A metabolic process called ketogenesis and a body state called ketosis are responsible. Ketosis is simply a normal metabolic pathway in which body and brain cells utilize ketones to make energy, instead of relying on only sugar (i.e., carbohydrate). In fact, humans developed an evolutionary ability to burn ketones as an adaptation to periods of food scarcity.
And here’s an important side note: The amount of sugar we need in our bodies to keep the blood sugar number normal is only 1 teaspoon for all the blood in your body (about 1 gallons of blood). And that tiny amount of sugar could come from eating vegetables or even protein. In reality we do not need any sugar in our food at all. Yet the average person consumes 31 teaspoons of sugar and hidden sugar each day!
Here's the reality: A high carb diet drives up blood sugar and insulin levels. All that sugar and insulin are inflammatory. The standard American diet offers lots of foods that are high sugar AND high in saturated fat, and in studies, these two factors were lumped together. So although saturated fat is healthy, it got the blame for the inflammation that causes heart disease because it was studied in combination with a high carb diet. A ketogenic diet plan which is high in saturated fat and very low in carbohydrate will REDUCE inflammation. (Reference here.)
Each person on the keto diet will have different macronutrient needs. Jalali says that typically the diets are about 65-85 percent fat, 15-25 percent protein and about 5 percent carbohydrates. "Some of my patients/clients find it easier to keep track of the foods they consume over the day, others prefer to keep track per meal since it holds them more accountable."
Why higher fat and moderate protein? Fats have little to no effect on blood sugar and insulin levels. Protein does affect both blood sugar and insulin. If you eat too much protein for your ideal body weight or lean muscle mass (usually more than 1.5-2.0 grams/kg lean body mass), it can spark gluconeogenesis and raise blood sugar. Protein will also spike blood insulin levels temporarily, which can interfere with ketone body production. However, it is important to note that this is an individually driven parameter, as detailed in this excellent post from the Optimizing Nutrition blog.
Lots of apps and website offer keto diet challenges—basically, a blueprint for the keto diet with a fixed starting and ending point (they typically last for a week to a month, though some may be longer). Speaking of apps, plenty of keto-centric ones are right at your fingertips (a.k.a., your smartphone), like the KetoDiet app, which can help you calculate your macros and track your keto diet effectively.
Eggs are a standout snack because they have one of the lowest energy-to-nutrient-density ratios of any food, as is noted in an article published in August 2016 in the journal Proceedings of the Nutrition Society. They’re rich in good fats (so long as you don’t skip the yolk!) and a solid source of high-quality protein: Each egg has 5 grams (g) of fat, 6 g of protein, and 0 g of carbohydrates, according to the Egg Nutrition Center. Plus, they’re inexpensive — about 20 cents per egg, the center says. Keep several hard-boiled eggs in your fridge, so you can easily grab one when you’re in need of a nutritious snack.
Net carbs is simply total carbs minus fiber and non-digestible sugar alcohols, like erythritol. (This doesn’t apply to high glycemic sugar alcohols, like maltitol.) We don’t have to count fiber and certain sugar alcohols in net carbs, because they either don’t get broken down by our bodies, are not absorbed, or are absorbed but not metabolized. (Read more about sugar alcohols here.)
Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose). Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.
Many ketogenic dieters also swear by MCT oil. (MCT simply stands for medium chain triglycerides.) MCT's energy-sustaining powers can be explained as follows: When MCT oil is metabolized in the body, it behaves more like a carbohydrate than a fat. Unlike other fats, MCT oil does not go through the lymphatic system. Instead, it is transported directly to the liver where it is metabolized so it releases energy like a carbohydrate and creates lots of ketones (which can be used for fuel) in the process.
Those issues can be part of what's known as the “keto flu,” Warren says. Other side effects of the keto diet, all of which are tied to carb withdrawal, can include lightheadedness, nausea, mental fog, cramps, and headaches, in addition to tiredness. Luckily, the keto flu doesn't usually last more than a week—which is coincidentally about when people start to see the number on the scale go down, says Warren.
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.