“I am a medical practitioner who has type 1 diabetes. Since adopting a very low-carb lifestyle I have found that day-to-day diabetes management has become so much easier with the added bonus of normal HbA1c. As a result of smaller insulin doses, I am not tied down to strict meal times and can eat when I choose. Similarly, glucose control with exercise is far more predictable. Very low carb for me gives as near to a ‘normal’ life as someone with diabetes can get.”
The weight loss program has 5 steps (Supplemental Fig. 1) and adheres to the most recent (2015) European Food Safety Authority guidelines on total carbohydrate intake (17). The first 3 steps consist of a VLCK diet (600 to 800 kcal/d), which is low in carbohydrates [< 50 g (26 to 30 g) per day from vegetables] and lipids (only 10 g of olive oil per day). The amount of high-biological-value proteins range from 0.8 to 1.2 g per kg of ideal body weight to ensure minimal body requirements are met and to prevent the loss of lean mass. In step 1, the patients consumed high-biological-value protein preparations 5 times per day, and vegetables with low glycemic indexes. In step 2, 1 of the protein servings was replaced by a natural protein (e.g., meat or fish) either at lunch or at dinner. In step 3, a second serving of low-fat natural protein replaced the second serving of biological protein. Throughout the ketogenic phases, supplements of vitamins and minerals, such as K, Na, Mg, Ca, and omega-3 fatty acids, were provided in accordance with international recommendations (18). These first 3 steps were maintained until the patient lost the target amount of weight, ideally 80%. Hence, the ketogenic steps were variable in time, depending on the individual and the weight loss target.
One area where food tracking can be especially helpful, though, is ensuring that you're hitting the right ratios of macronutrients—protein, carbs, and fat. "The most researched version of the ketogenic diet derives 70 percent of calories from healthy fats, 20 percent from protein, and only 10 percent from carbs," explains Charles Passler, D.C., nutritionist, and founder of Pure Change. "In the ideal world, each keto meal and snack should have that same (70/20/10) ratio of macronutrients, but studies have shown that you'll still achieve great results even if each meal varies slightly from that ratio, just as long as you don't exceed 50 grams per day of carbs, or eat those carbs in one sitting," says Passler. In order to achieve these ratios without a preset meal plan from a dietitian or doctor, some food tracking is probably going to be necessary. But once you get the hang of things, you may not need it anymore.
I have spent weeks reading and learning about the Keto diet plan, downloading random recipes that my husband might even try, and have been overwhelmed with all the information. I was pleased to find your system and how organized everything seems to be. The only question I have is will I be able to “temporarily suspend” my subscription if I find there are more recipes than I have time to prepare. I want to only do about 3 per week and repeat them as leftovers, since I have very little time after working a 12-hour shift, to do much cooking. Once I “catch up,” I would reinstate my subscription. Is that an option? Looking forward to trying out your program.
Ketosis was determined by measuring ketone bodies, specifically B-hydroxybutyrate (B-OHB), in capillary blood using a portable meter (GlucoMen LX Sensor, A. Menarini Diagnostics, Neuss, Germany) before measurements of anthropometric parameters. As with anthropometric assessments, all of the determinations of capillary ketonemia were made after an overnight fast of 8 to 10 hours. These measurements were performed daily by each patient during the entire VLCK diet, and the corresponding values were reviewed on the machine’s memory by the research team for managing adherence. Additionally, B-OHB levels were determined at each complete visit by the physician in charge of the patient. The measurements reported as “low value” (≤ 0.2 mmol/L) by the meter were assumed to be zero for purposes of statistical analyses.
Keto runs counter to many of the low-fat diet fads of the 1980s and 1990s: It actually emphasizes fat. “That is hard to comprehend because we don’t eat anything that’s pure fat, says Kristen Mancinelli, RD, author of The Ketogenic Diet. “We don’t eat a stick of butter or a spoonful of olive oil or even a nice cup of lard. That would be unpleasant, so we really have a hard time wrapping our heads around this concept of the ketogenic diet.”
I was a Corpsman (not a corpse-man as some recent somewhat fanatical president would say), and I can tell you many stories of Marines and Sailors who maintained restrictive diets (aka picky eaters). Most obvious was lack of sustaining energy (hypoglycemia) at mile 15 (with 80lbs of gear including a 6.5lb rifle and 200 rnds of ammo, etc.) and depletion of essential vitamins, electrolyte imbalance. They were always the first to collapse and have to hear me scold “see I told you so.” An IV of D5W usually does the trick (D is for dextrose, OMG!)