The case for the keto diet

Men's Fitness - - Con­tents -

Is a high-fat, low-carb diet re­ally the an­swer to build­ing a leaner and health­ier body? We in­ves­ti­gate

Fol­low­ing the low- carb, high- fat ke­to­genic or “keto” diet won’t just help you lose weight, ex­er­cise more ef­fi­ciently, feel bet­ter and gen­er­ally im­prove your life; it may also fight can­cer and wipe out di­a­betes for­ever… and even boost your chances of get­ting to Mars. Don’t take our word for it – that’s ac­cord­ing to lead­ing bio­hack­ers, US Spe­cial Forces and even Nasa. So what is it and how can you make it work for you? One of the world’s most ac­com­plished ex­er­cise phys­i­ol­o­gists ex­plains over the page.

While his name may not ring many bells on th­ese shores, Ti­mothy Noakes – emer­i­tus pro­fes­sor in ex­er­cise science and sports medicine at the Univer­sity of Cape Town – is a full-blown celebrity in his home coun­try of South Africa and one of the most ac­com­plished ex­er­cise phys­i­ol­o­gists on the planet. You can’t walk by a restau­rant in Cape Town that doesn’t of­fer a “Noakes op­tion”- say, an av­o­cado stuffed with break­fast sausage and eggs, or a dou­ble cheese­burger with let­tuce and no bun - and ev­i­dence of his teach­ings is ev­ery­where. He’s been en­dorsed by some of the na­tion’s best-known ath­letes, in­clud­ing age­less golf­ing leg­end Gary Player and eight-time Iron­man world cham­pion Paula Newby-Fraser (who said Noakes “has had the most in­flu­ence on how I viewed en­durance sports”). And Noakes even has fans at the very top of govern­ment – he was in­vited to ad­dress Par­lia­ment on nu­tri­tion in 2014, while Pres­i­dent Ja­cob Zuma’s wife Thobeka lost around 30kg in a year fol­low­ing the Noakes plan (the pres­i­dent him­self is ru­moured to be on it too).

To high-per­form­ing ath­letes, Noakes preaches that the long-ac­cepted bedrock tenet of en­durance ath­letic nu­tri­tion – that win­ning per­for­mance is best fu­elled by eat­ing lots of car­bo­hy­drates – is sim­ply wrong. In­stead, he be­lieves ath­letes can al­ter their bod­ies so that their me­tab­o­lism burns fat as a pri­mary fuel source, a phys­i­o­log­i­cal process known as ke­to­sis, ei­ther from stored body fat or from the foods they eat.

But for non-ath­letes and any­one try­ing to lose weight or keep it off, Noakes’s ad­vice is that eat­ing a high-fat diet, with few if any re­fined carbs and as lit­tle sugar as pos­si­ble, will switch on the same fat-burn­ing sys­tem and keep your body lean and your weight sta­ble with­out mak­ing you hun­gry. Ac­cord­ing to Noakes and a grow­ing num­ber of nu­tri­tion­ists, phys­i­ol­o­gists and bio­hack­ers, when you’re in a state of ke­to­sis – best at­tained by fol­low­ing a strict ke­to­genic diet – good things hap­pen to your body.

In 2014, bas­ket­ball su­per­star LeBron James lost 11kg and upped his late-game en­durance af­ter cut­ting carbs and sug­ars

from his diet for two months. The same year, ul­tra-fit prop­erty en­tre­pre­neur Sami Ink­i­nen rowed with his wife from Cal­i­for­nia to Hawaii in record time on a keto diet, partly in an at­tempt to pro­mote high-fat eat­ing and raise aware­ness about the dan­gers of too much sugar. Tim Fer­riss, au­thor of the 4-Hour self-im­prove­ment book se­ries, says fol­low­ing a strict keto diet cured his Lyme dis­ease and per­forms a multi-day

fast ev­ery four months with the aim of push­ing ke­to­sis fur­ther and starv­ing in­cip­i­ent pre-can­cer­ous cells of sugar (more on that later). The keto diet, say its sup­port­ers, is a nat­u­ral way to re­pro­gramme your me­tab­o­lism and up­grade your body’s op­er­at­ing sys­tem. You’ll feel bet­ter, you’ll per­form bet­ter and your body fat will plum­met.

But this low-car­bo­hy­drate, high-fat (LCHF) diet – as Noakes calls it – is still far from main­stream. It takes se­ri­ous ded­i­ca­tion to drop your daily to­tal carb in­take to be­low 50g (or 20–30g of net carbs, which means with­out fi­bre), the equiv­a­lent of a medi­um­size serv­ing of brown rice. And in the US, govern­ment di­etary guide­lines were only changed in 2015 to men­tion lim­it­ing in­take of added sug­ars and re­fined carbs (which spike blood sugar more rapidly than sweets), while in Bri­tain NHS guide­lines still main­tain that a third of our calo­ries should come from “starchy foods such as pota­toes, bread, rice, pasta and ce­re­als”. Sports drinks are of­ten loaded with nat­u­ral or added sug­ars, while su­per­mar­kets are packed with foods la­belled “low fat” or “zero fat”.

