I have been so looking forward to reviewing this book!
I am a big fan of Jimmy Moore. He has tirelessly and fearlessly charted his health journey over many years in full glare of the public eye. He has been unafraid to discuss his struggle or to challenge and debate alternative views via his extremely successful podcasts and blog. He has a thirst for knowledge which I admire and also a strong desire to help others who have suffered – or continue to suffer – with health issues. His story is one that many of us can identify with and because of this; he has a huge and loyal fan base.
The latest book Keto Clarity is written with co-author Dr Eric C. Westman and is a follow on to the extremely successful Cholesterol Clarity that they released last year. Jimmy and Dr Westman have assembled an impressive array of experts from the medical and nutritional world to discuss ketogenic diets and provide a thorough and definitive guide to a very misunderstood way of eating.
For those of you unfamiliar with Jimmy’s story, he saw amazing health results after starting the Atkins diet in 2004 and began blogging about low carbohydrate high fat diets in 2005 in an effort to help others and spread the word. You can read more about Jimmy’s story here. The shift to a fully ketogenic diet seems a natural transition for Jimmy and there is no doubt when reading the book and listening to Jimmy’s podcasts, he is experiencing many benefits brought about by ketosis. Dr Westman is Associate Professor of Medicine at Duke University in Durham, NC, and Director of the Duke Lifestyle Medicine Clinic, specializing in disease prevention and the treatment of obesity and diabetes. Dr Westman also co-wrote New Atkins for a New You with Dr Stephen Phinney and Dr Jeff Volek.
I read this book in record time – I couldn’t put it down! I would say that the first thing that struck me is how incredibly easy to read it was. I’m not one to shrink from trying to understand detailed medical texts (although Peter Dobromylskyj at the excellent Hyperlipid has me stumped much of the time). I was anticipating quite a hard read, having not read Cholesterol Clarity. I needn’t have worried – everything in this book is superbly explained and very clearly laid out. The text is interspersed with ‘Moments of Clarity’ quotes from ketogenic experts, as well as ‘Doctor’s Notes’ from Dr Westman. At the end of each chapter there are handy bullet points that succinctly sum up the information contained in the text. There is also a fantastic resources section at the back of the book with medical papers, book lists, websites and even films that relate to the ketogenic diet; a real wealth of information for anyone interested in finding out more.
I came to the book having also read The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance, both by Drs Volek and Phinney. I had also done quite a bit of reading on the diet out of general interest in the benefits, particularly as a therapeutic tool for cancer and epilepsy (the work of Thomas Seyfried, Dominic D’Angostino and Travis M. Christofferson of Single Cause, Single Cure is particularly exciting). The third stage of the Wahls Protocol (Wahls Paleo Plus) is also ketogenic (see my review here) and in Brain Grain Dr Perlmutter advises a ketogenic diet for optimum brain health also (see my review here), so I was very excited to read Jimmy’s book and find out more.
Many people that follow Paleo are well-researched in the ketogenic diet. The benefits of switching from the standard high carbohydrate, low fat diet to one that is rich in fat and lower in carbohydrates brings a myriad of benefits that Paleo adherents can testify to, not least of which the absence of hunger and the ability to go for long periods without food. A ketogenic diet takes these practices one step further. However, the debate within the community concerning carbohydrates and ‘safe starches’ shows no sign of abating and the issue of ketosis continually crops up. As always, I try to keep an open mind on the various arguments and go along with the importance of tailoring the diet according to the individual’s medical history, combined with the ‘experiment and see how you feel’ school of thought. However, I do believe that the ketogenic diet as a therapeutic tool in the treatment of various conditions is proving to be an exciting field of research and if this is true, then it may act as a preventative measure too.
In Keto Clarity, we learn exactly what a ketogenic diet entails and the many benefits that it brings about. For those of you who are new to a ketogenic diet, this is a high fat, moderate protein, low carbohydrate diet. Typically this would be less than 50 grams of carbohydrate per day and around 80 grams of protein per day (this varies according to the individual and ketone testing is necessary to determine optimum levels). The remainder of the daily calorific requirement (again varying between individuals) should be made up of fat. Fat equates to typically around 70-80% of calories. Short- and medium-chain fats such as butter and coconut oil are preferable as they convert easily to ketones. Some people supplement with MCT oil and there is also research into ketone ester supplements that help to push ketone levels up.
Excess carbohydrates and protein will push the body out of ketosis and precipitate a return to carbohydrates as the primary fuel source. Jimmy notes:
‘If you are especially sensitive to carbohydras (like me) then you will be more sensitive to protein.’
In view of this, fatty meat is preferred over lean because of the fat ratio and portion sizes need to be controlled.
As a response to this way of eating, the body switches from burning carbohydrates for fuel to fat for fuel and this brings about a myriad of benefits including mental clarity, stabilized blood sugar, lowered blood pressure, reduced triglycerides, reduced inflammation, increased energy, the list goes on and on… There are many who believe that a ketogenic state is the preferred, natural state for us to be in and that evolutionary speaking, it is one in which we would have spent the majority of our time. There is an argument that we may have cycled in and out of ketosis according to food sources, availability, seasons etc. That can be (and currently is) debated until the cows come home so I am leaving it up to you to read up on the various arguments for and against. I think that Jimmy puts it perfectly:
‘Ketosis is something you may want to pursue if you are dealing with weight or health issues and you are not getting the results you desire with your current strategy.’
Upon reading about the many benefits and therapeutic effects, a ketogenic diet may be something that some people will wish to explore, not only for the treatment of specific diseases but as a preventative measure. Keto Clarity gives them the perfect starting point.
