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Expert opinions

PUBLIC INTEREST IN ketogenic diets for the treatment of cancer and other challenging health conditions is growing rapidly – much faster, in fact, than the availability of high-quality resources people can use to apply these valuable dietary principles to their daily lives. That is precisely what makes The Ketogenic Kitchen such a timely treasure.

I follow a ketogenic diet myself, so I can tell you firsthand that it is safe, comfortable and effective. While it can be challenging to learn and adjust to at first, the benefits are well worth it. As a psychiatrist with a special interest in nutrition and metabolism who studies, writes about and prescribes ketogenic diets, I can tell you that they have uniquely powerful healing properties for the brain. Ketogenic diets have been used to treat a variety of complex neurological and psychiatric conditions, from epilepsy to Parkinson’s disease to Alzheimer’s dementia. There is even emerging evidence that people with bipolar disorder and other mood disorders may benefit from a ketogenic diet. These specially formulated low-carbohydrate, adequate-protein, high-fat diets rescue us from the invisible rollercoaster of blood sugar, insulin and stress hormones that most people ride all day long without even realising it. This dangerous pattern destabilises brain chemistry, causing spikes and crashes in energy, mood and concentration throughout the day. This is why I recommend low-carbohydrate/high-fat and ketogenic diets to my patients with mood and attention disorders.

Ketogenic diets are not just good for the brain, they are good for the whole body. Conventional carbohydrate-based diets flood our bodies with sugar and wreak havoc with our metabolism, which can lead to type 2 diabetes, obesity and other serious health problems, including cancer. It is firmly established that cancer cells thrive on glucose (sugar) and have a very difficult time burning fat, whereas most normal cells can easily burn fat for energy. Furthermore, excess glucose in the blood triggers insulin surges, which promote the growth and multiplication of all cells, including cancer cells. Ketogenic diets nourish normal cells with healthy fats and proteins and shield them from the damaging effects of excess sugar, starch and protein (all of which can turn into glucose) while simultaneously depriving cancer cells of the fuel they need to grow and spread. There is no other nutritional approach that can do all of these wonderful things.

Patricia Daly and Domini Kemp have written an authoritative guide that will help you put the powerful science of ketogenic principles to work in your daily life. Their hard-earned wisdom coupled with their culinary expertise set this book apart from other health-oriented cookbooks. For issues ranging from mental health disorders to diabetes to cancer, The Ketogenic Kitchen will be indispensable to those seeking to incorporate a powerful, science-based nutritional approach into their comprehensive treatment plan.

Georgia Ede, MD

Psychiatrist and Nutrition Consultant

www.diagnosisdiet.com

WHAT YOU EAT (and don’t eat), how you eat, the amount you eat, the nutritional supplements you take, the way you manage your stress and emotions, the support you receive, the amount of rest, physical activity and sleep you get and the level of happiness, awareness and meaning you have in your life all play a vital role in the cancer recovery process.

Let’s take the first one – what you eat (and don’t eat). When I provide advice to clients with cancer, I talk about two very different diets: the pesco-vegetarian, Mediterranean-style diet and the ketogenic diet. Of course there are many other options, but these are the two I focus on. They both have pros and cons. If someone is highly motivated, willing to learn about the ketogenic diet and committed to being on the ketogenic diet (and has the support of those within their household), then this is often the best option – especially if that client has high fasting insulin/glucose levels and/or is overweight. If someone lacks motivation and doesn’t really care about food, then we focus on cutting out sugar and processed foods, avoiding foods to which they are sensitive/intolerant and maximising nutrient intake.

Some clients start with a ketogenic diet and then transition to a Mediterranean diet after six months or so. Others will remain on the ketogenic diet. Why? Because they feel great! Until now, the challenge was a lack of access to ketogenic recipes that taste great. That has all changed with the arrival of The Ketogenic Kitchen. The Ketogenic Kitchen is a wonderful, practical resource for the person who wants to improve their health by shifting to ketone-based metabolism. This is the cookbook that my clients and I have been waiting for!

