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| An overview of the Keto Diet created by Dr. Phinney that he uses in his clinic to reverse diabetes and metabolic syndrome |
Are you thinking about giving the Keto Diet a try for 2019?
If so, you're going to need to take some time to discover exactly what the Keto Diet is and decide if it's right for you.
Keto is not a short-term weight-loss plan.
Keto is a drastic lifestyle change that attempts to get you into the optimal state of ketosis, often referred to as Nutritional Ketosis. Dr. Stephen Phinney is the medical doctor who coined that term and published his perspective on the ketogenic diet in 2011.
The reason I'm going to talk about the "real" Keto Diet in this post is because most of the information about Keto that is floating around the web these days didn't come from Dr. Phinney or even his books.
The information came from a popular blogger who read The Art and Science of Low Carb Performance, a book written for endurance athletes, and then created a personalized version of that weight-loss program that worked for him.
(Available at Amazon)
Since Jimmy Moore has a ton of followers who were interested in trying to recreate his success, Jimmy's high-fat, tweaked version spread quickly across the internet, by word-of-mouth, and became known as Nutritional Ketosis.
Even though it's NOT.
The real Keto Diet created by Dr. Phinney is very different. And so are his recommendations for a well-formulated ketogenic weight-loss diet.
This difference between Keto and what Jimmy Moore was doing several years ago has caused a lot of confusion. For that reason, I wrote a post on the truth about LCHF weight loss.
However, some of Dr. Phinney's techniques and recommendations have changed since he wrote his books, so this is the most up-to-date information I'm aware of.
As a group, athletes tend to be insulin sensitive, rather than insulin resistant. They don't have the same needs as those who have metabolic syndrome or diabetes.
They are not using Keto to lose weight.
For endurance athletes, the aim is to train the body to predominantly burn fat for fuel, so that when glycogen gets too low, you don't hit the wall and experience a large drop in performance. Instead, the body will instantly mobilize body fat.
Glycogen and blood glucose are secondary fuels and dietary fat becomes predominant to supply adequate calories.
While this same aim can make your ketogenic weight-loss diet work better than a standard low-carb nutritional approach, there are very different principles you need to know and understand if your goal is to lose weight rather than perform well.
Trying to do a maintenance diet for athletes when your goal is to ditch those pesky, excess pounds might not work so well, especially if you're insulin resistant.
Going too low in protein, in order to get your ketones into the upper level for optimal performance can backfire on you, and even cause you to gain weight!
This is what happened to me when I tried to do Jimmy Moore's version of Nutritional Ketosis. I gained weight like crazy.
I don't want that to happen to you, so I'm going to show you how to do the real Keto Diet created by Dr. Phinney, so 2019 will be your most successful weight-loss year yet!
Is the Keto Diet Safe to Do?
Nutritional Ketosis can be used to achieve metabolic health and well being in people who have conditions associated with inflammation or disease states, such as diabetes.
Insulin resistance responds exceptionally well to Keto.
The Keto Diet can also improve your cholesterol markers and reverse visceral fat deposits in the liver or abdomen. Visceral fat is the most dangerous type of fat you can have in your body, so the key to success is to implement the diet in a safe and effective way.
Dr. Phinney has been prescribing ketogenic diets for patients for over 40 years. In his clinical experience, Keto is safe to do, but it isn't safe for everyone.
This is because the diet can get a bit complex when mixed with medications and a variety of health concerns.
According to Dr. Phinney:
"In people who have medical conditions, it is not always safe."
Concern is mostly due to the medications you might be on, rather than something faulty with the diet itself.
When you have diabetes or high-blood pressure, and are on meds for these conditions, as well as a few others, you'll need to be under the direct care of a medical professional.
Keto works very well to control or manage metabolic conditions, such as diabetes, and can even reverse it in some individuals, but this will mean a change or reduction in medications.
When the need for medication goes down, you can often begin to experience the side effects that are associated with those medications.
Those who are not on medication won't be at risk, but still need to be overseen by a medical professional.
"For a ketogenic diet to be safe, it must be more scripted than [just eliminating carbs.]"
In addition, there are some medical conditions where people shouldn't do this type of diet at all.
For example, those with a heart condition or limited kidney function need to be evaluated by qualified medical personnel to determine if your body will be able to adapt to low carb successfully, or not.
Many doctors do not know how to do this, so make sure that you go to someone who is trained in ketogenic dieting if this caution pertains to you.
There are 4 Phases for the Real Keto Diet
There are a lot of different low-carb diet strategies, but not all of them are ketogenic, and not all of them provide keto adaption.
