“Has Mark given up Primal?” I get this question all the time, and I’m not surprised. Over the past few years, I’ve really focused on exploring the utility, applications, and ins and outs of the ketogenic diet. Why?
I’m still Primal and have been for over a decade. That won’t ever change. And you can go Primal—drop industrial seed oils, added sugar, and grains—and be perfectly fine. Better than 95%. You’ll lose body fat, gain energy and performance, and reduce your risk of degenerative disease. It will always be the foundation of my eating—and living. But I see (and have experienced) keto as a boost, an enhancement, a Reset. A return. Today I’m answering some questions around this idea with a new video.
Ketosis is the metabolic state in which our ancestors—all of them—spent a significant amount of time, whether from low carbohydrate availability, intense and protracted physical activity and exertion, or prolonged caloric deficits. We come from people who had to work for their food, who couldn’t count on a square well-balanced meal with “adequate” carbs, fats and protein, who sometimes simply didn’t have anything to eat for extended periods of time. As a result, they were often in ketosis. Intermittent ketosis is the metabolic milieu in which our physiologies were forged. That’s the metabolic milieu a modern person going keto is trying to emulate. It’s a smart move.
It’s why nearly everyone should spend time in ketosis. It’s why everyone should consider doing a full-on keto reset where you take six weeks to get completely fat-adapted, build up those fat-burning mitochondria, and enhance your metabolic flexibility. But, and this is a big “but,” very few people need to spend the rest of their lives there.
That’s where I am.
I’m in the Keto Zone.
Once in a while I’ll have 175 grams of carbs, usually after intense training.
Other days I might have close to zero carbs.
But most of the time I’ll hover somewhere around 50 grams of total carbs a day as defined in the Keto Reset approach.
But because I’ve built up the metabolic flexibility (and continue to refresh that flexibility with an intentional 6-week Keto Reset each year), I don’t have any issues utilizing all the various sources of energy. My energy doesn’t wane whether I eat 100 carbs or 10 carbs. Whether I’ve eaten nothing but meat or had a Big Ass Salad. I can tailor my fuel sources to my desires and requirements. That’s true flexibility. And freedom. It’s a version of Primal that works even better for me, and I’ve seen it benefit many others.
But let me share a video to take this further….
Thanks for stopping in, everybody. I hope I answered some questions here, but shoot me a line if there’s something outstanding or if you’re curious about something in your own Primal or Primal-keto journey. And have a great end to the week.
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When I say “hack” or “biohack,” what does that call to mind for you? Taking 20 supplements per day, shining special lights into your ears, stem cell injections? Simpler things like wearing blue light blocking glasses or turning your shower to cold for 30 seconds?
The term has become ubiquitous in modern parlance, to the point where its meaning has become blurred. On the one hand, hacking can be about optimizing—taking your health and fitness to the next level once you have the basics dialed in, or adopting strategies aimed at living well over 100. On the other hand, a hack can also be a shortcut or trick designed to reap certain benefits without putting in the usual work. (Whether that’s a clever maneuver or a form of “cheating” depends on the context and whom you ask.)
Since the keto diet has reached such massive popularity, there’s also great interest in hacking keto. This probably isn’t surprising since a keto diet is more restrictive than other ways of eating. Any tactic that might make it easier would therefore be welcome. Also, there’s a lot of hype surrounding the keto diet right now. Yes, it will naturally attract people who aim to optimize their health and who want to squeeze the greatest possible effects out of keto. And…occasionally it may attract people who are looking for a quick fix rather than a long-term solution. Some will assuredly be set up for disappointment when it turns out that keto isn’t a panacea. Results aren’t always forthcoming on people’s desired timeline, so they look for tricks to kick it into high gear.
As you’d expect, then, there are lots of resources promoting “keto hacks.” Most of these turn out to be basic common sense tips for any diet: set realistic goals, plan your meals, know how to read ingredient lists, find an accountability partner. This is all great advice, but it’s not about keto per se. Likewise, a lot of so-called keto hacks are just the Primal Blueprint Laws: move a lot (don’t be sedentary), lift heavy things, avoid sketchy oils, sleep. Everyone should be doing those things, keto or not.
In my view, a keto hack is a strategy that goes beyond the basics of ketogenic eating (i.e., drop carbs and increase fat) to do one of the following:
- Get you into ketosis quickly
- Make a keto diet easier and/or more enjoyable
- Enhance the effects of ketosis and/or increase ketone levels
- Mimic or achieve ketosis without having to strictly restrict dietary carbs
Let’s look at 10 common keto hacks and see how well they jibe with the Keto Reset and Primal approaches.
1. Ingredient Swaps
This one is the most basic, aimed at making keto easier and more enjoyable by taking higher-carbs foods you already know and love and swapping in keto-friendlier ingredients. Think zoodles with pesto and parmesan, almond flour mug bread, cauliflower rice in everything.
This also includes swapping traditional sugars/sweeteners for things like stevia and monk fruit. I’m on the fence regarding the sweeteners. If using keto sweeteners judiciously makes keto sustainable for you, they’re fine in moderation. (Search MDA for articles about the pros and cons of specific options.) However, if they keep your sweet tooth raging and your cravings high, they’re not worth it.
Verdict: Definitely, but be mindful about using keto-friendly sweeteners.
2. Manipulating Your Macros
Once you have the hang of eating basic keto macros, you can choose to strategically manipulate your intake of fat, protein, and carbs. You might want to do this if there’s still room for improving how you feel day-to-day or if you want to make faster progress toward your goals. Dropping dietary fat to lose body fat is one of the advanced strategies described in The Keto Reset Diet. If you’re struggling with hunger, changing your ratio of fat:protein might help. Experimenting with a cyclical or targeted keto approach falls into this category as well.
Verdict: Yes! The Primal+keto approach encourages self-experimentation and finding your personal “sweet spot.”
3. Going Carnivore
More and more people are starting with keto and moving on to carnivore nowadays. For some people it’s about the simplicity—eat meat, don’t eat other foods, done. Other people use carnivore as the ultimate elimination diet because they are desperate to solve the mysteries of their gut or other health issues that paleo/Primal/AIP/keto couldn’t fix.
The jury is still out on whether the carnivore diet is safe long term. As with keto, it surely depends on how you implement it. Are you truly eating nose to tail—organs, skin, blood, glands? That’s very different than only eating ground beef and ribeye. Personally, I doubt that it’s optimal compared to a diet that is at least somewhat omnivorous, but we need more data. Furthermore, I haven’t seen evidence that it’s superior health-wise to Primal+keto for the general population. Of course, if it profoundly changes an individual’s health for the better, that’s a different story.
Verdict: As a short-term experiment, sure. As a long-term diet, I’d need a good reason. (Not wanting to make a salad wouldn’t be good enough for me.)
4. Measuring Ketones and/or Blood Glucose
This falls into the category of self-quantification—not exactly a hack so much as a tool that biohackers use to track how their bodies respond to different stimuli. For individuals who are dealing with medical issues for which blood sugar regulation or ketone levels are important, measuring is a must. For the rest of us, tracking can be a useful tool, especially to see how these markers are affected by specific foods or quantities of foods. Some people simply like gathering data, and that’s cool too.
Just remember that higher ketone levels are not in and of themselves the goal (except in specific medical situations). Ketone and blood glucose levels do not directly predict weight loss or other outcomes, although they can give you some clues about what’s going on in your body.
Verdict: A useful tool for learning about your body, but not necessary if you’re doing keto for general wellness or weight loss. Subjective measures often suffice.
5. Incorporating MCT Oil
Medium-chain triglycerides (MCTs) can be especially useful for supporting a keto diet and are traditionally used in keto fatty coffee recipes. MCTs are digested differently from other fats, going directly to the liver where they can be converted into ketones. The increased ketone production is probably why some people report experiencing greater mental clarity or appetite suppression when they incorporate MCT oil into their diets. Research also suggests that MCTs increase the thermic effect of food and promote greater body fat loss, a benefit to those hoping to lose weight with keto. They might also positively affect gut health.
