormones leads to a higher percentage of chronic inflammation and omega-6 fatty acids, just as it does in humans. The low nutrient diets of these animals leads to meat and eggs that are also low in nutrients, and the practices of raising these animals is sickening. These are not healthy chickens. Steer clear if at all possible.

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CAGE-FREE

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Believe it or not, this term actually has no formal regulation or definition. Essentially, cage-free means that the animals are not confined in small cages smashed next to each other. They can still be (and likely are) in a gigantic warehouse smashed next to each other. Since this term is clearly misleading, several different groups are pushing for renaming this high-density floor confinement. Again, not healthy chickens. Don’t worry about paying extra for anything cage-free, you’re wasting your money and still supporting the awful plants that execute animal production this way.

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FREE RANGE

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This term can also be misleading; the USDA defines free range as allowing animals short access to the outdoors—for a full five minutes per day. While this sounds like a luxurious lifestyle for the chickens, it usually means no more than a concrete slab with access through a tiny door. The whole point of being outside is so they can peck away at their natural diet of insects. Simply another marketing ploy to add $2 a dozen to the price of eggs. Despite these being the most expensive eggs, you will find at most commercial grocers, the increase in price is not worth the five minutes of play time. They are not given any access to eat a real diet and are still crammed in a giant and disgusting warehouse.

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OMEGA-3 ENRICHED

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“Our hens were fed a diet rich with omega-3 fortified flax, grains, etc.” Sounds fantastic, doesn’t it? Sure, until you realize that the chicken isn’t eating what it is supposed to be eating. Given that there is also no regulation as to how much of the percentage of feed given to the chickens is actually fortified with omega-3, who knows if it is even a high enough concentration to trickle down to the consumer? If it says the percentage of omega-3 diet on the label (some do), and it is fairly high, this is a better bet than CAFO, but still far from optimal. The chickens are still given feed, which is not what you want.

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100 PERCENT VEGETARIAN FED

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This also sounds good—except healthy chickens are not vegetarians. They omnivorously eat insects, bugs, worms and other crawling things for a good portion of their nutrients. What this implies, however, as in the case of the omega-3 enriched diet, is that the chickens were intentionally fed something other than what they would naturally eat. This defeats the whole purpose of a proper and natural diet. Many times, this 100 percent vegetarian feed is also nearly 100 percent GMO grains and full of chemical fertilizers.

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On the positive side, some CAFO animals are known to be fed ground up feces and parts of other animals that have perished in the lot. So, not using that as feed is a plus. If you want insurance that the chicken wasn’t fed animal by-products and you’re going to spring for the extra price on 100 percent vegetarian fed, make sure it is also 100 percent organic.

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ORGANIC

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Organic eggs and chickens are not all that they are cracked up to be (ha-ha, we couldn’t help ourselves!). Organic here means that the chickens are being given feed that is 100 percent organic, non-GMO, and free of any pesticides, herbicides, or other chemical fertilizers. While this is better than other options, the chickens are still being given feed that is different from what they should be eating. This makes organic eggs and meat less nutritious compared to chickens that are eating their natural diet.

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The good news here is that there are a few hoops to jump through to get chickens and eggs labeled organic. An outdoor play period is required for organic designation, but there are no requirements on time (like the five-minute free-range minimum) or accessibility. An organic designation usually means that the birds are raised better, but more and more companies are catching on to marketing under the organic label, so they are just tossing a ton of “organic” feed into big pens.

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PASTURE RAISED

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This is essentially what free range should mean. This is truly naturally raised healthy chickens on a farm, roaming around on grass, pecking away at bugs and insects. When compared to commercially raised eggs, pastured eggs contain a much higher level of omega-3 fatty acids, lower level of inflammatory omega-6, 36 percent more vitamin A, 100 percent more vitamin E and 260 percent more beta carotene.

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FIND THE BEST EGGS

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DAIRY

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CAN I HAVE DAIRY ON KETO?

This is a loaded question and the answer is, it depends. Dairy does contain sugar, particularly lactose, and this sugar when consumed in high amounts can be harmful not only to your state of ketosis but your health as a whole. At the very least we can say that dairy should be consumed in moderation and choices that are higher in sugar, like most commercial yogurts and milk, should be avoided.

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As for dairy choices that are lower in carbohydrates, the answer is less clear and depends on your ability to tolerate dairy. There are two potential reasons why some people are sensitive to dairy: intolerance to either the sugar (lactose) or to one of the proteins (casein) normally found in dairy. Simply put, some people don’t have the enzymes needed to properly break down these proteins and sugars, while others do. If you are unable to break down these components, you may experience some very unpleasant and serious side-effects like fatigue, metabolism issues, skin problems, and/or digestive problems.