Dr Mark Atkinson, MBBS

Mind–Body Medicine Physician, Cancer Recovery Advisor and Developer of the Cancer Recovery by Design Programme

www.drmarkatkinson.com

CHOOSING TO ADAPT your diet to a lower-carbohydrate, higher-fat version involves an understanding of food composition and a creative flair for turning this into tasty, nutritious meals that suit YOU. One size certainly does not fit all, so it is refreshing to see a range of recipe ideas for the moderate carbohydrate eater through to options for the very low-carbohydrate ketogenic approach, all in one book. Lower-carbohydrate, higher-fat diets are most widely used by comparatively well adults looking to improve weight control, moderate blood glucose levels or perhaps alter body composition and improve sports performance. Medical use in disease management is mainly confined to drug-resistant epilepsy where there are treatment protocols, experienced clinical teams and a wealth of published evidence endorsing the effectiveness. Medical use as a component of tumour management is very much an outsider, only just being considered with a small number of human trials (mainly in relation to brain tumours) just getting started. It’s an exciting time, but also a frustrating time for those of us supporting this clinical sector. Public interest is increasing but clinical trials exploring the effect of lower-carbohydrate or ketogenic diets are slow to get off the ground, and clinical support, experience and understanding can be frustratingly hard to come by. Patricia and Domini’s book explains the precautions, the practicalities, the theories and the uncertainties and will be of value to individuals, their families and the clinicians supporting their treatment pathway. Thank you, Patricia and Domini, for your considerable endeavours in creating such an informative and deliciously practical book.

Sue Wood

Specialist ketogenic dietician, Matthew’s Friends Clinics, UK

BASED ON A plethora of preclinical data, trials are underway from the US to Germany. The benefits of a ketogenic diet have already been shown for weight loss and metabolic improvement, and we are hopeful that similar benefits will be seen in the cancer world. Perhaps most intriguing is that some of the data albeit based on preclinical animal studies, may suggest a preventative role of a ketogenic diet. While the diet has been shown to synergise with standard therapies like radiation therapy in preclinical studies, recent studies are underway to test this in humans.

Unable to wait for these results, many have chosen to engage in a ketogenic diet during their cancer treatment. It is our job to make sure this is done safely and effectively, and The Ketogenic Kitchen is a vital resource that we have been lacking in the clinic. This is a great source of information for both patient and physician, helping to ensure that the diet is done safely with a variety of healthy, delicious and nutrient-dense foods.

Dr Colin E. Champ

Assistant Professor, Pittsburgh Cancer Institute Radiation Oncologist

University of Pittsburgh Medical Center Author of Misguided Medicine

www.cavemandoctor.com

WORK IN OUR laboratory and others has demonstrated that a ketogenic diet can slow the growth of brain and other tumours in preclinical models. In addition, it has been shown that a ketogenic diet can enhance the effectiveness of radiation and chemotherapy in these same models. We now have scientific evidence demonstrating that it is not just the reduction in glucose that has a beneficial effect; it is also the increase in ketones. For this reason, the proper use of a ketogenic diet is likely to have a multitude of beneficial effects in the fight against cancer. This is now being recognised by patients and clinicians alike.

Published case reports and a large body of as yet unpublished information from reputable sources are demonstrating the utility of a ketogenic diet in people with brain tumours and other cancers. This has led to the opening of clinical trials designed to demonstrate efficacy; however, the available data combined with the demonstrated safety of a properly managed ketogenic diet from the epilepsy community has made this approach desirable even before the clinical trial data is available.

The proper design of a ketogenic diet that is both palatable and safe is not common knowledge, even among registered dieticians. The Ketogenic Kitchen will be an invaluable resource for those wanting to follow a ketogenic diet under the direction of their medical professionals, and it will be an equally useful resource for medical professionals who want to add this to their patients’ therapeutic regime.

Adrienne C. Scheck, PhD

Associate Professor

Neuro-Oncology Research

Barrow Brain Tumor Research Center

Barrow Neurological Institute

Phoenix, AZ

Introduction from Domini and Patricia

Welcome to our ketogenic kitchen!

We have written this book because we’ve both experienced the very real health benefits of a new way of eating – in our cases, to support our treatment for cancer when we had it and to support our (and our families’) health more generally now that treatment is over. The results have been so astonishing that we feel we simply have to share it with more people.