Because MCTs can raise ketones even when consumed alongside high-carb foods, using MCTs might allow you to still reap some of the benefits of ketosis on higher-carb days. MCTs can also be used alongside intermittent fasting to enhance ketone production and stave off hunger. (Mark’s official decree about whether MCT oil breaks a fast: “technically yes, but realistically no—and it may even enhance your fasting experience when consumed in moderation.”)
On the other hand, an over-reliance on fatty coffee can crowd out more nutrient-dense breakfast options, and MCTs are still calories (though energy efficient ones). If your weight loss stalls, and you’re consuming a lot of MCT oil, that might be the problem. It’s possible to have too much of a good thing.
Verdict: Thumbs up! Start slowly because MCTs can lead to disaster pants if you’re unaccustomed to using them.
6. Taking Exogenous Ketones
Commercially available ketone salts or ketone esters can be used to raise blood ketones above the levels that are typically achievable with diet alone. They are somewhat controversial in the keto diet world, at least in the corner that we inhabit with the Keto Reset. However, I think the research into their possible applications for medicine, sport, and cognitive performance is intriguing.
I’m less enthusiastic about exogenous ketones as a weight-loss supplement. Yes, exogenous ketones can support a ketogenic diet by suppressing appetite, increasing energy, and being used to extend fasting. They do not, however, cause fat burning and weight loss, which is often how they are portrayed to consumers.
Verdict: Unnecessary and expensive. If you have the funds and want to experiment, by all means do so, but check out Mark’s take on exogenous ketones before you buy.
7. Intermittent Fasting
Keto folks love intermittent fasting. Eating in a compressed window during the day makes it easier to control caloric intake and regulate insulin production over a 24-hour period. Some people notice marked improvements in gut health by giving their guts a break from digesting food all the time. As with MCTs and exogenous ketones, intermittent fasting can “make up” for the effects of a somewhat higher-carb diet, allowing you to loosen the reins on the carb restriction a bit and still be in ketosis some of the time.
Many people also find that they naturally slip into a compressed eating window once the appetite suppressing effects of keto start to kick in. In The Keto Reset Diet, Mark recommends starting by delaying the first meal of the day until hunger ensues naturally. This is a gentle way to introduce intermittent fasting.
There are important cautions here though. Women need to be more mindful about fasting and caloric restriction than men, as do high-volume athletes. Intermittent fasting can be stressful on the body, so if you are already under a lot of stress from work, family, health issues, poor sleep, or heavy training load, now is not the time to start.
Verdict: Yes! Start by building a foundation of fat-adaptation first through Primal and ketogenic eating.
8. Fat Fasts, Egg Fasts, Etc.
None of these strategies is actually fasting for the record. They’re very-low-carb eating plans that allow a very limited range of foods. Usually they’re aimed at breaking through a weight loss plateau. If they work, it’s likely due to caloric restriction (it’s boring to eat a lot of the same food all the time). Otherwise, the purported benefits are the same as the regular ol’ keto diet: reduced appetite, increased satiety, and insulin regulation.
To me, these don’t pass the sniff test of “optimizing health.” Indeed, if you look at the “rules” for any of these, there are always myriad warnings about not doing them for more than a few days, if you have certain medical conditions, or if you are already low body fat. You can break through weight loss plateaus with other methods and still get plenty of nutrients.
Verdict: No thanks.
9. Fasted Exercise
This is another of the advanced strategies in The Keto Reset Diet, meaning it should only be undertaken once you have acclimated to the keto diet. Mark recommends working out fasted to help accelerate the process of fat- and keto- adaptation and to promote mitochondrial biogenesis and autophagy. Research has also shown that fasted exercise can improve insulin sensitivity, fat-burning, and endurance.
Note that while it can yield beneficial hormonal and metabolic effects (and is probably useful for endurance athletes), training fasted might not be optimal for people looking for muscle gains. Also, fasting can increase the stress of a workout, so if you already struggle with excess stress or cortisol, this strategy is probably not for you.
Verdict: Yes, once you are fat- and keto-adapted. You need not conduct all workouts fasted to reap the benefits.
Mark just wrote a very comprehensive two-part series on sprinting (Part 1, Part 2), so I won’t rehash it all here. Suffice it to say sprinting has tremendous adaptive hormonal effects, and it upregulates fat-burning, which all keto folks want. Sprinting can help deplete glycogen stores and get you into a state of ketosis faster. On the flip side, sprinting in a somewhat glycogen-depleted state (as keto folks generally are) enhances the benefits.
You can adapt sprinting to different fitness levels and physical abilities, so don’t avoid sprinting just because you’re not a runner. If you’re stalled out on your weight loss or fitness goals with your current diet and exercise routine, or if you want to take your fitness to the next level, throwing in the (healthy) stress of sprinting might be just the ticket.
Verdict: Go for it!
Final Thoughts: Use Your Brain (AKA Primal Blueprint Law #9: Avoid Stupid Mistakes)
I feel it’s important to mention that you can be successful and happy with a keto approach that involves none of these hacks. Also, of course, some of these might be inappropriate for your unique situation. With any hacks, understand why you are doing them, as well as the possible benefits and downsides. Don’t try something just because you saw it on YouTube or heard about it from your neighbor if it doesn’t feel right to you.
Most of all, don’t get sucked into the “keto harder” mentality where you just keep pushing and pushing your body to achieve better/faster results to the point where you go way past what is healthy or necessary for you. Be mindful about keeping self-imposed stressors in the “adaptive” category, and don’t compare your journey to others’.
Do you practice any of these? Do you have questions on other keto “hacks” you’ve heard about? Share your thoughts below, and thanks for stopping in today.
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For today’s edition of Dear Mark, I’m answering a few questions from recent comment boards. First, with all the scary tick-related news coming out lately, are there any non-toxic tick repellents that actually work? Are there essential oils that repel and/or kill ticks? Is there a safer way to use insecticides? Next, were the people in the Mediterranean keto study actually eating a kilo of fish on their fish days? And is the wine an important part of the Mediterranean diet? Is the wine therapeutic or just for pleasure?
Let’s find out:
Non toxic effective tick repellents safe for children? Any suggestions? I live in NC so the tick thing scares the hell out of me. Found at parks in short grasses, like how am I supposed to avoid this???
If you want to avoid DEET and other pesticides, there are many essential oils that repel ticks. Let’s go through the various tick species.
The castor bean tick:
Repelled by Dorado azul, also known as pignut or bushmint and traditionally used as mosquito repellent. The terpene known as alpha-humulene was the most repellent terpene found in the oil; you can buy both the oil and the humelene.
Repelled by turmeric oil, even beating out DEET.
The cattle tick:
The deer tick:
Repelled by nootkatone (a grapefruit aromatic compound) and to a lesser degree ECOSMART organic insect repellent. Here’s a cool video showing ticks trying to climb a person’s finger that’s been dipped in nootkatone.
Nothing is 100% guaranteed to repel all ticks. In fact, many of these oils show 50-60% effectiveness in the field. But if you use a combination of relevant essential oils, frequent tick checking, smart clothing choices (long socks, shoes/boots, pants), and avoidance of tick-heavy landscapes (tall grass, oak leaves, etc, notwithstanding these new breeds that apparently love short grass), you’ll be in good hands—or at least better hands than the naked guy rolling around in piles of oak leaves.
And if you’re really worried, you could always tuck pants into your shoes, then spray the shoes and lower section of your pants with peremethrin, an insecticide that kills the ticks as they climb before they can reach your flesh. Use a dedicated pair of pants and shoes that you don’t use for anything else and reapply each time you go out. A light spray on the outside of reasonably-thick pants should provide tick protection without actually putting the pesticide into contact with your skin.
2.2 pounds of fish each day?!
I know, I was surprised to read that myself. But right there, according to the researchers:
We estimated during the first 4 weeks of this study that the average edible fish consumption per subject during the ‘‘fish block’’ day was approximately 1.12 0.41 kg=day.
So it wasn’t just an allowance of fish. They actually tracked their consumption and found they were eating over 2 pounds of fish on average on the days they ate fish.
The study said that they had “fish block” and “no fish block” days. With no mix of fish and other meats on the same day. What is the reason for this?
They offered no justification in the study write-up.
Maybe it was to increase variety.