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There are a few things to consider before assuming you are lactose intolerant. If you have to run to the bathroom fifteen minutes after consuming “dairy,” it doesn’t necessarily mean you are sensitive or allergic to dairy. In fact, the likelihood that you are getting the real food version of dairy is low. Ninety-nine percent of commercially available dairy is “franken food.” The majority of dairy most people consume is weird, watery, over-processed made-up foods—nothing like what comes out of an animal.

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Real foods spoil. Real foods are consumed close to how they are found. Is this how you are getting your dairy? All people, tolerant or not of dairy, should avoid ingesting milk and dairy that is highly pasteurized, homogenized, and/or processed.

Pasteurization typically kills all of the beneficial bacteria and enzymes that help you digest dairy. Moreover, homogenization forces fat through a tiny little screen, which breaks the fat particles into smaller damaging and oxidized versions of otherwise stable and beneficial saturated fats. Processing of dairy is hard to miss. Think of the super bright orange shredded cheese found in groceries, or the cheese that comes in brick form that won’t be growing mold any time soon. These cheeses last approximately three years. Alert: they are not good for you.

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For those who can tolerate dairy, it can be an excellent nutrient dense food if properly sourced. Dairy is packed with fat soluble vitamins like A, D, and K2. These nutrients not only play key roles in your body, they are also pretty tough to get if you’re not eating a lot of organ meats or fermented soy. Can I get a raise of hands of those who regularly consume organ meats and fermented soy?

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Dairy also contains high levels of calcium. Now, the vegans may say, “Yeah, but you can also get calcium from leafy greens!” Ah, touché! However, vitamins A, D, and K2 (the ones found in dairy, remember?) can lower your need for calcium, so you may be able to obtain all the calcium you need without those leafy greens.

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Dairy also contains short chain fatty acids like butyrate that are excellent for gut energy. Conjugated linoleic acid is another type of fat found in dairy that can aid in fat burning. Some dairy also includes medium chain triglycerides, which are highly ketogenic fatty acids. This and the associated saturated fats in dairy can make it an excellent ketogenic food.

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In addition, certain fermented dairy foods have high probiotic densities (i.e., yogurt, kefir, and cheese) that can help populate your gut with good bacteria—bacteria that is tremendously good for your overall health. For many people, fermented dairy products like whole-fat yogurt are more palatable sources of probiotics than raw sauerkraut (my personal favorite), kimchi, or other fermented foods.

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HOW DO I CHOOSE THE BEST DAIRY?

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HOMOGENIZED

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Dairy should not be homogenous. There should be a cream top layer to milk that separates from the more liquid solution. Many people find this gross or inconvenient, so we invented a machine to spray milk through a very fine screen. This process chops up the fat, so it stays suspended in the milk, eliminating the cream layer on top and creating “whole milk.”

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The fat that was chopped up in the screen is no longer made up of the same molecular strands; it is fragmented. What does that mean? Just as you wouldn’t recognize the milk fats and proteins under a microscope, your body isn’t going to recognize them either. This leads to inferior quality liquid that your body doesn’t know what to do with. It is not advantageous to your health when your body doesn’t know what to do with things that are inside it. High-quality fat is a must.

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What does this mean for the ever so popular skim, 1 percent, and 2 percent milk? Well, it means that the fats and proteins are fragmented and destroyed. If you don’t like the taste of whole milk, go for non-homogenized and skim off the top cream layer! Homemade skim milk! But that isn’t really keto and you’re throwing away tons of beneficial nutrients and fat here. So, don’t be silly—eat the fat.

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PASTEURIZATION

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Dairy was consumed raw for thousands of years on farms and ranches. Then things changed. People started living in dense cities without refrigeration. Buying dairy was difficult. Transportation time increased and dairy wasn’t kept cold, so bacteria grew. People got sick from consuming that bacteria. We can all agree that wasn’t a good thing.

So, what happened? A French man named Louis Pasteur invented a process to heat dairy up to a certain temperature to kill all of the bacteria. Great! No one got sick anymore! But all of the beneficial bacteria and natural enzymes were destroyed along with the dangerous bacteria. Some of the fats and milk proteins were destroyed as well. What were we left with? Some liquid mysterious to our bodies. The same milk proteins remained, but all of the helpful enzymes and fats that assisted our bodies in breaking them down in our digestive system did not.

