The ketogenic diet was developed in the 1920s as a treatment for children suffering from epilepsy by several paediatricians, such as Rollin Woodyatt and Mynie Paterman

The basic idea of the ketogenic diet is that through a diet low in carbohydrates but rich in proteins and fats, the accumulation of fat is avoided and its use for energy is promoted, while maintaining constant insulin levels

The aim is to lower glucose levels so that the body draws its energy elsewhere, from fat.

Following such a structured diet increases the number of calories burned and stimulates the secretion of hormones that promote the disposal of fat and reduce appetite.

When the metabolic system adapts to this situation, the body reduces the utilisation of valuable protein, relying on fat burning and ketone bodies as the preferred source of energy.

Ketone bodies are acidic by-products caused by high levels of fatty acid oxidation, i.e. the mobilisation and burning of large quantities of fatty acids as an energy resource.

Under conditions of severe glucose deficiency, the body resorts to ketone bodies, which are normally produced in minimal quantities and are easily disposed of.

If the production of ketone bodies increases significantly, their accumulation in the blood generates a state called ketosis during which the blood pH is lowered, resulting in metabolic acidosis (typical in untreated diabetics).

The idea behind this is simple: by receiving a small amount of carbohydrates, the body can derive a minimal amount of energy from glucose, which is no longer sufficient for sustenance.

As an alternative source, it must therefore use fat by setting so-called ketosis in motion.

This process appears to be particularly effective for burning fat.

The ketogenic diet involves eating predominantly protein and fat foods in order to develop lean muscle mass and lose up to 3 kg per week.

Basic rules of the ketogenic diet

One of the basic principles of the ketogenic diet is to keep the calorie intake to a minimum and instead promote the intake of fats and, moderately, proteins.

When following a ketogenic diet, in fact, it is generally advisable to keep the carbohydrate level below 50 grams per day, although there are variants that allow both increasing and decreasing the daily intake even further.

In this way, fats replace most of the carbohydrates, thus providing approximately 75 per cent of your total calorie intake, protein, on the other hand, should provide 20 per cent of your energy needs, and finally carbohydrates would be limited to 5 per cent.

The reduction of the latter is necessary in order to ‘force’ the body to rely on fats instead of glucose to obtain the necessary energy and to function regularly – this whole mechanism is part of a process known as ketosis, which can be reached after just a few days of dieting.

While in this phase of ketosis, our body makes use of so-called ketone bodies, i.e. molecules produced by the liver and obtained from fat in the absence of glucose, as a kind of alternative energy source.

Although fat is often kept at bay by those on a standard diet, research shows that the ketogenic diet is an absolutely safe and effective diet for weight loss, certainly even more so than many low-fat diets. In addition, the ketogenic diet reduces appetite and increases satiety, which is particularly helpful when trying to lose weight.

Diet plan of the ketogenic diet

Switching from a more traditional diet to the one described by the ketogenic diet may seem difficult, but in reality it should not be difficult at all, as the focus here is mainly on reducing carbohydrates and increasing fat and protein throughout the day in order to maintain a constant state of ketosis.

While some individuals can only achieve the latter by reducing carbohydrates to less than 20 grams per day, others can get there much more easily and with a certainly higher intake.

Generally, however, the lower the calorie intake, the easier it is for the body to remain in this state of ketosis, which is why it is imperative to stick to the list of foods considered ‘positive’ in a ketogenic diet.

Recommended foods during the ketogenic diet

While following an eating pattern such as that provided by the ketogenic diet, meals and snacks should all focus on the following foods:

– Eggs: the best choice is pasteurised eggs.

– Poultry: especially chicken and turkey.

– Fatty fish: Fish varieties such as salmon or tuna are indispensable due to their abundance in omega-3 acids. Shrimp, mackerel and herring are also sources of protein that can be consumed during the keto diet.

– Meat: Grass fed meat, venison, pork. Red meat is preferable as it tends to have a higher lipid intake than the others, as well as being abundant in myoglobin – a globular protein whose function is to reversibly bind oxygen.

