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How to Start a Keto Diet

Experts Weigh In on How to Master the Ketogenic Diet

Image Source: Unsplash / Fábio Alves

If you're into health and fitness, you've probably heard the buzz about the ketogenic diet. Celebrities like Tim Tebow, Kourtney Kardashian, Adriana Lima, Megan Fox, and Halle Barry have touted its benefits, united in their praise of the program. And for a lot of other people looking to drop some pounds in the short term, you can't argue with the results. But it is kind of intense, so if you're thinking about trying it out, you should be aware of what you're getting yourself into.

To help you better understand what you need to know if you want to go keto, we talked to celebrity nutritionist and Performance Fitness Concepts founder Philip Goglia, PhD, based out of Santa Monica, and Dr. Sharon Orrange, MD, who is a practicing physician and clinical associate professor of medicine at the Keck School of Medicine of the University of Southern California in Los Angeles.

We also got on the phone with comedian, author, and actor Iliza Shlesinger, who tried out the meal plan herself in preparation for her book tour and latest Netflix special taping. Here's what they all had to say about the diet that's currently on the tip of everyone's tongue.

Why People Are Trying the Ketogenic Diet

In addition to wanting to drop five pounds or so, Iliza decided to try the keto diet because she was attracted to the structure of the program. She thought she could use it to avoid making unhealthy food choices that would leave her feeling sluggish and less than her best while promoting her new book, Girl Logic, which came out in November.

"I just didn't want to feel 'gross,'" she said, describing that overly stuffed, uncomfortably full feeling that we all sometimes get after a big meal that includes a lot of carbs.

"Not feeling 'gross' is huge because women hold so much of their identity in their physicality. I wanted to feel good on the book tour and look good for the taping of my Netflix special," she said, referring to her fourth solo show for the streaming service.

Generally speaking, carbohydrates are our bodies' main source of fuel. The keto diet focuses on limiting that source, which forces our bodies to break down fat for energy instead. That state of being is called ketosis.

When fat is broken down for energy, the liver breaks it down into ketones through a process called ketogenesis. Ketones are then used as the primary fuel for our bodies and our brains.

"Ketones are sort of like the emergency generator that kicks in when the power goes out," Dr. Orrange said.

When this happens, people start to see rapid weight loss, so long as they keep their bodies in a state of ketosis.

Beyond that, too, Iliza pointed out that she thought it was cool that this program gave her the power to change her body, rather than feeling like she simply had to accept it now, whatever way that it was, after turning 35 in February.

"I always like to change my body," she said, detailing how she lifted a lot of weights going into her third Netflix special, Confirmed Kills, because she wanted to look strong for the performance.

This time, she wanted to look thinner on camera, so she went this route. "Sometimes just knowing that change is possible is more important than the actual change," she said. "My job isn't to be in shape, so I just [work out and eat what makes me feel good] because I like it."

What Are the Rules of the Ketogenic Diet?

The ketogenic diet has one simple rule, according to medical studies, Dr. Orrange explained. Those partaking are to consume no more than 20-50 grams of carbohydrates per day. "If you like bananas, that means you can have one, because after that, at 26 grams of carbs, you're done for the day," Dr. Orrange said.

To break it down in a different way, Dr. Orrange said basically, 75 percent of your day's calories will come from fats, and only five percent or so will come from carbs. "And those fats can't be sweets," she said. "They need to be things like coconut oil, butter, and sour cream."

Your Fridge Should Look Like This

Iliza either lucked out or planned perfectly, because she has a chef for a fiancé and he handled all of her meal prep for her. "I would call him from restaurants [while I was on tour] or send him a picture of the menu and ask him, "What should I order?"' she said.

"In any other situation, that sounds so bad and controlling and terrible, but it was actually so great," she added, with a laugh.

But if you have to stock your fridge yourself, you should be buying things like oils like olive oil, coconut oil, and MCT oil, creams like sour cream, ghee butter, high-fat cheeses like cheddar and mascarpone, eggs, avocado, and dark chocolate.

"One thing I loved eating was parmesan crisps," Iliza said. "I really missed the crunch of food and the density of bread, because on this diet you're eating a lot of wet or soft food, so the crisps were really good for that."

You'll also want to make sure you have plenty of fish, chicken, and nuts like cashews, almonds, and pistachios, as well as fatty meats like beef, pork, and bacon.

That last list of grocery items was one of the strangest thing for Iliza to wrap her head around. "As women, we're so hyper aware of what we think we shouldn't be eating," she said. "It was a really mentally weird exercise to think to myself, 'You have to finish your fat.'"

Also, Iliza noted, if you plan on including bacon as a staple in your keto diet, be careful about which bacon you're selecting. "A lot of bacon has sugar in it!" she said. "So you really have to look at how your meat is cured."