While many gov­ern­ments (in­clud­ing the UK’s) still ad­vise lim­it­ing all fats in the diet, Noakes has con­tin­ued preach­ing that the right kinds of fats – the ones our bod­ies evolved to process, like an­i­mal fat, but­ter, olive oil and co­conut oil – are ex­tremely healthy. He called his 2012 mem­oir Chal­leng­ing Beliefs, and he’s still wag­ing a pub­lic war against carbs and sugar from his Twit­ter ac­count, @ProfTimNoakes, with more than 33,000 tweets since 2012. The 67-year-old Noakes is con­stantly ac­tive on so­cial me­dia, shar­ing the lat­est nu­tri­tion sto­ries as well as of­fer­ing his own food for thought: “Con­sump­tion of re­fined grains, sweets and desserts, sug­ared drinks, and deep-fried foods = more heart dis­ease” or “Truth wins in the end. But it takes time.”

Noakes’s war on sugar goes back a gen­er­a­tion to when his fa­ther de­vel­oped type 2 di­a­betes,

a dis­ease that causes the body to grad­u­ally lose its abil­ity to reg­u­late blood sugar through the pro­duc­tion of the hor­mone in­sulin. It’s linked to ge­net­ics, but also to diet – par­tic­u­larly sugar and re­fined carbs – as well as obe­sity and in­ac­tiv­ity. Di­a­betes ex­perts say the dis­ease speeds up the age­ing process by roughly a third as ex­cess blood sugar slowly de­stroys blood ves­sels, with re­sults rang­ing from mild – early wrin­kling of skin – to cat­a­strophic: heart dis­ease, blind­ness, stroke, am­pu­ta­tions ow­ing to poor cir­cu­la­tion, and even Alzheimer’s dis­ease.

Noakes’s fa­ther even­tu­ally died from type 2, but be­cause Noakes him­self fol­lowed a low-fat diet, ex­er­cised reg­u­larly (he’s run more than 70 marathons and ul­tras) and didn’t smoke, he fig­ured he’d be spared. To be sure, as he got older he put on some weight, and his en­ergy sagged, but he was in good shape.

In 2010, though, Noakes was di­ag­nosed with type 2 di­a­betes. He didn’t know it yet, but a life­time of well-in­ten­tioned car­bload­ing for his ath­letic en­deav­ours had set him up for a fall.

Not long af­ter he got the di­ag­no­sis, he hap­pened to re­ceive an email about a book ti­tled The New Atkins For A New You, and recog­nised the names of the au­thors – re­spected aca­demics and ex­er­cise ex­perts Stephen Phin­ney, Jeff Volek and Eric West­man. They ar­gued that the late Robert Atkins, who fa­mously pro­moted a low-carb, high-fat diet in the 1980s and was rou­tinely lam­pooned for cham­pi­oning eggs, ba­con and cheese as healthy foods that helped you lose weight, had been right all along. The pro­fes­sors backed up their po­si­tion with more than 50 new di­etary stud­ies and an ac­tion plan for get­ting and say­ing lean. Noakes says he learned more about nu­tri­tion that year than in his pre­vi­ous four decades as a doc­tor.

“I was 100kg when I picked up that book,” he tells MF. “To­day, I’m 80kg. I’ve achieved my high school weight and my old run­ning times.”

His new way of eat­ing, he says, elim­i­nated spikes in blood sugar, kept his ap­petite in check and al­lowed his body to burn its own fat stores as fuel. On top of that, it cured his mi­graines and acid re­flux – and he also dis­cov­ered that his di­a­betes had re­versed course. When he wrote about his ex­pe­ri­ences and re­sults in Dis­cov­ery Health News in South Africa, the ar­ti­cle trig­gered a na­tional de­bate across a coun­try plagued by an epi­demic of di­a­betes and its as­so­ci­ated con­di­tions. (Black Africans and eth­nic In­di­ans, who make up more than 80% of South Africa’s pop­u­la­tion, are es­pe­cially prone to the dis­ease.) In 2015 Noakes pub­lished his fourth book, The Real Meal Revo­lu­tion, which ex­plains why high-fat di­ets work and how to in­cor­po­rate them into ev­ery­day life. “It’s gone vi­ral,” he says. One place it’s been en­thu­si­as­ti­cally adopted is

among bio­hack­ers in Sil­i­con Val­ley - peo­ple at­tempt­ing to mod­ify their own ge­net­ics with the aim of en­hanc­ing their bod­ies.

