The ketogenic diet has exploded in popularity in recent years for one main reason — it works. And not simply for weight loss. The scientific evidence is mounting for a variety of health benefits associated with the ketogenic diet, with healthcare practitioners generally supportive of this approach.
The one main problem that exists is the lack of long-term compliance, as many individuals find it difficult to adhere to the severe carbohydrate restriction. To address this, modified versions of the ketogenic diet have been proposed, using less restrictive dietary recommendations that still allow the user to enter into a state of ketosis, albeit to a lesser degree.
Exogenous ketones may be favored over the ingestion of additional carbohydrates, as doing so may elevate blood glucose and impair the formation of endogenous ketones (i.e., ketones produced within the body).
Additionally, exogenous ketones have been reported to reduce hunger and the desire to eat (Stubbs et al., 2018), which should lead to a reduction in calorie intake and weight loss over time. They may also be used in conjunction with a program of intermittent fasting, as these high-energy nutrients can provide needed energy without negatively impacting blood glucose or insulin.
When using exogenous ketones, the ester form results in greater elevation in blood ketone levels as compared to ketone salts (Stubbs et al., 2017), so ingesting ketone esters vs. ketone salts may be considered.
For many individuals, one of the most persistent and challenging obstacles they face each year (or perhaps, each day) is maintaining an appropriate body weight (Paixão et al., 2020).
For some, “appropriate” is defined as a weight that allows them to look great. For others, this may be a weight that allows them to maintain normal physical function while carrying out activities of daily living with ease. Indeed, there are many definitions of weight maintenance or an appropriate/ideal body weight, and these appear dependent on who is being asked and what their ultimate goals might be.
From a scientific and clinical perspective, maintaining an ideal body weight is important for a variety of reasons. For example, we know that excess body weight is linked to several adverse health outcomes, including but certainly not limited to the following: increased risk of cardiovascular (Powell-Wiley et al., 2021) and metabolic (O’Rourke, 2018) disease, increased risk of orthopedic complications (Kulkarni et al., 2016), impaired cognitive function (Vieira et al., 2021), impaired physical and functional capacity (Hansen et al., 2014), impaired quality of sleep (Hur et al., 2021), and lowered self-esteem and confidence (Fields et al., 2021).
Optimize your Physical and Mental Potential with Ketone Hydration
So, what is an appropriate/ideal body weight?
This can vary based on the individual and their personal genetic makeup. For example, two women standing 5’6’’ might both be otherwise healthy and feel great, while one weighs in at 125 lbs and the other at 165 lbs. Both exercise regularly and are in very good physical condition, but the 165-pound woman carries much more muscle mass and is not quite as lean as her counterpart—but still maintains a body fat of 25%, which is quite good for a woman.
In the same way, there may be two men, both of whom stand 6 ft tall but one who weighs in at 180 lbs and the other at 240 lbs. Neither is physically active, but both have good genetics and maintain a body fat percentage of about 15%, which is also quite good for a man.
When considering body weight, most clinicians measure the body mass index (BMI), which is a ratio of body weight to height. The BMI has taken a bad rap in recent years. While it seems to work well in categorizing large groups of individuals (and in most cases does exactly what it is designed to do), it does have one major problem: It cannot differentiate between lean and fat mass. Therefore, individuals with more muscle often have an inflated BMI.
Regardless, if the BMI standard were to be employed to characterize the above four individuals, the women would come in at 20 kg/m2 and 27 kg/m2, respectively, and the men at 24 kg/m2 and 32 kg/m2. While the lower weight individuals would both be categorized as “normal” weight using the BMI tables, the heavier female would be categorized as “overweight” and the heavier man as “obese.” This, despite the fact that all of these individuals generally feel good, perform well physically and have very good clinical chemistry values based on their latest physical exam.
As the above example shows, a great degree of variance can exist between individuals regarding body weight and what might be considered ideal for them personally. While a lower relative body weight is generally considered to be “healthier” as pertaining to a variety of clinical outcomes, the absolute body weight can vary considerably from person to person. Hence, each individual needs to pay close attention to how they feel, how they physically and cognitively perform, and what their healthcare provider says regarding their overall health metrics (e.g., blood pressure and clinical chemistry values). These variables may be more important than a simple number on a scale or a chart (Lavie et al., 2013), which for many individuals, may not tell the complete story.
Addressing the Ongoing Problem of Weight Management
Once we understand what our appropriate body weight should be, we need to do what is necessary to maintain this.
Of course, if the target weight is far from the current weight, there first needs to be an intervention employed to arrive at the target weight. This goes beyond the scope of this article, but in simple terms, two approaches have been shown repeatedly to yield success: 1) adherence to a calorie-restricted or time-restricted diet (Liu et al., 2022) (or perhaps an adjustment in the macronutrients consumed [Alleman et al., 2013]) and 2), increased physical activity and structured exercise—in an attempt to expend additional calories (Petridou et al., 2019).
The combination of dietary change and exercise is quite helpful, with dietary manipulation (and caloric restriction) resulting in more of an effect than exercise alone—a finding that has been known for many years (Miller et al., 1995). Note: please don’t make the mistake of thinking that exercise apart from a change in diet will yield excellent results. It rarely does. If you are eating far too many calories and/or a poor-quality of food, this needs to stop.
Working with a licensed registered dietitian/nutritionist is a great idea with regard to dietary coaching, while seeking the advice of a certified personal trainer and/or exercise physiologist can help greatly when it comes to the exercise portion of the plan. Treatment of excess body weight requires ongoing attention for long-term success (Hall and Kahan, 2018).
