The Diet that Shreds Fat; Is it Good for the Long-Term?

Americans eat like crap.

Really, though.

The Standard American Diet (SAD), consisting of mostly refined and processed foods (soft drinks, potato chips, granola bars, and desserts), leads to excessive weight gain and obesity.

Obesity increases the risk for Insulin Resistance (IR), which in turn increases the risk for Type 2 Diabetes (T2D).

In addition to that, obesity increases fat accumulation in weird places, like your muscles and your liver. This ectopic fat accumulation increases the risk of Non-Alcoholic Fatty Liver Disease (NAFLD), which is another risk factor for developing IR and T2D. NAFLD is also associated with higher blood fats and blood pressure.

It’s almost like you can’t win.

Oh, and NAFLD is found in 90% of obese patients.

SAD –> obesity –> NAFLD –> increased lipids and blood pressure –> IR and T2D.

How about that?

The good news is that weight loss has been shown to decrease all of those risk factors.

Enter the Ketogenic Diet (KD). We’ve all heard of it, but is it really effective for fat loss and improving your health?

Ketogenic diets are characterized by very low carbohydrate intake, offset by higher fat and protein intake. 

Here’s a chart that should break it down even more (you can find my previous discussion of KD & it’s impact on migraines here):

Protein Carb Fat
Mixed Meal  ~30% ~40% ~30%
Paleo Meal ~40% ~20% ~40%
Low-Carb Meal ~40% ~10% ~50%
Ketogenic Meal ~20% ~5% ~75%

 

What’s the mechanism for weight loss in a KD?

After a few days, blood glucose — from a much lower carbohydrate intake — gets too low to provide sufficient energy to the brain and central nervous system (CNS). 

Luckily, the body can produce ketone bodies in the liver as an alternative fuel source for the brain and CNS.

Essentially, fatty acids are turned into ketone bodies. This process is called ketogenesis. This is thought to be one of the reasons accounting for the reduction in body fat in individuals following a ketogenic diet.

 

KD and Obesity

belly-body-clothes-diet-53528

*image courtesy of public domain pictures*

Losing weight decreases the risk for all of the conditions and risk factors we’ve discussed.

Weight loss  — the loss of both fat and lean mass — is seen in mice and humans who undergo ketogenic diets.

The process of ketogenesis increases the amount of energy expended; in other words, elevating your metabolism.

In addition to that, people tend to eat a bit less  , leading to involuntary caloric restriction, which can lead to more weight loss in the short-term. 

This reduction in calories intake is thought to be due to the increased satiety — feeling of fullness — provided by a higher intake of fats and proteins.

 

KD and Non-Alcoholic Fatty Liver Disease

This one is important, as NAFLD increases lipids — cholesterol and triglycerides — and blood pressure, as well as insulin resistance and Type 2 Diabetes risk.

Unfortunately, the jury is out on this one.

Human studies show conflicting evidence, and there just aren’t enough studies out there.

Rodent studies show an increase in liver fat storage  — meaning even quicker NAFLD development — as well as increased insulin resistance while on a ketogenic diet.

It’s too soon to jump to conclusions, but the increase in liver fat storage and IR while on a ketogenic diet aren’t good signs for optimizing your health.

Remember, though, that regardless of how much you dislike your ex-husband, humans aren’t rodents, and may respond to KDs differently.

 

KD, Insulin Resistance, and Type 2 Diabetes

Here’s where things get interesting.

Rodent studies showed an increase in IR and a decrease in glucose (blood sugar) control.

That’s not good.

Humans without T2D show normal fasting glucose, but also show an elevated post-meal glucose reading when compared to people eating a standard diet.

That’s kind of neutral.

Humans with T2D show improved insulin sensitivity, improved blood sugar control, and were able to decrease the amount of antidiabetic medications they were taking.

That’s awesome.

We could say that KDs improve the conditions leading to Type 2 Diabetes.

 

KD and Dyslipidemia.

Dyslipidemia is elevation of plasma cholesterol, triglycerides (TGs), or both, or a low high-density lipoprotein level that contributes to the development of atherosclerosis.”

Dyslipidemia is a risk factor for cardiovascular disease.