Keto adaption is what makes the Keto Diet different.
While anything short of 100 carbs per day will force the body to become fat adapted to a certain degree, the Keto Diet recommends a very low-carb diet so that you can maintain an optimal state of ketosis indefinitely.
To accomplish this, the Keto Diet offers four phases.
These phases are like stepping stones that take you from overweight and obesity to a ketogenic maintenance.
Each dietary phase comes with different levels of dietary fat, carbohydrates, and fat calories. In addition, each phase is designed to accomplish certain things.
Keto Phase 1
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| Phase 1 is quite restrictive: 30 total carbs and 3 to 5 servings of non-starchy vegetables per day |
Phase 1 is the introductory phase of the Keto Diet and is now referred to as Induction.
This phase lasts for several weeks, until you feel ready to move on to Phase 2. It's your choice when you decide to do that.
The aim of Induction is to get you into an optimal state of ketosis, which Dr. Phinney calls Nutritional Ketosis.
Induction moves you toward being fat-adapted, which occurs when you begin to burn fatty acids for fuel, and then keto-adapted, when the body prefers to burn fats over glucose.
Carbohydrates on this phase of the plan are set at 30 total carbs, (not net), most of which need to come from salad and non-starchy vegetables. This helps you get into the state of ketosis quickly and easily.
Please note that the real Keto Diet does not recommend using "net" carb calculations. It uses only total carbs.
Recommendations for salad vegetables and non-starchy vegetables is to eat 3 to 5 servings per day.
[If you don't know what non-starchy vegetables and salad vegetables are, check out our article on how to do the Atkins Induction diet correctly. It contains a list of acceptable salad vegetables and non-starchy vegetables.]
Keto is basically a meat-and-vegetable diet at this stage of the weight-loss process. Carbs are kept ultra low to help insulin levels fall to normal very quickly, so that your blood glucose level can stabilize.
Since carb-restriction drives Nutritonal Ketosis, using a blood-ketone meter to make sure that you're in the optimal zone for ketosis is recommended, but with the caution not to get obsessive with the numbers.
(Available at Amazon)
While you do need to limit your diet to the foods that will enable you to stay within that optimal zone for Nutritional Ketosis most of the time, there will be hourly and daily fluctuations in your ketone levels.
Don't freak out if your ketones happen to drop after exercise or after eating.
Ketone levels don't stay consistent throughout the day.
Any reading that falls within the 0.5 mmol/L to 4.0 mmol/L range is well within the acceptable range for Nutritional Ketosis.
Dietary protein needs are 15 to 20 percent of your maintenance calories and stay the same throughout the course of the diet, even at maintenance. This is because your need for protein doesn't change as you lose the weight.
For the average woman, this would be about 90 grams of protein, equivalent to 10 to 12 ounces of protein sources per day. Men's needs are a bit higher. Perhaps, up to 120 grams of protein per day, or up to 17 ounces.
And shorter women might need to stick to the lower end of this range, maybe as low as 80 grams of protein, depending on how muscular you are.
Even though I'm very short, only 5-feet tall, I have a large bone structure. When I tried Jimmy Moore's version of Nutritional Ketosis, I ate 60 grams of protein a day, which comes to only 8 ounces of meat.
On that amount of protein, I lost a lot of muscle, so don't skimp on the protein.
Optimal protein for me is 72 to 90 grams a day.
[If you are on Keto already, and your protein intake is lower than is recommended here, check out our article for the signs and symptoms of protein deficiency -- to make sure that you are getting enough.]
Dietary fats is where a lot of Keto dieters make their mistake.
Jimmy Moore's version recommends you eat 80 percent of your calories in healthy fats. On the real Keto Diet, after setting up your carbohydrate and protein needs, dietary fat makes up the rest of your calories.
Dr. Phinney makes it clear in his videos at Virta Health, where he is the co-founder and Chief Medical Officer of that dietary intervention for diabetes and metabolic syndrome, that the amount of fat you eat needs to be just enough to reach satiety, and not fullness.
The amount of fat you eat on a weight-loss diet needs to be less than your total calorie needs for the day to ensure that you're eating at a calorie deficit.
If you try to eat 80 percent of your energy needs in fat each day, as many keto dieters are doing, that's maintenance:
5 percent carbs + 15 percent protein + 80 percent fat = 100 percent of your calories
At 80 percent of your calories, you'll either maintain or you'll gain weight because you've misjudged your current calorie needs.