Other di­ets pre­scribe high fat and low carb in­takes – the Pa­leo, Zone and South Beach di­ets all re­strict sug­ary foods and re­fined carbs,

while the stan­dard low-carb diet is usu­ally called Bant­ing in South Africa, af­ter the 19th-cen­tury un­der­taker who was an early pro­po­nent – but the ke­to­genic diet has taken this to a whole new level. Here’s how it works.

Ke­tones are mol­e­cules formed by the break­down of stored fat, and they’re an im­por­tant fuel for the body. In fact ke­to­sis, the process by which the body uses those fu­els, is es­sen­tial for sur­vival. The hu­man body – even that of a very lean ath­lete – stores about 40,000 calo­ries of fat and just 2,000 calo­ries of the car­bo­hy­drat­ed­erived form of glu­cose called glyco­gen. When the glyco­gen is de­pleted, the body taps its fat stores for en­ergy. That’s what hap­pens when ath­letes “bonk” dur­ing ex­er­cise – they’ve used up all their stored glyco­gen. To go on, they must ei­ther eat more carbs (to burn as sugar) or start burn­ing fat. When marathon­ers break through the so-called “wall” late in a race, they’ve be­gun to burn fat.

A grow­ing num­ber of ath­letes to­day pre­fer to be in that state at all times, thanks in part to Noakes and other keto diet pro­mot­ers. Once they make the switch, they say, not only are their race re­sults and game-day per­for­mances bet­ter, they re­port sus­tained en­ergy, bet­ter moods, and clearer think­ing.

Switch­ing from foods that are linked to chronic ill­ness and make you fat to foods that keep you per­ma­nently lean and en­er­getic with­out get­ting hun­gry would seem like a no-brainer. But it’s not as easy as that. The pre­dom­i­nant West­ern diet makes us into what nu­tri­tion ex­perts call “sugar burn­ers” – we in­gest carbs for break­fast, so our blood sugar goes up quickly then crashes down be­fore lunch, when we get our next carb fix. The process hap­pens over and over again and our bod­ies never en­ter ke­to­sis.

But get­ting your body to en­ter full ke­to­sis is no small feat. You have to forgo all starchy veg­eta­bles, breads, sug­ary drinks (in­clud­ing fruit juice), pasta – es­sen­tially ev­ery­thing that isn’t meat or a non-starchy veg­etable. It’s a tall or­der that gets taller, be­cause once you’ve started the process the body, feel­ing de­prived, un­der­goes a tran­si­tion phase of­ten termed “low-carb flu”. For a few weeks, phys­i­cal and men­tal per­for­mance – at work, in the gym – dips no­tice­ably and un­com­fort­ably as the body tries to tap its miss­ing fuel source. Not ev­ery­one sticks it out. (For more on what it’s like to go full keto, see “The Road To 7% Body Fat” on p76.)

There’s a short­cut to ke­to­sis, how­ever: fast­ing. If you don’t eat for many hours, your body will nat­u­rally go into fat-burn­ing mode. There are many dif­fer­ent fast­ing pro­to­cols to get into ke­to­sis, but the most com­mon is called in­ter­mit­tent fast­ing, which con­sists of not eat­ing for 12 to 16 hours. For in­stance, you could can eat din­ner at 8pm, skip break­fast the next morn­ing, and eat lunch at noon. Or, like Mark Matt­son, chief neu­ro­sci­en­tist at the US Na­tional In­sti­tute on Aging, you can push it even fur­ther. Matt­son reg­u­larly skips break­fast and lunch al­to­gether and says that with no blood sugar spikes and crashes, just steady fat burn­ing, he feels men­tally sharp and ex­pe­ri­ences lit­tle if any sense of de­pri­va­tion.

If all of this sounds like too much mis­ery for you, con­sider an­other rea­son for go­ing keto:

ev­i­dence shows that ke­to­sis could help stave off dis­eases in­clud­ing Alzheimer’s and can­cer.

In 2007 Do­minic D’Agostino, a neu­ro­sci­en­tist and phys­i­ol­o­gist then at the Univer­sity of San Fran­cisco, was try­ing to solve a se­ri­ous prob­lem for the mil­i­tary divers. They use a de­vice called a re­breather, which re­cy­cles ex­haled breath and al­lows for ex­tra­long dives but also, for rea­sons that still aren’t fully un­der­stood, makes divers prone to life-threat­en­ing oxy­gen tox­i­c­ity seizures.

While look­ing for a way to treat th­ese seizures, D’Agostino stum­bled upon the ke­to­genic diet, which is

a proven treat­ment for a pos­si­bly re­lated mal­ady: epilep­tic seizures in chil­dren. “There are a lot of treat­ments for epilepsy,” he says, “but the only one board-cer­ti­fied neu­rol­o­gists can say [suc­cess­fully treats] the dis­ease is the ke­to­genic diet.”

