The Handbook of Ketogenic Diet

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This book does not perform any diagnoses, therapies, or treatments in the medical sense, nor is any other healing in the legal sense performed.

This book is not a substitute for medical or remedial advice. For medical advice, please consult a qualified physician.

The responsibility for your medical care rests solely with yourself.

If you are under psychotherapeutic or medical supervision or are taking medication, a clarifying discussion with your doctor is necessary before applying the measures described in this book.

No promises of a cure are made.

The publisher and the author are not liable for any adverse effects directly or indirectly related to the information contained in this book.

Chapter 1:

The importance of ketosis and ketogenic metabolism

In human and veterinary medicine, ketosis is a metabolic state in which the concentration of ketone bodies – or, more precisely, acetoacetate, 3-hydroxybutyrate and acetone in the blood and extracellular space – rises above normal values. This condition is an entirely physiological process and must not – as in the case of diabetes – be understood to be a pathological process. If a ketogenic diet is now consumed, then the ketone bodies listed above can replace glucose as the primary energy source of the organism.

The cause of ketosis is either a prolonged state of hunger, such as during fasting, or a prolonged low intake of carbohydrates of less than 50 grams per day in adults. Under the influence of glucagon, fatty acids are intensively broken down into ketone bodies in the liver as an alternative to providing glucose from the breakdown of carbohydrates in order to meet the required energy demand.

The three molecules acetoacetate (AcAc), beta-hydroxybutyrate (beta-OH-B) and acetone are referred to as ketone bodies (Laffel 1999, p. 1).

Acetoacetate and beta-hydroxybutyrate are significant, energy-rich compounds that can also be formed under physiological conditions and can, under certain conditions, contribute to the energy supply of the organism to a considerable extent.

The smallest ketone body, acetone, is formed by the spontaneous decarboxylation of acetoacetate. Decarboxylation is a chemical reaction in which a carbon dioxide molecule is split off from a molecule. Decarboxylation can take place particularly easily in the case of carboxylic acids (preferably beta-keto acids or malonic acids) by heating or by enzymatic catalysis.

Ketone bodies are used by all tissues, but especially by the muscles and our brain as an energy supplier. Ketone bodies are able to cross the blood-brain barrier without any problem. A residual need for carbohydrates, such as for the synthesis of secretions such as saliva, for example, can be covered by gluconeogenesis from amino acids and the glycerol of fats – but more about that later in the course of this book.

The ketogenic diet is consequently a form of nutrition that is individually calculated, strictly balanced, very high in fat and very reduced in carbohydrates and with a sufficient protein and energy content. If this form of nutrition is considered to be a diet, then it is to be seen as a restriction, in which you must go to bed hungry at night.

The ketogenic diet does not necessarily have to be understood as a diet. For me personally, it is a way of life that I can turn to again and again in order to escape from the clutches of carbohydrate metabolism.

The origins of the keto-adapted diet actually go back a long way. The knowledge that fasting leads to the suspension of epileptic seizures goes back to antiquity. In the Bible, the Gospel of Mark (in the New Testament) tells of the healing of an epileptic child: Then Jesus said, 'It is only by prayer and fasting that such spirits can be cast out'.

(Mark 9:14-29; Good News Bible 1990, New Testament, p. 51).

The ketogenic diet was developed in the 1920's for the treatment of epilepsy, but, because of the progress of anticonvulsant pharmacotherapy as well as surgical options for the treatment of epilepsy, it fell into disuse. The ketogenic diet has experienced a renaissance in recent years, due not least to Atkins, as an effective therapeutic option for the treatment of various diseases and for the treatment of the number 1 disease of civilization, obesity, in industrialized countries.

Ketogenesis – that is to say, the formation of ketone bodies in the liver of the human organism –, represents an extremely important metabolic pathway for energy supply. Without this essential energy supply, the survival of periods of hunger would never have been possible during the evolution of mankind. If our organism is dependent on its endogenous energy reserves over a longer period of time, it is precisely the ketogenesis of the liver that enables the supply of extrahepatic organs – and this ultimately leads to a reduction of fatty acids from the body's own fat deposits.