Maybe it was to reduce their intake of omega-3s. I mean, a kilo of fish per day adds up to a lot of omega-3s, especially if you’re doing sardines and salmon. There is such a thing as too much a good thing, and excessive omega-3 can lead to blood thinning, excessive bleeding, and imbalanced omega-3:omega-6 ratios in the opposite direction.
Maybe it was to help people stick to the diet, to break up all that fish with some meat and chicken.
Great, but why the wine? Is it not a contradictory with ketosis? But is it for pleasure or is it for a therapeutic reason?
Wine is emphasized in Mediterranean diet studies (both keto and regular) because wine is considered an important part of the cuisines of most Mediterranean countries, at least on the European side. Italy, France, Spain, Portugal, and Greece all have an extensive history of wine production and consumption. Since researchers are casting a wide net to capture everything that might be contributing to the health effects, they’re including everything that appears in the “Mediterranean diet.”
It’s good to keep in mind that ketosis and alcohol detoxification do utilize some of the same physiological pathways. If you’re drinking an excessive amount, you’ll run the risk of inhibiting ketone production.
Still, wine does appear to have therapeutic effects, especially in people with metabolic syndrome—the subjects of this study.
Red wine is very high in polyphenols, due to both the polyphenols in grapes themselves and the unique polyphenols that form during fermentation. One study compared grape extract to red wine made with the same types of grapes, finding that red wine provided benefits the grape extract did not.
Drinking wine with a fast food meal can reduce postprandial oxidative stress and inflammatory gene expression; it can actually make an otherwise unhealthy meal full of refined, rancid fats less damaging (though still not advisable).
Blood pressure: In people with (but not without) a genetic propensity toward efficient or “fast” alcohol metabolism, drinking red wine at dinner seems to lower blood pressure.
Type 2 diabetics: Type 2 diabetics who initiate red wine drinking at dinner see reduced signs of metabolic syndrome, including moderately improved glycemic control and blood lipids.
Inflammation: A study found that non-drinkers who begin regularly drinking moderate amounts of Sicilian red wine enjoy reduced inflammatory markers and improved blood lipids.
I’d say the wine is a therapeutic addition to the Mediterranean keto diet. Don’t let that override your own experience, however. Wine might have therapeutic effects for many people, but not everyone feels better including it. It’s an option, but it’s hardly a necessary one for a healthy diet.
If you have any more questions, feel free to ask away down below. Thanks for reading, everyone.
El-seedi HR, Khalil NS, Azeem M, et al. Chemical composition and repellency of essential oils from four medicinal plants against Ixodes ricinus nymphs (Acari: Ixodidae). J Med Entomol. 2012;49(5):1067-75.
Ashitani T, Garboui SS, Schubert F, et al. Activity studies of sesquiterpene oxides and sulfides from the plant Hyptis suaveolens (Lamiaceae) and its repellency on Ixodes ricinus (Acari: Ixodidae). Exp Appl Acarol. 2015;67(4):595-606.
Goode P, Ellse L, Wall R. Preventing tick attachment to dogs using essential oils. Ticks Tick Borne Dis. 2018;9(4):921-926.
Politi FAS, Fantatto RR, Da silva AA, et al. Evaluation of Tagetes patula (Asteraceae) as an ecological alternative in the search for natural control of the cattle tick Rhipicephalus (Boophilus) microplus (Acari: Ixodidae). Exp Appl Acarol. 2019;77(4):601-618.
Lima Ada S, Carvalho JF, Peixoto MG, Blank AF, Borges LM, Costa junior LM. Assessment of the repellent effect of Lippia alba essential oil and major monoterpenes on the cattle tick Rhipicephalus microplus. Med Vet Entomol. 2016;30(1):73-7.
Schulze TL, Jordan RA, Dolan MC. Experimental use of two standard tick collection methods to evaluate the relative effectiveness of several plant-derived and synthetic repellents against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae). J Econ Entomol. 2011;104(6):2062-7.
Hansen AS, Marckmann P, Dragsted LO, Finné nielsen IL, Nielsen SE, Grønbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. Eur J Clin Nutr. 2005;59(3):449-55.
Di renzo L, Carraro A, Valente R, Iacopino L, Colica C, De lorenzo A. Intake of red wine in different meals modulates oxidized LDL level, oxidative and inflammatory gene expression in healthy people: a randomized crossover trial. Oxid Med Cell Longev. 2014;2014:681318.
Gepner Y, Henkin Y, Schwarzfuchs D, et al. Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes. Am J Hypertens. 2016;29(4):476-83.
Gepner Y, Golan R, Harman-boehm I, et al. Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes: A 2-Year Randomized, Controlled Trial. Ann Intern Med. 2015;163(8):569-79.
Avellone G, Di garbo V, Campisi D, et al. Effects of moderate Sicilian red wine consumption on inflammatory biomarkers of atherosclerosis. Eur J Clin Nutr. 2006;60(1):41-7.
The post Dear Mark: Safe Tick Repellent, Fish Intake on Mediterranean Diet, and Therapeutic Value of Wine appeared first on Mark’s Daily Apple.
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As I’ve written before, although most people’s lipid numbers improve across the board, some people get interesting cholesterol responses to Primal ketogenic diets. LDL skyrockets, even LDL particle number. The jury’s out on whether or not they indicate negative health concerns or if keto dieters are a special breed that hasn’t received enough study. (There may be a few genetic profiles, such as APOE4 carriers, that react differently to certain dietary inputs.) Either way some people just want their cholesterol numbers to look good in a conventional way. These days, whenever I run into someone in the real world with these or similar concerns, I tell them to try “Mediterranean keto.”
What is that, anyway?
The Mediterranean diet can mean a lot of different things depending on who you ask. On one side, you have the folks who make the ridiculous claim that the Mediterranean diet consisted of pasta, low-fat dairy, beans, green veggies, seed oils with a “drizzle or two” of extra virgin olive oil for good measure, a handfuls of nuts, and a single filet of sardine once every three days. They avoided salt and red meat and full-fat cheese, somehow ignoring the vast body of salt water on their shores and the large population of sheep and goats roaming the land. I guess that livestock is only there to keep the weeds down.
On the other side, you have the people claiming that the true Mediterranean diet consisted of fatty lamb, hard cheeses, fish filets dripping with oil, skins of homemade red wine, cured meats, endless olives, vegetables at will, and the occasional legume bathing in mutton juices and a tiny piece of bread crust submerged in extra virgin olive oil.
This is probably closer to the truth, but both are a bit hyperbolic.
It also depends on where you’re looking. The Mediterranean is a big sea. Spain, Italy, Portugal, Greece, Crete, Turkey, Morocco, Algeria, Israel, Lebanon, Egypt, and even France are all technically Mediterranean countries. Are their diets identical? No. Are there common threads running through their respective cuisines? Yes.
- Olive oil
- Wine (excepting Muslim dietary practices)
- Grains and legumes (Yes, they do eat beans and pasta and bread, although perhaps not in the quantities the grain-addicted would prefer)
And that’s not even mentioning all the various social, spiritual, and lifestyle components of the Mediterranean way of life. The sun, the walking, the hills, the family connections, the religious leanings. Today’s label is all about the diet.
The Mediterranean keto diet emphasizes olive oil, fish, cheese, meat, low-carb vegetables, and red wine. In other words, it takes all the keto-compliant foods readily available to denizens of the Mediterranean and constructs a nutrient-dense diet out of them.
And you know what? It seems to work really well.
In one of the most impressive studies, people with severe obesity and metabolic syndrome tried a Mediterranean keto diet for 12 weeks. That’s three months.
Here’s what the diet consisted of:
- No calorie counting
- Unlimited protein
- Lots of fish. At least (and often more than) four days a week, subjects ate over a kilogram of fish each day, mostly sardines, trout, mackerel, and salmon. On the other days, they got their protein from shellfish, meat, fowl, eggs, and cheese.
- Lots of omega-3s. Subjects were getting over 15 grams of omega-3s on their fish days and supplementing with 9 grams of salmon oil on their non-fish days.
- At least 200-400 mL of red wine a day, 100-200 mL at lunch and dinner. That’s up to over half a bottle.
- At least 30 mL (2 tablespoons) of olive oil a day, 10 mL per meal.