The clue, really, is in the title. But what is a ketogenic diet? And what benefits does it offer that would make you want to try it? Essentially, it is a way of eating that is low in carbs and high in fat – an idea that sort of flips the food pyramid on its head. It’s a way of eating that people have been talking a lot about lately, but in fact keto has been around for millennia.

In simple terms, a ketogenic diet is one that, over time, switches the body from burning sugar (glucose/carbs) for energy to burning fat (ketones). After you’ve consumed them, all carbohydrates – whether it’s a spud or a slice of bread – turn to glucose, or sugars, in the blood. But if you eat a very low amount of carbohydrates and instead replace them with lots of fats and a moderate amount of protein, the cells in your body will switch from burning glucose to burning fat for their energy. The diet that causes this switch to be made is called ketogenic, and when it happens, the body enters a state called ketosis.

The ketogenic diet has been around as long as humans have been roving the planet, simply because when certain foods (carbs) weren’t available – due to seasonal shortages or crop failure, for example – our bodies had to adapt and switch to burning fat for energy instead.

There are many people who credit a ketogenic way of eating for successful weight loss and management, but what is really exciting for us is the emerging evidence of the benefits of this way of eating for our health. For example, for decades the diet has been used very successfully to treat epilepsy, especially in children (Groesbeck, Bluml and Kossoff, 2006). But the most exciting developments have been seen in the last decade or so, when this way of eating – the keto lifestyle – has been shown to be beneficial in the management and treatment of illness, particularly cancer (which we’ve both had, twice) and many chronic illnesses (Paoli et al, 2013).

Patricia has followed the ketogenic diet for over four years, while Domini takes a more 80:20 approach. Thankfully (and currently) we are both well. We attribute our health not only to the conventional cancer treatments and excellent care we received, but also to the support that our diets and lifestyle gave our systems both during and after treatment. It was a good combination.

And while we’re on the subject of cancer, a word about conventional treatments. First and foremost, the benefits of the ketogenic diet have been shown when it is used alongside conventional treatments. There is currently no data to support the idea that the diet by itself can treat, cure, maintain or manage cancer. We’re both huge lovers of food and firmly believe in its potential to improve (or indeed damage) health.

The recipes have their roots in our very different professional backgrounds. Domini is a chef, food writer and businesswoman. Patricia is a nutritional therapist helping people around the world manage and overcome illness, and support their treatment, through the life-giving qualities of honest, good food and the nutrients it contains. Both of us are busy women (mothers, wives, friends, colleagues) with heavy work schedules. And yes, both of us have had cancer. So between us we believe we’ve found a balance that works: food that tastes good, gets you cooking, supports your health (especially when sick) and makes you feel great not just in the moment – at the dinner table – but in the long term. In Domini’s case that means low-carb meals, and in Patricia’s, fully ketogenic meals.

The food in this book is not faddy or flashy. This is food that functions – it energises, nourishes and supports you – without being merely (or boringly!) functional. And while we give a lot of attention to flavour, the emphasis is very firmly on the nutritional side of things and on the magic that nutrients work in the body.

But this book is not just for people with cancer. The recipes in it celebrate food’s ability to make us feel good in rather than about our bodies. It’s about simple, truly nutritious food that makes you feel great. And once you feel great, there’s no going back.

How to navigate the confusing world of nutrition

Where have we gone wrong?

Have you been told to do or follow at least one of the following?

• Have at least 1 litre of fresh juice a day, but not too much fruit.

• Stop eating dairy, but make sure you have enough calcium in your diet.

• Have some red meat, but not too much.

• Eat a healthy, balanced diet. Follow the food pyramid.

• Avoid foods you might be intolerant to, but have lots of variety in your diet.

• Make sure you don’t have too much mercury from fish, but get enough omega-3s.

• Don’t drink coffee.

• You must drink coffee, but only decaf coffee.

• You don’t need supplements if you have a balanced diet.

• Take supplements.

• Stick to low-fat options.

• Raw diets are the best for health.

• Eggs cause high cholesterol.

Inevitably you will have followed the advice of at least one of the above and then seen the arguments for and against eventually unravel.

