Ketogenic Diets: Fat-Filled Lies Won’t Make You Slim (or a Better Athlete)

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How do you turn your body into a fat burning machine, run faster than Usain Bolt, recover from exercise immediately and wake up each day bursting with energy? According to some people, the ketogenic diet is your answer (learn the basics of this diet here). This high-fat, moderate protein diet that is practically void of carbohydrates forces your body to use fat for energy. LeBron James supposedly tried it and offensive lineman decided to give it a shot after an ex-NFL center and O-line coach LeCharles Bentley recommended it. However, the offensive lineman and LeBron weren’t actually following a ketogenic diet. Though these athletes didn’t really know what they were following (no worries LeCharles, I’m sure your nutrition advice is on par with me coaching the O-line), people who actually follow it swear by it. Could this be an unconventional path to weight loss and better health? Unfortunately, the ketogenic diet craze has been fattened with misinformation.

Here is what I am covering in this post:

  • Eat Fat, Lose Fat? Does the ketogenic diet make you lose weight?
  • How does this diet impact muscle?
  • The ketogenic diet and athletic performance.
  • The issue with ketogenic research studies.

I am not covering “training low” or low carbohydrate  / non-ketogenic diets in this article.

Eat Fat, Lose Fat?

During the first several days on a ketogenic diet your weight will take a nosedive. Carbohydrate is stored in the form of glycogen in liver and muscle. Each gram of carbohydrate is stored with 3 – 4 grams of water. Decrease your carbohydrate intake, use glycogen and you’ll lose water weight very quickly. Weight loss, even if from water, can motivate people driven by the number on the scale. Given that adherence is the number one predictor of weight loss when on a diet, we can’t discount psychological effect of the number on the scale going down.

What happens if you stay on the diet? A group of NIH researchers admitted seventeen overweight or obese men to a metabolic ward and placed them on a high carbohydrate baseline diet for four weeks followed by four weeks on an isocaloric ketogenic diet (this diet contained the same amount of calories as the high carbohydrate baseline diet). The men lost weight and body fat on both diets. The ketogenic diet did not lead to greater fat loss as compared to the high carbohydrate diet and in fact body fat loss slowed during the ketogenic diet and subjects lost muscle (1). Time to chuck the “carbohydrates make you fat” books in the recycling bin.

What about other studies showing ketogenic diets help athletes lose body fat and maintain performance? These studies were not actually using a ketogenic diet protocol but instead were high fat, high protein, low carbohydrate diets. Also, none of the studies measured if the study subjects were actually in nutritional ketosis (2, 3, 4).  See the section on The Issue with Ketogenic Research Studies for more information on this topic.

Ketogenic diet and weight

Regardless of the studies indicating the ketogenic diet will not lead to greater weight loss as compared to a diet composed of the same amount of calories, some may lose weight because they will end up cutting down on their favorite foods. Fewer food choices often means fewer calories consumed.

Muscle Up with the Ketogenic Diet?

The ketogenic diet isn’t high enough in protein for maximal muscle gains. Using the lower end of fat intake on a classic ketogenic diet (80% of calories), one could consume 15% of calories from protein (112 grams) on a 3,000-calorie diet. Protein requirements are at least 1.2 – 1.8 grams of protein per kilogram bodyweight (or 0.55 – 0.82 grams per lb. bodyweight) per day if training and eating a diet with enough calories to maintain weight. Protein needs go up if you are cutting calories to spare the breakdown of muscle tissue when dieting. On this diet, 112 grams of protein equals just under 1.3 grams of protein per kg bodyweight for a 200 lb. person and even less for anyone who weighs more.

In addition to inadequate protein intake, “the ketogenic diet reduces many of the signaling molecules involved in muscle hypertrophy (growth),” states Dr. Antonio Paoli, M.D., B.Sc., Associate Professor and Vice Dean of the School of Human Movement Sciences, University of Padova. Without getting too technical, even with sufficient calorie intake, the ketogenic diet suppresses the IGF-1 / AKT / mTOR pathway (5). Using ketones for energy slows muscle breakdown. However it doesn’t stop this process (5).

The Ketogenic Diet and Athletic Performance

Once fully adapted to a ketogenic diet, athletes can supposedly rely on a seemingly endless supply of body fat for energy. No need for carbohydrate gels, beans, gummies and sports drinks every 15-30 minutes during long runs, rides or triathlons to sustain energy levels. Fewer calories consumed may make it easier for some people to stay within their total daily calorie needs (though if you are training that much staying within your calorie requirements shouldn’t be difficult).

Trading carbs for fat seems like a huge benefit for athletes, particularly endurance athletes who train and compete for several hours at a time (6). In addition to utilizing body fat, fat actually produces more energy (ATP) (5). However, fat is a slow source of fuel (see graphic below), the human body cannot access it quickly enough to sustain high-intensity exercise and therefore, this diet is really only (potentially) applicable to ultra-runners and triathletes competing at a relatively moderate to slow pace.

