Picture By Brian Ambrozy - Flickr

Hi everyone,

A couple of days ago, I wrote an article which discussed how is it, people who are obese, stay obese and what's the potential contributing factors which can cause obesity. In this article, we're going to explore ketogenic diet, one of many diet plans which are used in the past for the treatment of diabetes mellitus type II and epilepsy.

Introduction to Ketogenic Diet

I'm sure some of you have heard about Atkins and Paleo diet before. Like both of them, the ketogenic diet is a well-known diet plan, which entails a high portion of dietary fat and low carbohydrate meal. There is numerous proposed ratio used by different people who understood how this kind of diet works, but the commonest proportion of macronutrient would be:

• 70% dietary fats
• 25% protein
• Less than 5% carbohydrate

This kind of diet will convert your body into a fat burning machine which utilises fat as the primary source of energy instead of glucose as a consequence from the depletion of glucose storage and a significant reduction in insulin concentration in the bloodstream. This is attributable to a metabolic state which we called as ketosis (the production of the ketone by the liver to replace glucose as the source of energy).

Although this kind of diet seems restrictive and rigid, there are a few types of ketogenic diet which can be used by different kind of people based on their preferences:

• Standard Ketogenic Diet: This is the commonest plan used by a newbie who tries a ketogenic diet. It's relatively easy to understand but difficult to practice. Like what I've mentioned in the paragraph above, 70% of macronutrient come from dietary fat, 25% come from protein (it's relatively moderate) and less than 5% come from carbohydrate.

• Cyclical Ketogenic Diet (CKD): This kind of diet usually starts with an extended period of strict macro-monitoring, in which the proportion of macronutrients resemble the standard ketogenic diet but follow by 1 to 2 days of high carbohydrate refeeds. This type of ketogenic diet is commonly used by athletes and bodybuilders.

• Targeted Ketogenic Diet (TKD): Apart from using CKD, some athletes and bodybuilders prefer to stuff some carbohydrate 2-3 hours before a workout session to give them some extra boost in energy. This is termed as the Targeted Ketogenic Diet (TKD). If an individual workout for 4 times a week, then they will eat carbohydrates for the particular workout days (which is 4 days).

• High-protein Ketogenic Diet (HKD): The difference in the amount of protein in this type of ketogenic diet with the SKD is not that much. In SKD, the amount protein taken is around 25% while in HKD, the amount of protein is 35%. Fat is still the primary source of macronutrient.

Picture By Muhammad Rafizeldi - Wikimedia

In this article, we would discuss mainly on the Standard Ketogenic Diet (SKD).

New Fat Making and Why Do Obese People Gets Hungry All The Time

When we eat something which is rich in carbohydrates such as rice, potato and bread, our blood sugar level (which is synonymous with blood glucose) will rise. Let's say that you didn't take any fibre-rich foods such as vegetables and fruits; your blood sugar level will increase significantly in a short period of time. This would trigger beta cell from the pancreas to secrete some insulin.

The action carried out by the pancreas is actually, a preventative measure to avoid any further damage that high blood glucose could do. Glucose can't stay in the blood vessel for too long, or it will interact with some circulating proteins such as albumin and globulin to form an advanced glycation end product (AGE) which has been associated with extensive cellular damages.

Insulin will signal the Glucose Transporter (GLUT 4) on the cell membrane, to take in some glucose so that it can be used for energy, but a cell can take so much of this particular compound. When all of the cells have been saturated with glucose, 200g of it would be stored in the liver as glycogens, and another 70g would be stored in the muscle. When all of the "empty" space has been refilled, and there is some extra blood glucose left, the insulin will convert that particular compound into a fat cell through a process known as De Novo Lipogenesis.

Basically, that's the process which entails the conversion of glucose into a fat cell. If we think carefully, then we would know that people with the most numerous amount of energy storage would be the obese people. So why do they have to eat in order to replenish their energy store when they have a lot, dangling around their abdomen?