A much better alternative is to eat just enough fat to make your weight-loss diet work, maybe a maximum of 90 grams of fat for the average woman.
I personally did best on 60 grams of fat.
I know that sounds like that isn't enough fat, but it fits within what Dr. Phinney recommends -- 60 to 100 grams of fat for weight loss.
I'm very short, and quite inactive. I don't need as many fat calories as you might need to be successful on Keto.
Keto Phase 2
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| Phase 2 of Keto gives you room for raspberry mousse and other low-carb foods like nuts and seeds |
Once you have become fat adapted and keto adapted, it's fine to move into Phase 2.
This phase is where you will lose most of your weight.
At this point, carbs can be increased to around 40 to 45 total carbs per day. This increase provides a greater helping of salads and non-starchy vegetables, or makes room for additional low-carb foods, such as nuts or an occasional bowl of berries with whipped cream for dessert.
Protein needs stay the same.
Fat calories tend to increase a bit as you move into Phase 2 because you become more comfortable with the diet and are not as excited about dieting, and therefore, less self-restrictive than you were when you were during Phase 1.
Most people are not as strict as they were initially.
The increase in carbs and fat will result in a slow down of your weight loss.
During this phase of my own weight-loss diet, I used to do what I called "Atkins Days." I ate a bit more fat and didn't keep track of my macros, generally on the days when hubby and I took a trip up north and I was eating out.
Doing this caused my weight loss to slow down quite a bit, but made dieting not so intrusive into our lifestyle.
Continue to eat to satiety, but you can keep a closer eye on the scale to make sure that you're going in the right direction. Sometimes, it's hard to figure out the difference between satiety and fullness, so that can take a while.
Be kind to yourself.
The idea behind Keto is to make your ketogenic diet sustainable, so you don't want to be too restrictive during this phase, but you do need to eat less than your daily calorie needs.
Focus on finding recipes and dishes that you enjoy -- with the future firmly in mind -- because maintenance won't be much different than your weight loss diet is.
Keto Phase 3
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| Phase 3 is less restrictive and allows for a few low-carb treats, such as low-carb ice cream |
Phase 3 is the pre-maintenance phase of the Keto Diet, where you begin to return a few more carbs and additional fats to your diet to slow down your progress.
Carbs can be increased to 50, or more, if you do it slowly, provided you don't go over your carbohydrate tolerance. Most people discover that to stay within the optimal range for Nutritional Ketosis, they cannot eat more than 70 carbs.
You'll know when you've reached your upper limit for carbs because you'll find yourself out of the range for Nutritional Ketosis.
Only increase your carbs if you can stay within the 0.5 mmol/L to 4.0 mmol/L range.
If you can't stay in range, eliminate those extra carbs and raise your dietary fats instead.
At this point in your weight loss efforts, dietary fats might go as high as 138 to 140 grams of fat, but you'll need to be careful here as well.
There is no way I could eat that much fat and not start to regain my weight, and here's why:
When you lose weight, your calorie needs fall rather drastically. For the average woman who started out with 40 pounds to lose, your calorie needs are going to decrease by 300 to 400 calories by the time you reach maintenance.
And the more weight you have to lose the more your calorie needs will go down by the time you achieve your goal.
Average calorie intake is about 10 to 15 calories per pound of body weight, depending on your:
- genetics
- gender
- age
- height
- bone structure
- lean body mass
- nervous habits
- activity level
- amount of protein you eat
- number of weight-loss diets you've been on
- metabolic health
Pre-maintenance gives you time to play around with your macros and calories to discover just where your maintenance level falls.
My own maintenance is roughly 10 to 12 calories per pound right now, but might go higher as I become more active.
Keto Phase 4
By maintenance, you will be eating roughly 80 percent of your calories in dietary fats, but this, too, might be a bit too high if you're not active enough to sustain that much fat.
Keto is a very personalized approach to nutrition, so you'll want to adapt the diet to fit your tastes and lifestyle.
Since the aim of Keto is to maintain optimal performance or optimal nutrition, your final diet will be whatever allows you to stay in the Nutritional Ketosis zone.
Two people are not going to respond to carb and fat additions in exactly the same way. Food sensitivities and biological differences will also play a huge role in what you'll be able to return to your diet.
Unlike other ketogenic diets that gently raise you out of ketosis at maintenance, however, Keto keeps you in Nutritional Ketosis for the rest of your life.
This enables the body to continue to predominantly use dietary fats for energy and physical repairs.
But this doesn't mean that you'll never be able to eat something off plan.