In a ketogenic diet study examining athletic endurance, researchers had subjects cycle at a snails pace (equivalent to a heart rate of about 120 beats per minute for anyone 20-30 years old or 115 for a 40 year old) until they became exhausted before and after 4-weeks on a ketogenic diet. There were no differences in the amount of time they were able to cycle before getting tired prior to or after the four-week ketogenic diet (7). In studies examining high fat diets (not ketogenic and ketones weren’t measured) and endurance performance, study subjects relied on more fat as opposed to carbohydrate during low intensity exercise, yet there was no clear performance advantage on the higher fat diet (8). A recently published study examined 20 elite ultra-marathoners and Ironman distance triathletes. Some were habitually consuming a traditional high carbohydrate diet while the other group was following a ketogenic diet (slightly adjusted macronutrient ratios yet they were in ketosis as measured by blood ketone levels). As expected, those following a higher fat diet used a greater percentage of fat for energy while the higher carbohydrate diet group used more carbohydrate for energy during a 180 minute submaximal running test (I’d call that leisure running intensity). There was no difference in calories burned over the course of the run. Both groups had the same level of perceived exertion and there was no test to determine performance differences between groups (9).

If there’s no performance benefit and we know carbohydrates work, why follow this diet? If your primary goal is weight loss, it doesn’t matter if you use more fat than carbohydrate while exercising (SN: can we please stop talking about the fat burning zone) as long as you’re burning more total calories over the course of the day. Plus, in the interest of (if you are not an ultra endurance athlete) jack up the intensity and burn as many calories in a short period of time as possible. Unfortunately, a ketogenic diet won’t help you do that – when relying on fat for fuel, the intensity of your exercise will drop – the body simply can’t access fat (a slow source of energy) quickly enough to sustain high-intensity exercise. Instead, carbohydrates are necessary for high intensity activity.
ketogenic diet and sports

The Issue with Ketogenic Research Studies

Here’s the issue with many ketogenic research studies and media reports based on them: in most cases, the study subjects were not actually following a ketogenic diet – they were following a higher fat, high-protein low carbohydrate diet (10, 11, 12). Each person’s carbohydrate and protein limits needed to stay in ketosis vary and therefore, measuring ketones through blood or urine is the only definitive way to determine if you are in ketosis. Complicating matters more, low carbohydrate diets (including ketogenic diets) lead to a substantial drop in carbohydrate content, and associated water stored with it, in muscle. This change overestimates the drop in lean body mass as measured by DEXA.

ketogenic and low carbohydrate diets

There are no modifications, higher protein intakes or “on again, off again” (where you go on it one day and off it the next) to this diet. You must be in a state of nutritional ketosis or you will need to decrease carbohydrate and protein intake even further to get into nutritional ketosis and rely on ketones for energy.

Is There Any Benefit?

Ketogenic diets help decrease incidence and severity of seizures in epileptic patients (this is what the diet is intended for). Also, ketogenic diets may be beneficial when implemented soon after a traumatic brain injury (including concussion) (13). In addition, scientists are examining if this diet is beneficial for diseases that affect the brain such as Alzheimer’s.

If you want to lose weight, the ketogenic diet is not superior to a reduced calorie diet. Also, unless you are an ultra endurance athlete who just loves dietary fat, hates eating at social occasions and can put up with the potential side effects from this diet it isn’t for you.
Now where is the O-line? I’ve got some coaching to do…

References

1 Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Jul 6. [Epub ahead of print]

2 Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients 2014;6(7):2493-508.

3 Rhyu HS, Cho SY. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. J Exerc Rehabil 2014;10(5):326-31.

4 Paoli A, Grimaldi K, D’Agostino D et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. JISSN 2012;9:34.

5 Paoli A, Bianco A, Grimaldi KA. The ketogenic diet and sport: a possible marriage? Ex Sports Sci Reviews 2015.

6 Volek J, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci 2014;2:1-8.

7 Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism 1983;32(8):769-76.

8 Burke LM, Kiens B. “Fat adaptation” for athletic performance: the nail in the coffin? J Appl Physiol 2006;100(1):7-8.

9 Volek J, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt pm, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic characteristics of keto-adapted ultra-endurance runners. Metab Clin Exp 2016;65(3):100-110.

10 Tinsley GM, Willoughby DS. Fat-Free mass changes during ketogenic diets and the potential role of resistance training. Int J Sport Nutr Exerc Metab. 2015 Aug 12. [Epub ahead of print]2 Rouillier MA, Riel D, Brazeau AS, St. Pierre DH, Karelis AD. Effect of an Acute High Carbohydrate Diet on Body Composition Using DXA in Young Men. Ann Nutr Metab 2015;66:233-236

11  Paoli A. The ketogenic diet and sport: a possible marriage? Ex Sci Sports Sciences Rev 2015;43(3):153-62.

12  Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am Society Clin Nutr 2008;87(1):44-55.