Image Source: Unsplash / Antonio Barroro

The Skinny on Fasting

Dr. Goglia, who is familiar with placing his body in a state of ketosis from his days as a professional fitness competitor, mentioned 12-hour fasting periods, give or take a bit either way, associated with the use of the keto diet to reduce body fat quickly. Dr. Orrange explained that intermittent fasting regimens, which could range from periodic fasting each day to skipping certain meals on only certain days of the week, and the keto diet are actually totally separate concepts.

The two practices, however, can be incorporated together into an overall diet plan, she said. Dr. Orrange recommended specifically that individuals interested in the benefits of fasting check out Valter D. Longo's paper on the fasting-mimicking diet, published by Science Translational Medicine in February 2017, which showed promising results when it comes to short-term weight loss as well as long-term changes in how the body breaks down food for fuel.

But technically, medically speaking, the official ketogenic diet doesn't include a fasting element. For Iliza, she chose not to try to incorporate fasting, anyway, because she felt cutting out carbs and sugars was enough of a challenge, and she didn't feel her results where hindered by that choice.

You Might Feel Pretty Bad Before You Start to Feel Good

People embarking on the keto diet for the first time night be surprised when they experience what's come to be known as the "keto flu." Dr. Goglia described this as a sort of brain fog, coupled with exhaustion, disconnected and interrupted digestion (constipation), and mood swings.

"As bodybuilders, we would place ourselves in ketosis close to bodybuilding events for a series of days in order to remove body fat, but it was exhausting and left us literally 'brain dead' during the day," Dr. Goglia said. "In fact, we would only slip into ketosis for limited hours daily because it made training extremely difficult, due to both loss of and inconsistency in energy patterns."

Other early side effects might include headaches, dizziness, and bad-smelling breath, sweat, and urine.

Iliza said her "keto flu" consisted mostly of nausea, but that after a few weeks, it subsided. Finally, she said, she broke through to the part of the diet where she started to feel good. "I didn't feel 'gross' anymore," she said. "Which was a welcome change."

If you can tough it out for the first few weeks, after about three to six months, you should see weight-loss results.

Also, after about three to six months on the keto diet meal plan, Dr. Orrange added, short-term cardiovascular risk factors associated with lipid panels, blood pressure, and blood glucose regulations have been preliminary shown to be reduced.

Potential Health Risks You Should Be Aware Of

Dr. Orrange pointed out that the keto diet is very low in fibre, as high-fibre foods like beans and grains are generally also high in carbohydrates. "Dietary fibre is protective for colon cancer," she pointed out. "There is no grey area. It is black and white, and you need a lot of dietary fibre for cancer prevention."

Dr. Orrange also said that individuals considering the keto diet who are on medication for blood pressure or diabetes should be sure to have their doctors monitor their prescriptions while they're on the program. This is because their previously required doses of certain medicines may shift as their body starts to process food differently.

Thinking more long-term, Dr. Orrange said animal studies have shown diets high in fat over an extended period of time have resulted in high cholesterol levels, hardened vessels, and overall reduced vascular health.

Who the Keto Diet Might Be Right For

The keto diet has been around since the 1920s, according to Dr. Eric Kossoff, director of the Child Neurology Residency Program at Johns Hopkins, who notes its initial use was for the treatment of epilepsy. "Your body will create ketones, and either the ketones, or keeping your carbohydrates low, or probably something even more than that helps suppress seizures in people who have epilepsy," Dr. Kossoff told USA Today.

Beyond its initial intended use as a medical treatment, Dr. Goglia said he doesn't recommend the keto diet to his celebrity clients for the purpose of achieving rapid weight loss. "There are too many adverse risks associated with ketosis, along with it not being a sustainable lifestyle," he said. "It should be considered a medically supervised food protocol for certain disease scenarios, but other than that, it is not a sustainable food protocol with multiple long-term pitfalls."

Both Dr. Goglia and Dr. Orrange agreed that a ketogenic diet, if followed over an extended period of time, could have many potential health risks.

"The role of the ketogenic diet is really a jump-start," Dr. Orrange said, bringing it back to medical uses and specifically referencing how she's seen prediabetic patients have success with avoiding prescription medication by following the meal plan for a brief period of time. "Being on it for two to three months is OK, but we don't yet know the long-term complications of ingesting so much fat," she said.

Iliza followed her keto program strictly from late October to the end of February. Since then, she's stuck with a modified version of the diet, in part because of her upcoming wedding in May. "I'm not an expert on if this is for everyone," she said. "But I'm personally still doing a version of it now."

She added that she does think, from now on, she'll probably always consume fewer carbs and less sugar after learning how much better she feels without putting so much of those things in her body. "Now that I have the knowledge, there's no going back," she said.

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