It is interesting to note that, during carbohydrate restriction, ketone bodies already cover from two to six percent of the human organism's energy requirements after the first night. This proportion grows to 30 percent to 40 percent after three days (Laffel L. 1999, page 2).

At the beginning of ketosis, the ketone bodies are preferentially metabolized by the heart, the skeletal muscles and the kidneys. After an adaptation phase ranging from several days to several weeks, the neurons of the brain, in particular, which cannot utilize the fatty acids transported in the blood, are able to cover a large part of their energy requirements from the oxidation of ketone bodies.

Ketogenesis represents an extremely important metabolic pathway for energy supply

The fact that the human organism is able to get along permanently without carbohydrates and to maintain its energy supply permanently without the presence of carbohydrates should make each of us prick up our ears at this point at the latest. How can that possibly be? All nutritional scientists constantly preach about what our nutrition pyramid – which is based on carbohydrate-rich food and which the entire construct is built on – is supposed to look like. Can it really be healthy to permanently abstain from carbohydrates? Isn't it dangerous to eat only lipids and proteins? What happens to the body after three, six, nine and twelve months of a low-carbohydrate diet? When do the first deficiency symptoms become noticeable? How does one come to eat such a diet in the first place?

From a nutritional point of view, a diet without carbohydrates is essentially unthinkable. I find it all the more fascinating that it is possible to eat without carbohydrates in the long term and, above all, in a healthy way. I have been living this form of nutrition for almost a year now and I must say that, when I compare my condition with that in the carbohydrate metabolism, I notice an enormous (positive) difference.

I will thoroughly address all the questions that arise in the following pages. But I can already assure you of one thing at this point:

If you should actually decide to embark on the ketosis experiment, you will be amazed at what extraordinary feats your organism is actually capable of. I would also like to expressly point out that before you begin the ketosis experiment, you should have yourself thoroughly examined by your personal physician. This examination is necessary in order to be able to determine whether there is anything wrong with the diet.

If you are having problems with your blood sugar level or triglycerides, you should not change your diet on your own! Ketosis is a powerful tool and, if certain conditions are not present, the change can even become threatening to the health relatively quickly and, as a member of a health profession, I am very much interested in promoting health, preventing disease, restoring health and alleviating suffering.

However, if there is nothing against it, then you may already look forward to being able to fully benefit from the numerous advantages of ketosis. You can already look forward to the incredible benefits of the ketogenic diet:

o      Weight loss:

If you are one of those people who cannot manage to noticeably reduce their weight without starving, then the ketogenic diet may help you. You don't have to go to bed hungry and the pounds will still just drop away.

o      Better concentration and increased mental focus:

As soon as you are past the adaptation phase, you will very quickly notice that you will be able to show significantly more energy than was ever the case with our carbohydrate metabolism. Your blood sugar levels will stabilize drastically, you will no longer be subject to large fluctuations, and your mental focus will increase significantly.

o      Better quality of sleep and more energy to cope with everyday life:

Since the ketone bodies produced in the liver are the optimal source of energy for our organism, you will feel more balanced, refreshed and fit than is the case with carbohydrate metabolism.

o      Prevention of disease:

Ketone bodies not only protect our bodies from oxidative stress, but they are also able to stabilize your immune system and make you less susceptible to a number of diseases. For example, if you are one of those people who get herpes labialis (cold sores) several times a year, you will be able to notice that the frequency of their occurrence decreases significantly. As long as you are in a ketogenic metabolic state, you might possibly not experience a recurrence, even if you are in a particularly stressful situation or are exposed to more sunlight.

o      Slowing down of the aging process:

Ketone bodies appear to significantly influence and slow down the aging process in our bodies.

o      Better quality of life:

Anyone who knows about the state of ketosis and how much one's overall condition changes for the better would not want to casually miss this feeling. I often compare the state of ketosis with the release of endorphin in extreme athletes.

The ketogenic diet requires extensive clarification, and if I had had such a work at my disposal a year ago when I started with this diet, then I could have prepared myself much better on the one hand, and I would have been spared a great many mistakes as well as other inconveniences, on the other hand. You will find a detailed guide about the topic of ketogenic or keto-adapted nutrition in the following pages.

