The ketogenic diet: why the switch is more important than the fuel

It’s three years this month since I wrote The Dissident Diet, based on my own experience of losing three stone, and a pilot study carried out with 16 people who needed to do the same. At the time it was ground-breaking, and more than a little brave, for a professional nutritionist to recommend a ketogenic diet when so many people in nutrition and medicine felt it was dangerous.

Since then, the ketogenic diet has become a buzz word; it’s considered both safe and effective for a whole range of the conditions that beset us in the 21st century. Its use in epilepsy is long established, but now we know that it can work wonders in obesity and diabetes, and we suspect it may be important for cancer and Alzheimer’s. Powerful indeed.

In a clinical setting I have used the diet to good effect with most of my clients. While it’s not suitable as a long term solution for everyone, I believe that nearly everyone (including those who consider themselves to be über-fit) can benefit from 6 to 12 weeks of ketosis to regulate their insulin responsiveness. It works a bit like a computer reboot.

And that’s the key.

I was in the Soho Theatre bar last Saturday night with my daughter, Polly, drinking tea and waiting to see the brilliant Pajama Men. We got chatting to a guy who shared our table and, when he discovered I was a nutritional therapist, he had just one question: “Should I be eating carbs?”

Where to begin?

For starters, diet is genuinely a completely individual thing. Some people cope well with carbs and others struggle. It depends on your genes, your metabolism, your stress levels, your environment, your exercise regime, and – in particular – your insulin response.

Just from looking at him I knew he could benefit from eating fewer carby foods for a while, but without more information I couldn’t be more precise.

What I could tell him, however, is that he was asking the wrong question.

The more important question he should have been asking is, “How can I get my body to switch quickly and seamlessly between carbs and fats when making energy”.

For most of us*, the benefits of the ketogenic diet are not brought about by an absence of carbohydrate but by oiling the switch that takes us from carb burning to fat burning or, more accurately, ketone burning. It’s a switch that tends to become rusted in place because of our high carb, high stress lives.

Ironically, it turns out that oiling the switch is an apt metaphor because oils and fats are the solution to the problem. Eating in a way that allows you to switch in and out of lipolysis between meals in order to use eaten or stored fat is a key factor for good health and longevity. The precise food balance to achieve that is different for different people but it’s not hard to work it out.

A common misconception around the ketogenic diet is that we are simply dealing with too much blood sugar but, in fact, we are most likely dealing with a faulty insulin response. Some of us, it seems, become over-sensitive to insulin’s body building message and start storing more than we need to – and that’s why our bodies don’t respond to conventional diet invervetions and medicine advice the way we’re supposed to.

People like us (i.e. those who have a persistent weight problem, diabetes, or cancer – in practice well over half the population) have different insulin regulation that stops us switching into fat burning leading to sugar cravings, energy dips, over-storing and metabolic disruption.

Restoring insulin regulation  – not just reducing carbs – is the key to reversing the disease states we’re facing. For that to happen we have identify and at least temporarily avoid the foods that aggravate the insulin response (normally carbs but sometimes some protein foods too) and introduce more foods that don’t stimulate insulin (normally fats and well-chosen proteins). There’s a lot of personal trial and error and some complex biochemistry involved, which is why it’s a good idea to get professional help so that you don’t end up with a dietary imbalance. The ketogenic diet is not a one-size-fits-all solution any more than any other diet.

Certainly, in the early days, most people need a drastic reduction of carbs to reboot their insulin response, but in the longer term you will get to know your own body and discover the level of carbs that suits you. From clinical experience I can tell you that people can maintain healthy ketosis on very different carb/fat ratios.

So, you see, carbs aren’t the problem: insulin is. To find out whether hyper-secretion of insulin could be your problem there are a couple of tests you could do. They are easy enough to do – but complicated to explain in a blog post. Contact me to find out more.