- Maximum two portions of salad and one portion of low-carb vegetables (cauliflower, broccoli, eggplant, etc) per day.
- A comprehensive vitamin and mineral supplement covering all the basics.
What happened to these subjects after 12 weeks on this Mediterranean keto diet regimen?
- They lost 30+ pounds.
- Their BMIs dropped from almost 37 to 31.5, from the middle of class 2 obesity to the bottom of class 1 obesity.
- They lost 16 centimeters, or 6 inches, from their waist.
- Fasting blood sugar dropped from 118 (pre-diabetic) to 91 (ideal).
- Triglycerides dropped from 224 to 109.
- HDL increased from 44 to 58.
- They went from prehypertensive to normotensive.
- Their liver enzymes and liver fat reduced and in some cases completely resolved.
- All 22 subjects started the study with metabolic syndrome and ended it without metabolic syndrome.
That last bit is pretty interesting. Note that the majority of the participants were still obese (BMI over 30) by the end of the study, yet every single one had cured their metabolic syndrome. Sure, they lost weight, and the trend was fantastic and heading down, but they weren’t there yet. Something about the diet itself was incredibly powerful.
The only limitation? It was a pilot study, not a randomized controlled trial pitting the Mediterranean keto diet against a control diet in real time. But considering that these people were coming off control diets—which clearly weren’t working for them—and onto the Mediterranean keto diet, it has more real-world power than you might think. You can bet the participants weren’t complaining about a lack of placebo control.
I’m not saying this is the best incarnation of all the potential Mediterranean keto diets out there. But if you’re having mixed metabolic results from the keto diet and looking for a ketogenic option with more monounsaturated fat and omega-3s, it’s the one that has some clinical research behind it. It’s one that doesn’t possess any glaring red flags.
This is also a form of ketogenic dieting that most people will view as “healthy.” It can be hard to get people to accept that putting real cream in their coffee and steak on their plates is good for them, even if they’re approaching death’s door eating what they’ve always eaten. It’s not so hard to get people on board with a diet of olive oil, fish, red wine, and salad. That’s no small feature.
In the end, the ketogenic Mediterranean diet appears to be an effective way to treat metabolic syndrome without scaring people away. For that reason, it might be a good option to try if you’re having issues with cardiovascular markers, blood sugar, hypertension, body fat, or any of the components that make up the metabolic syndrome.
What do you think of the Mediterranean keto diet? Think you could stick to it?
Pérez-guisado J, Muñoz-serrano A. A pilot study of the Spanish Ketogenic Mediterranean Diet: an effective therapy for the metabolic syndrome. J Med Food. 2011;14(7-8):681-7.
Pérez-guisado J, Muñoz-serrano A. The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study. J Med Food. 2011;14(7-8):677-80.
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I love dairy. As a man of primarily Northern European descent, my ancestors have been consuming the stuff for thousands of years. It doesn’t give me any issues. You won’t find me chugging tall glasses of straight milk these days, but I’m a big believer in cream, cheese, yogurt, and kefir. Very nutrient-dense food if you can handle it. Lactase persistence? I practically have lactase insistence.
My favorable response to dairy makes keto especially easy. High-fat and fermented dairy is high in nutrients and low in digestible carbs (the bacteria consume most of the lactose). Cheese, cream, kefir, and yogurt all happen to be the most nutritious forms of dairy and the most keto-friendly. Many others getting into keto lean heavily on dairy. It just makes keto easier, especially if you’ve grown up eating dairy.
But globally my reaction to dairy is pretty rare, and that changes the keto landscape for most people.
Most of the world has some degree of lactose intolerance, meaning once weaned from breast milk they no longer retain the digestive enzyme required to comfortably break down the milk sugar lactose. A smaller but still significant chunk of people have dairy protein intolerance; they get an inflammatory or allergic response to the proteins found in dairy, most commonly casein. And there’s also the problem of A1 casein, a relatively novel form of dairy casein that has been shown to cause inflammatory issues in the guts of susceptible people, whereas the more “ancestral” form of casein—A2 casein—does not. A1 casein is far more common these days, and not everyone can handle it or find access to A2 casein-producing dairy animals.
In other words, there are many people reading this blog interested in going keto who either cannot or don’t want to consume dairy. They need tips for doing it dairy-free. And today, I’m going to give them some.
Before anything, make sure you actually are dairy or lactose-intolerant. I wrote a post explaining how to determine whether you truly are intolerant of dairy, as well as some suggestions for overcoming it (if possible).
If you know you’re dairy intolerant or choose to avoid dairy for other reasons, here are a few tips for keto eating dairy-free.
Explore Cream Alternatives
If you prefer cream in your coffee, it doesn’t have to be heavy whipping cream. Other options exist.
Coconut milk/cream: Pretty simple stuff. Coconut cream is richer and heavier.
Coconut butter: Just add a spoonful or two and blend to combine.
MCT oil powder: I’ve never been a big fan of the straight-up MCT oils. They’re fine if you like adding oil to your coffee, but I really prefer using the powdered MCT oil. The way I do it is mix a scoop or two with a little liquid—milk (although not if you’re avoiding dairy), coconut milk, water, etc—and then add the resulting slurry to the coffee.
Cashews: Cashews are a great creamer replacement because they have a natural sweetness to them. They’re also very rich in fat and low in fiber for a nut, so they promote extreme creaminess when blended. Some of my favorite Indian curries use cashews blended into water as the base instead of heavy cream or yogurt.
Tahini: A fantastic alternative to heavy cream is to blend tahini (sesame seed butter) with coconut milk and a teaspoon of blackstrap molasses. I normally blend the tahini into a bit of heavy cream, but coconut milk or cream also work. Don’t fear the few carbs in that teaspoon of blackstrap molasses; it’s key. You’ll find a nice coffee recipe using tahini here.
Macadamia cream: Blend macadamia butter (make by throwing mac nuts into a food processor) with a bit of water. Mac nuts are almost pure fat, so they make a fantastic creamer base.
Hemp: As I mentioned in one of my recent Sunday With Sisson emails (subscribe to the newsletter to receive those if you’re interested), one of my latest favorites is using 2-3 TB whole hemp hearts, a scoop of Vanilla Collagen Fuel, a dash of salt and cinnamon, and blending it all together until frothy and creamy. The hemp provides a ton of magnesium and creaminess, the Fuel gives collagen and rounds it out, and the salt and cinnamon provide flavor, sodium, and a little extra barrier against insulin resistance. All told, it’s a great way to enhance your coffee and provide many of the nutrients you need while ketogenic.
Eggs: Primal egg coffee. Egg yolks are also great thickeners for sauces where you’d normally use cream or butter.
Non-dairy milks: Read all about the relative benefits and drawbacks of the various non-dairy milks, then make your choice.
Get Enough Calcium
Yeah, yeah, conventional wisdom sources are obsessed with people missing out on calcium if they choose to eschew dairy, and they get so much about nutrition so wrong that it’s easy to ignore that one, too. They’re not wrong though. Dairy is a good source of calcium, perhaps the best, and definitely the easiest and most available. And although one reason why people feel they need so much calcium for good bone health is that they’re walking around with vitamin D deficiency—which impairs calcium metabolism—you do need calcium.
How do you get calcium on a dairy-free keto diet?
Eat bone-in fish. Canned sardines are a really easy, really delicious way to do it. An average can provides about 20% of your daily calcium requirements. Trader Joe’s has a great bone-in, skin-on wild pink salmon in a BPA-free can. If you eat all 7 servings in the can, you’ll hit 70% of your calcium requirements plus 35 grams of fat, much of which is omega-3, and 90 grams of protein. You could even slow cook whole bone-in fish until the bones soften enough to eat.
Cook bones or bone-in meat in acidic liquid. The old practice of adding a splash or two of apple cider vinegar to your bone broth pot doesn’t actually extract any measurable calcium from the bones. To really extract calcium, you need lots of acidity. An old Chinese postnatal meal was spare ribs cooked in vinegar (and sugar, but you can leave that out); the vinegar extracted huge amounts of calcium from the bones, giving the mother a much-needed source of calcium as she nursed her child. Cook ribs, shanks, or make bone broth using an acidic liquid like red wine or a high vinegar:water ratio. The Chinese vinegar sauce had a pH of 3.2, so you’ll want to aim for something in that realm of acidity. Red wine runs between 3.3 and 3.5 pH.
