While everyone uses fat for fuel to some degree, a ketogenic diet aims to reduce insulin levels to a point where ketone levels are high enough to be measured in the blood, breath or urine. 
In starvation, insulin levels plummet with glucose levels coming down and ketone levels increase progressively.
According to Dr Steve Phinney’s chart below,  a “well formulated ketogenic diet” (WFKD) contains between 3 and 20% carbohydrates and between 10 and 30% protein. Other dietary templates such as the Mediterranean or Paleo diets typically contain more carbohydrates and less fat.
There is a lot of knowledge encapsulated into this chart, so I encourage you to take the time to digest it, or even better, take the 20 minutes to watch this video from the man himself.
The concern typically expressed about restricted carbohydrate diets is that they will not provide adequate nutrition (i.e. vitamins, minerals and amino acids).
Diabetics, along with the general population, are advised to eat in line with the USDA Food Pyramid / My Plate guidelines which emphasise “healthy whole grains” while discouraging saturated fat and cholesterol.
Diabetics are told that they should not deprive themselves of any foods or not to risk getting inadequate nutrition, but rather to “cover” any carbohydrates they eat with insulin (or treat with medications such as Metformin for type 2 diabetics).
Even in health circles ketosis is sometimes considered to be extreme and not worth the effort for most people, but is it really that hard to achieve?
When we look at the relationship between ketones, blood sugar and HbA1c we see that someone with excellent blood glucose levels will have a moderate amount of blood ketones.
The chart and table below are based on my tracking of blood sugars and ketone values. Optimal blood (i.e. 4.6mmol/L) glucose corresponds to a ketone value of about 1.3mmol/L.
|HbA1c||average blood sugar||ketones|
|excellent||< 5.0||< 5.4||< 97||> 0.4|
|good||< 5.4||< 6.0||< 108||< 0.3|
|danger||> 6.5||> 7.8||> 140||< 0.3|
In view of this it’s hard to see why ketosis is extreme. It’s just what happens when someone has reduced their dietary insulin load to a point where they are achieving excellent blood sugars!
Ketosis is a sliding scale. Some people will want to push their ketone levels to therapeutic levels though fasting and a higher fat diet, but this may not be necessary for general health.
Most people would benefit from reducing their dietary insulin load to a point where their blood sugars are close to excellent.
I am a big fan of Steve Phinney (I attended a masterclass with him when he was in Brisbane last year), but I think he potentially alienates people when he starts off talking about the Inuit and Steffanson living off all meat diets.
I also understand why the people generally might baulk at the idea of mainlining butter and MCT oil to drive up ketones. “How can eating all that extra fat really be healthy?” they ask.
I propose an alternative sales pitch for ketosis:
- ketosis occurs when your blood sugars are close to optimal,
- blood sugars can be optimised by reducing the insulin load of your diet, and
- once you optimise your blood sugars you will reduce your hunger, access your body fat for fuel and a whole host of other health markers will improve.
What’s not to like?
What do you think?
[this post is part of the insulin index series]
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