It's no secret that there is often controversy within the ketogenic community. It's unfortunate, but we seem to have divided ourselves into some pretty hard-core camps, and there can sometimes be some fairly vitriolic stuff thrown back and forth.
Body building versus therapeutic. Traditional versus high protein. IIFYM versus clean eating. Dairy-free/paleo keto versus a more primal style. Fasters and those opposed. Carnivore versus regular keto versus vegetarian versus vegan! And then you get into the vitriol, wherein you've got the "meathead" crowd yelling insults back and forth with the so-called butter chuggers.
It's sad that we get so entrenched in our camps and spend so much effort on the infighting, because ultimately we are all trying to do the same thing: change the dietary culture to something more accepting of the ketogenic way of eating, and to help people achieve their best self via the lifestyle. What often gets lost in the mix here is the average Joe or Jane, just looking to change their lives and reach their health goals.
Today, we'd like to try and clear away the confusion about the different camps and their various approaches, so that hopefully the keto-curious- or even long-termers who venture outside their bubble into the confusion- can figure out which style of keto will be best for them.
Let's start by defining our terms.
What Is Keto Anyway?
A ketogenic protocol is technically defined as very low carbohydrate, with a minimum macronutrient ratio of 65% or more calories from dietary fat, 35% or less calories from dietary protein, and 5% or less calories from dietary carbohydrate (yes, we're aware this equals 105%. If one were to eat 0 carbohydrate, they could technically eat 35% calories from protein and still be ketogenic). These are the parameters for keto, as laid out by researchers Phinney and Volek in their Art and Science book series.
Since most people are looking at grams rather than percentage of caloric energy, these parameters roughly translate into a gram to gram ratio that is at minimum 1:1 fat to protein. That means, the lowest fat to protein ratio you can regularly eat and still maintain ketogenic macros is 1 gram fat for every 1 gram protein. No matter which approach you choose, these ratios are always the starting point for developing a ketogenic protocol.
What Is the Difference Between the Various Approaches?
When it comes to keto approaches, there can be a lot of variations. However, most fall into one of three major categories: (a) high fat, moderate protein; (b) low-to-moderate fat, high protein, and; (c) therapeutic. The type you choose is going to depend heavily on your body and your goals.
High Fat, Moderate Protein
This camp, which we will abbreviate as HFMP, is exactly as its moniker describes. The HFMP approach is very low carb, usually under 20 grams a day, keeps protein in a very moderate range, and is usually very high in dietary fat. Whereas the minimum fat in a ketogenic protocol is 65%, or 1:1 in grams of fat to protein, HFMP tends to be more like 75% dietary fat, which usually works out to something over a 2:1 fat to protein ratio. In a nutshell, if you've cut carbs down to almost nil, and are keeping protein in a moderate range, the rest of your daily energy intake must come from somewhere and that somewhere is dietary fat, almost but not quite by default (you could technically get the rest of your calories from alcohol, but that would probably kill you. Don't do that). The HFMP camp is basically what most of us in the community would consider "standard" keto.
HFMP works by controlling insulin levels. As we have discussed many times over, insulin is the primary driver of fat storage. Glucagon, the hormone which opposes insulin, is the primary driver of fat loss. When insulin is low, glucagon rises and begins shuttling energy out of your cells for use or to be eliminated via waste. Fat is the one macronutrient that has the least effect on insulin release, and so it is the primary macronutrient consumed on a HFMP protocol. And because people are not encouraged to drastically cut their energy intake, it helps to spare the metabolism from damage that occurs with severe or prolonged caloric restriction.
This method tends to work really well for people who are sedentary, who have serious metabolic damage from prolonged caloric restriction, who are diabetic or have insulin resistance, who have PCOS and related hormonal and/or reproductive disorders, and who have autoimmune or other inflammatory conditions. While we here at Ketogenic Success are not in the business of telling people what they must do, it should be noted that this is the method we promote through our Facebook community and our Coaching program.
Low-to-Moderate Fat, High Protein
The high protein approach has several variations. In our experience, we believe the moderate fat camp is probably the most numerous, but the low fat camp is definitely the most vocal. We will abbreviate this approach as MFHP, for ease of reading. This approach essentially calls for a much higher percentage of daily caloric intake coming from protein. Whereas the HFMP approach tends to recommend consuming fat at 75% calories or higher (a minimum of 2:1 fat to protein in grams), the MFHP approach calls for a lower fat and higher protein intake, generally in the ballpark of the minimum ratios for ketogenic macros (65% fat and more like 30% + protein, which translates to roughly 1:1 fat to protein in grams).
The nuts-and-bolts of how this approach works is via the higher protein intake, usually coupled with caloric restriction. Protein is insulinogenic, meaning it requires an insulin release to metabolize, but there also seems to be an effective increase in glucagon production when protein is higher, which may balance out the insulin increases (remember glucagon shuttles energy out of the cells). It is typically paired with caloric restriction, sometimes fairly substantially so depending on whichever group you frequent. It should also be noted that protein is the most difficult macronutrient to digest and metabolize, so there is an underlying assumption that someone following this protocol will have a somewhat increased metabolism from the increased protein intake.
This method undeniably works for people who are actively body building, and/or have minimal to no metabolic damage. For people who are already pretty insulin sensitive and are lifting heavy for multiple hours a day, this is probably a pretty good approach. However, for those who fall into any of the categories we've mentioned as being appropriate for HFMP, this isn't an approach we typically recommend. Especially so when it comes to diabetics and those suffering from insulin related disorders. As we have documented before, studies have repeatedly shown that protein (being insulinogenic) has an exaggerated effect on both blood glucose and insulin levels in those who have insulin resistance, and so these folks need to be more cautious when following a MFHP approach.
This does not mean MFHP is absolutely out for this group of people. As we have stated before, every body is different, so it's very possible some with severe insulin resistance, for example, might do well with more protein. Just be aware of the potential issues, keep an eye out for trouble, and don't be afraid to tweak as needed.
The Therapeutic Approach
The therapeutic approach to a ketogenic protocol is exactly what it sounds like; it is an approach specifically for therapy of the medical kind. Ratios can vary from doctor to doctor, but this protocol is typically very high fat, and moderate to low-moderate protein, depending on individual needs. While it's not completely consistent, we have seen individuals on therapeutic ketogenic protocols eating as little as 80% calories from dietary fat, and as high as over 90%. This translates to well over the minimum 2:1 fat to protein gram ratio commonly associated with HFMP. Many patients on therapeutic ketogenic protocols are regularly eating over 4:1 fat to protein, depending on their needs.
The basic idea to this approach is that patients want to keep their blood ketones very high as part of their therapy or disease management. Epileptics and those suffering from neurological disorders and degenerative diseases are generally greatly helped by a therapeutic protocol because ketones are taken up by the brain for use as energy in a different and more efficient pathway than sugar, and do not contribute to oxidative stress and cellular damage. Those diagnosed with cancer are another good example of people who may turn to ketosis as part of disease management, in an attempt to "starve" cancer cells, which typically feed on glucose. Because keto is muscle sparing, those following a therapeutic protocol may be able to eat at fairly low protein levels without losing substantial muscle mass.
This approach, as stated above, is typically for medical use only. We wouldn't recommend it for the average person.
Where Does that Leave Us?
While we certainly can't address every different ketogenic method in the span of one post, hopefully this gives you a better idea of the three main approaches and for whom/what they may best be utilized.
Next week, the discussion of the various ketogenic approaches continues, and there will be pictures! Stay tuned, ketonians, and stay awesome.