13 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011). The National Academies Press, Institute of Medicine. Washington DC. 2011 http://www.nap.edu/read/13121/chapter/15

 

Electrolytes That Will Help You Stay Hydrated & Perform Better

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tennis athleteElectrolytes are minerals that help you stay hydrated, regulate nerve functioning, and influence muscle contraction and relaxation. Any electrolyte disturbance can potentially hinder athletic performance and may lead to muscle weakness, muscle twitching, dehydration, and cramping.

Sodium and chloride (together they make table salt) are the major electrolytes lost through sweat followed by smaller amounts of potassium, calcium, and magnesium. Sodium is the primary electrolyte that needs replacing during exercise. In a healthy individual, blood potassium is well regulated. Also, supplemental potassium in high doses can be very dangerous therefore, while some electrolyte replacement products provide a tiny bit of potassium, this isn’t an essential ingredient.

Sweat sodium losses vary tremendously between athletes with reported losses ranging from the amount in a “pinch” of salt (0.2 grams of sodium) per liter (1 liter = 4.23 cups) of sweat to over 12.5 grams of sodium per liter (12.5 grams of sodium is the amount in 5.4 teaspoons of salt) of sweat. Sweat sodium losses are dependent on an athlete’s dietary sodium intake, sweat rate, adaptation to heat, and rehydration source (and how much sodium their during exercise beverage contains).

Hydrating with water alone can help prevent over-heating, though sodium helps your body hold onto the fluid you drink. In fact, relying solely on water and drinking tons of water (let’s say you only rehydrate with water during a four hour marathon) can dilute blood sodium levels and contribute to hyponatremia (dangerously low blood sodium that can result in muscle weakness spasms or cramps,  headache or confusion, low energy and at worst, brain swelling, seizure and coma). Drink tons of water after exercise to rehydrate and you’ll pee a good bit of it right back out. Popular sports drinks typically provide varying amounts of electrolytes though some athletes may need to add sodium to their sports drink to fully replace sodium lost through sweat.

If you find that you need more sodium, start by adding 50 – 100 mg for every 8 oz. of fluid. So for instance, mix ½ packet Gatorlytes into a 32 oz. bottle of Gatorade or PowerAde (or similar sports drink).

Electrolyte Comparison Chart

Product, Rating, Description Bottom Line
Gatorlytes   ****
1 packet; powder
– Mix in any amount of water or other beverages
– No calories– Sodium: 780 mg
– Potassium: 400 mg
– Magnesium: 40 mg
Easily mixes into any beverage; good amount of sodium and you can use part of a package if you want a partial serving.

 

Generation UCAN Hydrate  **
1 packet; powder
– Mix in 16 – 20 oz. water
– No calories
-Lemon lime flavor
-Sweetened with Stevia -Sodium: 300 mg
-Potassium: 100 mg
-Magnesium: 50 mg
-Calcium: 15 mg
Already flavored so this can only be mixed with water. Best for the very light sweater – one who doesn’t sweat much or lose much sodium through sweat.

 

Not for serious athletes.

Hammer Endurolytes   *
2 electrolyte capsules
-Swallow capsules or open & mix in a drink
-Contains glycine to help neutralize the salty taste

-Sodium: 80 mg
-Potassium: 50 mg
-Magnesium: 50 mg
-Calcium: 100 mg

Low in sodium for an electrolyte product. Many athletes would need several capsules.

 

-Xylitol is a common ingredient in Hammer products, which like all sugar alcohols, has the potential cause GI problems

Infinit Nutrition :Speed < 3 hours  ****
1 packet :Speed < 3 hours
– 230 calories
– 55 g carbohydrate from maltodextrin and dextrose

-Sodium: 325 mg
-Potassium: 94 mg
-Magnesium: 5 mg
-Calcium: 3 mg

Good for the athlete who is looking for a sports drink with sodium.

 

Many athletes, especially those who are heavy sweaters or salty sweaters, will need to add additional sodium.

Klean Electrolytes   *
1 electrolyte capsuleThey recommend taking 1 – 3 capsules, depending on sweat rate, weight, and activity duration.

