The Ketogenic diet


debThe art and science of peak performance on a low-carb high-fat diet

More than just a diet, using fat to fuel the body instead of carbohydrates has scientifically proven to improve biomarkers of age, optimise weight loss and reverse chronic diseases, including some cancers.

Not only does the ketogenic diet offer a potential cure for diabesity (diabetes + obesity), it may provide a solution for endurance athletes, who as they age are gaining weight and no longer reaching peak performance levels.

Big claims? Indeed. However, new long-term research into this way of eating is shattering old-school paradigms on nutrition, and is changing the way we view and approach our modern diet.

Over the past decade I have spent 80 percent of my time in nutritional ketosis. I am living proof that a long-term ketogenic diet works. If my schedule is demanding (it usually is) or if I am public speaking and need to be at my best, I will ensure I reach nutritional ketosis leading up to and during the event.  It is while I am in this fat-adapted state that I perform at my absolute best. Moreover, for the past decade my weight hasn’t fluctuated more than 3kgs, not bad for a woman in her 40s.

In a ketogenic state I have untold energy and my brain function and IQ are optimised. As a weightloss coach for nearly two decades, I am convinced that for a majority of overweight people (there are exceptions), this way of life improves health and wellbeing in a myriad of ways. Most people suffering with obesity are in more often than not, sensitive to carbohydrates, so limiting carbohydrate intake makes sense.

What is Nutritional Ketosis?
The term Nutritional Ketosis was coined by Dr Stephen D. Phinney some 30 years ago to clarify confusion particularly among physicians, between ketosis induced by carbohydrate restriction and ketosis caused by the absence of insulin in type 1 diabetes, which leads to ketoacidosis.

Ketones in extremely high levels can be a toxic byproduct of fat metabolism. However in very low doses they are also a useful substrate for healthy fat metabolism and weight loss.  There is no more risk of ketoacidosis in healthy individuals by inducing nutritional ketosis, as there is inducing diabetic coma through extreme blood sugar levels in healthy individuals.  A healthy body will keep these levels in a healthy range.

The ketogenic diet has been around since the beginning of time. It refers to the fuel source your body survives on. The standard western supermarket diet is high in carbohydrates and as your body digests these carbohydrates, they are converted into glucose (sugar) then glucose molecules fuel each cell in your body. When we reduce our carbohydrate intake to a minimum (usually five to 10 percent of daily caloric intake) there is no longer enough glucose to fuel the body, so the body very cleverly goes looking for a second fuel source.  It turns to stored fat cells and or dietary fat, and the liver converts this fat into ketones.  Ketones then become the primary fuel for each cell in your body. This is called fat-adaptation, and the clinical term for this is to say you are in a ketogenic state, or your body is in nutritional ketosis. And the side-effects can be extremely positive.

Ketosis and cancer
It is interesting that many cancer cells do not have the ability to adapt to using ketones as fuel and in return quite literally starve to death. Hence the ketogenic diet has sparked enormous interest in cancer research.

We still don’t know how cancer kills us exactly but what we do know is that robs us of glucose (sugar, our fuel source).

Cancer loves sugar; it robs our body of it and feasts upon it. Eventually it can do this to an extent that by the time someone has cancer throughout their body, it quite literally starves them to death, which is why we see wasting away towards the end of life with cancer.

Ask any oncologist if their cancer patients are sugar addicts. The problem is that it is not the patient themselves who desire the sugar; it is the cancer in their bodies robbing them of it and demanding more.
While cancer remains a mystery, some theories have emerged that cancer is in fact a fungus. Whether it is or not, it can act like one in the body; it overtakes us and gains strength from sugar. I have coached many cancer patients through my cancer ketogenic dietary protocol with great success. At this level it can be quite a technical nutritional approach and does require an experienced person to guide them into reaching optimal ketogenic levels while maintaining an alkalised state which is also important for cancer.  (Yes the two are possible).

Is ketosis a natural metabolic state?
Many traditional nutrition experts believe that nutritional ketosis is actually the natural state of Paleolithic man,  given how restricted our carbohydrate and sugar intake was historically. The macronutrient ratios of a ketogenic diet are 65 percent fat, 30 percent protein and 5 percent carbohydrate (from daily caloric intake).