Eat collard greens. Some of the other calcium plant sources are also quite high in oxalates, which can bind to calcium and inhibit its absorption. Collard greens have less oxalate than most others and plenty of calcium. They’re also delicious cooked in some bacon fat, bone broth (maybe the high-calcium bone broth from the last section, even), and vinegar.
Focus On Whole Foods Rather Than Isolated Fats
Lots of keto people use dairy as a crutch. They drink cream by the cupful. They eat blocks of cheese like apples (not a bad thing, necessarily). They eat bowls and bowls of stevia-sweetened whip cream. They throw sticks of butter in their coffee. All of this in a quest to “get more fat.” These are good foods, to be sure (it’s a great crutch), but I don’t think they should form the basis of your caloric intake. They should enhance a meal, not replace it.
What if instead of subbing in buckets of coconut cream, cashew cheese, and MCT oil, you ate more eggs, meat, and salads? You don’t need to drink shots of olive oil or avocado oil. You can add them to your salad along with some olives and avocado. You can eat actual foods. Actual meals.
This applies to people eating dairy, too. But if you’re dropping dairy and are interested in 1-to-1 isolated fat sources, perhaps use this opportunity to switch over to a whole foods-focus.
A big reason keto folks rely on dairy so much is that it’s easy. It’s right there, ready to be poured (kefir, cream), sliced up (cheese), spread (butter), or scooped out (yogurt, cottage cheese).
If you’re like most people, and you don’t have unlimited time to whip up amazing meals at the drop of a hat, you need to be prepared. You need to go shopping and get easy-to-prepare and prepared foods.
- Charcuterie/cured meats, boiled eggs, cooked bacon, olives, nuts, seeds, canned fish, smoked oysters.
- Cook meals ahead of time, or make enough for leftovers. A cold chicken leg or cold NY strip steak sliced up are some of my favorite “easy” meals.
- Salad makings prepared and on hand (veggies, lettuces, dressings).
- Coconut butter on hand for those times you just need a spoonful.
- Primal Kitchen® fare—this is pretty much the reason I started making mayo, dressings, and bars. I wanted something I could travel with and just have on hand whenever I wanted.
Most of all, don’t sweat it too much. Dairy isn’t essential. Dairy isn’t necessary. You’ll do just fine with or without dairy.
What about you folks? Do you do dairy? Do you not? How do you approach keto without dairy?
Thanks for reading, everyone. Take care!
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A criticism often leveled against the keto diet is that it’s more expensive than a “regular” (read: SAD) diet. There’s some truth to that. It does cost more to buy meat than ramen and beans. I personally spend more on groceries now than I did before finding Primal. Not only did I shift to buying different types of food, I also came to care more about food quality. I started choosing more pasture-raised meat and eggs, and more pesticide-free and organic produce and dairy.
However, my grocery bills haven’t changed noticeably since going keto. If you’re already eating Primally, your daily foods don’t have to change that much if you decide to try keto. You’ll remove some (okay, most) of the fruits and root veggies, and sub in more above-ground veggies and probably some healthy fats. It’s not a substantial overhaul. However, if you’re coming from a standard high-carb, lots-of-cheap-packaged-foods diet straight into Primal+keto, it can be a shock to the wallet.
Sure, I can tell you that this is an investment in your long-term health and spending more on food now means spending less on medical care later. I believe that. I also know that doesn’t help you today if you’re looking at your food budget and your fridge, now mostly empty after purging it of non-Primal, higher-carb foods.
If you’re committed to making Primal+keto work on limited funds, it can be done. Here are some tips for making it happen.
1) Buy What You Can Afford
With Primal+keto, there are ideals when it comes to food quality, and then there’s what fits your budget. Now is the time to call on the saying, “Don’t let the perfect be the enemy of the good.” Don’t stress about buying the best quality everything. Don’t forgo eating vegetables because you can’t always fit organic options into your budget. Non-pastured eggs still have more to offer nutrient-wise than a bagel for breakfast.
In terms of priorities, aim for better quality meat. (I’ll include tips for finding less expensive meat choices below.) Check the Monterey Bay Aquarium’s Seafood Watch to see which types of seafood are worth your money and which should be avoided altogether; don’t spend money on the latter.
For produce, check out the Environmental Working Group’s Dirty Dozen—the vegetables and fruits they recommend buying organic—and the Clean Fifteen that are safer to buy conventional. Of note to keto eaters, spinach and kale should be organic, but many of our keto-friendly faves make the clean list. Don’t stress if you need to choose conventional avocados, cauliflower, and broccoli.
Remember, too, that it’s not always necessary to look for the organic label even for the “dirty dozen.” If you’re buying from local farmers, ask about their practices. Many small farmers are pesticide-free or use organic practices but simply can’t afford the process of becoming organic certified (it’s quite expensive and arduous). The same goes for meat.
2) Don’t Menu Plan
I’m going against the grain here. Most articles on budgeting tell you to make and stick to a strict plan. I find, however, that it’s more cost-effective to let sales be my guide. I’d rather check out my local grocery stores and farmer’s markets, buy what’s cheapest, and make it work. Use apps that tell you where the sales are and buy accordingly. Sign up for the customer loyalty cards at the stores you frequent so they can send you deals and coupons.
I realize that this might sound stressful if you don’t feel confident in the kitchen. If you’re beholden to recipes, this doesn’t always work. (Of course, you can always look up recipes on your phone in the grocery store—I’ve done it a million times.) Remember that you can always default to making a Big-Ass Salad or an omelet or scramble.
3) Shop Around
Get to know the various supermarkets, specialty stores, and farmer’s markets in your area. Learn what’s the freshest, cheapest, and most likely to be available at each. While it’s convenient to do one-stop shopping, it might be worth the extra time it takes to make two or three different trips during the week to hit up different stores.
Think outside the traditional grocery store box. In many smaller communities, a “big box” store may have the largest selection of meat and veggies, including organic, and a wide variety of specialty products. In my town, Grocery Outlet is the best place to buy organic coconut oil and olive oil, and they carry lots of other keto-friendly staples like nut butters, grass-fed meat, and cheese at low prices.
If you have access to a farmer’s market, definitely make sure you check it out. Sometimes farmers will mark down their remaining items at the end of the day so they don’t have to pack it up. You won’t have the same selection, but you might score some deals.
Also look into local CSAs, farm stands, and meat purveyors who sell direct to customers. Again, you can often find ones that offer sustainable practices and high-quality products without the expensive organic label. Check out Eat Wild and Local Harvest to find farmers near you. I’m a fan of CSAs that sell “ugly produce”—the items that aren’t pretty enough for grocery stores but that are still tasty and nutritious—so it doesn’t go to waste.
Finally, check Facebook marketplace, Craigslist, and so on for people looking to sell backyard eggs for cheaper than the store. If you live in an area where people hunt, you might be able to score some meat this way during hunting season, too.
4) Skip the MCT Oil and Exogenous Ketone Products
Unless you have a medical reason to have very elevated ketones, these expensive products aren’t a priority. You don’t need them to do keto “right.”
5) Reconsider the Keto-fied Baking
Almond flour, coconut flour, arrowroot powder, erythritol, and so on can also be pricey. From a nutrient perspective, there are better ways to invest your grocery dollars. You don’t have to give it up entirely, but consider how big a chunk it’s taking out of your budget and whether it’s worth it.
6) Eat the Stuff that Other People Don’t Want
I’m talking organ meat, bone-in chicken thighs and drumsticks, sardines, and the like. The great irony is that these are some of the most nutrient-packed foods in the store, and you can often get them for cheap because the average consumer is looking for boneless, skinless chicken breasts. Good news for you!
Ask the butcher at your grocery store if they have organ meats or cuts that they aren’t going to put in the case because they aren’t popular enough. You might be able to snag cheap (or even free) bones for bone broth that way too—although probably less so now that bone broth has become such a trendy item.