I found the history of ketogenic diets and their current use in a variety of conditions particularly interesting. They have been used in the treatment of epilepsy and seizures since the 1920s but were superseded when new drugs appeared in the 1950s. Therapeutic ketogenic diets are still used now and you can find out more about this at websites such as The Charlie Foundation and Matthew’s Friends.
To successfully remain in ketosis it is important to find your personal carbohydrate and protein threshold, so the success of this diet involves a fair amount of self-experimentation. An excess in either of these will bump you out of ketosis. It is very easy to over-consume carbohydrates and if protein levels are too high, the liver will convert excess protein to glucose via gluconeogenesis (although again this is a debated point – see the article from Ketotic here). Jimmy explains clearly how to go about testing for ketones. There are currently 3 methods to do this – each measuring different ketone bodies:
a) Urine strips which measure acetoacetate in the urine such as these. As ketones become the primary source of fuel, the body switches to Beta-hydroxybutyrate, so urine strip readings will decrease although you are still in ketosis. For that reason it is essential to use an additional method of testing
b) Blood meters which measure Beta-hydroxybutyrate in the blood such as these.
c) Breath meters which measure acetone in the breath – Ketonix is a new device on the market. Acetone correlates to Beta-hydroxybutyrate so is a more reliable method of testing than urine strips. I have been reading some reviews of this device and they have been very positive.
Testing is essential and Jimmy lists the pros and cons of each method. He also stresses the fact that just because a person is following a low-carb diet, this does not guarantee that they will be in a state of ketosis. Tinkering around with macro-nutrient ratios according to your personal requirements is the key here! At the time of writing, Jimmy was eating 80% fat, 15% protein and 5% carbohydrate.
‘Knowing the difference between how you feel in and out of ketosis is key.’
There is a great chapter on trouble-shooting, with tips to help you overcome the most common mistakes as well as a FAQ chapter that deals with some of the more contentious issues around ketosis (such as the effect on thyroid and adrenal function). I was particularly interested in the subject of gut microbiota in relation to ketosis after reading this article by Jeff Leach over at Human Food Project. It will be interesting to see how Jeff’s research pans out. The book goes on to address criticisms of the diet in a clear and easy to understand way – it really is essential reading for anyone that is confused by the conflicting arguments out there at the moment.
The culmination of the book – and probably my favourite part – is the chapters that deal with current research on the therapeutic effects of the ketogenic diet. They are split into three distinct sections: ‘Solid Science’, ‘Good Evidence’ and ‘Emerging Areas’. These chapters are preceded by an excellent guide to using the current information out there with a clear explanation of the various types of studies used in medical research: epidemiological, observational, controlled etc. Knowing how to isolate the strong and relevant studies from the thousands of papers published each year is crucial.
It is absolutely fascinating to read about the various conditions that are currently treated with ketogenic diets, as well as some of the emerging areas of study. I have reproduced the list of these in full below as it exciting to see the importance of nutrition coming into play in such a wide range of health problems. It is worth researching the ketogenic diet if you suffer from any of these. This information is supplemented by an extensive list of research papers at the back of the book.
Solid science: Epilepsy, Type 2 Diabetes, obesity, cardiovascular disease, metabolic syndrome and contributing factors, Polycystic Ovary Syndrome (PCOS, Irritable Bowel Syndrome (IBS), GERD and heartburn, Non-alcoholic Fatty Liver Disease (NAFLD)
Good evidence: Alzheimer’s, Parkinson’s and Dementia, Schizophrenia, Bipolar and other mental illnesses, Narcolepsy and other sleep disorders
Emerging areas: Cancer, Autism Fibromyalgia, chronic pain and Migraines, Traumatic Brain Injury and Stroke, Gum Disease and Tooth Decay, Acne, Eyesight, ALS, Multiple Sclerosis, Huntington’s disease, Kidney disease, Restless Leg Syndrome (RLS), Arthritis, Alopecia and hair loss, GLUT1 Deficiency Syndrome.
Keto Clarity finishes with some shopping lists, recipes and meal plans to get you started and as well as the excellent Resources section there is even a Glossary of frequently used terms.
This really is a great book for anyone interested in ketogenic diets. Jimmy Moore and Dr Eric Westman have done a fantastic job in bringing together vast amounts of information into a concise and enjoyable read.
What is clear from reading this book, and particularly reading some of stories of people who are finding benefits from the ketogenic diet, is that increasingly we are turning to n=1 experiments to treat a variety of conditions. Physicians may still be reluctant to recommend the ketogenic diet as a therapeutic tool – see for instance this story behind Matthew’s Friends – but those who are prepared to investigate may just find unexpected success. The research is clearly taking off and is much needed, but there is a whole community of people that are willing to experiment themselves rather than wait for randomized controlled trials to be published. Some may warn against this and argue that people should wait to hear conclusive evidence before embarking on a ketogenic diet. However, this diet is not a new development or fad and there is already a hefty body of research behind it, together with nearly 100 years of experience in using ketosis to treat epilepsy. As discussed in the context of an evolutionary perspective, ketosis may be a perfectly natural and preferred state for the body given that we went for long periods without food and mostly favoured high fat meat with limited carbohydrates (yes, I know about the Kitavans…). This is an extremely exciting time for nutritional research and I expect to hear much more about the benefits of a ketogenic diet in the years to come. Well done for Jimmy Moore and Dr Westman for helping to bring the ketogenic diet to a whole new audience.
For an overview of the ketogenic diet in addition to the links contained in the text above(please check those out!), see the Ketogenic Diet Resource and the Ketogenic Diet for Health. Also check out the Resources page and of course the resources section in Keto Clarity.
Interview with Jimmy on Robb Wolf’s recent podcast here.
Interview with Dr Kenneth Ford on Robb Wolf podcast here. This is a fascinating!