How to Achieve Ketogenic Gains with a Paleo Diet

carrot-soup-clark-2Part Two in Our Ketogenic Diet Series

The Paleo diet approach shares many similar traits to a ketogenic diet and a few modifications to your Paleo diet may make it possible to achieve the best of both worlds.

In part one of this series on ketogenic diets, Christopher Clarke outlined the physiology of a ketogenic diet and its significant benefits with a myriad of chronic health conditions including weight gain, diabetes, metabolic syndrome, cardiovascular disease, neurological conditions and certain cancers.1,2

Now, the practical part… How can you transform your Paleo diet into a ketogenic Paleo approach?

#1 Reduce Your Carb Intake

If you’re following a Paleo approach, you’re likely already eating a moderate to low-carb diet, so it will probably be easier than you think to reduce your carb intake a little further to begin the shift into a ketogenic state.

Root Veggies vs. Cruciferous Veggies
The general guideline for carb intake on a ketogenic diet is 30-50g per day.3 Practically speaking, this usually involves shifting from Paleo-friendly root vegetables to cruciferous veggies and leafy greens. For example, one cup of sweet potato provides 27g of carbs, while 1 cup of broccoli yields only 6g. Starchy, carb-dense veggies can also be swapped out for leafy greens like arugula, spinach, mustard greens, etc. which carry minimal amounts of carbs.

Figure 1.0 – Carbohydrate in Root & Cruciferous Vegetables

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Reduce Fruit Intake – Swap Out for Berries
Fruit is tremendously nutrient-dense. However, it can pack a significant carb punch. From an evolutionary perspective, our ancestors’ intake would likely have plummeted after the fall and throughout the winter months. On a ketogenic diet, you want be able to eat large amounts of fruit, but you can tweak your fruit selection to reduce total carb intake.

The following is a list of possible “swaps” to reduce your intake of carbs from fruit.

Figure 2.0 – Carbohydrate in Fruit

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#2 Increase Your Healthy Fat Intake

A ketogenic diet emphasizes a robust intake of healthy dietary fat – approximately 70% of your total caloric intake.3 This can seem a little daunting for some (especially those still fearful of dietary cholesterol). Here’s a breakdown of how to add healthy Paleo-friendly fats into your diet.

Saturated Fats – MCTs
Medium-chain triglycerides (MCTs) are a group of saturated fats that play a key role in supporting energy and vitality on a ketogenic diet. MCTs are absorbed directly into the bloodstream as free fatty acids via the portal vein (attached to albumin) and thus, unlike other fats, are ready to be converted to ketones by the liver to be used for energy (with no impact on insulin levels), All other long-chain fats are reformed into triglycerides and packaged into chylomicrons that travel through the lymphatic (immune) system before being released into circulation.

MCTs are naturally found in coconut oil (approximately two-thirds of the fat content) and are also a popular supplement. You can use coconut or MCT oil to cook your food, add it to a high-fat and -protein breakfast smoothie, or blended in your morning coffee or tea. Other key saturated fats include egg yolks, as well as duck fat or beef tallow for cooking food at higher temperatures.

#3 Modify Your Protein Intake

If you’re already following a Paleo diet, you’ll likely not need to change your protein intake. A common misconception is that a ketogenic diet is a high protein diet. In reality, if you consume too much protein on a ketogenic diet it will kick you out of ketosis (as amino acids are converted into glucose)4. The general recommendation is to consume about 0.7-0.9g per pound bodyweight.5 That’s about 100g for a 125lbs. adult. If you’re active and following a high-protein Paleo diet start by adjusting your carbs and fat intake, then adjust protein intake if needed.

How Do I Know I’ve Reached Ketosis?

A simple urine test, using the standard urinalysis “dipstick” provided by your local pharmacy, will highlight when ketones are present in your urine. Test seven and 14 days after starting your diet. It’s a quick and easy way to assess your progress. If you become more dedicated to a keto-Paleo approach as a dietary lifestyle, then you can think about using “keto-strips” to assess your blood levels of ketones. (This is costlier but typically more beneficial once you’ve been in ketosis for some time.)