Understandably, it’s a reason for concern in a diet where >70% of calorie intake is from fats.

Studies in humans have shown the following results in both obese and normal weight individuals, as well as those both with and without metabolic syndrome risk factors:

  1. Decrease in total cholesterol
  2. Increase in high-density lipoprotein (HDL), frequently called “good cholesterol”
  3. Decrease in triglycerides (TG), basically the storage form of fat hanging out in your blood
  4. Decrease in low-density lipoprotein (LDL), frequently called “bad cholesterol
  5. Increased size and volume in LDL, which lowers cardiovascular disease risk (more on this later).

These improvements require a few key things.

First off, these improvements were highly dependent on the types of fats consumed. Those consuming a higher intake of unsaturated fats saw positive changes, while individuals consuming a higher intake of saturated fats saw only moderate changes.

Secondly, it seems to be dependent on heritage as well. “Interestingly, the effect of a KD on lipid profile may be associated with ethnicity: in a study, white subjects lost more weight and had a bigger decrease in triglycerides levels than black subjects.”

If you’re looking to improve your cholesterol and triglyceride levels, it looks as if you’ll be better off sticking with a higher unsaturated fat and lower saturated fat intake.

Variables and Adherence

As discussed a second ago, a ketogenic diet with higher unsaturated fat intake seems to deliver more favorable changes than a KD high in saturated fats.

In addition to that, vegetable based KDs seem to deliver more favorable changes than those emphasizing meat as the primary source of protein.

As for adherence, individuals have difficulty sticking with the dietary approach in the long-term, though adherence is better than it is for low fat diets. This is possibly due to the increased satiety from higher protein and fat intake, as well as the feeling like you can eat as much as you please.

After comparing research, ketogenic diets, especially those high in veggies and unsaturated fats, decreased risk of cardiovascular disease, improved function in Type 2 Diabetics, and improved HDL. 

Did I mention the weight loss?

Remember, though, these improvements were hard to maintain in the long-term due to difficulties with adherence.

Then There’s The Other Thing…

The ketogenic diet mimics the metabolic state of fasting and starvation in the body. 

Unfortunately, your body is very smart, and responds through down-regulation of Thyroid hormone in order to slow metabolic rate and conserve energy in response. More on that here. This appears to be a side effect associated with long term ketogenic diets. 

Here’s how I understand the mechanism.

Even if your body is producing enough Free T3 (active thyroid), T4 (inactive thyroid), and Thyroid Stimulating Hormone (TSH: secreted by the hypothalamus to tell your body to make more T4 and T3), your body will produce more of it’s emergency break hormone, Reverse T3.

Regardless of how much TSH, T4, and T3 produced, reverse T3 signals your body to dump the extra T3 to slow metabolic rate — we’re in a starvation emergency! — and conserve energy.

Over the long-term, this can wreak havoc on both male and female sex hormones as well. 

Interestingly, in the short-term, it appears as though males will see an increase in Testosterone production. More on that here.

I Want to Make This Work.

pexels-photo-262959

**image courtesy of Greek Food Ta Mystika**

So you want to take a shot at a ketogenic diet. You want the weight reduction, improved blood lipids, and maybe you want to get off of your antidiabetic medications.

Great!

I’ve found that KD works really well for me, and is backed up with my nutrigenomic testing from DNAFit, as my body seems to be built at a genetic level for low carbohydrate diets.

In order to make this thing work over the long-term, I recommend an approach called cyclical ketosis, where you’re eating very low carb and high fat the majority of the time, followed by short periods of higher carb and lower fat. This helps with the mental part — I want ice cream — as well as the physical part — maintaining proper hormone levels.

There are a few different approaches, and it appears that, as demonstrated by the study on males and testosterone, you could stay in your low carb phase for up to 11 weeks while preserving normal testosterone levels. Unfortunately, I don’t have an equivalent study on Thyroid, so we’ll stick with 11 weeks.

Some see success with a weekly cycle where, after a 10 day  low carb period, you’d have a weekly high carb and low fat day.

An example might be 4 days of ketogenic diet, followed by one high carb day. After that, you’d go right back into your KD.

This may help prevent any negative insulin, thyroid or testosterone changes.