Let’s face it: nutrition is a controversial, confusing and at times frustrating topic. Eating food affects each and every one of us, whether we like it or not, and more and more people are taking an active interest in what, how and why they eat. Yet many of us can easily get overwhelmed by all the information out there.

You may have noticed that the outcomes of nutrition studies tend to attract more media attention than most other areas of science. Hardly a day goes by that you don’t read about a specific food or diet claiming to cause or prevent certain diseases. For the general public, it’s hard to see the big picture amidst all those messages making different, often competing claims.

One thing has become clear: whatever guidelines we as a population have followed since the mid-1970s, it’s not working. Whether in the developed world or in low-and middle-income countries, today we are sicker and heavier than ever before. While improvements in sanitation, medical services and access to food have led to a sharp decline in deaths from malnutrition and infectious disease over the past decades, chronic disease is on the rise. The World Health Organization (WHO) presents some insightful statistics:

• Chronic (also called ‘non-communicable’) diseases like cardiovascular disease, cancer, respiratory diseases and diabetes were the leading cause of death globally in 2012.

• Chronic disease now accounts for more than two out of every three deaths worldwide, up from just over half in 1990.

• Worldwide obesity rates have more than doubled since 1980, and the scary thing is that they have increased particularly fast in children.

• The number of new cancer cases is expected to rise by about 70% over the next two decades.

In the UK, one in two people will develop cancer at some point in their lives, according to Cancer Research UK. According to the National Cancer Registry of Ireland (NCRI), one in three people in Ireland will develop cancer during their lifetime. In Ireland, an average of 30,000 new cases of cancer are diagnosed each year. The number is expected to rise to over 40,000 per year by 2020.

Of course, we could attribute these developments to the fact that life expectancy has improved nicely and that we simply become more susceptible to developing a chronic disease the older we get. But we can’t deny that cancer rates are also on a steady rise in children and young adults (see www.cancerresearchuk.org/cancer-info/cancerstats/teenage-and-young-adult-cancer/incidence/#Trends).

Research shows that cancer and other chronic diseases could be preventable by making major lifestyle choices. Poor dietary choices, for instance, can increase the risk of developing cancer by 30–35% (Anand et al, 2008).

But the big question remains: which dietary choices are poor? In recent times, many well-established and accepted nutrition ‘facts’ have been turned upside down and revised. Foods that we have avoided for decades make a comeback overnight and we’re told that they’ve been wrongly accused of being troublemakers. Here are a few highlights from the Academy of Nutrition and Dietetics, the world’s largest organisation of food and nutrition professionals:

• Eggs are good and are not to be blamed for causing high blood cholesterol levels.

• Cholesterol has been dropped from the ‘nutrients of concern’ list.

• Saturated fats are ‘de-emphasized from nutrients of concern, given the lack of evidence connecting it with cardiovascular disease’.

• There are also concerns over sodium restrictions because there is ‘a growing body of research suggesting that the low sodium intake levels recommended by the DGAC (Dietary Guidelines Advisory Committee) are actually associated with increased mortality for healthy individuals’.

• ‘The identification and recognition of the specific health risks posed by added sugars represents an important step forward for public health.’

In short, many of the guidelines we’ve been following for decades, like limiting cholesterol and saturated fat intake, not adding salt to food and loading our plates with carbohydrates and sugars, are now being revisited. This is incredibly confusing for the general public, but in actual fact the data has been here for a good while.

Let’s take an example. Most mainstream health organisations recommend that we restrict dietary fat to less than 30% of our total calorie intake, but a large number of randomised controlled trials (the gold standard in science) confirm that a high-fat diet is more effective for weight loss than low-fat (for example, see Tobias et al, 2015). In addition, high-fat diets also significantly improved important biomarkers like insulin, triglycerides or fasting blood glucose. Many of these studies were done in 2003 and 2004, more than 10 years ago, and yet the guidelines the general public are given remain the same.

The same applies to the saturated fat debate. For more than five decades we’ve been told that saturated fat causes heart disease. Many people think they have a healthy diet because they eat margarine instead of butter, replace their beloved full-fat Greek yoghurt with low-fat versions or cook their spuds in vegetable oil instead of duck fat.