If you’re squeamish about organ meat, remember that almost anything can be ground up in a food processor and mixed with ground beef for burgers or meatballs, or to be hidden in chili or meat sauce. Heart is an excellent place to start. It doesn’t have the distinctive strong flavor of liver or kidney, and it’s very affordable.
7) Your Freezer is Your Friend
Many items are less expensive if you buy them frozen—vegetables (especially off-season), berries, seafood—and they’re just as nutritious. Freezing also allows you to buy in bulk and freeze the extras, or prepare big batches of food and freeze smaller portions for later. If you have a chest freezer, look into splitting a cow or a pig with friends. This can sometimes land you a great deal on a pasture-raised animal.
Throwing away food is throwing away money. There’s no reason to waste food if you have a freezer. Most leftovers can be frozen if you’re not going to consume them immediately (though some things, like mashed cauliflower, don’t reheat well). If your avocados are on the verge of going bad, slice and freeze them. Blend fresh herbs with your oil of choice and freeze them in ice cube trays to add to soups and sauces later. Strain leftover bacon grease into a jar and freeze that, too.
My favorite freezer trick is to keep a large zip-top bag to which I add vegetable trimmings like the ends of carrots, celery, onions, and beets, and broccoli stems. I also keep the bones from all the delicious bone-in meat I’m cooking. (I always buy bone-in when I can—it’s one of Dr. Cate Shanahan’s Four Pillars of health.) This allows me to…
8) Make Your Own Bone Broth (and Nut Milk)
Bone broth is a hot commodity nowadays—no pun intended—and you can spend a pretty penny on it at the store… or you can just make it yourself out of stuff that other people are throwing away.
Whenever I cook a whole chicken (which is usually more cost-effective than buying just breasts or thighs), or when my aforementioned freezer bags fill up, I make a batch of bone broth in my slow cooker or Instant Pot. To store it, I freeze it in mason jars or silicone muffin cups. The latter makes broth “pucks” that are uber convenient for adding to dishes later.
Nut milk isn’t necessary for keto obviously. However, if you’re dairy-free and buying nut milk, you really have to try making your own. It couldn’t be easier, and I strongly prefer my homemade nut milk (a blend of almond, hazelnut, and Brazil nut) to anything I can find in the store. As a bonus, I use the leftover nut pulp to make pancakes, bread, and rolls. (See the recipe in The Keto Reset Diet.) It’s a double bang for my buck, and no waste.
The Good News…
Despite the naysaying, it’s not only possible to do keto on a budget, but sometimes going keto actually saves you money. First, many people are able to reduce or eliminate certain medications—insulin, blood pressure meds—which can be a significant monthly savings. Second, once you’ve become keto-adapted, you might find that you’re eating fewer calories overall for the same amount of energy. Mark touts this benefit all the time.
Also, your “non-essentials” budget usually goes down. I’m talking things like frappuccinos, restaurant desserts, and alcohol. The cost of a night on the town decreases significantly when you’re fully buzzed off a glass and a half of wine once you go keto! (And when you’re not ordering 2 a.m. pizza.)
So, let me turn it over to you: Do you have other tips for making Primal+keto easier on the wallet? Share them below, and have a great week, everybody.
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I don’t like being told what to do. That’s why I’m not a fan of hard and fast food rules, as I’ve written before. Don’t get me wrong, that doesn’t mean I believe all foods are created equal. There are foods that aren’t health-promoting in any context. (I’m looking at you, processed chemical nacho cheese-like sauce.) Nevertheless, I’m incredulous when people suggest that they’re not “allowed” to eat certain foods on a Primal or keto diet.
Sure, we Primal folks choose to center our diets around the foods in the Primal Blueprint Food Pyramid. And once you go keto, higher-carb foods—even nutrient-dense ones—are harder to fit into your daily macros if staying in ketosis is important to you. However, I’ve found that keto people are overly prone to policing one another’s food choices based on their notions of keto.
Context is important. As a metabolically healthy person, I recognize that I have the luxury of eating more carbs than someone who’s insulin resistant and who struggles to regulate blood glucose. I also have the freedom to move in and out of ketosis in a way that someone doing a therapeutic keto diet might not.
Depending on your circumstances, the “rules” of keto might be different for you than they are for me. My beef is with people who insist that everyone adhere to the strictest possible version of keto no matter the context or who villainize “carbs” as if that’s a discrete food group. Different foods provide different benefits, so I prefer to incorporate as many types of food as I can within reason. Plus, variety helps me enjoy my diet more.
I don’t want to exclude foods just because they don’t work for someone else—or because of some arbitrary notion that they “aren’t keto.” In fact, here’s a list of foods that people have genuinely told me I’m not allowed to eat on keto, presumably because they’re too high-carb. (And, yes, I eat all these foods even when I’m keto.)
Disclaimer: Of course, I’m not suggesting that you have to eat these just because I do. This is simply a reminder that you don’t have to listen to the keto police. You can and should find a way of eating that suits you personally.
(Note: the carb counts are from Cron-o-meter and reflect the servings I’m used to eating while keto.)
I love beets, so the blame and shame around beets while keto makes me shake my head. Sure, as a root they’re higher in carbs than above-ground veggies. The ½ cup of cubed cooked beets I add to my Big-Ass Salad comes in at 8 grams of carbs.
To me, that’s not bad, especially weighed against the health benefits of beets. They happen to be a fantastic source of folate, manganese, potassium, and other nutrients. The betalain found in beets has been studied extensively as an anti-inflammatory, antioxidant compound with a variety of potential medical applications. Beets are also rich in nitrates, which can be cardioprotective, improve blood flow to the brain, and—of particular interest to me—improve cardiorespiratory endurance in athletes. (Although research focuses mostly on beetroot juice or concentrate, eating whole beets appears to work, too.)
I’ll keeping my beets, along with the greens.
You’ll see a lot of soapbox rants on keto boards decrying berries, which is surprising because berries are GRAOKFK (generally regarded as O.K. for keto). Nonetheless, there are plenty of people out there proclaiming that blueberries are too high-carb for keto. I’ve also seen people argue that only blueberries are allowed (presumably because they’re a “superfood”—more on that in a moment).
Take a look at the carbohydrates in these common berries:
- Blueberries (1/3 cup ): 7 grams
- Blackberries (1/3 cup): 5 grams
- Raspberries (1/3 cup): 5 grams
- Strawberries (1/3 cup): 4 grams
As you can see, blueberries actually deliver the most carbs among these options, but their carb count is still pretty modest. Anyway, berries are healthy and delicious. All berries score well on the antioxidant charts, but blackberries and raspberries actually have slightly higher ORAC values than “superfood” blueberries (the blueberry industry must have a better marketing team). Berries also score low on glycemic index (GI) and glycemic load (GL), although blueberries push the middle range of GI.
The bottom line is: if your carb budget is tight, sure, go for strawberries instead of blueberries, but blueberries are hardly a “non-keto” food.
There’s a running joke in our Keto Reset Facebook group about carrots. Along with beets, carrots tend to be metaphorically slapped out of your hand if you admit to eating them in some of the other online keto groups.
I’ve known keto folks who’ll pick the shredded carrot out of packaged broccoli slaw or restaurant salad mix. The thing is, if you manage to painstakingly pick ¼ cup of shredded carrot from your salad, all the painstaking effort saves you less than 3 grams of carbs. (Not worth it if you ask me.) Even a large whole carrot contains only 7 grams of carbs—and low-GL carbs, at that.
I don’t know where this fear-mongering came from. Perhaps it’s because carrots are a root vegetable, and one of the keto police rules is that root veggies are not keto. While it makes sense that most of your vegetable intake should be in the form of above-ground vegetables, that doesn’t necessitate avoiding every shred (literally) of healthy root vegetables.
Truth be told, I don’t eat cashews all that often. At 10 grams of carbs in ¼ cup, they are higher carb than any other nuts I eat regularly, and for no special health benefits. Check out my Definitive Guide to Nuts for the lowdown on how different varieties compare.
One application I do appreciate is cashew cream for dairy-free and egg-free recipes such as this one. Personally, I have no problem with dairy, but for people with food sensitivities, this can be a nice option.
I used to have a grapefruit tree in my backyard, and I’ve enjoyed incorporating fresh grapefruit into summer salads now and then. Arugula, shaved fennel, avocado, and grapefruit is a tasty combo.