Therefore, there must be a plan in place, and the plan must be adhered to regularly. This is most important when it comes to weight loss and maintenance—having a detailed plan of action and sticking to this month after month, year after year.
There are no secrets or shortcuts, just smart and hard work from this day forward. The mindset must change to one of a lifestyle approach to healthy living involving quality food intake, regular exercise, adequate nightly sleep, and the use of select dietary supplements that might aid overall success. This is where ketones may prove helpful.
How Might a Ketogenic Diet Help with Weight Management?
Most people have heard of the “ketogenic diet” or “keto” as it’s often referred to. This dietary plan has increased significantly in popularity in recent years and has been used by millions with favorable results in terms of weight/fat loss.
The scientific evidence supports the use of the ketogenic diet for weight loss in a variety of individuals, including those with obesity and mild kidney failure (Bruci et al., 2020) and type II diabetes (Goday et al., 2016).
The health benefits extend far beyond weight loss, with noted improvements in a variety of parameters that may relate to weight management and overall health (Kuchkuntla et al., 2019). These include but are certainly not limited to favorable changes in cardio-metabolic parameters such as blood lipids and measures of insulin resistance (Tragni et al., 2021), improvements in glycemic control (Zhou et al., 2022), and a possible increased genetic diversity of the microbiome (Dowis and Banga, 2021). A very low-calorie ketogenic diet has also been shown to be effective for further weight loss in patients following bariatric surgery (Correa et al., 2021).
While there exist variations and the plan should always be tailored to the individuals, the typical ketogenic diet involves the severe restriction of dietary carbohydrates (e.g., bread, rice, pasta, fruit) to a level of approximately 30 grams per day—about the equivalent of one piece of fruit or one slice of bread. However, such foods will not actually be consumed. Rather, the very small amount of carbohydrates will usually be ingested as part of other fat- and protein-containing foods, with the exception of some green vegetables.
In essence, the majority of the diet is comprised of fat (usually about 60% or more), with protein adding the balance, along with a small amount of carbohydrates. In other words, lots of meat, fish, eggs, certain cheeses, plain yogurt, oil, avocado, nuts and seeds and some green vegetables.
When adhering to such a plan, weight loss is common and likely realized for four main reasons:
- Most people do not crave fat and protein as much as they do carbohydrates. Hence, there is less snacking while adhering to a ketogenic diet and, therefore, lower calorie intake.
- Ketogenic diets are often associated with greater satiety. That is, people are not as hungry (Deemer et al., 2020) and do not desire to eat as much as compared to a “usual” diet that is high in carbohydrates. Again, this results in lower calorie intake.
- Restricting carbohydrates leads to lower glycogen storage and hence, less water retention—so weight will decrease due to a loss in body water.
- Restricting carbohydrates allows for a low and stable concentration of blood glucose and insulin. Since the body needs energy to function, it will rely primarily on stored body fat…and the natural production of endogenous ketones.
Related to this latter point, when carbs are restricted and blood glucose and insulin levels are low, stored fats are broken down. The fatty acids are released into the bloodstream and transported to the liver to be converted into ketones.
This breakdown and release of stored fat may be responsible for the loss of body fat/weight over time. Once produced, the ketones can be released from the liver and travel in the bloodstream to various tissues to be used as a fuel source or “burned.” This is what most people desire when adopting a ketogenic diet—to burn their stored body fat as a fuel source rather than consuming additional calories in the form of carbohydrates to serve as fuel.
While the above may sound like a good plan, and certainly is for many who can adhere to it, the problem lies in an individual’s ability to maintain the diet long-term, in addition to the potential micronutrient (and fiber) deficiency when an individual follows the diet.
As an alternative, individuals may consider adopting a modified form of the ketogenic diet, which is not as restrictive and may appease some of the concerns related to the ingestion of a high-fat diet (O’Neill and Raggi, 2020). Such an approach may consider the use of exogenous ketones.
What about Exogenous Ketones?
Much like the ketogenic diet, exogenous ketones have gained a great deal of attention in recent years (Yao et al., 2021). For many clinical conditions, adding an external ketone source has been shown to be helpful, with recent suggestions that ketones may function as an anti-aging metabolite (Wang et al., 2021). In addition, because compliance with a standard ketogenic diet can be poor in many individuals, the use of exogenous ketones may be more feasible than dietary intervention (Dewbury et al., 2021).
From a weight management perspective, the use of exogenous ketones may prove helpful for the following three reasons.
- Ketones can be used as a nutritional tool to reduce hunger (Deemer et al., 2020), as shown in both animals and humans. They can provide acute energy when individuals are attempting to keep calories low. The reduction in hunger may be related to a suppression in the gut hormone ghrelin (Pradhan et al., 2013), as investigators have noted that lower ghrelin is related to a decrease in both hunger and the desire to eat at 1.5 hours following the intake of ketone esters (Stubbs et al., 2018).
- Ketones can work to extend a fasting period in those who are using the effective intermittent fasting approach (Mattson et al., 2017) in their weight loss strategy. Elongating the fasting window (from 16 to 18 hours, for example) may yield additional metabolic benefits that can further enhance the effectiveness of the fast, in particular, if this can be done on a regular basis.
- Ketones may result in a lowering of blood glucose (Ari et al., 2019), which may serve as an impetus for endogenous ketone production, with the result of lowering body fat. Admittedly, the study by Ari and colleagues (2019) was performed in rodents, so additional human studies are needed to confirm this hypothesis.
Lastly, if using exogenous ketones, it may be best to use the ester form, as the ketone esters result in a much more rapid and robust elevation in blood ketone levels as compared to ketone salts (Stubbs et al., 2017).