The carbohydrates that are consumed consist of low-glycemic high-fibre vegetables with some fruit.

Adequate protein levels are consumed to maintain, build and repair muscle mass, however too much protein is not advised.

The rest of our diet is made up of nutrient-dense fats that fuel the body; such as nuts and seeds including their oils, avocado, olive and coconut oils and animal fats such as butter, lard, cream and soft cheeses.  And in case you are wondering, yes, you can drink wine if you follow this protocol correctly.

One could argue that hunter-gatherers naturally ate very similar to this and certainly the most studied ketogenic diet is that of the Inuit. Called the Inuit Paradox, their native diet consists of high-fat/high-protein with basically no fruits or vegetables. The Inuit have extremely low levels of the world’s biggest killers – heart disease and cancer.

Neurological benefits
The  ketogenic way of eating also provides enormous levels of satiety (fullness after a meal), as the body becomes deeply nourished when we eat this way and therefore our brain isn’t constantly looking for nourishment. High carb diets make you hungry.

Another benefit is that obtaining a ketogenic state optimises brain function. In fact this diet has proven to reduce symptoms of neurological disorders such as Parkinson’s disease, Alzheimer’s disease, brain cancer, autism, and multiple sclerosis. It has long been used to treat childhood epilepsy and ketosis has clinically proven to significantly reduce seizures.

The paradigm shift
It is obvious to see that the low-fat/high-carb diet has truly been one of the biggest dietary blunders in history; it has led to unprecedented rates of obesity, heart disease and chronic illness. Simply put – we were wrong.

Fat doesn’t make you fat or unhealthy – carbohydrate (sugar) does. For most of us, the suggestion that high-fat diets may actually be healthy seems totally contradictory to everything we’ve been told about nutrition, as experts have endorsed low-fat/high-carb over 60 years. But it’s time every health professional took the time to research thoroughly the evidence that has been brought to light.  It takes a brave clinician indeed to change opinion and admit we all had it very wrong, but it must and will eventually happen.

The politics
Food is political, in fact our western dietary guidelines originated with the United States Department of Agriculture (USDA); they were designed to support agriculture not human nutrition. Therefore a shift in the public consensus will be one shrouded in politics, because in order to change we must first admit we were wrong.

The truth is not only are high-carb diets are killing us, but fat is actually healthy. The billion-dollar-a-year statin drug (cholesterol lowering) cartel along with the power of the grain and sugar (processed foods) industries will spark a food and nutrition debate that will span decades. This really is the new tobacco.

There is hope
Sweden has become the first country to officially reject the low-fat/high-carb diet and has publicly announced new dietary guidelines to support low-carb/high-fat nutrition advice. The Swedish Council on Health Technology Assessment provided a two-year study analysing 16,000 nutrition studies published through May 2013. So there is hope that other countries may eventually change. The first to lead will be countries that allow science over politics to prevail. However it is a known fact that currently politics wins over science.

The cholesterol myth
The leading question is “what about cholesterol? Won’t this cause heart disease and cause heart attacks?”

While this is still a mainstream attitude by most health professionals, the answer is no, dietary cholesterol has no impact of the body’s cholesterol levels. So next time your doctor suggests you lower your butter intake, ask them if they in fact they mean you should lower your sugar intake. The cholesterol myth is that dietary fat causes heart disease, however this is a hypothesis that to this day has never been scientifically validated.

Why don’t dieticians and doctors currently promote this diet?
Professionals frequently recommend the ketogenic diet however it is not yet accepted as a mainstream protocol. The reason is both political and a matter of education. This diet is shrouded in controversy against old-school science verses modern scientific research. So low-carb diets have remained fringe concepts, because it is not only hard for us to admit we were wrong, but also it’s easy to criticise what we don’t understand. If we studied one philosophy and adopted that as our belief, it is very difficult to change what has been ingrained in us. We don’t have to learn new information opting for wilful ignorance instead.