To convert the fat cell into something which can be used as an energy source, which is ketones, would depend on a particular hormone called Hormone Sensitive Lipase (HSL). As the name implies, this kind of lipase is sensitive to a specific hormone, and in this case, it is the insulin. When there is a high volume of insulin in the bloodstream, HSL would not be triggered to do its job.

The problem is, after processing a lot of glucose, insulin would sometimes take to disappear. If for the sake of arguments, let say, your energy source depleted a few hours after eating; your fat cell can't be mobilised because insulin is still high, or sufficient enough to disable the HSL. This would cause you to become ravenously hungry, and you need to jack up your blood glucose level (despite a large number of fat cells available for energy).

This is how a high carbohydrate diet makes fat people fatter.

Condition Needed For Lipolysis

Picture Source - Pxhere

Based on the explanation that I have provided above, there are two ideal conditions which are needed in order to stimulate fat burning processes:

• Low insulin level in the blood
• High hormone-sensitive lipase activated

There are a few other reasons that could explain the importance of maintaining a low blood insulin level despite its role in the new fat cells formation. There are two key hormones which would affect the tendency or motivation of an individual to eat:

• Ghrelin
• Leptin

Ghrelin is a hunger hormone; it's pretty obvious, this hormone would encourage you to eat some foods in response to the high insulin level but low blood glucose level for processing. The body can't use its fat energy stored, due to the high insulin level so ghrelin would be secreted to encouraged food taking for energy. We can say that the production of ghrelin is directly proportional to the insulin level. Have you ever eaten anything that's is sweet, and later become stuff? Me neither.

As opposed to ghrelin, leptin (satiety hormone) is secreted by the fat cell. It's a signal which would be sent to the brain in order to discourage food intake. Basically, it's a form of communication between your fat cells and your brain. So, by that logic, people with a high body fat percentage would have a higher leptin signal compare to the other, don't you agree? So why is it, fat people seem to be hungry all the time?

Apart from producing the ghrelin, the insulin would disrupt the chemical signal sent by the leptin to be translated in the brain. As there is some sort of disturbance, the brain would be having some difficulties in translating those signal, so it would ignore the message making you feel hungrier than ever. This is why keeping the level of insulin at a lower concentration is vital for weight loss. It's to avoid confusion regarding whether or not you are satiated.

After about 6-8 hours post-meal, the level of insulin will decline, and the energy storage in the form of glycogen will become depleted (depends on the individual lifestyle). This will trigger the activation of hormone-sensitive lipase which would send the fat cell to the liver so that it can be converted into ketone bodies. Why is it important for it to be in the ketone form? Can't we use the fat cell directly? The importance of having a stable energy source can be traced back to the importance of maintaining the central nervous system so it can carry out its normal function without any disturbances. The problem is, the one and only blood-brain barrier which kind of restrictive.

Picture By Armin Kübelbeck - Wikimedia

Fatty acid can't cross the blood-brain barrier but a ketone could. This is why people who eat fewer carbohydrates and lots of fat, have a higher but within the normal range of blood ketone. People are generally afraid of ketone bodies as it is commonly associated with some form of pathological consequences of severe diabetes mellitus called diabetic ketoacidosis (DKA). This is because this particular compound was first discovered from people who have DKA. It is a form of bias. Ketone can normally be found in an infant, which provide a majority of its energy toward a normal neurocognitive development. Our heart muscle prefers acetoacetate (ketone bodies) over glucose for a stable supply of energy. There's nothing wrong with ketone, ladies and gentlemen.

There are three types of ketone bodies which would be produced by the liver:

• Acetone
• Acetoacetate
• Beta-Hydroxybutyric Acid (BHB)

Unlike the latter, acetone is a volatile compound. This particular type of ketone bodies would be excreted through the respiratory system which caused the fruity breath. Acetoacetate is utilised mainly by the heart muscle while BHB is the major proportion of ketone bodies circulating the bloodstream. Both of this acetoacetate and BHB would be excreted through urine, which can be measured by using a keto stick.