How Will I Feel on A Ketogenic Diet?

When you start a ketogenic diet, it will typically take about two weeks for you to become “fat-adapted” and experience the acute benefits of a keto approach. Some of the benefits are sustained energy throughout the day (no more energy crashes at 3h00pm), improved mental clarity (say goodbye to brain fog), weight loss, and improved base aerobic fitness. That said, the first two weeks may be a struggle.

As your body adapts to burning fat as a primary fuel source, you may feel periods of fatigue, poor concentration and reduced exercise capacity. While these symptoms are common, the severity depends on the individual.

The term metabolic flexibility describes the body’s ability to easily switch from primarily burning carbohydrate for fuel, to burning fats for fuel. The fitter and healthier you are, the more metabolically flexible, and thus the easier it should for you to make the shift to a keto diet.

If you’re overweight, out of shape, or eat a high-carb diet, then the symptoms may be more pronounced. But that shouldn’t necessarily shy you away from trying a ketogenic diet for short period. It can powerfully improve blood sugar and insulin levels, promote weight loss, improve cardiovascular health, and possibly have an “anti-aging” effect on your brain.6-8 It will likely do you some good!

How Long Should I Be in Ketosis?

From an evolutionary perspective, our hunter-gatherer ancestors would have entered a state of ketosis periodically throughout the year as they scavenged for food or during the winter months when food sources were scarce. Ancestrally, our bodies are hard-wired to be able to enter and exit the state of ketosis. So, it’s not surprising that new research is uncovering a myriad of health benefits. It can be highly beneficial to go “keto-Paleo” periodically throughout the year.

Some people feel so good on a ketogenic diet they decide they want to adopt a ketogenic diet full-time. While there is no current evidence that this is harmful for the body, there is some literature showing abnormally high levels of HDL cholesterol, which may be associated with adverse heart and kidney health.9,10 For this reason, I would recommend 2-4 week ketogenic cycles, anywhere from 1-6 times per year.

The Keto-Paleo Diet… Final Word

Transforming your Paleo diet into a ketogenic-Paleo approach is actually quite simple; ramp up your fat intake, dial down the carbs, and modify your protein intake to suit your activity level (i.e. active vs. sedentary). From an ancestral perspective, short periods of ketosis are consistent with human evolution and have been shown to be have many health benefits.8 Is a ketogenic diet right for you? Try it out and find out for yourself!

References

[1] Freeman JM. (Mar-Apr 2013). Epilepsy’s Big Fat Answer. Cerebrum. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662214/

2).[2] Paoli A, et al. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67. Retrieved from //www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html

[3] Volek, J. Phinney, S. (2012) Art & Science of Low Carb Eating. Beyond Obesity LLC.

[4] Veldhorst, M et al. (2009) Gluconeogenesis and energy expenditure after a high-protein, carbohydrate-free diet. Amer J Clin Nutr 2009;90:519-26.

[5] Volek, J. Phinney, S. (2012) Art & Science of Low Carb Performance. Beyond Obesity LLC.

[6] Owen OE, et al. (Mar 1969). Liver and kidney metabolism during prolonged starvation. The Journal of Clinical Investigation, 48(3). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/5773093/

[7] Grady D. (Aug 17, 2012). George F. Cahill Jr., Diabetes Expert, Dies at 85. The New York Times. Retrieved from //www.nytimes.com/2012/08/17/health/george-f-cahill-jr-diabetes-expert-dies-at-85.html

[8] Paoli A, et al. (2011). [The ketogenic diet: an underappreciated therapeutic option?]. La Clinica Terapeutica, 162(5). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22041813

[9] Shotji et al. Elevated Non-high-density Lipoprotein Cholesterol (Non-HDL-C) Predicts Atherosclerotic Cardiovascular Events in Hemodialysis Patients. Clin J Am Soc Neprhol. 2011 May;6(5): 1112-1120. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087778/

[10] Ejida, Y et al. Serum non-high-density lipoprotein cholesterol (non-HDL-C) levels and cardiovascular mortality in chronic hemodialysis patients. Clin Exp Nephrol. 2012 Oct:16(5):767-72. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22374049

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“7” Comments

  1. “Medium-chain triglycerides (MCTs) are a group of saturated fats that play a key role in supporting energy and vitality on a ketogenic diet. MCTs differ from other fats because they’re absorbed directly into the bloodstream to be used for energy (with no impact on insulin levels), whereas other fats must travel through the portal vein to the liver where they are packaged before being put into circulation.”