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Unfortunately, raw milk is outlawed in some states. Some farmers are, unbelievably, being raided by law enforcement for producing raw milk. If you are lucky enough to be able to purchase raw in your state, then spring for this much more nutritious form. Google your way to finding if you can locate raw, local dairy close to your area to support your farmers and get the most nutrient dense, tolerable form of dairy.

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ORGANIC

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Organic is better than conventional, but not always optimal. What does organic mean for dairy? It ensures that the animal ate organic and wasn’t given any hormones. However, you will likely still be consuming mystery dairy that has been processed and heated beyond repair. When buying dairy, if you’re for some reason not going to go with raw, non-homogenized, then we fully suggest at least springing for a jug of organic.

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GRASS-FED DAIRY

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Why is buying dairy that is grass fed important? Just like beef, it increases the beneficial omega-3 fats and balances out the ratio of omega-3 to omega-6 fats. Grass-fed leads to much higher levels of fat soluble vitamins and important compounds like CLA that help burn fat and provide usable energy. Grass-fed is a crucial step if you can afford it.

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When it comes to butter, especially don’t waste your time with traditional butters. They are devoid of nutrients and good fats. However, when butter comes from grass-fed animals, it is full of usable and healthy fats, vitamins, and fat burning compounds. There are a lot of local brands, depending on where you live, and some commercial brands that produce butter and other dairy products from grass-fed cows. Sometimes this is branded as “European Style” butters. Check the labels to make sure.

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CHAPTER 9

FASTING AND KETO

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Fasting, similar to keto, induces a transition in fuel utilization. Your body is continually running; it doesn’t shut off. It has to have energy available to some degree at all times. When you eat food, you provide the body with many of the things it needs to function, including energy and that energy can be used or stored away for later. Once it is stored, it can be accessed during periods of fasting. Since carb stores are limited, they can only contribute a small amount of energy during fasting. The rest comes from the body’s ability to burn fat and produce ketones. This sounds just like ketosis because it is. While there are many other benefits that happen during fasting, the way it operates is essentially through ketosis.

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Fasting is somewhat like working out. When you’re working out, you’re not actually doing good things to your body. You are breaking down your tissues and sending a signal to your body that they should be stronger next time you face that stress. This is what is called a hermetic stressor. Your body is responding positively to a stress. When you are fasting, you are telling your body that you need to adapt and make sure you are more resilient. Your body is forced to recycle old cells and ones that aren’t working that well in order to make new cells and improve function.

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Fasting benefits include lower blood sugar, increase in blood ketones, improved energy, decrease in inflammation, improved immune function, enhanced weight loss, and improved overall health. Fasting, depending on the length, also offers a particularly useful benefit known as autophagy. Autophagy is a process that results in the recycling of damaged cells and replacing them with new healthy cells. This is a process that is crucial to make sure that damaged or mutated cells are not replicated and is a great way to rid the body of potentially precancerous cells.

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Fasting can also be used therapeutically to weaken cancer cells. As we will get into more later in the book, cancer cells thrive on glucose. Lowering glucose through fasting is a great way to weaken cancer cells, thus making them more susceptible to standard care cancer treatments like radiation and chemotherapy.113

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113 Brittany A. Simone, Colin E. Champ, Anne L. Rosenberg, Adam C. Berger, Daniel A. Monti, Adam P. Dicker, and Nicole L. Simone, “Selectively Starving Cancer Cells Through Dietary Manipulation: Methods And Clinical Implications,” Future Oncology 9, no. 7 (2013): 959-976.

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Fasting may also be able to promote longevity. If your body is constantly metabolizing nutrients it is much more prone to accelerated aging. Fasting for brief periods of time can help slow this cycle. Furthermore, research looking at calorie restriction, a feature that typically accompanies fasting, has also been shown to slow aging.114

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114 Edda Cava and Luigi Fontana, “Will Calorie Restriction Work in Humans?” Aging (Albany, NY) 5, no. 7 (2013): 507-514.

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INTERMITTENT FASTING

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Intermittent fasting is like it sounds, intermittent bouts of food restriction implemented strategically. These bouts are referred to as the “fasting window,” which is followed by a period of eating, called the “eating window.” Typically, people eat right when they wake up and right before they go to bed, leading to an eating window of anywhere from 12-16 hours. Intermittent fasting employs much shorter eating windows, 8, 6, 4 or even 2 hours within the day. This means you’ll be fasting for 16, 18, 20 or 22 hours. Fasting for 16+ hours is a significant enough time for your body to tap into stored energy sources, meaning that intermittent bouts of these fasting windows can…well, intermittently provide benefits.

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a recent systematic review demonstrated that intermittent fasting can improve several clinical outcomes, including decreases in fat mass, triglycerides, and inflammatory markers.115 Preliminary data also suggest intermittent fasting may also improve cognition.