At this point, I would also like to express my gratitude to all those people who have made this book possible.

Chapter 2

Basics of ketosis

The official definition of ketosis is A metabolic state in which the concentration of ketone bodies in the blood is elevated above normal.

Not exactly meaningful. What is the normal value of ketone bodies in the blood? The normal value is the value that an average consumer or eater has when he is not fasting or has limited his carbohydrate intake. Just an hour ago, he probably ate a roll with warm leberkäse [liver cheese] and a chocolate bar. He usually eats three to six meals a day, and he even fasts – namely, whenever he sleeps.

Our average eater therefore has a concentration of less than 0.1 mmol ketone bodies per liter in the blood. This is the normal value and if you have this value in your blood, you are not in ketosis. People who are in ketosis have values between 2 to 5 mmol per liter. This value is absolutely healthy and physiological, so it is a very healthy state. By the way, mole and mmol are units of measurement for chemists, similar to kg and g for the gourmet.

Ketone bodies are small molecules that supply our organs with energy

We have already learned that three compounds are called ketone bodies: Acetoacetate, beta-hydroxybutyrate, and acetone. Acetoacetate is a ketocarboxylic acid, beta-hydroxy butyrate is a carboxylic acid, and acetone is the simplest of the ketone bodies – so, all in all, these are diverse small organic molecules. Carbon, oxygen, and hydrogen atoms are linked in a variety of ways in the various molecules. But what is important is the fact that there is a great deal of energy in them!

Ketone bodies and ketones are not the same thing

All chemical compounds that have a double bond from a carbon atom to an oxygen atom are called ketones, but only if they do not occur at the edge of the molecule (a non-terminal carbonyl group). There are an incredible number of such molecules, such as ketones. However, there are only three variants of ketone bodies, and they get their name from the fact that acetoacetate and acetone each have such a non-terminal carbonyl group in their chemical structure. Well, then: two of the ketone bodies belong to the ketones, but not all ketones are ketone bodies. Makes sense, doesn't it? So, raspberry ketones, no matter how much they are touted on various sites, have absolutely nothing in common with ketosis. From a purely chemical point of view, beta-hydroxybutyrate is not a ketone, since this keto group has been converted to a hydroxy group. And yet, it is counted among the ketone bodies because it can be rapidly converted from acetoacetate and has comparable specifications in the body. Furthermore, it is the most abundant of all ketone bodies and the most important ketone body in metabolism.

Some ketone bodies are excreted in urine and breath

Beta-hydroxybutyrate is converted from acetoacetate by enzymes. Acetone, on the other hand, is formed by the spontaneous decomposition of acetoacetate, without enzymes. It is volatile and is virtually unused in metabolism. Instead, it is released primarily through the lungs upon exhalation. This is responsible for the sweet mouth odor in ketosis. However, ketone bodies are not only excreted via expiration, but also via urine. This process is called ketonuria – the excretion of ketone bodies in the urine. Over the course of time, however, the excretion decreases, since the ketone bodies can simply be utilized much better by the organs and the body does not simply flush out these energy carriers, but instead uses them more efficiently. Therefore, one should not be unsettled by a low concentration of ketone bodies in the urine after weeks of ketosis.

The liver constantly produces ketone bodies in small amounts, even without ketosis

In the case of an average, that is to say, non-ketogenic, substance exchange situation in a healthy organism, small amounts of ketone bodies are permanently synthesized by the liver in the mitochondria of the perivenous hepatocytes and used by the organs. The concentration of acetoacetate and beta-hydroxybutyrate after a meal is about 0.01 mmol per liter of blood. Even after nocturnal fasting, their concentration in the blood is, at 0.1 mmol/L, still relatively low. It is only after a sustained period of abstaining from food (or carbohydrates) that the concentration gradually increases, reaching 2 mmol/L after about 72 hours of fasting and about 5 mmol/L after a week of no food intake. In this range, one speaks of so-called ketosis.

Ketogenic diet, put into practice

We have now heard quite a bit about how the body produces ketone bodies and what conditions are necessary for this. But what exactly