Welcome to Keto Sister.  If this is your first time here, I invite you to start with my Keto Basics series.  If you have been following my posts since the beginning, then welcome back dear friend!  I am sure this post will answer a question in the hearts and minds of many who follow a ketogenic diet.

I have been considering the fact that people can follow different dietary profiles and still be in nutritional ketosis.  They can follow:

  1. A traditional ketogenic diet, which usually means that they are eating 75-80% of calories as fat, 15-20% of calories as protein, and 5% of calories as net carbs. For the person who eats 2,000 calories a day, this breaks down to 1500-1600 calories or 167-177 grams fat; 300-400 calories or 75-100 grams protein; and 100 calories or 25 grams net carbs (fiber calories are often excluded but they only amount to about 100 extra calories for most people anyway).  This protocol works well for a person who is new to a ketogenic diet, as it requires the lowest number of calories from foods that impact insulin levels.  When you begin to eat a high fat diet, the primary strategy is to reduce foods like protein and carbs dramatically in order to cajole the body into utilizing fats as a primary fuel source.  The best way to do this is to reduce carbs and protein to a minimum and feed the body high amounts of fat.  Fat is an abundant fuel source that has minimal impact on insulin levels.  Thus, fat is a great way to fuel the body while still allowing insulin and blood glucose levels to drop.  As they lower, fat becomes the body’s primary fuel substrate and it develops the enzymatic and metabolic processes to convert and utilize fats for fuel.  This process is what defines the term “fat adapted.”
  2. A higher protein ketogenic diet. Some people find that eating 30% or more of their calories as protein works well for their ketosis.  In this situation, the fat calories are often reduced to 65% and in the cases where someone eats a zero carb diet (all foods from animal proteins), they may eat 35% or more calories from protein.  For a person who eats 2,000 calories a day, this can break down to a minimum of 600 calories or 150 grams protein and 1300 calories or about 145 grams protein.  One reason for eating a higher protein ketogenic diet is that it is very satisfying to eat large amounts of protein.  Also, when carbs are as limited as they are on a traditional ketogenic diet, the remaining food sources are fat and protein.  It can be difficult to eat a very fatty diet with limited proteins if you have a big appetite, if you exercise heavily or are building muscle, if you struggle to digest fats or if you have unstable blood glucose.  Protein is a great source of vital components for building muscle and connective tissues in the body.  In addition, it is a self limiting food for most people.  Because the body cannot store excess protein and has to convert it to other sources for use and storage if it is not all utilized, overeating protein is very difficult to do.  Moreso than carbs or fats, the body will often draw a line in the sand when its protein limit has been reached.  This explains the basis for the protein-leverage hypothesis, which I wont go into in this article but I invite you read about here, here and here to learn more.
  3. A moderate carb, moderate protein ketogenic diet. A large number of those eating a low carb diet find that they cannot eat as low carb and high fat as a traditional diet.  Rather than eating 75 or 80% of calories as fat, it is not uncommon for someone to obtain 60-75% of calories from fat, 15% of calories from protein and 10-25% of calories from carbs.  For the person eating 2,000 calories a day, this breaks down to roughly 1200-1500 calories or 135-165 grams from fats; 300 calories or 75 grams from protein; and 200-500 calories or 50-125 grams net carbs.  How, you may be wondering, can a person be in nutritional ketosis eating 125 grams carbs per day?  The body’s glucose needs can exceed 150 grams carbs per day (see this post titled “Keto Problems: Too Little Carbs?”), and this is especially true for those who exercise regularly and are active during the day (if you are a parent of young children, you are considered “active”).  When in nutritional ketosis, the body is able to make up for the short fall by replacing many of the body’s energy needs with ketone bodies which is makes from fatty acids.  Those functions that cannot be replaced by ketone bodies are still fueled by glucose.

The reason that the first two strategies work well is, in part, determined by the health of a person’s gut and effectiveness of gluconeogenic processes in the person’s body.  The same set of processes that trigger ketosis in the body also trigger gluconeogenesis.  When the body is in ketosis, it does a few things simultaneously.

  • It fuels as many functions as it can with ketone bodies in place of glucose.
  • It down-regulates glucose functions in the body, meaning that it tries to minimize the number of processes for which glucose is absolutely required that it cannot fuel with ketones (again, see here for details).
  • It creates glucose to fuel those functions that must be fueled with glucose for which it does not get enough glucose in the diet. This process is called gluconeogenesis and literally means “to create” (genesis) “new” (neo) “glucose” (gluco).  Because the demand for glucose increases simply by being in a state of ketosis, the body automatically triggers gluconeogenesis at the same time that ketosis is triggered so that the body can make glucose from either proteins or fats when there is a need.  This is not based upon how much protein or fat you eat but by the needs of the body.  When you need more glucose, the body makes it for you.  And the body always needs more glucose when you are in ketosis because ketosis is triggered by a shortage of glucose.

This process works very well in people with healthy guts and healthy bodies.  When a person has impaired gut function (such as a gut infection like small intestinal bacterial overgrowth or fatty liver); has high amounts of stress in the body (which happens when one is fighting a virus or not getting enough sleep); has not gotten enough sleep (which is when the body creates ketones and additional glucose), then gluconeogenesis does not work as efficiently as it should.  This is why having optimal gut function is so critical to ketosis.  The body literally cannot function on a high fat, low carb diet if a person’s gut does not allow gluconeogenesis to occur.  Remember, ketosis does not eliminate the need for glucose.  It can eliminate the need to eat carbohydrates, but only because in the absence of dietary carbs a healthy body can make all the glucose it needs.

If you have impaired gut function, I strongly urge you to devise a gut healing protocol so that your body can obtain all the nutrients it needs from the foods you eat as well as making what it needs.

Some things you can do to improve gut function include:

  • Eat collagen and gelatin. This provides the building blocks for the body to rebuild a damaged gut lining.
  • Supplement with l-glutamine powder. Similarly to collagen and gelatin, glutamine powder can be utilized to rebuild the intestinal lining.
  • Eat healthy amounts of fiber. Soluble fiber in particular feeds the gut bacteria and helps the body to better breakdown foods.  Healthy gut bacteria are essential to a well functioning gut.
  • Eat more carbs. Those who struggle with gluconeogenesis may find that the third profile above works best for them.  If you feed your body some of the glucose it needs as glucose, then it reduces the body’s reliance upon gluconeogenesis and may help you feel better while you resolve your gut issues.  In addition to needing proteins, the body needs a little glucose in order to rebuild the gut lining as well (glucose and protein form glycoproteins) so eating a little extra carbohydrate can directly help improve gut function.

Once gut function is optimized, then the profile you select ultimately depends upon which feels best in your body.  Can you be in nutritional ketosis following any of the strategies above?  Of course you can.  The best way to determine what works best for you in to give it a try and pay attention to how you feel.  Ultimately, I care less about how deeply in ketosis you are and more about how well you feel following your chosen diet.  If I can help you determine the best fit for you, feel free to complete my Lifestyle Questionnaire to get started.  Thanks for reading.