Wellness Refocused Education

Wellness Refocused Education: Fat and the Ketogenic Diet

Reading Time: 9 minutes

For a long time there was a war on fat, like over 30 years long. I’ve talked a lot about the importance of reading labels and understanding what you’re consuming. Not necessarily saying no to the processed food, but understanding or knowing what is in it. Well, taking that a step further – we need to also understand that the guidelines that back those labels up are created by governing bodies that may or may not benefit by creating certain guidelines or encouraging certain studies.

I’m not saying that the FDA or USDA or other regulatory groups are bad, but I am saying that the information can be misleading or a generalization in some cases.

A good example: the nutrition label you see on your boxed and canned goods is based off of a 2,000 calorie diet. This means the percentage listed as daily value is based off of 2,000 calories, but you may not be eating 2,000 calories – you may be consuming more or less.

Another example: the most recent guidelines by the USDA have a caloric recommendation for individuals based on gender, age and activity level with all numbers being whole, round numbers. These numbers are only below 1,400 daily calories for children under the age of 6, sedentary males peak at 2,600 calories for a 19/20 year old with sedentary females peaking at 2,000 calories for ages 19-25 – individuals who are more active peaked calories up to 3,200 daily.  The guidelines state that the sample bodies used to determine were an average height and a “healthy” weight (page 77-78).

“For adults, the reference man is 5 feet 10 inches tall and weighs 154 pounds. The reference woman is 5 feet 4 inches tall and weighs 126 pounds.”

I’m 5’4″ and I weight about 138 pounds. I’m roughly 17% body fat, which is lean and considered athletic for a female. My measurements are small. I don’t fit the sample body. I also don’t know many “healthy” men that would fit this sample body either.

The first dietary guidelines were rolled out in the 1980s and at the time, the biggest concern was heart disease and heart attacks. Ultimately, the first guidelines recommended against all fat and foods that had cholesterol like red meat.  However, more research has shown that not all fats are created equal and that dietary fat is necessary for bodily function. In the most recent guidelines for 2015-2020, it’s stated that saturated fat consumption should be 10% or less of overall calories consumed (page 15 footnotes). It’s also recommended that you replace saturated fats with unsaturated fats.

Before we get ahead of ourselves, let’s talk about fats. Have you ever heard about triglycerides? It’s possible that your doctor has mentioned this term before when discussing blood work and overall health. These are the most common dietary fat we eat. This is also the form that fat is stored in our bodies.

The science of triglycerides

Triglycerides are a molecule consisting of 3 fatty acids attached to a 3 carbon glycerol backbone (Thompson & Manore, 2015). They are classified by their chain length (how many carbons are attached), their level of saturation (how much hydrogen is attached to each carbon) and their shape.

The first way to classify – chain length. The first thing we learned in biology is that structure determines function – if you have a wheel it can move things forward, right? It can’t make things fly. There are three chain lengths: short (6 or fewer carbon), medium (6 to 12 carbon) and long (14 or more carbon). The lengths determine the method of fat digestion and absorption as well as how the fat works within your body. As you imagine, the shorter the chain, the faster the digestion and absorption (Thompson & Manore, 2015).

Now, saturation level. What’s the difference between these two kind of fats?

The simple answer – saturated fatty acids have closely packed molecules because they lack a double bond that would “space” them out. This means they can solidify at room temperature, example: a jar of coconut oil. unsaturated fatty acids do have a double bond, which prevent them from solidifying at room temperature, example: olive oil (Reece, Taylor, Simon, Dickey, & Hogan, 2015).

Lastly, shape – the carbon molecules impact the shape. The lack of the double bond in saturated fat allows the chain to be straight and pack tightly together. The double bond in unsaturated fat prevents the chain from being straight and actually adds kinks, which makes them liquid at room temperature.

But what about  bottles of coconut oil at the store, how are those liquids? Coconut oil that is liquid at room temperature is manipulated during manufacturing. The removal of natural fatty acids that solidify allow liquid coconut oil to be just that. Lauric acid, the fatty acid in coconut oil known for its health benefits like being a germ killer, is actually removed in this process. This is because it’s melting point is over 100 degrees Fahrenheit. To read more about the production, safety and use of liquid coconut oil check out this article.

Coconut oil isn’t the only thing that is manipulated on the market. Unsaturated fats can also be manipulated by food manufacturing in a process called hydrogenation, which started in the early 1900s (Thompson & Manore, 2015). This process adds hydrogen molecules, which in unsaturated fats causes the double bonds to be partially or totally removed allowing the fat to become solid and store more easily for a longer period of time.

