Back to top

Is the Ketogenic Diet Right for Me?

Collection of healthy foods including grains, nuts, broccolli and an avacado

Another question I’m asked several times per week. Whether I’m in the office sitting across a wooden desk from a patient or behind my mask, instruments in someone’s brain, the questions are endless.

Not wanting to scream, I asked the circulating nurse to lower the volume of the by-any-standard-loud trance music and answered, with a question: “Well that depends on your goals. What are they, Steve?” I asked the scrub tech as he reached across the field to pass me a cauterizing forceps.

“Shedding body fat? Amassing muscle?” I probed further.

“Hmm, never thought of that. I just heard about “keto” online. It’s the thing nowadays.”

This type of thinking makes me nuts. It’s understandable though because, to a great degree, our actions are motivated by internet memes or “trends.” But the ketogenic diet is far from that. This is not the brainchild of some garage-based guru. It was described nearly a hundred years ago, in fact. There is nothing mystical about it. The ability to produce ketones is resident within every one of us. Heck, you can even buy ketones in powder form and reap some of their benefits in a late night cocktail!

But is the ketogenic protocol right for you?

Well, that depends upon your goals. If your goal is to shed body fat aggressively even if it means sacrificing some muscle – and that means loss of size and strength – go for it. I know, some of the diehards out there will argue against this (based upon the purported “muscle-sparing” effects of ketones), but that’s not reality. Take it from someone with thousands of patients. You will lose muscular size because ketosis, by definition, is a glycogen-depleted state. And what gives muscle its bulk? Glycogen (or really the water that is bound to it). This is a fact. Just ask a bodybuilder prepping for a contest.

Performance in the gym will suffer as well IF you are training within the glycolytic rep range: 8-15 reps or so. That said, powerlifters, by virtue of the different energy system (phosphagen) taxed during singles or doubles will not suffer, performance-wise. And for the same reason, neither will endurance athletes.

In fact, endurance athletes will often perform better on a ketogenic protocol. Why? Because they are living in an aggressive fat-burning state (ketosis) already and during race time can most effectively mobilize their fat stores for ATP production. Sort of the perfect storm for you runners out there.

And there are a whole host of other benefits of the ketogenic diet:
  • Provided red meat consumption is limited, the ketogenic diet lowers bodily inflammation. And you know how important that is, right?
  • Ketones, essentially sources of energy like fat and carbohydrates, drive blood sugar levels lower. No, that wasn’t a typo. Even those mixing ketone salts into their smoothies and not eating a low carbohydrate diet will note a lowering of their blood sugar levels over time. Will oral ketones be the next treatment for type II diabetes? Well, these molecules are non-patentable, so you know how that goes.
  • Ketones are neuroprotective. They protect my favorite body part – No, the brain! Via several mechanisms, ketones slow the progression of neurodegenerative diseases such as Alzheimer’s and Parkinson’s Disease. And they may even confer some protection against stroke. Why? They’re an alternate energy source for the brain and other tissues. So will ketones be labeled the “fourth macronutrient?” Maybe.
It all sounds great, doesn’t it? But not so fast.

You can’t have your cake and eat it too. Especially not on a ketogenic protocol. Truth be told, ketogenic diets can be difficult to tolerate long-term. Why? Well, as alluded to previously, there is an element of fatigue associated with carbohydrate depletion, particularly during the induction phase, typically 6-12 weeks’ long, during which your body is being accustomed to running on well… ketones. Once keto-adapted, your brain is not-expecting of the periodic rush of glucose (sugar) to fulfill its energy demands. There are no energy surges after a carbohydrate-laden meal or a Snicker’s bar. Fat (and ketones) provide a slow, steady stream of energy without the “ups.” And that eliminates the “downs.” Gone are the days of sleeping on the couch after four slices of the city’s finest pizza. Those are no longer in your lexicon. Not easy.

You see, most people are dependent on or literally addicted to carbohydrates. And this goes way beyond servicing the energy demands of the brain. That trails off after 6-12 weeks, remember. Many simply have a psychological “need” for carbohydrates and not the good kind. They see a French fry; they feel compelled to eat it. Even the smell of fast food is too alluring. And once the mouth gets watery, down the hatch it goes. Bottom line: Many just get sick and tired (literally or figuratively) of not eating their, not the, preferred energy source of the body. And so the attrition rate of the diet is fairly high. As with every other “diet.” It’s a four-letter word in my clinic, in fact, because “diet” connotes a short-term goal, like winning The Biggest Loser. And you saw how far that got them? Nearly all contestants gained the weight back and the celebrity trainer had a heart attack!

In my clinic, it’s all about health and longevity.

And the development of a long-term plan. For life. The aesthetics are secondary, not a means to an end. But you’ll get there! Not via a quick weight loss scheme like Oprah’s “IV diet,” but through a modified ketogenic protocol. By being less deprived of carbohydrates relative to a classic ketogenic diet, you’ll be less likely to fall off the wagon. It’s just more tolerable. It’s more “sticky.” And that drives compliance. To boot, you can actually build muscle on the protocol if you strength train regularly as detailed in the appendix of Get Serious. And in addition to looking and feeling better than you have in years, you will leave your “grey-haired-doctor-with-the-stethoscope” gobsmacked at the sight of your annual blood labs. Why? Because your biochemistry will be that of someone half your age. I just turned 48 on June 22nd. My biological age (calculated in our clinic using an AI algorithm) is 26. So I’m pretty damn close because I’m committed to lifelong health. Are you? Or are you just following the latest internet-based dietary trend?