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So can we live entirely without glucose as most of the energy is being supplied by the ketone bodies?

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The answer is no; we do need glucose. Our red blood cells lack mitochondria, an organelle which is essential for BHB oxidation to gain some energy, so it would use glucose instead. The funny thing about the blood glucose level in an individual who eat less than 20g of carbohydrate per day is its stay within the normal range. If we think logically, the volume should be declining below the average level because we starved ourselves from taking any food which can provide glucose.

So, where do we get the glucose if we don't eat food which contains carbohydrates? There are two primary sources of glucose provided if an individual doesn't eat food which is rich in carbohydrates:

• Amino acids
• Backbone of glycerol

In a process called gluconeogenesis, which produces glucose from a non-carbohydrate source, both amino acid and glycerol can be converted into glucose in the liver.

Foods to Eat In Ketogenic Diet

Maintaining ketosis is not an easy task. The carbohydrate intakes in this kind of diet should be limited, and the amount of fat should be optimised. Let's see some of the foods which we can eat to ensure we stay in ketosis.

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The Benefits Of Ketogenic Diet

There are a few benefits of ketogenic diet which might seems intriguing. A diet which utilises the low carbohydrate concept has been found to exert a numerous amount of benefits which would include:

• Weight Loss: This is the most popular reasons for dieting; weight loss. People usually are motivated to do something which gives a high yield with a minimal amount of effort, but it's not the case with a ketogenic diet. The effort needed in order to incorporate a ketogenic lifestyle is enormous. You have to be particular about your food intake and avoid any sugary, fun stuff. but if you are strong enough, you can see the result within 2 weeks of your ketogenic journey. There are a few studies which are conducted in the past proving ketogenic diet as being efficient compared to the other diet which incorporates high carbohydrates and low fats, in terms of weight loss.

• Blood Sugar Control: This mainly due to the fact that people who chose to adopt the ketogenic lifestyle, eat food which has low sugar content. The blood glucose concentration is maintained by glycerol and amino acids which discard the need for people to take carbohydrates to keep normal blood sugar. Multiple studies have proved that ketogenic diet can efficiently prevent the onset of diabetes mellitus compared to the other kind of diets. The ketogenic diet also has been used on multiple occasions to treat patients with diabetes mellitus type II.

• Good Mental Focus: Fasting, which has been associated with the production of ketone has the reputation of increasing cognitive function. In fact, some people opted to fast in order to enhance their mental clarity. The ketogenic diet, which uses ketone bodies as the primary source of fuel can provide stable energy to the brain which would improve mental focus. There are some studies which were conducted in the past that found some benefits imposed by the fatty acids towards the brain's development which contribute to an increase in brain's function.

The 3 benefits which have been discussed above have been proven by multiple studies which are associated with ketogenic diet. Some other benefits which you can get from adopting ketogenic lifestyle are:

• Decrease sugar craving
• Increased energy
• Prevent epilepsy
• Reduces Triglyceride levels
• Reduces insulin resistance
• Prevent acne

References and reading materials

• Rudy Mawer, MSc, CISSN. Healthline. The Ketogenic Diet 101: A Detailed Beginner's Guide. Retrieved March 26, 2018, from https://www.healthline.com/nutrition/ketogenic-diet-101
• Dr Andreas Eenfeldt, MD. Diet Doctor. A ketogenic diet for beginners. Retrieved March 26, 2018, from https://www.dietdoctor.com/low-carb/keto
• Ruled.me. A Comprehensive Beginner's Guide to the Ketogenic Diet. Retrieved March 26, 2018, from https://www.ruled.me/guide-keto-diet/
• Low Carb Alpha. Introduction to Ketogenic Diet. Retrieved March 26, 2018, from https://lowcarbalpha.com/introduction-to-ketogenic-diet/