Keto-adaption means that your body prefers to burn fatty acids for fuel over glucose, so when you eat something that you don't ordinarily eat every day, the body will quickly and easily go back to burning fatty acids as soon as the glucose is used up.
Keto Flu
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| Keto Flu isn't a virus. It's an imbalance in your electrolytes. Make sure you have 2 cups of broth per day and eat lots of salty low-carb foods |
Because the real Keto Diet is so low in carbohydrate, there is more danger in coming down with what's called the Keto Flu. This is not really a flu virus, but the symptoms are similar to the flu:
- aches and pains
- nausea and upset stomach
- severe exhaustion
- leg cramps
- dehydration
- light-headedness
- dizziness or vertigo
- constipation
When carbs are taken down very low, the kidneys are even more proficient at dumping sodium than on a general low-carb diet, so it's super easy for your electrolytes to get out of balance.
This means you'll have to be extra diligent at getting in enough sodium, potassium, calcium, and magnesium -- with sodium being the most important in Dr. Phinney's professional opinion.
Make sure that you are eating plenty of salty foods, such as:
- cheese
- salted nuts
- pickles and olives
- salty meats like bacon and ham
- ocean seafood like salmon or tuna
What is a Well-Formulated Keto Diet?
Basically, the foods that are acceptable on a Keto Diet consists of:
- eggs
- meat, fish, poultry
- full-fat dairy products (no milk)
- non-starchy vegetables and lettuce salads
- only fruit is berries
- nuts and seeds (including flaxmeal, coconut flour, almond flour)
- healthy fats (plenty of omega-3's)
- low-carb condiments
- herbs and spices
In addition, there are 10 characteristics of a well-formulated Keto Diet that were put out by Dr. Phinney and Jeff Volek at their Virta Health blog.
These 10 characteristics are what separate the real Keto Diet from all of the other programs on the internet who claim to be Keto.
According to Dr. Phinney, a well-formulated ketogenic diet is more than just deciding to eat fewer carbs. It should:
1) Sustain Nutritional Ketosis
2) Maintain or improve your lean body mass and performance
3) Contain adequate minerals and hydration management
4) Let fat provide the majority of your dietary calories
5) Contain no calorie counting
6) Contain mostly whole foods
7) Avoid very low-calorie deficits [large]
8) Not recommend Keto for certain chronic conditions
9) Have ongoing expert medical supervision for those on medication
10) Not necessarily adhere to traditional dietary guidelines
In addition, Dr. Phinney also cautions that:
"Calorie counting is not essential; however, individuals must be mindful not to eat past satiety or purposely consume fats in excess of energy needs in an effort to increase ketone values."
Getting your ketone levels up above 3.0 mmol/L by over-consuming fat or adding MCT oils isn't going to do a lot of good, when it comes to weight loss.
While satiety is important, the body can't store Medium-chain fatty acids. A buildup of MCT fats is dangerous, so the body has to use them as soon as they are absorbed.
During the weight-loss phase, this is NOT helpful.
While your ketone level might go up from putting coconut oil and/or MCT oils in your coffee, that rise in ketones is the body protecting itself from the medium-chain triglycerides.
These extra ketones do not improve your ability to burn fat. Like when you consume alcohol on Keto, you'll burn less body fat until that coconut oil or MCT fat is oxidized.
Consume enough coconut oil or other MCT fat and your body weight can stall well above where you want to be.
There is nothing wrong with adding a little coconut oil to your diet as part of your fats for the day. You just need to understand that coconut oil and MCT oils are used first, so what you don't want to do is add coconut oil in addition to all of your other fats. They need to be instead of some of that fat.
Real Keto Diet is Safe and Effective
After looking over Dr. Phinney's various examples of what a Keto Diet looks like, I came to realize that the flack I got from the low-carb community over how I was eating during my weight-loss phase wasn't correct.
Keto is exactly what I did to lose over 100 pounds:
- 72 to 90 grams of protein per day
- 20 total carbs (never tested a higher amount)
- 60 grams of fat (just enough fat to make the diet work)
Since Keto is designed to help those with metabolic syndrome or diabetes, it can improve or reverse those health conditions when done correctly.
Carbohydrates are set to your personal carbohydrate tolerance level, protein is dialed in to fit your body's amino acid needs, and fat is eaten to satiety, but below your total daily calorie maintenance level, so the real Keto Diet is also a very effective weight-loss program.
Are any of you doing Keto? How is it going for you? I'd love to hear about it in the comments below!
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