Caveat: this one is probably the biggest stretch for people who are still struggling with insulin and glucose regulation. Half a small grapefruit—enough for two servings of the aforementioned arugula salad—packs 11 grams of carbs. That said, grapefruit are among the lowest GI and GL fruits, on par with raspberries. If you’re at a place with keto where you’re ready to test your metabolic flexibility and see how you respond to introducing some fruits in moderate quantities, grapefruit might be one to try.
One-quarter cup of homemade cooked pumpkin has 3 grams of carbs (canned unsweetened pumpkin has 5 grams).
So, go ahead and whip up a homemade PSL sweetened with stevia. There’s a recipe in The Keto Reset Diet Cookbook. In fact, you’ll find several pumpkin recipes in there, including directions for making your own puree.
Tomatoes are another one of those “they taste kind of sweet, so they must be bad for keto” foods. Nah. It’s tomato season right now, and I’m enjoying a Caprese salad with cherry tomatoes every single day. The ten cherry tomatoes in my salad have fewer than 7 grams of carbs. A thick slice of tomato on your lettuce-wrapped burger comes in at a whopping 1 gram of carbs.
Keto folks do need to be mindful of the carbs in sugary store-bought ketchup (which is why I created Primal Kitchen® Unsweetened Ketchup). The carbs in a huge plate of zoodles with marinara can definitely add up. As with all the foods on this list, the quantity matters.
Finally, Did I Mention That Context Is Important?
If you’re looking at this list, going, “There’s no way I could allot XX grams of carbs to ____!”, is it because you’re limiting yourself to 20 or 30 grams of carbs per day? If yes, is there a specific reason? The Keto Reset Diet recommends that most people aim for 50 grams of carbs per day, not counting non-starchy vegetables and avocados. (If you’re doing a therapeutic keto diet, or if you’re highly insulin resistant, you might do better starting at 30 grams per day.)
With any of these foods, if you aren’t sure if they work for you, consider experimenting. I’m not a huge proponent of measuring and assessing everything, but in this case it might offer helpful info. Eat the food you want to include, then test your blood glucose and ketones two hours later. For example, if you want to add a handful of blueberries to your Big-Ass Salad, try it and see how your body responds. Of course, this only works if you know your baseline blood glucose and ketones—and if you also know how your body responds to the salad without the blueberries.
Or you don’t have to be that systematic about it. Barring a medical need to be in ketosis all the time, you can go by subjective evaluations of how you feel when you include certain foods.
Finally, if you are working with a limited carb budget and want to expand your vegetable (and even fruit) repertoire, considering targeting your intake of these foods around exercise to blunt the effect.
There you go, folks. Surprises? Additions? Responses? Share your thoughts below, and have a great rest of the week.
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It’s easy to forget how weird we all are.
You spend your days reading this and other health blogs, communing with Primal and keto folks on social media, staying abreast of the nutrition literature, arguing about arcane metabolic minutiae on forums, counting your linoleic acid intake, and you forget that most people don’t know 2% of what you know about diet.
So, when you hear people criticize keto, don’t get exasperated (even if the criticisms are silly). Be ready to respond. And hey, not all criticisms are unfounded. In many cases, wrangling with them will only make you more honest and informed about your diet. Let’s look at some of the more astute keto critiques….
1) Your Brain Needs Glucose, How Do You Even Think?
This isn’t so much wrong as incomplete. Yes, the brain famously needs glucose—but not as much as we’re lead to believe. Once you’re keto-adapted, ketones can provide most of the brain’s energy needs. At max ketone production and adaptation, you’ll still need about 30 grams of glucose for your brain.
Your liver can make about 150 grams of carbohydrates a day from gluconeogenesis, so even if you don’t eat any carbs at all (and you can definitely eat carbs on keto) you’ll still be able to manufacture the requisite 30 grams of glucose.
2) Don’t You Need Carbs for Energy?
The beauty of keto (and low-carb eating in general) is that it leads to low insulin—both fasting and post-prandial (after meals). When your insulin is low, you’re able to access your stored body fat and liberate it to be burned for energy. Since even the leanest among us carry pounds of body fat, that means you have tens of thousands of calories of clean-burning energy available for liberation at any time.
Once you’re keto-adapted, you’ll most likely find that you have steadier energy than before.
3) How Do You Get Fiber?
Actually, there are plenty of ways to obtain fiber on a ketogenic diet. Many of the best sources of prebiotic fiber—the kind that feed and nourish the good gut bacteria living in your digestive tract—are fairly low in digestible carbohydrates and mesh well with keto. For example:
- Dandelion greens
- Green bananas (Yes, a green banana is mostly resistant starch, which your body cannot digest.)
- Dark chocolate
- Almonds and pistachios
Plenty of fiber in those.
4) How Do You Exercise Without Carbs?
There are two primary energy systems used during exercise: aerobic and anaerobic. Aerobic energy relies on fat; anaerobic relies on glucose. The better you are at burning fat, the more work you can do while remaining aerobic. This preserves stored glucose (glycogen) for more intense efforts, increasing your overall energy efficiency. Particularly for endurance training, being keto-adapted allows you to utilize greater amounts of stored body fat for energy and reserve glycogen for when you really need it.
And besides, if you do engage in glycolytic, glucose-intensive training, you can always cycle carbs in and around your workout sessions. Your insulin-sensitive muscles will suck up any glucose you consume as glycogen without affecting your insulin levels or your ability to generate ketones and burn fat.
5) Doesn’t All That Fat Give You Heart Disease?
The vast majority of studies placing people on low-carb, high-fat or ketogenic diets find that markers of heart health improve rather than decline.
In obese adults with type 2 diabetes, a ketogenic diet improved blood lipids and boosted fat loss compared to a low-calorie diet.
In lean, healthy adults without any weight to lose (and who didn’t lose any weight during the course of the diet), total cholesterol went up from 159 to 208 mg/dL and triglycerides fell from 107 to 79 mg/dL. A lipophobic doc might freak out at the rise in TC, but given that the triglycerides dropped, I bet the change reflects a rise in HDL and an overall positive, at worst-neutral effect.
Now, do some people see classically-deleterious changes to their blood lipids? Sure. Anything can happen. We’re all different. I talk more about keto and cholesterol effects here. But the weight of evidence shows that becoming fat-adapted through a keto diet is better for your heart health than not.
6) You’re Just Losing Water Weight, Not Fat
Here’s the truth:
Yes, when you go keto and start shedding glycogen from your liver and your muscles, you lose a lot of water. That’s because every gram of glycogen is stored with 3-4 grams of water. Burn the glycogen and you lose the water along with it.
But this glycogen-and-water loss is a prerequisite for losing “real” weight. It’s a harbinger for fat loss. Once the glycogen runs low, that’s when you start getting into deep ketosis and developing the ability to burn massive amounts of body fat for energy.
7) I Heard the Keto Diet Kills Your Gut Bacteria
Ah, yes, I remember that study. They either fed people a varied diet of fruits, vegetables, grains, legumes, and other foods—or a diet of lunch meat and cheese. Turns out the lunch meat and cheese “keto diet” was bad for the gut biome, increasing gut bacteria linked to obesity and metabolic problems and decreasing gut bacteria linked to health. Of course it was.
A keto diet doesn’t have to consist of bologna and American cheese slices. In fact, it shouldn’t. As I explained in the fiber section, a well-formulated ketogenic diet is full of prebiotic fiber, non-starchy vegetables, and even low-sugar fruit that provide plenty of nourishment for your healthy gut bacteria. What these studies and media stories attack is a caricature of keto, a diet full of processed meat and low quality cheese. They aren’t relevant for someone following a Primal keto diet.
8) Keto Isn’t Sustainable
Well, what do you mean by sustainable?
If you’re talking about the “restrictiveness” of the diet at a personal level, that depends. Sure, you can’t go keto and continue eating Pop Tarts and donuts for breakfast, heaping bowls of pasta for lunch, and fast food burgers (with the bun, at least) and fries with a shake for dinner. But you can eat eggs, bacon, and blackberries for breakfast. You can eat a Big Ass Salad full of a dozen different species of vegetables for lunch. And you can have a ribeye with buttered broccoli for dinner with a glass of wine. I don’t know about you, but that’s a pretty damn sustainable way to eat in my book.
