Wellness Refocused Education: Alcohol

I can’t have wine. I can’t have beer. I can’t go out.

I’ve heard this from a few clients. I’ve read it and heard it from a few people online. When I started, it’s something that I said myself.

It’s possible to still have a beer or a glass of wine and lose weight and create a healthy lifestyle. I kept alcohol in my plan during my last competition prep and saw the lowest body fat percentage I have ever had. This isn’t something many people practice, but in my last prep, it’s something I wanted to keep in for when I wanted a drink with dinner or date night. I wanted the ability to have a drink if I felt comfortable with having one work in my day.

Alcohol consumption and weight loss comes down to a few things.

  1. Maintaining a caloric deficit consistently over time.
  2. Determining how you feel about the choice of having a drink.

Weight loss/fat loss occur over time. While weight can fluctuate greatly day-to-day, true fat loss occurs over a period of time longer than a few days. You need to be in a caloric deficit over that period and that can be created through your nutrition protocol and workout programming.

The mental aspect of dieting is something that I talk about heavily with my clients because I don’t believe in eating things you don’t like (you won’t adhere to your plan if you don’t like it) and you also need to be comfortable or at least ok with the ramifications (if any) of your choices.

Three questions I get often are:

  • Why doesn’t alcohol have a nutrition label?
  • How do I track alcohol?
  • Should I leave space in my diet for alcohol? i.e. should there be an allotted number of calories or macros for alcohol to replace food?

Before we answer these questions, let understand alcohol a little bit better.

When we talk about alcohol as a consumable like beer, we’re meaning ethanol. Ethanol is a specific type of alcohol that you find in beer, wine and distilled spirits. Alcohol and ethanol are used interchangeably.

Alcohol is technically a macronutrient.

Chemically they are structurally similar to carbohydrates. Chemically, carbohydrates are C6H12O6 whereas ethanol alcohol is C2H5OH. Alcohol is similar to carbohydrates because they’re created from fermented carbohydrates in a process called ethanol fermentation or alcoholic fermentation.

Image result for alcoholic fermentation formula

Alcohol has 7 calories associated per gram. This makes them more calorically dense than carbohydrates and protein, but less calorically dense than fat (Thompson & Manore, 2015). Ethanol is a specific type of alcohol that you find in beer, wine and distilled spirits.

Alcohol provides no nutritional value, but it has energy.

So, if it’s a macronutrient why isn’t it on a nutrition label?

While the FDA and USDA are regulatory entities for food and supplements, they don’t regulate alcohol. That’s the short answer. Alcohol is regulated by the Alcohol and Tobacco Tax and Trade Bureau (TTB). This organization doesn’t require that companies provide nutritional information on their products. However, in 2004 a ruling called the Federal Alcohol Administration Act allowed TTB to implement labeling regulations as long as the information was accurate and not misleading to consumers. The FAA Act also had restrictions about marketing and statements in relation to benefits of alcohol. Since the FAA Action, more alcohol companies have tried to appease health conscious consumers by adding nutrition labels, however, if you look closely, you’ll see in many cases the calories don’t match the nutritional values provided on the label.

The reason – alcohol isn’t a nutrient that is usually provided on a label, and since much of the carbohydrates are converted into alcohol only those not converted are accounted for on the label.

Below is a label of Angry Orchard Hard Cider. We all know that apples are carbohydrates and we know carbohydrates is a fancy name for sugar. You’ll see that calories, carbohydrates and sugars are accounted for on the label, but if you multiply 31g of carbohydrates by 4 calories per gram, you get 124 calories, not 210. That’s not to say that there are truly 84 calories or 12g of alcohol in this bottle, but you get the idea – the energy is accounted for, but not the nutrient.

This was in the fridge at JP’s parents house. Notice how it lists carbohydrates as 5g (which is 20 calories) and at the top it says calories from alcohol 120 (roughly 17g). I’m not sure if this is something that we will be seeing more of, but I do think it allows people to make more healthful decisions – nutritionally and psychologically.

How do you track it if you’re counting macros?

I recommended threeways to accommodate alcohol into their plan.

1. Since it’s chemically similar to carbohydrates, you can over-accommodate by taking the total calories of the drink and dividing by 4 calories (1g of carbohydrates) to determine how many grams of carbohydrates you would use to account for your drink.

2. Calorically, since they’re close to fats at 7 calories per gram, you can divide by 9 calories (1g of fats) and determine how many grams of fats you want to use to account for your drink.