– Dairy products and fatty cheeses: yoghurt, butter, mozzarella, goat cheese, etc.

– Olives, nuts and seeds: during a keto diet, it can be difficult to find foods that can be used as snacks, but we usually go for pumpkin seeds, almonds, walnuts, chia seeds and olives.

– Good’ fats: coconut oil, olive oil and seed oil.

– Avocado: avocados can have a great use in the diet.

– Non-starchy vegetables: broccoli, tomatoes, mushrooms, peppers.

– Condiments: Salt, pepper, lemon juice, spices and herbs.

Foods to avoid during the ketogenic diet

As already mentioned, carbohydrate intake must be minimal if the aim is to induce the body into a state of ketosis.

Here are the foods that should at least be limited:

– Bread, pasta and derivatives: no white or wholemeal bread, no savoury biscuits or pasta. Rice is also not recommended, as it contains little fibre and a lot of starch (another form of carbohydrate).

– Sweets and foods that are too sugary: ice cream, sweets, maple syrup.

– Drinks with sweeteners: juices, sodas, energy drinks.

– Starchy vegetables: potatoes, sweet potatoes, maize, pumpkin and peas.

– Beans and pulses: black beans, chickpeas and lentils.

– Fruit: no grapes, bananas and pineapples. Fruit is both a source of fibre and sugar, but since fruit gives a high carbohydrate intake, it is generally not used during a ketogenic diet. Some, however, consume a relatively small amount of berries (such as raspberries), but still remain in a state of ketosis.

– High-calorie sauces: barbecue sauce, overly sugary condiments and sauces such as mayonnaise and ketchup.

– Certain alcoholic beverages: beer and mixed drinks are out of the question.

Make sure you make healthy choices for your body by staying away from processed foods and ‘bad’ fats. The following foods should be avoided altogether: margarine, vegetable oils such as corn oil, fast food, processed meat such as hot dogs, foods that contain artificial colours, preservatives and sweeteners such as aspartame.

Drinks in a ketogenic diet

The category of drinks that can be consumed during a ketogenic diet includes:

• Water: somewhat obvious, but water remains the best choice when it comes to hydration, not to mention that one should consume at least eight glasses a day. Sparkling water, then, can be considered as a replacement for the classic carbonated drink. If you want to add a little extra flavour, try fresh mint or lemon peel to put in the water. Despite the fact that alcohol should be consumed in a limited way, indulging in a little vodka or tequila with tonic water is allowed during special occasions.
• Sugar-free coffee and tea: coffee is allowed, as long as it is sugar-free, as is tea.
• Alcohol, for those on this diet, is not compulsorily banned, but care must certainly be taken when drinking.

 Contraindications

The ketogenic diet is contraindicated in a number of particular pathological conditions

• pregnancy and lactation;
• porphyria, arrhythmia, angina, recent myocardial infarction;
• alcoholism;
• renal insufficiency;
• hepatic insufficiency;
• mental disorders.
• type I diabetes.

The objections to the use of a ketogenic diet in obese subjects seem unfounded due to fears of a possible increase in LDL cholesterol and triglycerides, which, on the contrary, in most studies are reduced, along with total cholesterol, with a simultaneous increase in HDL cholesterol (the good one) during the diet.

Similarly, concerns about potential kidney damage seem exaggerated given that properly conducted ketogenic diets are essentially normoprotein.

Indeed, the few studies that have found potential adverse effects caused by ketogenic diets have tended to confuse these diets with mostly commercial, high-protein and high-fat protocols: a well-implemented ketogenic diet is instead a low-calorie, slightly hyperlipidic and essentially normoprotein diet plan.

Side effects

Headache is the most frequent early side effect: present in about one third of patients, it tends to disappear spontaneously within 72 hours.

Some patients also complain of reduced cold tolerance and postural dizziness.

Halitosis is also described (many patients report the need to use oral sprays or chewing gum, strictly without carbohydrate sources), xerostomia (dry mouth), constipation.

Finally, an increased incidence of biliary disorders and gallstones has been reported.

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