    OMG, that is way off. Yes, MCTs are absorbed directly into the blood stream as Free Fatty Acids attached to albumin. But that blood stream is the portal vein. Most nutrients from digestion go straight into the portal vein which is just a shuttle from the alimentary canal to the liver. So MCTs do not require lipolysis before entering beta oxidation and they are going directly to the main ketone body- generating organ, the liver.

    The one class of food that does NOT enter the portal vein is the “other fats”, long chain fatty acids. So your paragraph is directly wrong on this point. Long chain fatty acids are re-formed into triglycerides and packaged into lipoproteins, chylomicrons, in the gut lining cells themselves and disgorged into the lymphatic system, not the blood circulation at all. The lymph system empties these chylomicrons into the peripheral circulation, not the portal vein, just short of the heart. So the heart gets first pick of these LCFA followed by other tissues before any remaining LCFA turn up at the liver. All these tissues can download fat from these chylomicrons for energy production but only by shredding the triglycerides into FFA with the help of LPL, lipoprotein lipase.

    The liver is the main site of ketone production and the MCTs come to it first and already as FFAs, not triglycerides. So the FFAs can enter beta oxidation almost immediately regardless of the presence or otherwise of insulin. LCFAs, on the other hand, require insulin to be low enough to allow HSL – hormone sensitive lipase – to shred the triglyceride form that they are in into FFAs before they can enter beta oxidation. Beta oxidation is the first step of energy production from FFAs including via ketone bodies.

    The above 2 reasons are why MCTs, and short chain fatty acids too, are more conducive to ketone production than LCFAs.

  2. Keto dieters advocate using an insane amount of salt, saying it is required as the kidneys function differently in ketosis. Supposedly, they flush electrolytes out faster (in particular potassium and sodium) and if you don’t keep the intake of these two up, you can have serious problems. How true is this? Is it possible to follow a ketogenic diet without adding salt? Do you really need salt at the beginning when you’re shedding water weight?

  3. As regards coconut fat, a study from 1981 (http://ajcn.nutrition.org/content/34/8/1552.short) compared two population groups in the Pacific, the Pukapukans and the Tokelauans eating a diet supplying 34% and 63% of energy respectively from coconut products. This was a relatively unrefined traditional diet, very low in modern foods like grains, sugar and dairy, and in a sense «paleo». The Tokelauans obtained around 52-53% of energy from fat (almost exclusively saturated from coconut), 12-13% from protein and 34% of energy from carbohydrates. What is crucial to notice is that while the Tokelauans apparently were free of modern disease, and vascular disease, they had a very high BMI, almost 30 for the females. The Pukapukans had much lower BMI. Furthermore, the population group of Kitava studied by Staffan Lindeberg eating around 20% of energy from coconut fat, had very low BMI. It was also shown that 10-12% of the fat in the adipose tissue of the Pukapukans and the Tokelauans was lauric acid (compared to almost zero in the general population), dispelling the idea that the fat in coconut oil is directly used for energy and never stored in the body.

    Another more recent study which compared a low calorie diet with either olive oil or MCT oil (18-24 grams) for 16 weeks (http://ajcn.nutrition.org/content/87/3/621.full%29), showed that while weight loss was superior for the MCT group, the overall reduction in waist circumference was similar over the 16 weeks. Also, the fat loss difference was only present the first eight weeks. I think this points to a common observation: MCT or coconut oil boosts metabolism and leads to weight loss in the short term. In the long run, the body adjusts, and the MCT or coconut fat is then no longer effective (likely the body has then started to store it as fat, as seen in the Pukapukans and Tokelauans).

    • Hi G,

      Absolutely… calories “do matter” and once people become better adapted you must find the right macro balance to suit your activity level and genetic make-up.

      Great comment!

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