Both of these ways to accommodate alcohol aren’t going to be perfect – there’s no perfect way to account for it. Even if you’re counting calories, many people aren’t measuring all of the ingredients in their drinks and are estimating their consumption – especially if they’re ordering out.

3. The most common way I recommend they accommodate alcohol into their plan is to calculate it similarly to above and accepting and allowing themselves to eat in a surplus that day. I hardly ever recommend that clients substitute alcohol for food. Not only is alcohol not nutritious but decreasing food will also amplify the impacts that alcohol can have on a body such as stimulant effects.

Early in my journey, I made the mistake of attempting to leave space in my day for a drink to go out and it hits you like a ton of bricks if you’re not careful. Now, if I have a drink I’ve actively made the decision to have it and go over my calories for the day. This doesn’t mean that I load up and go over excessively. In many cases I’m putting my body into maintenance range, not necessarily a surplus.

We’ve talked about how the body breaks down certain nutrients from complex to simple forms and we’ve talk about how some things are broken down at different rates. As a liquid, alcohol is readily absorbed from the both the stomach and the small intestine – it’s not digested before reaching these two organs (Thompson & Manore, 2015). Foods containing protein, fat and fiber help slow down absorption rates of alcohol and therefore slowly the effects of it.

After alcohol enters the bloodstream, it moves to the liver where it’s broken down. The liver produces two enzymes that break down alcohol – alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) (Thompson & Manore, 2015). These enzymes break down alcohol so that it’s energy can be readily available to the body.  After the energy has been made ready, the body only has two options – use it for energy if caloric needs haven’t been met or convert it to fatty acids and store it for later.

While age, gender and weight can impact how alcohol impacts a person, the rate at which alcohol breaks down once it reaches the liver can’t be altered regardless of the myths out there.

Why do so many people cut it out of their diets if you can still lose weight and fat when consuming alcohol?

Again, there’s no nutritional value and it’s easy over consume energy through alcohol consumption. It’s not just from alcohol in beverages that the calories come from, many who enjoy mixed drinks are adding calories through sugary mixers and additions likes cherries and whipped cream. Other negative behaviors like over-eating as well as heavy drinking are also associated with alcohol consumption.

It’s possible that there are some benefits to light or moderate alcohol consumption. Resveratrol is a phytochemical found in red wines, grapes and other plants that can play a role in limiting cellular damage and help lower risk of certain chronic diseases (Thompson & Manore, 2015). However, the amount of resveratrol in wines may be too little to make a meaningful impact and therefore a purified supplement of resveratrol would be recommended. Much research has found links between moderate alcohol consumption and lower chronic disease, but not causation. “Clinical studies are limited by their observational nature as well as for the difficulties to abstract the benefits of wine from other confounders” meaning that it can be hard to determine if the benefits were from the wine or other healthy positive behaviors (Artero, Artero, Tarin & Cano, 2015). There are clear risks to drinking too much alcohol such as higher risk of chronic disease like impaired bone health, pancreatic injury and diabetes, abdominal obesity, cancer.

There is no recommended daily allowance (RDA) for alcohol, however, moderation per gender is encouraged. Moderation for women is one drink per day and no more than two drink per day for men.

Similarly to deciding if you should have a dessert after dinner or an extra serving of what would be considered a treat, you should feel confident in the decision to participate. Having a glass of wine or a bottle of beer shouldn’t make you feel derailed or feel like you’re ruining progress. It should be accounted for in whatever way you believe will be helpful. If it’s moderating the rest of the day and acknowledging that you will be out of a deficit that day – then so be it. If it’s not counting it, but going about your day tracking other items – then so be it. Just don’t allow yourself to become out of control.

As for me, I enjoy a beer with dinner. I like a cocktail when it’s hot. Sometimes I put liquor in my coffee when we make brunch.

Cheers!

❤ Cristina

References

Alcohol and Tobacco Tax and Trade Bureau. (2018, July 2). Beverage Alcohol. Retrieved from Alcohol and Tobacco Tax and Trade Bureau: https://www.ttb.gov/alcohol/bev-alc.shtml

Artero, A., Artero, A., Tarin, J. J., & Cano, A. (2015). The impact of moderate wine consumption on health. Maturitas, 3-13.

Department of the Treasury: Alcohol and Tobacco Tax and Trade Bureau. (2004, April 7). Caloric and Carbohydrate Representations in the Labeling and Advertising of Wine, Distilled Spirits and Malt Beverages. Retrieved from Department of the Treasury: Alcohol and Tobacco Tax and Trade Bureau: https://www.ttb.gov/rulings/2004-1.pdf

ScienceDirect. (2018, July 2). Ethanol fermentation. Retrieved from ScienceDirect: https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/ethanol-fermentation

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

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Wellness Refocused Education: What Are Carbohydrates?