  • Eat lean protein, not too much 2-3 times a day.
  • Focus on green leafy and high-fibre vegetables, raw is best. Include micro-greens and sprouts as these are nutrient-dense and alkalising.
  • Eat some raw low glycemic index fruits, mostly citrus and berries, but not too much at once.
  • Enjoy nuts and seeds including their oils and milks.
  • Include fat at every meal including avocado, duck-fat, lard, butter, olive oil, coconut oil and soft cheeses.
  • Home-made mayonnaise and oil-based dressing should be used with every meal.
  • The use of a little apple cider vinegar in water can help the body maintain and alkalised state.
  • Avoid vegetable oils such as canola, grapeseed and soy oils; these are high in omega 6 and can be pro-inflammatory.
  • Avoid all grains, sugars and processed foods.

Ketosis for weight loss
Without being aware, most people today have become carb-sensitive. Our blood sugar levels are on a constant rollercoaster resulting in highs and lows in energy.

If you are a mid-afternoon napper or snacker, you will know what I mean. But high blood sugar also contributes to many chronic degenerative diseases, including heart disease.

Other symptoms of carbohydrate intolerance are bloating, sleepiness after eating, physical and mental fatigue, depression and fat storage.  Due to a life on the high-carb diet carb sensitivity is now a common problem. The ketogenic diet provides the solution.

Endurance exercise and ketosis
“Studies of elite athletes adapted to low-carb diets have uncovered one unexpected finding – their extraordinary ability to produce energy at very high rates purely from the oxidation of fat,” Tim Noakes wrote in the British Journal of Sports Medicine.

Noakes and his colleagues, Drs Jeff Volek and Stephen Phinney, said the field of low-carb sports performance is under-investigated and in need of further exploration. Meanwhile, in nine out of 11 low-carb performance studies a low-carb diet proved better than, or just as effective as, a high-carb diet for endurance performance.

Many athletes report greater endurance and increased performance in this state, largely put down to the fact the body will fuel not only off dietary fat, but also stored fat. We can store more fat as fuel than we can glycogen from carbohydrate consumption. In other words fat is nutrient-dense and we require much less of it, as it takes longer to burn.  Carbohydrate levels must be topped up during endurance events whereas fat doesn’t require topping up – your body will efficiently burn your body’s fat stores for prolonged periods of time.

Why carb fueling doesn’t work long-term
For many athletes the long-term effects of carb-fueling can result in adverse biomarkers of age, such as elevated body fat percentage, high cholesterol and increased blood sugar levels leading to inflammation. Inflammation is linked to chronic disease.

A diet containing simple carbohydrates can easily result in a slightly elevated insulin level, which in turn can paradoxically result in an inability to oxidise fat. So despite all your exercise, an elevated insulin level can create an environment where your body cannot access its internal fat stores. This is commonly observed in my clinic with clients, who despite intense exercise, fail to lose weight.

In carb sensitive individuals, no amount of exercise will result in weight loss while you are fueling it with carbohydrate. In fact you will become inflamed and your body will retain water as well as fat. The key is nutritional coaching that induces a ketogenic state – I see stubborn weight loss completely overturned with this approach.

Will it work with you?
So far I have worked with thousands of patients coaching them into a ketogenic fat-adapted state. Rarely will I see this protocol not work for health, endurance and weight loss.

Occasionally a client with a pre-existing metabolic condition may not easily reach ketosis. These issues are generally resolved by addressing these conditions first.  However I have yet to see a client who hasn’t dramatically improved energy levels, cognitive thinking and emotional stability on a ketogenic diet.

This is a highly disclipined dietary approach and one that is difficult to learn for a novice, hence I recommend seeking professional advice.

At my clinic we offer professional eight-week coaching packages, whereby almost daily contact is offered so clients stay both motivated and inspired to achieve their goals. We find that intimate coaching allows the client to focus on enjoying the process, while we worry about tweaking the details, so results are optimised.  There is a healthy way to approach this diet and a very unhealthy way, so ensuring your body gets the nutrients it requires while on this protocol it is the key to long-term success.

My advice – give it a go. You have nothing to lose but fat and brain fog.

Deborah Murtagh founded Whole Food Secrets, a nutrition and cookery school in rural Cambridge which also offers an online programme in nutrition and weight loss, and The Body Coaches, a nutrition consultancy dedicated to ketogenic dietary protocols for athletes, weight loss, cancer and chronic diseases.


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