Ten Defining Characteristics of a Well-Formulated Ketogenic Diet by Stephen Phinney, MD, PhD, Jeff Volek, PhD, RD This is Part Two.

Note: This Post contains the last 5 characteristics. The first 5 where posted last week. Here is the link to the Blog Post https://2healthyhabits.wordpress.com/2019/03/22/ten-defining-characteristics-of-a-well-formulated-ketogenic-diet-part-one/

To promote a better understanding of what constitutes a well-formulated ketogenic diet, we have identified 10 key characteristics:

  1. Sustains nutritional ketosis
  2. Maintains or improves lean body mass and performance
  3. Effective electrolyte, mineral and hydration management
  4. Fat provides majority of dietary energy in all phases
  5. Counting calories is not necessary for success
  6. Totally or predominantly composed of ‘whole foods’
  7. Short-term very low-calorie diets should be avoided until proven effective in long term studies
  8. Contraindicated for chronic conditions unless a credible long-term maintenance phase has been demonstrated
  9. On going expert medical supervision required for medication management of chronic conditions (e.g., type 2 diabetes, hypertension)
  10. A well-formulated ketogenic diet does not necessarily adhere to traditional dietary guidelines

The emphasis is on whole foods.

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Defining Characteristic #6: A WFKD is preferably composed of all or mostly whole, unprocessed foods.

  • Choose fresh unprocessed vegetables, meats, eggs, dairy, berry fruit, and minimally seasoned nuts and seeds when possible
  • Fresh frozen choices with no added sugar and minimal processing are also encouraged
  • Fermented foods with no added sugar are allowed (e.g., yogurt, sauerkraut, pickles, kimchi).
  • Specialty frozen low carbohydrate meals can be used as needed
  • Exceptions to whole foods (electrolyte replacement): Magnesium and Bouillon (sodium)
  • Purified protein sources, specialized fats, high potency vitamin formulations, and meal-replacement formulations should be used sparingly.

Defining Characteristic #7: Any ketogenic regimen under 1000 kcal/d (very-low calorie diets (VLCD)) does not qualify as a WFKD due to a lack of adequate macronutrients and calories for long-term sustainability.

  • To our knowledge there are no published studies of sizeable cohorts fed a VLCD for up to 6 months that did not demonstrate substantial weight regain within 12 months. While very restricted prepared formula or food-based diets can have dramatic short-term effects on body weight and disease reversal, these benefits have proven to be fleeting when viewed one to two years post intervention.

Defining Characteristic #8: If intended to treat, manage, or reverse a chronic condition, a WFKD needs to have a credible maintenance phase that can be followed for years and decades.

  • For people with underlying insulin resistance in particular, a well-formulated ketogenic diet eaten to satiety frequently allows one to achieve a natural transition into a sustainable maintenance pattern of eating.
  • A short-term ketogenic diet or VLCD followed by the re-introduction of carbohydrate in amounts that reverse nutritional ketosis is seldom successful at maintaining weight loss or metabolic health long-term.
  • Long-term severe voluntary calorie restriction resulting in constant hunger is NOT a credible, sustainable maintenance strategy.
  • High volume exercise, particularly in individuals with a history of diabetes or obesity, is rarely an effective weight maintenance strategy in the absence of some degree of on-going carbohydrate restriction.

Defining Characteristic #9: A therapeutic WFKD requires expert supervision and avoidance of unnecessary cycling in and out of nutritional ketosis.

  • If intended to improve diabetes or hypertension, inconsistent and intermittent restriction of carbohydrate intake alone or in combination with restriction of total calories in the context of on-going medication use adds unacceptable risk of medication side-effects.
  • While time restricted feeding or intermittent fasting for periods less than 24 hours may be tolerated within the definition of a WFKD, any fasting longer than 24 hours, even if infrequent, is not likely to confer long-term benefits for those with chronic medical conditions.

Defining Characteristic #10: A well-formulated ketogenic diet does not necessarily adhere to traditional dietary guidelines.

  • A well-formulated ketogenic diet has characteristics that cannot be consistent with traditional dietary guidelines.
  • A “ketogenic diet” that is very energy restricted but contains a substantial carbohydrate content (e.g., 50% or more of energy), moderate protein, and low fat is not a well-formulated ketogenic diet.
  • Always consult with a trained physician when beginning a well-formulated ketogenic diet, especially if you have any health conditions and/or you are taking any medications.
  • If all of these ten characteristics are not addressed correctly, it is likely not a well-formulated ketogenic diet.

Nutritional ketosis achieved by consuming a well-formulated ketogenic diet can be a safe and sustainable therapy for a variety of conditions, particularly those driven by underlying insulin resistance or inflammation. To have a lasting effect, however, in most cases the physiological blood ketone levels characteristic of nutritional ketosis need to be maintained, along with adequate intake of electrolytes and minerals. When used to reverse disease states requiring medication withdrawal, constant medical oversight during the early phases of the dietary intervention is needed.

With attention to these 10 defining characteristics, we have demonstrated that a safe and sustainable state of nutritional ketosis is within reach for a majority of motivated adults who choose to try it.

SOURCE: The Ten Defining Characteristics of a Well-Formulated Ketogenic Diet

Stephen Phinney, MD, PhD, Jeff Volek, PhD, RD on August 13, 2018. This post has been condensed from the original Virta Post.


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Author: 2healthyhabits

My goal in life is to experience the exuberance of true good health by returning my body to the healthy state it was meant to have.

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