If you’re talking about the environment, and worrying about farting cows or whatever, the evidence is quickly accumulating that properly-raised and managed grazing livestock can sequester more carbon than they emit, revitalize (and even de-desertify) grasslands, and produce more calories-per-unit-of-input than conventional pasture-raising. A large portion of the world’s surface isn’t even suitable for growing crops and is better used for grazing animals. The environmental sustainability of meat-eating is still an open question, but the popular conception of “meat bad, grains good” is completely incorrect and incomplete.
What other keto criticisms have you encountered in the wild? Leave them down below, and thanks for stopping in today, everyone.
Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-zaid N, Dashti HM. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012;28(10):1016-21.
Phinney SD, Bistrian BR, Wolfe RR, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation. Metab Clin Exp. 1983;32(8):757-68.
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For today’s edition of Dear Mark, I’m answering questions from the comment sections of the recent posts on daily keto carb limits, within-meal keto carb limits, and electrolytes. I’m addressing questions about alcohol, uniform carb allowances versus personalized, potassium supplementation, salt appetite, salt water, electrolytes after the transition, whether fruits fit in, and why I don’t count above-ground non-starchy vegetables.
Without further ado, let’s go:
How does alcohol count towards the 50g of carbs per day? Would that be measured proportionate to the caloric values (ratio 7 (a) : 4 (c) ) or is it easier to simply ignore alcohol along with the fiber … ?
Alcohol doesn’t “count” as a carb, but I wouldn’t ignore it.
The body stops burning other macronutrients in the presence of alcohol until the alcohol is metabolized. When you consume alcohol, the body suppresses oxidation of fat, carbohydrates, and protein. The alcohol itself can’t really be stored as fat, but its inhibition of traditional fuel oxidation means you’re more likely to store rather than burn dietary fat.
If you’re keeping carbs low to improve body composition, you should definitely take alcohol calories into account.
Why is 50g of carbs set as the upper limit for everyone? Wouldn’t it make more sense to set the limit using macro percentage?
My BMR is roughly 1300 kcal, so 50g of carbs corresponds to a macro ratio of 15% (a bit above the suggested 5-10%).
Is it more important to follow the 50g upper limit or the macro percentage?
Ease of use. I want to make this as effortless as possible for as many people as possible.
And again, it’s total carbs, not net, and you’re eating whole foods, so a good number of those 50 grams will be fiber and thus indigestible (by you).
It all seems to balance out in the end and end up “lower carb” than one might assume by looking at “50 grams of carbs”—for most people.
If people try this and it doesn’t work, then they can come with follow-up questions and get the detailed guidance they need. They can get more specific and take the (admittedly small amount of) time to calculate their macros.
How about low-sodium salt for extra potassium?
Not a big fan. Potassium citrate powder seems to work a lot better than potassium chloride (low-sodium salt) in several areas:
It’s quite tasteless, whereas potassium chloride’s taste is quite distinct.
Just make sure you clear potassium supplementation with your doctor, especially if you have or suspect you have kidney health problems; the kidneys excrete excess potassium, and a bad kidney can make potassium supplementation dangerous.
I’ve struggled with postural hypotension since childhood, but it used to be caused mainly by excessive heat. Recently I made the connection that if I don’t drink caffeine, it goes away completely. Soon as I drink it I’m lightheaded again, *especially* if I’m also pregnant. I could probably benefit from increasing my salt intake dramatically. I find that if I add 1/4tsp sea salt to a cup of water it tastes amazing, so that probably indicates I need more salt. I heard an interview where someone recommended adding salt to water especially if you drink coffee, and they said it tastes gross like you’re drinking sweat, but I really think it tastes delicious.
This is a really important point. Your craving for salt appears to track closely with salt requirements.
The more sodium you need (and the more you’ve excreted), the better salt will taste if you’re eating a natural, whole foods diet without the skewing effect of processed food products. That’s probably why salt in your water “tastes amazing.” This jibes with my personal recommendation for salt:
“Salt food to taste. Don’t avoid added salt if your taste buds and intuition suggest you could and should have some extra.”
I hesitate to offer iron-clad numbers for potassium and magnesium (even though I gave some ranges in the last post). “Sisson says take 200 mg of this and 300 mg of that.” We don’t want that. We don’t know everyone’s needs. We don’t have a “potassium appetite” or a “magnesium appetite,” but potassium tracks largely with sodium and most people aren’t getting enough magnesium so I feel comfortable saying “eat more of them” and having people follow their salt appetite.
Still, I’ll also mention that some people are clinically salt-sensitive, and the effects can be significant, especially in terms of blood pressure. It’s always best to let you doctor know. It’s a definite must if you’re salt sensitive.
Does anyone make a “sole” by diluting pink Himalayan salt, Red Hawaiian Alaea, etc. into water?
Any success with that method?
I’ll sometimes put a few healthy pinches of Hawaiian red salt into a glass of water before bed. When I wake up, it’s totally dissolved and I throw it back. Tastes good for sure.
What I do often is have a couple of mugs of black coffee in the morning with the last one having butter and coconut oil in it.
Then walk 18 holes while drinking a couple of bottles of spring water each with a pinch of Himalayan sea salt.
Seems to work for me
I like it. If it seems to work, it’s working.
Thank you so much for this articles, Mark. You are the first keto expert I have read who says to add electrolytes “for the transition”! I am no longer in the transition period…but I still take all my electrolytes daily. Is a person who is fat-adapted supposed to wean themselves from supplemental electrolytes?? I’ve been keto for over 18 months, and I really do not think I have heard that particular advice before. Could you clarify? Thank you again!
While transition is the most important and full fat-adaptation means you won’t be shedding water/glycogen as often and all the electrolytes with it, you’re not out of the woods entirely because you’ll still be enjoying low insulin levels. And what doesn’t change post-transition is the inhibitory effects of low insulin on sodium retention. If you’re living a low-insulin lifestyle, you won’t retain as much sodium—you’ll expel more—and you should probably maintain higher levels in your diet long-term. Keep your doctor in the loop.
Since potassium loss is downstream of sodium loss (from the kidneys trying to balance out your potassium:sodium ratios), you’ll also need to keep potassium intake up.
And pretty much everyone could use more magnesium, so taking some extra there, too, is likely a good idea.
Question, so should the carbs be coming from below-ground vegetables like beets and onions and carrots, or if it falls under said carb amount per meal, does it matter if it comes from higher sugar fruits or from potatoes? My meals tend to be usually proteins and above ground vegetables, so I wouldn’t be counting any of those. For example I really like pink lady apples. The ones I buy state 16g carbs per apple. Having one of those with a meal would be fine? How about without a meal, would that be more likely to knock someone out of ketosis?
Below ground vegetables and potatoes and fruits all work and count. An apple counts, is completely fine to eat if it fits your personal carb allowance (and even if it doesn’t—it’s your choice!). If you have an apple by itself, there won’t be any fat or protein to slow down the assimilation of glucose, so you’ll get a “faster hit” that could “knock you out” of ketosis. But ultimately it’s about that meal in the context of your daily carb intake, your exercise levels, whether you’ve just trained or gone for a long walk, your fat-adaptation progress, and your goals.
I’m unclear as to why Mark says “don’t count above ground, non-starchy vegetables”. I mean, they have net carbs after you subtract the fiber. Surely a carb is a carb? I can easily eat 15 grams of carb per day in kale and broccoli alone; sometimes in a single meal..
You won’t ever find an athlete carbing up with kale before a race.
That’s it for today, folks. If you have any further questions or comments, let me know down below!
Granchi D, Caudarella R, Ripamonti C, et al. Potassium Citrate Supplementation Decreases the Biochemical Markers of Bone Loss in a Group of Osteopenic Women: The Results of a Randomized, Double-Blind, Placebo-Controlled Pilot Study. Nutrients. 2018;10(9)
Nicar MJ, Peterson R, Pak CY. Use of potassium citrate as potassium supplement during thiazide therapy of calcium nephrolithiasis. J Urol. 1984;131(3):430-3.
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