What you need to know about the ketogenic diet



Lets talk keto.

This is the #1 topic of interest from clients and was the first question that came up during this Monday's live Q&A with the Noelle Floyd’s Equestrian Masterclass Facebook Group. This has been quite the hot topic over the past few years now, and one with SO much misinformation, which I’ll clear up for you today.


Before I get into it, I just want to say that I freaking LOVE the Ketogenic Diet. I’ve always found it to be extremely fascinating - so much so, that I conducted research on it for two years and wrote my 100-page Master’s thesis on it at Oregon Health and Science University. Keto is also what initially brought me to UCLA to work with patients who may benefit from the diet. But here’s the thing, it’s not for everyone. As much as I love this diet and as fascinating as it will always be, it’s not magic, nor is it the answer to most performance/nutrition/health goals.


Past and Present Day

To understand the Ketogenic Diet, it’s important to go back to its roots. It was created by two doctors in 1923 to help manage seizures in children with epilepsy. Since then, research on the diet continues to grow looking at additional potential applications for its use in various conditions and diseases.


So why can this diet be considered a fad when it’s been around for so long? This comes down to the big difference in the use and end goals of this diet – one is to manage medical conditions (which should be done by a trained dietitian), and the other is as yet another strategy in the quest for “the one” diet that will help you finally meet your weight, wellness, and performance goals. The latter use of this medically managed diet is without a doubt portrayed as another fad. It’s another strategy from the diet and wellness industry telling you that if you eat “x, y, and z” foods in “the right amounts” in “these times” that your health and performance goals will be answered. Replace keto with Atkins, Whole 30, Paleo, Noom…you name the diet, it’s all the same. At the foundation of all these diets is limiting/restricting certain foods and/or food groups, which is the key to fueling the never-ending restrict, binge, guilt cycle that diets tend to trigger.


What is the Ketogenic Diet?

What exactly is the Ketogenic Diet? It’s a very high fat, moderate protein, low carbohydrate diet. It's prescribed as a ratio of grams of fat to grams of protein plus carbohydrate combined. While there are different variations of the diet, the end goal is the same – to change the type of fuel that the body uses for energy. In a non-ketotic state, the body’s preferred energy source is glucose, which is what all carbohydrates get broken down into and can then be used as fuel. By switching to a very high fat, moderate protein, low carbohydrate diet, the body starts to break down the fat. The byproducts of this fat metabolism are called ketones, which is what gets used as an alternative energy source in the body. The shift from glucose to ketones in the brain is one potential mechanism by which the diet is thought to work to help control seizures. Interestingly, there are several theories, and we still don’t know the exact mechanism of action for this. Quick side-note on why moderate and not high protein (for any fellow nutrition nerds who may be interested): if the macronutrient ratio described above is off, the body can convert excess protein to glucose through a process called gluconeogenesis. This essentially negates the way in which the ketogenic diet works.


How does someone get appropriately and safely started on the diet? They’re first screened for a number of things during an in-depth nutritional and medical assessment including the presence of any metabolic disorders, ability to stick to the diet, history of kidney stones, fluid intake, GI issues, among a number of other factors. After that person is screened and all checks out, the diet is then typically implemented with a trained dietitian and physician/nurse practitioner in part because of the long list of potential side effects. Some of the side effects include: acidosis, constipation, dehydration, diarrhea (especially if using MCT oil), reflux, irritability, kidney stones, nausea, vomiting, nutritional deficiencies, osteoporosis, and more. Needless to say, NONE of these things would benefit athletic performance and could seriously disrupt your rides or any physical activity in addition to affecting overall health.


Reminder

Not that you need a reminder on this last point, but I'll say it anyway: riders are athletes. Whether you’re a recreational/competitive amateur or professional, your body has increased and more specific nutritional needs compared to non-athletes. Unless you’re limiting or restricting carbohydrates for a medical purpose, they are absolutely essential to optimal athletic performance and overall health. This topic is out of the scope of today’s post, so keep an eye out for a follow-up blog post on keto and athletes.


Thanks for reading! I’d love to hear your thoughts, questions, and comments, so leave them in the comment section below! You can also connect with GE on Instagram by tagging @the.equestrian.dietitian and using #gaviequestrian.

-Natalie