Did anyone else feel bad for Regina George when she was duped by Cady Herron when she asked if butter was a carb? I found myself laughing at the time the movie came out, but after a year of working with clients and more time talking with others, it’s clear that it can be hard for people to think about food in terms of their macro nutrients, especially carbohydrates.

So what is a carbohydrate and why is it important?

This post will talk about the what because it’s slightly more complicated that you think. There’s a little bit of the why in here, but that will mostly come in the next post.

Ok, so what are carbohydrates?

Carbohydrates are the first source of energy for us. They are fuel for us when we are sitting, sleeping, exercising or thinking of doing all of those things.

The Acceptable Macronutrient Distribution Range (AMDR) suggests that carbohydrates make up 45 to 65% of your diet…if you’re consuming 2,000 calories a day. We’ll talk about this more in the next post because I think it’s safe to say that most people won’t fit these guidelines.

The Institute of Medicine set the Recommended Dietary Allowance (RDA)  for carbohydrate intake to a minimum of 130g a day. Obviously, this amount wouldn’t fit the AMDR – it would be too little based off a 2,000 calorie diet. The RDA number is set based off the estimated minimum use of glucose for the brain for an average body, which means it’s relative (Institute of Medicine, 2005). It might be slightly lower or slightly higher.

Since we have some of those basics out of the way, let’s start small, molecular small.

This is where biology and chemistry meet.

Carbohydrate means hydrated carbon (Reece, Taylor, Simon, Dickey, & Hogan, 2015). At the molecular level (and trust me this is helpful to know later) carbohydrates are made up of CH2O – 1 carbon, 2 hydrogen and 1 oxygen. In biology we actually learned a little upbeat rhyme of the abbreviates to memorize the molecular make up for carbohydrates, lipids (fats), nucleic acid and protein: CHO CHO CHOPN CHON, but you had to study so you knew how many of each were needed. Moving on…

The simplest carbohydrate is a monosaccharide – you’ll find these in glucose and fructose, which are sugars that carbohydrates break down to (Reece, Taylor, Simon, Dickey, & Hogan, 2015). You’ll find fructose in fruit. Glucose can be found in corn syrup and plants and found in the blood stream after certain carbohydrates are consumed and broken down. No your blood isn’t made of corn syrup.

Below are the chemical layout for glucose and fructose at the molecular level so you can see the difference.

Glucose and Fructose molecules

When you add two monosaccharides together, they form a disaccharide. For this binding to happen, water has to be lost. This is how we get maltose, which is used to make beer, malt whiskey and malted milk candy (Thompson & Manore, 2015).

Below is a picture of maltose, so you can see how glucose joins together. It’s like they’re holding hands if molecules had hands.

 

maltose

We also get sucrose when glucose and fructose join together. Sucrose is found in plants and it’s how we get table sugar (Thompson & Manore, 2015).

Below is a picture of sucrose. See more water is lost. Goodbye H2O!

sucrose

A longer chain, known as a polysaccharide are made up of hundreds of thousands of monosaccharides connected by water loss. Starch is an example, this is found in plants and contains glucose mononers. Glucose is stored in us in the form of glycogen in our muscles as a form of energy.

There’s a lot of ‘oses.

Here’s a few other ‘oses:

  • galactose – doesn’t occur alone in foods. It combines with glucose to create lactose.
  • lactose – “milk sugar”. A common disaccharide found in cow’s milk and breast milk.
  • ribose – five-carbon monosaccharide produced in our bodies from eating other carbohydrates. Can be found in the genetic material in our cells

Knowing the information above can be helpful for this next part. Carbohydrates are considered either simple or complex (Thompson & Manore, 2015). Like stated above the simplest carbohydrate is a monosaccharide and consists of one sugar; disaccharides are also simple and consist of two molecules of sugar. As you imagine, the most complex is the polysaccharide that is made up of hundreds of thousands of monosaccharides.

What is considered simple?

  • fruit (fructose)
  • vegetables (fructose)
  • milk (lactose)
  • fermented beverages (maltose)
  • sweeteners like honey, maple syrup, table sugar, brown sugar (sucrose)

What is considered complex?

  • starches including grains like rice, wheat, corn, oats and barley
  • legumes like peas, beans and lentils
  • tubers like sweet potatoes and yam

The digestion process is different for each macronutrient (fat, carbohydrates and protein), which means they breakdown at different rates (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Carbohydrates breakdown the fastest out of the macronutrients with fat being the slowest.