A review of large, well-designed studies published in 2010 (Siri-Tarino et al, 2010) questions the relationship between saturated fat intake and the incidence of heart disease or stroke. Similarly, a Japanese study showed that saturated fat intake can actually lower your risk of stroke (Yamagishi et al, 2010). This relatively new information is now starting to make its way into mainstream dietary recommendations, which is good to see.

Epigenetics

The emerging concept of epigenetics will also shed more light on why and how we react differently to diet and lifestyle changes. As we all know, DNA contains the instructions for building all the parts of the body. All cells in the human body contain an identical copy of DNA, with the potential for producing more than 20,000 proteins.

We don’t have any influence on our genome, the genetic instructions that we inherited from our parents. And up until recently, scientists were convinced that a person’s genetic characteristics were set in stone at the moment of conception. But we now know that this isn’t entirely true and that the chemical environment in the womb can determine which genes are expressed and which ones are silenced in various parts of the body. And most importantly, gene expression is regulated by environmental factors like stress, diet, behaviour and toxins. In short, it matters what we eat (and drink and do!).

Epigenetics therefore refers to changes in gene expression through our environment. Research into this discipline is still in its infancy, but it shows promise when it comes to preventing and managing chronic degenerative disease.

Navigating your way through the nutrition jungle

But why is it so difficult to find reliable information on nutrition? What’s the reason for so many disagreements even among the most prominent experts and researchers? Why do they seem to change their minds so quickly? Let’s shed some light on the challenges of nutrition and research.

• First and foremost, there’s the so-called ‘biochemical individuality’. It’s something every nutrition student learns in one of their first lessons: we are all different! There is no one food, supplement or diet that suits everybody because we all have different genetic predispositions, we grew up in different climates, under more or less stress and are influenced heavily by our environment. This obviously doesn’t only apply to nutrition science. Just because a study shows positive outcomes for a drug, for instance, doesn’t mean it will work for everybody.

• Many nutrition studies rely on past self-recalled nutrition data to draw conclusions on medical outcomes and health conditions. In other words, these studies rely on what people can remember about what they’ve eaten. To be honest, this approach can’t possibly be evidence based. Do you remember what you ate three days ago, a month ago or even a year ago? We certainly don’t, and food plays a vital role in our lives.

• Confounding factors (exercise, smoking, sun exposure, alcohol, psychological aspects) can have an impact on nutrition study outcomes. If one study participant makes other lifestyle changes on top of the dietary change that he is supposed to do, it can obviously have either positive or negative effects on health markers.

• The first thing we check when studying a research paper is who funded the study and what possible conflicts of interest the authors might have. There can be political and economic interests involved in some of those studies, so we’re extra cautious when taking on board the results of a possibly biased study.

• Nutrition is a very young and multifaceted field of science that is constantly changing and advancing rapidly. Not all studies are rigorous randomised controlled trials (RCTs), but rather are correlational studies that show preliminary results and give guidance on starting points for further studies.

So what can you do to navigate this nutrition jungle? At the risk of repeating ourselves, you know yourself better than any doctor or nutritionist does. If you eat a food – even if it’s super nutritious – or follow a certain regime but don’t feel well on it, chances are it’s not for you. Also, try to follow practitioners, scientists and reputable sources of information that you know and trust. Believe us, it’s a full-time job learning about research, combing through the most recent studies and drawing the correct conclusions from them. If you can lean on somebody who can give you guidance and support and then combine this with the knowledge of your own body, you’re on the right track.

How to use this book

This is really two books in one, and there’s a serious reason we decided to do it together: because we’ve both had amazing results with this way of eating.

Both our sections are about low-carb eating and its potential to offer significant health benefits. Even a moderate carb restriction has proven to be beneficial for many individuals (Ebbeling et al, 2012) and Domini’s recipes are all about moderate carb restriction. So if you’ve never heard of the ketogenic diet and haven’t a clue where to start, these recipes will be just the gentle learning curve you need: low-carb most of the time and low-ish some of the time. And if you find it’s a lifestyle that suits you, you can stick to it rather than go the whole way to being fully ketogenic.