This is also where we get trans-fats, which actually is describing the double bonds in the molecule. This kind of fat is found mostly in foods that are manipulated, although a small amount of natural trans fatty acids are found in cow’s milk and meat.

Now that I’ve confused you, triglycerides do contain essential fatty acids that are important for health (Thompson & Manore, 2015). Essential fatty acids (EFA) are obtained from the foods we consume – our bodies cannot produce them. There are two groups of them: Omega-6 and Omega-3.

Omega-6 Fatty Acids have a double bond 6 carbons from the end (omega = end of the chain, 6 = number of bonds away from the end). Linoleic acid is an omega-6 that is essential for human health. This is found in vegetable and nut oils like peanut oil, sunflower oil, corn oil and soy.

Omega-3 Fatty Acids have a double bond 3 carbons from the end. Alpha-linolenic acid is the most common in our diets and primarily comes from plants like leafy greens, walnuts, flaxseeds.

Why are EFAs important?

They’re precursors to biological compounds found in every cell in the body that regulate cell function.

Why is fat in general important?Fat provides energy; it has 9 calories per gram, which makes it the most dense energy source. Our bodies use fat when we’re at rest and during physical activity.

  • Fat helps transport vitamins A, D, E and K throughout the body, which help regulate functions like calcium absorption and utilization, cell membrane protection, blood clotting, bone health and vision.
  • Fat regulates our hormone production and cell function. *
  • Fat contributes to satiety, which means we stop eating sooner and helps us feel full longer.

Fat Importance on Cell Function and Hormone Production

This is something I talk a lot about with my clients. Fat is important because of the reasons listed, but as someone who works predominately with women this is something I want to drive home with them. There’s no reason to fear dietary fat, but we do need to moderate it. Phospholipids are a major component of our cells (Reece, Taylor, Simon, Dickey, & Hogan, 2015). These are similar to fats, except they contain two fatty acids attached at the glycerol, not three. Steroids are hormones produced in the adrenal cortex, cortisol is an example of a steroid hormone, which regulates carbohydrate metabolism and provides an anti-inflammatory effect on the body.

Fat -loving and the Ketogenic Diet

As the war on fat has started to settle, the rise of high fat diets like the ketogenic diet have started to become increasingly popular for fat loss; however, this style diet isn’t for everyone and should be monitored because of other potential health outcomes.

So what is the ketogenic diet?In simple terms it’s a high fat, very low carbohydrate (~20g or less daily), moderate protein diet that has been utilized to help with refractory epilepsy since the 1920s (Gupta, et al., 2017). It’s especially helpful for children with epilepsy, but according to the Epilepsy Society, adults may also benefit from it. The ketogenic diet has also been found to assist with fat loss in individuals who are obese lose as well as help manage other disorders like polycystic ovarian syndrome (Gupta, et al., 2017). However, be reminded that less extreme diets that moderate calories will also result in fat loss as long as the individual adheres to it and a diet that moderates carbohydrate intake may also assist with PCOS.

So how does the ketogenic diet work?

Our bodies utilize carbohydrates that have been broken down to glucose as a main source of energy (Thompson & Manore, 2015). While our bodies also use fat as fuel, glucose is favorited by red blood cells, some nervous tissue and our brains for energy.

When we don’t take in enough carbohydrates…. let me pause…enough carbohydrates doesn’t mean hundreds of grams daily. Enough carbohydrates could be 100g a day depending on the age, gender and activity levels of the person. Ok continuing…our bodies start looking for another fuel source. In the process of ketosis, the liver converts fat into fatty acids and creates ketone bodies or ketones that will be utilized as fuel. These ketones are a natural appetite suppressant that can help control nutritional intake (Thompson & Manore, 2015).

What about the keto diet is beneficial to different populations?

The effects on the “central nervous system, cellular metabolism and metabolic pathways, have shown promising results in a variety of neurological disorders, traumatic brain injury, acne, cancers, and metabolic disorders (Gupta, et al., 2017).” “The ketogenic diet alters the energy metabolism in the brain, therefore altering brain excitability,” which impacts  how cells communicate with each other and regulate the CNS (Lee, 2012).

Is there one way to practice keto?

This is a tricky question. The classical diet of keto that is utilized with epilepsy patients suggests strict ratios of fat, carbohydrates and protein at every meal. It also includes little protein and carbohydrate because of the body’s ability to be “knocked out” of ketosis by too many of either.