Why? D’Agostino be­lieves the diet reme­dies a me­tab­o­lism im­bal­ance in which brain cells are starved of, or un­able to process, glu­cose, caus­ing the brain to go hay­wire. Live brain cells are ex­tremely dif­fi­cult to study (for ob­vi­ous rea­sons), but re­searchers have been able to tease out some clues from the petri dish about why keto di­ets are good for the brain. Aside from be­ing an en­ergy source, ke­tones also seem to mod­u­late the stress re­sponse in neu­rons and make them more re­silient to ex­ci­ta­tory nerve trans­mis­sions – the kind that can cause seizures. D’Agostino also found that ke­tones can el­e­vate lev­els of the calm­ing neu­ro­trans­mit­ter GABA.

The­o­ries aside, when he treated the divers with a keto diet, their seizures stopped.

Brain dis­eases aren’t the only ill­nesses doc­tors are be­gin­ning to think are meta­bolic rather than purely ge­netic in ori­gin.

Many com­mon types of can­cer – esophageal, pan­cre­atic, colon, kid­ney, thy­roid – are as­so­ci­ated with obe­sity and di­a­betes, and D’Agostino be­lieves he’s on the path to un­der­stand­ing why.

Can­cer cells thrive in high-sugar en­vi­ron­ments be­cause they rely on glyco­gen to sur­vive; type 2 di­a­betes, es­pe­cially, pro­vides po­ten­tial can­cer cells with a high-sugar en­vi­ron­ment. (In fact, PET imag­ing scans de­tect can­cer by find­ing ar­eas in the body with ex­cess glu­cose com­pared with nor­mal tis­sues.) This sug­gests not only that glyco­gen may con­trib­ute to can­cer, but also that it may be can­cer’s achilles heel: if can­cer cells be­come com­pro­mised when their host is in a ke­to­genic state, the body’s own im­mune re­sponses may be able to fight the dis­ease ef­fec­tively.

“We think the ma­jor­ity of can­cers could be metabol­i­cally man­aged through nu­tri­tional ke­to­sis, ei­ther as a stand­alone pill or an ad­junct to stan­dard care,” says D’Agostino, now at the Univer­sity of South Florida Col­lege of Medicine, who has pub­lished re­search show­ing that ke­to­genic di­ets can dou­ble the life­span of mice with metastatic can­cers. A lead­ing can­cer re­searcher at Bos­ton Col­lege, Thomas Seyfried, says his re­search has lead him to be­lieve that a ke­to­genic diet is ther­a­peu­ti­cally even more valu­able in fight­ing can­cer than chemo­ther­apy.

Achiev­ing a ke­to­genic state could get a lot eas­ier in the com­ing years. D’Agostino be­lieves a ke­tone sup­ple­ment will be the break­through,

mak­ing the job of dras­ti­cally cut­ting carbs from the diet much eas­ier. He has cre­ated Ke­toCana, which floods the body with ke­tones and elim­i­nates the symp­toms of carb with­drawal.

Mean­while, mil­i­tary re­searchers are fo­cus­ing on keto di­ets as well, be­liev­ing sol­diers could op­er­ate op­ti­mally on fewer, denser meals. In the US, the De­fense Ad­vanced Re­search Projects Agency, the De­part­ment of De­fense and Nasa have all run ke­to­genic ex­per­i­ments. Nasa be­lieves the diet will be im­por­tant in manned mis­sions to Mars be­cause it pro­tects against higher lev­els of ra­di­a­tion in space by in­creas­ing the brain’s re­silience to stress. Plus, says D’Agostino, “the en­ergy den­sity of a ke­to­genic diet is higher, so you have to carry less weight”.

But for ev­i­dence of the keto diet’s more im­me­di­ate ef­fects, Noakes cites South African ath­lete Bruce Fordyce, now 61, who won the coun­try’s big­gest ul­tra­ma­rathon, the 89km Com­rades, a record nine times from 1981-1990. He ate high-carb his whole life, even­tu­ally putting on weight and be­com­ing in­sulin-re­sis­tant. Re­cently, though, he switched to a high-fat diet. “Sim­ply by re­duc­ing my car­bo­hy­drate in­take and es­pe­cially junk car­bo­hy­drates I shed 13kg, and re­duced my Com­rades time from 9hr 48min to 7hr 30min and broke three hours for the stan­dard marathon for the first time in many years,” Fordyce wrote at cit­i­zen.co.za.

Lit­tle by lit­tle, says Noakes, we’re learn­ing. “This is the sin­gle most im­por­tant health in­ter­ven­tion we can make as doc­tors,” he says. “And as na­tions.”

Good news: ba­si­cally all meat, in­clud­ing ba­con, is keto-friendly – as long as it’s from grass-fed or pas­ture-raised an­i­mals

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