-Sodium: 40 mg
-Potassium: 25 mg
-Magnesium: 25 mg
-Calcium: 25 mg

Relatively low in sodium for an electrolyte supplement.
MyProtein  ****
-flavored Electrolyte powder

-Chloride: 320 mg
-Sodium: 210 mg

This is table salt (exact same ratio of chloride and sodium) with potassium sulfate, calcium di phosphate and magnesium added (it isn’t clear how much is added).
NUUN   *
Electrolyte tablets (12 per tube)
Comes in 3 drink options:1 NUUN Active Hydration Tablet
-Sodium: 360 mg
-Potassium: 100 mg
-Magnesium: 25 mg
-Calcium: 13 mg

NUUN All Day Hydration
– Sodium: 60 mg
– Potassium: 200 mg
– Magnesium: 20 mg
– Calcium: 0 mg

NUUN U Natural Hydration
– Sodium: 180 mg
– Potassium: 77 mg
– Magnesium: 20 mg
– Calcium: 0 mg

NUUN Active Hydration contains sorbitol which is a sugar alcohol that may cause GI (stomach) distress (sorbitol is one of the 2 worst ones for stomach uspet)

 

NUUN’s U natural hydration uses Stevia instead of sorbitol

 

 

Skratch Exercise Hydration mix   ***

Electrolyte mix that can be added into any drink
– 80 calories; 20 grams carbohydrate
– Uses fruit
– No artificial flavors or colors

1 scoop (20 gm) Lemons and Limes Skratch exercise hydration mix:

-Sodium: 240 mg
-Potassium: 40 mg
-Magnesium: 24 mg
-Calcium: 10 mg

As a powder this can be modified to fit a person’s individual needs. It contains carbohydrate though and therefore it may deliver too many carbs at a time when combined with a sports drink or other calorie-containing beverage. Too many carbs at a time = stomach upset.
The Right Stuff   ***

20 ml liquid electrolyte replacement designed as a pre-exercise hyperhydrator (to expand plasma volume via sodium fluid load)

-Liquid form
-Sweetened with Splenda

-Sodium: 1,780 mg
-Chloride: 1,379 mg
-Citrate: 2,953 mg

Good option for “heavy sweaters” or athletes exercising in hot and humid environments (due to its high sodium content). However, there is nothing to suggest The Right Stuff is better than other electrolyte products when equating for sodium content or, in the case of rehydration, other factors that may contribute to fluid balance including macronutrients (fat, protein, carbs).

The research listed on their website is less than impressive since most studies compared The Right Stuff against low and no sodium conditions (the studies were not designed to truly test The Right Stuff but instead make the product look good).
In one well-designed study, that included seven total beverages. Two contained the same amount of sodium, beverages 3 & 4 (The Right Stuff). Oddly beverage 3 is missing from the results data. Also, The Right Stuff didn’t fare better than a lower sodium beverage for improving hydration status after dehydration (technically termed hypohydration). Reference below:

Greenleaf et al. Vascular Uptake of Rehydration Fluids in Hypohydrated Men at Rest and Exercise. NASA Technical Memorandum. August 1992.

You Booze, You Lose. How Alcohol Can Wreck Your Athletic Performance

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It’s called a beer gut for a reason. But, over drinking will do more than just cover up those abs you’ve been working so hard for. Take a close look at how it will wreck your athletic performance:

Athletic Performance & Recovery

Alcohol has a number of effects on the body that can impair performance and delay recovery by:

  • Impairing muscle growth in the short-term – decreasing gains you’ve worked for in the weight room and on the field
  • Disrupting your sleep cycle, which impairs how you learn and retain/recall information (slowed reaction time on the field several days after consumption)
  • Decreasing blood testosterone levels for up to 24 hours after consumption which decreases aggression, lean muscle mass, recovery and overall athletic performance
  • Causing nausea, vomiting and drowsiness for several days after consumption

Body Fat

  • Alcohol interrupts your sleep cycle, which decreases your body’s production of HGH (human growth hormone). HGH promotes muscle mass while decreasing fat mass, is critical for recovery (by stimulating protein synthesis) and is important for immune system functioning.
  • Alcohol suppresses testosterone production.
  • Alcoholic drinks are high in calories and metabolized first, before food so extra calories from food are stored as body fat. Because your liver is busy processing alcohol, fat metabolism is delayed.
  • Alcohol also inhibits your body’s absorption of vitamins B1, B12, folic acid and zinc.

Dehydration

Alcohol is a diuretic that leads to dehydration and electrolyte imbalances. And, dehydration can increase one’s risk of muscle cramps and other muscle injuries.

For all of the younger athletes reading this who feel peer pressure about drinking, think about this, the effects of 3 drinks will last a few days. Drink on Thursday and your reaction time on Saturday will still be impaired (and it may be impaired on Sunday too). Need an out? You just got one. Need another out? Use my all time favorite response when someone asks if you want a drink, “That’s a Clown Question, Bro.”

References:

  • J Clin Endocrin & Metab 1980;51:759-764.
  • Firth G. Manzo LG. For the Athlete: Alcohol and Athletic Performance. University of Notre Dame; 2004.
  • J Am Acad Dermatol 43(1 Pt 1):1-16.