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WHOLE DAY FASTING

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Whole day fasting is as it sounds, a whole day of not eating. Twenty-four hours. Many things happen in the body during a fast and some of the benefits that occur may be more robust the longer you fast, such as cell recycling, autophagy, and immune system regeneration.

Since whole day fasting is a little more intense than intermittent fasting, it is not done as frequently. Some individuals may report doing this once a month or a little more aggressively at once a week. The data is not out on how frequently to do these fasts for maximum benefit, but incorporating them occasionally will provide health benefits.

If you are adapted to keto, a whole day fast, like intermittent fasting, is likely not very challenging. Whole day fasts may be a good induction to a keto diet to enhance keto-adaptation; however, due to the challenging nature of this approach, it may not be advisable to new keto dieters.

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ALTERNATE DAY FASTS

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Alternate day fasting means alternating whole days of fasting with eating days. Alternate day fasting is pretty simple and looks like:

Wake up

Fast all day

Wake up

Don’t fast

While this is a simple approach, research has shown positive health outcomes. One research group had thirty-two normal weight and overweight individuals perform either alternate day fasting or maintain their normal dietary patterns. On fasting days, subjects in the alternate day fasting group were provided with one meal by the researchers which met 25 percent of their daily caloric needs. After twelve weeks, subjects in the alternate day fast group decreased their body weight by an average of 5.2 kg (6.5 percent ) compared to control! Fat mass was reduced by 3.6 kg and muscle mass values did not change versus control. These researchers concluded that alternate day fasting is effective for weight loss and cardio protection.116

This approach is a bit more extreme than the previously mentioned fasting methods and is not recommended for those who are new to fasting. This approach should be worked up to.

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115 Benjamin D. Horne, Joseph B. Muhlestein, and Jeffrey L. Anderson, “Health Effects of Intermittent Fasting: Hormesis or Harm? A Systematic Review,” The American Journal of Clinical Nutrition 102, no. 2 (2015): 464-470.

116 Krista A. Varady, Surabhi Bhutani, Monica C. Klempel, Cynthia M. Kroeger, John F. Trepanowski, Jacob M. Haus, Kristin K. Hoddy, and Yolian Calvo, “Alternate Day Fasting for Weight Loss in Normal Weight and Overweight Subjects: A Randomized Controlled Trial,” Nutrition Journal 12, no. 11 (2013): 146.

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EXTENDED FASTS

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Extended fasts last longer than three days. Like whole day fasting, the benefit here is in the longer duration. Also, like whole day fasting, the greater intensity of this approach implies infrequent use, unless for therapeutic intervention.

Extended fasting is where you would start to really see improved immune function and autophagy occurring which is why one recommendation, made by the great cancer researcher Dr. Thomas Seyfried from Boston College, is to do an extended fast quarterly to rid your body of precancerous cells.

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The glucose ketone index (GKI), which as we will get into in Chapter 13, is a calculated relationship between your blood glucose and ketone levels. Fasting for 2-3 days can induce a GKI that is conducive of autophagy.

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To optimize performance and limit potential side effects of fasting, we believe that supplementing with electrolytes is also advantageous and is more important in longer fasts. This may be referred to as a supplemental water fast. This line of thinking leads to the definition of fasting as “not consuming anything of caloric value.” This is the most widely accepted and also typically allows for black coffee.

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However, there is another view on the definition of fasting based on the principle that the major benefits of fasting are a result of lower blood glucose and insulin, and greater ketone production. This line of thinking leads to the definition of fasting as “not consuming anything that spikes blood glucose or insulin levels.” This is most often referred to as fat fasting.

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A fat fast means consuming fat or exogenous ketones during the fasting window. Yes, fat has calories and yes, fat can trigger an insulin response. However, fat consumed in small amounts only triggers insulin to a minimal amount and has minimal to no effect on blood glucose, making this approach a possible alternative method of fasting.

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When choosing the best fasting technique, it is important to consider what is most optimal vs. what is most sustainable. For example, if your main goal is fat loss, maybe consuming no calories is most optimal, but you can only fast for 12 hours this way. If fat fasting allows you to extend that to 16+ hours, maybe that is more sustainable and may even produce similar benefits.

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Also consider whether consuming strategic foods that do not spike insulin or glucose, such as MCTs and exogenous ketones, may allow you to experience the benefits of no-calorie fasting to a lower degree but with additional benefits, such as increased energy and cognitive focus.

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Exercise while fasting can be a great way to improve insulin sensitivity, induce greater ketone production, and promote more fat burning.

🔮 The Cosmos

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