There are a few enzymes that help breakdown carbohydrates.

  • Salivary Amylase is found in the mouth in your saliva
  • Pancreatic Amylase and Maltase are found in the pancreatic juices (yes, gross I know) that are released into the small intestine to breakdown maltose
  • Sucrase and Lactase are found in the small intestine and help breakdown sucrose and lactose, respectively
*side note: when your body lacks the ability to create enough enzymes you may find intolerances like lactose in tolerant – you lack enough lactase enzyme to breakdown lactose. This can result in bloating or other digestive issues.

This is important to know the rate of digestion for a couple reasons:

1. Simple carbohydrates are digested and absorbed more easily causing a quicker energy utilization, which is why you may feel a “spike” in energy after eating something high in sugar, but then feel a “crash” later. This is also why individuals who are diabetic are encouraged to eat low-glycemic foods – foods that will breakdown at slower rates causing less of an increase in blood glucose since their bodies can’t produce insulin at all or don’t produce enough.

2. Our bodies can’t utilize complex carbohydrates in their consumed state, they need to be broken down to glucose (Thompson & Manore, 2015). These foods also contain fiber, which impacts how satiety controlling hormones are released (Chambers, McCrickerd, & Yeomans, 2015). This is why these foods keep us fuller longer even though protein has the highest satiety effect out of all three macronutrients.

When there’s not enough carbohydrates for this process the body turns to fat. To learn more about that, please check out this post.

Understanding the difference between simple and complex carbohydrates can be helpful for a  couple of reasons.

1. You can create a meal plan that combines complex carbohydrates with other foods to not only provide energy in the immediate time, but help you stay feeling full longer. That’s why oats and peanut butter “stick” with you for a long time. Being satisfied for a longer period of time prevents snacking and can assist you in staying in  caloric deficit if you are seeking fat loss.

2. You can create a meal plan that prevents or lessens “energy crashes”. Like stated above, complex carbohydrates take a longer time to breakdown a, which means glucose enters the blood slower so feeling tired or fatigued are less likely or are less impactful.

Carbohydrates that aren’t easily digested and broken down into this simple state are classified as fiber.

What is fiber?

Fiber is also a carbohydrate and is considered a polysaccharide, but it’s not easily digestible so it doesn’t provide energy to us (Thompson & Manore, 2015). There are two kinds of fiber:

  1. dietary – nondigestible parts of plants that make the form of the plant like leaves
  2. functional –  nondigestible parts of plants that are extracted or manufactured in a lab that is added to foods for health benefits

Even though fiber doesn’t provide energy to us, fiber is important because it helps regulate blood sugar. It also helps prevent constipation when consumed in a moderate (relative to an individual) amount, however, it can also cause constipation when over consumption occurs (also relative to an individual) (Anderson, et al., 2009). Foods with fiber also help regulate satiety hormone leptin, which tells our brains that we’re no longer hungry.

Currently, the recommended amount of fiber daily is 14g per 1,000 calories consumed, however, this number is relative to an individual and may be a little more or less based on your own caloric intake, weight and activity level. You should listen to your body to determine true needs. I personally need a little less fiber or I get bloated and constipated #everyonepoops.

 

 

Ok, so we know carbohydrates are the first source of energy for us. We know they breakdown at different rates. We know they’re relative to each individual. We know that they are found in fruits and veggies just like they are found in cookies and pizza.

Before we get into why they’re important and what the do for us, think about the carbohydrate sources you consume on a regular basis. Do they make you feel energized? Do you crash quickly in the day? Do you feel bloated? Do you combine simple and complex in your diet? Do you get enough fiber?

 

 

 

References

Anderson, J. W., Baird, P., Davis, R. H., Ferreri, S., Knudtson, M., Koraym, A., . . . Williams, C. L. (2009). Health Benefits of dietary Fiber. Nutrition Reviews, 188-205.

Chambers, L., McCrickerd, K., & Yeomans, M. R. (2015). Optimising Foods for Satiety. Trends in Food Science and Technology, 149-160.

Institute of Medicine. (2005). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, D.C.: The National Academies Press.

National Institute of Diabetes and Digestive and Kidney Diseases. (2017, December). Your Digestie Syste & How it Works. Retrieved from National Institute of Diabetes and Digestive and Kidney Diseases: https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works

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.

Wellness Refocused Education: Fat and the Ketogenic Diet

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.