Keto Q&A: Practitioner Questions Answered
Occasionally we receive questions from practitioners on certain topics. With the ketogenic diet’s recent rise in popularity, we put together a Q&A with Mark Kaye, DC to answer questions that have arisen.
What effect do coffee and tea have during a ketogenic diet?
Tea, in particular green or similar herbal teas, are the most popular beverages consumed worldwide. Phytonutrient-rich teas contain appreciable amounts of antioxidant phytochemical compounds that the body can use to maintain proper cellular communication and function. One of the most well-known compounds in tea is epigallocatechin gallate (EGCG), which has shown positive support for a variety of health applications such as support for blood glucose metabolism and mitochondrial energy support (ATP production). Proper cell signaling and mitochondrial energy function are key targets of diet modification through a nutritional ketogenic food program.
While coffee has traditionally been considered a stimulant, current research on the physiological and metabolic impact of coffee focuses on the myriad of phytochemical antioxidants found in moderate consumption of coffee as showing potential health benefit. Caffeine is far from a simple stimulant. Current research affirms caffeine’s impact on focus and attention through support of dopamine modulation in the brain. A recent study (2017) affirmed caffeine intake, equivalent to up to five cups per day of caffeinated tea or several cups of coffee, increased measured ketones in vivo.1
The available literature and scientific data affirms that reasonable, moderate intake of these beverages provides positive health benefit. That is not to say that their abuse or overuse as “thermogenic” aids is desirable. Proper diet of any type, whether Mediterranean, Asian, Paleolithic, or ketogenic, can be healthy or unhealthy depending on how it is implemented. Moderation and variety remain key to any dietary approach, including moderate intake of healthy beverages, with water remaining the main drink of choice, along with healthy fat choices and broad variety of phytonutrients derived from whole foods or phytonutrient-rich supplementation.
For a start, here is a fine recipe for a coffee-based keto shake:
- 2 scoops keto shake powder
- 1 tsp. heavy cream
- 1½ Tbsp. ground flaxseeds
- 4 oz. coffee (room temperature or cold)
Directions: Mix ingredients together in a blender along with water and ice. Blend until desired consistency and enjoy.
How long can a ketogenic diet be sustained?
The ketogenic dietary plan has been known for perhaps 100 years. Researchers such as Volek and Phinney do advocate long-term use of a “ketogenic lifestyle” and have offered compelling reasons in the literature for its use. Some may not prefer to maintain the ketogenic diet for the long term. For those who desire a dietary program with greater food variety, once they have achieved their health goals through a ketogenic diet plan, they may consider transitioning to a Mediterranean or Asian (Okinawan) dietary plan high in low-starch plant foods, healthy seafood, fruits, berries, and nut and seed oils. For further information on healthy ketogenic dietary choices, please see the Metagenics Blog Quick Start Guide to Ketosis, section “What to Eat for Ketosis.” Consult with your healthcare practitioner before beginning any diet plan.
After starting a ketogenic diet and going through adaptation, how do you know you are in ketosis?
Measuring ketones, whether in the blood, urine, or breath, remains highly desirable from an efficacy standpoint—ensuring that one is truly within “nutritional” or physiological ketosis. While a patient may see many improvements in overall feeling of wellbeing and may see positive changes in weight, these measures are more subjective. Measuring is objective.
The most common method remains urine testing. Urine test strips are readily available and test for excreted acetoacetate (a ketone metabolite). Initial urinary ketone testing may be high and decrease as the body becomes more efficient at ketone utilization for energy. The most accurate and graphical measure is blood ketones (primarily beta-hydroxybutyrate), which can demonstrate if one is within the desirable, healthy physiological ketosis range.
What recommendations/contraindications can you provide for the use of electrolyte supplementation during the ketogenic diet?
Quality food choices remain important in any diet. Low-starch plant foods (vegetables) are the main consideration for electrolytes such as potassium. Vegetables not only provide valuable vitamins and minerals but also add valuable phytonutrients to the program. Sodium is a key electrolyte. It is understood that many in North America consume excesses of salt; however, maintaining sodium intake is important in the ketogenic food plan. A practitioner should monitor salt intake. For those patients who may benefit from exogenous ketone salts to facilitate transition to ketosis, sodium and calcium bHB salts can assist in electrolyte balance.
How long is it safe to stay on a ketogenic diet before transition?
There is no maximum length of time to stay with a ketogenic diet plan. Some may find that the ketogenic food plan is appropriate for extended periods of time—they may adopt a keto lifestyle for the remainder of their lives. For others, a ketogenic eating plan may be too restrictive. For these, transitioning to a Mediterranean-style food plan is often a choice that provides a great variety of healthy, whole-food choices and may be a diet plan easier to comply with. In the latter instance, it is always best to set a few goals to achieve with a ketogenic food plan and, once achieved, transition to the Mediterranean diet and lifestyle plan. As always, consult with your healthcare practitioner before beginning any diet plan.
How much protein is allowed for runners on a ketogenic program?
Each athlete will be different as to needed or tolerated protein intake. What is most important in a ketogenic food plan is the macronutrient ratio (70% fat, 20% protein, and 10% carbs). Ketogenic diets are moderate protein-intake programs. It is suggested that the satiety effects of a ketogenic food plan are also naturally calorie-moderating. The emphasis in a ketogenic diet, as with any diet, is on quality proteins both as quality whole food and functional protein supplements. RDA protein intake is approximately 0.8 g/kg of body weight. For athletes, that number is a bit higher: 1.0 to perhaps ~2.0 g/kg of body weight (75-150 g/day for a 75 kg person), which is a number easily obtainable by the athlete.
- Vandenberghe et al. Caffeine intake increases plasma ketones: an acute metabolic study in humans. Can J Physiol Pharmacol. 2017;95(4):455-458.