Another popular method is called back-loading. This one seems to be the easiest to maintain over the long-term, and is not a true ketogenic diet, but may prove to deliver similar results. 

After your initial 10 day ketogenic kickstart, you’d “back-load” with higher carbohydrate intake after difficult strength training sessions.

You know what difficult means.

This doesn’t mean go walk on the treadmill or go to a group fitness class.

Move heavy weights, work up to actual muscular fatigue, deplete your glycogen (muscle sugar) stores. 

Your post training carb load will help to replenish those stores via your GLUT4 receptors in your muscles.

Exercise training is the most potent stimulus to increase skeletal muscle GLUT4 expression, an effect that may partly contribute to improved insulin action and glucose disposal and enhanced muscle glycogen storage following exercise training in health and disease.”

Hence, you’re improving your response to insulin, your glucose disposal, and your muscle glycogen storage while on a modified ketogenic diet.

Remember that insulin response and glucose regulation may be impaired in a long-term ketogenic diet.

Following the “back-loading” method,  you’d continue to follow a ketogenic diet on your non-training days.

That’s Cool, But What Should I Take Away from This?

I know, I’ve thrown a lot at you.

Here are some key take-aways:

Ketogenic diets are fantastic for:

  1. Short-term weight loss.
  2. Improved insulin sensitivity and blood sugar control in diabetic individuals.
  3. In diets emphasizing vegetable protein and unsaturated fats:
    1. Decrease in total cholesterol.
    2. Increase in high-density lipoprotein (HDL), frequently called “good cholesterol.”
    3. Decrease in triglycerides (TG), basically the storage form of fat hanging out in your blood.
    4. Decrease in low-density lipoprotein (LDL), frequently called “bad cholesterol
    5. Increased size and volume in LDL, which lowers cardiovascular disease risk (more on this later).
  4. Decreasing risk of Cardiovascular Disease (due to the above mentioned changes)
  5. Improvement in conditions falling under the Metabolic Syndrome umbrella. 
  6. Improving migraines
  7. Improvement for individuals who experience epileptic seizures

Ketogenic diets may not be good for:

  1. Long term changes in weight, cardiovascular health.
  2. Insulin and blood sugar regulation in individuals without Type 2 Diabetes.
  3. Individuals who consume too much meat-based protein. 
  4. Individuals emphasizing saturated fats as their primary fat source. 

Ketogenic diets may be bad for:

  1. Maintaining optimal hormone levels — testosterone, thyroid — over the long-term.

The jury is still out for:

  1. KD and it’s positive/negative effects on Non-Alcoholic Fatty Liver Disease

Disclaimer…

Every individual is different.

Each of us carries different genes, and these genes can express themselves differently at points throughout your life.

The best practice is to use a genetic testing service, like DNAFit to find your optimal diet type.

In addition to that, check your blood, and check it on a yearly basis (at the very least). You can find these services, and reliable ones, through WellnessFX or HealthCheckUSA.

Yes, you could check these things with your doctor.

First off, your doc may not be trained to look at some of the important markers. Second, they may not know what some of these markers are(when were they last in school?). Third, they’re looking for values within a range determined by other sick people who have been tested in your region. Not for for optimal values.

That kind of  sucks.

Using a service like WellnessFX or HealthCheck ensures that you receive a full interpretation with a Holistic Doctor or health care professional designed to get you to your optimal values.

Lastly, work with a coach. The hardest part is making changes that fit you, in your lifestyle, and sticking with it over the long-term. 

You live in real life. Not some fantasy land where it’s easy to make long-term changes to how you’ve done things for the past 30 years.

It you want that kind of help, give me a call at 847.807.5361.

The time is free, and it’s on me.

If calling is not your thing, shoot me a text or an email.

Lastly (really this time), I’m not a doctor. This is not medical advice. I’m just a nerd who likes to read research, and this is my way of sharing that with the world.

I read it so you don’t have to.

-RB3

P.S. If you have questions, leave them in the comments, send me a DM, or shoot me a text! I’ll answer them directly, or in a future post if that’s what you’re looking for.

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2 thoughts on “The Diet that Shreds Fat; Is it Good for the Long-Term?

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