The medium chain triglyceride (MCT) diet allows for a little more carbohydrates and protein. This version provides some flexibility and allows MCT oil to be used a supplement. Nutrients are also calculated by the percentage of calories for each group, meaning it’s not a specific number of grams, but a percentage of overall calories.

If keto can be helpful, why shouldn’t everyone utilize it?

A true ketosis diet should be monitored because of higher risks for other health concerns like osteoporosis (weak and brittle bones), hyperlipidemia (abnormally high fat in the blood), nephrolithiasis (kidney stones). Some of these health concerns can onset as we age, but nutritional deficiencies can increase risk. This means that supplementation is necessarily because there is a lack of diversity by lowering carbohydrate intake. This would be a recommendation for many people seeking fat loss with any diet – supplement appropriately.

The use of carbohydrates in our diets isn’t just for daily function like walking, talking and sitting; they’re also used for fuel during prolonged period of activity and protect again the use of stored protein as a fuel source  i.e. muscle loss (Thompson & Manore, 2015). When our bodies don’t have enough carbohydrates our bodies continue to find fuel sources, and while in a perfect world we imagine the body will find stored fat to utilize, it will also find stored protein. Not only does this result in muscle mass loss, but it can weaken our immune systems and prevent optimal function. However, this kind of loss can be associated with too little calorie intake because a nutrient group has be drastically decreased or eliminated.  

If ketone levels are too high the blood can become very acidic and can lead to ketoacidosis. This actually prevents optimal body function and ultimately can lead to damaged tissue.

Why don’t I believe the ketogenic diet should be prescribed to everyone?

My personal belief is that the ketogenic diet should be utilized for clinical conditions like epilepsy and other cognitive or metabolic disorders. I do believe that some people feel better on lower carbohydrates, but lower is relative.

I had a client who recognized she felt physically better on higher fat, moderate carbohydrate and protein. Her macros were 75F/100C/147P or 1,663 calories. Her goal was fat loss and this was a deficit for her. On days that she would run long distances (over 4 miles) she would increase her carbohydrates between 20-40g because it helped in those runs.

Yes, I eat processed food and things with real and artificial sweeteners in them, but I also know that’s not for everyone. I know not everyone can moderate these foods and that’s completely ok. I do believe that one way to work towards creating a healthier food plan is to examine the carbohydrates that are you taking in and how they make you feel. I ask my clients to do this often by making a list or notes when they recognize they feel bloated, jittery, exhausted, fatigued, etc.

Carbohydrates breakdown to sugars like stated above so in many cases they feel these things because of 1. too much sugar (real or added) 2. too many overall carbohydrates 3. the kind of carbohydrates they’re consuming (simple versus complex). I don’t think extremes need to be implemented to see change or progress unless specified by a physician.

Mentally, I think elimination diets that pull full groups of foods can be harmful over time to the relationship that we have with food. Creating a balance lifestyle also means enjoying foods that tastes good, but isn’t necessarily the greatest for us, but understanding that moderation is key. Eating out, attending and participating in parties and functions is a part of life and experience. While many suffer from auto immune disorders or illnesses that force them to create alternative eating styles to manage their health, many don’t need extreme measures.

Health coaches, lifestyle coaches, personal trainers, wellness coaches, etc. people assisting others like I do, should be encouraging individuals to bring in all their resources to find what ultimately works for them in a reasonable and safe way.

We shouldn’t fear fat in our diet, but we also shouldn’t fear other nutritional groups either – we just need to better understand them.

References

Epilepsy Society. (2016, March). Ketogenic Diet. Retrieved from Epilepsy Society: https://www.epilepsysociety.org.uk/ketogenic-diet#.WkzL6TdG1PY

Gupta, L., Khandelwal, D., Kalra, S., Gupta, P., Dutta, D., & Aggarwal, S. (2017). Ketogenic diet in endocrine disorders: Current perspectives. Journal of Postgraduate Medicine, 242-251.

Lee, M. (2012). The use of ketogenic diet in special situations: expanding use in intractable epilepsy and other neurologic disorders. Korean Journal of Pediatrics, 316-321.

Reece, J. B., Taylor, M. R., Simon, E. J., Dickey, J. L., & Hogan, K. (2015). Campbell Biology: Concepts and Connections. New York: Pearson Education.

Thompson, J., & Manore, M. (2015). Nutrition: An Applied Approach. San Francisco: Pearson Education.