Patricia’s recipes, on the other hand, are carefully put together to meet the precise requirements of the ketogenic diet, which should consist of no more than 4% carbs at any time and, often, over 70% fat(s). For most people this represents a dramatic reduction in carb intake, but the book is full of advice on how to successfully make that transition in your own time and at your own pace, without being overwhelmed (see the Before You Start and Clean Up Your Diet sections here and here respectively). And that’s important if you are already dealing with the very real change (and challenges) that serious illness can bring. In essence, then, keto is metabolic therapy – it fundamentally changes the way our cells generate energy. And that includes cancer cells.

Of course, it has to suit you, which is why the book includes details of contraindications (see here) as well as information on what to expect when you start the diet. There are also important notes in the appendix on pantry essentials and kitchen equipment to make life easier; on the particular blood tests you need to do before embarking on the keto diet; and on monitoring yourself to ensure optimal health while you follow the diet, particularly if you are receiving treatment for cancer.

Our approaches are slightly different. Patricia’s recipes and meal plans are designed for periods during and post-cancer treatment or when you’re feeling poorly and are fully ketogenic. They are carefully designed to maximise the effectiveness of treatment and to support your system to recover quickly and be more resilient in the longer term.

Domini takes a looser approach: her recipes are low-carb but allow for times when you need to let your hair down – and the carbs in. This is food for people looking to eat more wholesome, healthy grub that packs in a greater amount of plants and good fats and lower amounts of carbohydrates than we are used to. Designed as a way to eat every day, it’s for people who want to keep their weight under control by following a low-carb diet; for cancer patients in long-term management; for people who want to get to know low-carb recipes; or for people who can’t/don’t want to go the whole hog with keto. While some people, for instance, thrive on being in ketosis during cancer treatment and indeed find that it helps keep side effects at bay, others find it so challenging and restrictive that they prefer the more moderate approach of a low-carb diet. This book offers you choice and information.

References

Anand, P. et al (2008) ‘Cancer is a preventable disease that requires major lifestyle changes’, Pharmaceutical Research, 25(9), pp. 2,097–2,116.

Ebbeling, C.B. et al (2012) ‘Effects of dietary composition during weight loss maintenance: A controlled feeding study’, Journal of the American Medical Association, 307(24), pp. 2,627–2,634.

Paoli, A. et al (2013) ‘Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets’, European Journal of Clinical Nutrition, 67(8), pp. 789–796.

Siri-Tarino, P.W. et al (2010) ‘Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease’, American Journal of Clinical Nutrition, 91(3), pp. 535–546.

Tobias, D.K. et al (2015) ‘Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: A systematic review and meta-analysis’, The Lancet Diabetes & Endocrinology.

Yamagishi, K. et al (2010) ‘Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: The Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study’, American Journal of Clinical Nutrition, 92(4), pp. 759–765.

Introduction to the low-carb way

Let’s make one thing clear: there is no one perfect diet for everyone. Although low-carb diets can be incredibly beneficial for many – especially chronically ill – people, this doesn’t imply that all high-carb foods are ‘bad’. There is no doubt that some foods high in carbohydrates have amazing health benefits and provide lots of essential nutrients, like buckwheat, quinoa, oats, bananas, beetroot, oranges, sweet potatoes, kidney beans or chickpeas. We encourage you to reduce the high-carb foods that are refined and processed, like white breads and pastas. But your body needs to know what to do with carbohydrates and how to use them efficiently to reap any benefits, otherwise carbohydrate-rich foods can wreak more havoc with your body despite all the nutrients. In order to understand how this happens, let’s look at the role of insulin in the body.

The role of insulin

Insulin is a crucial hormone with many functions. Without it, we simply wouldn’t survive. Insulin tells our cells to pick up glucose from the bloodstream if levels become too high. It’s also the ‘fat-storing hormone’ that triggers our cells to store energy, either as glycogen (the stored form of glucose) or fat. Dr Robert Lustig, an American paediatric endocrinologist, sums it up nicely in ‘The Cause of Obesity’ video on YouTube: ‘Insulin shunts sugar to fat. Insulin makes fat. More insulin, more fat. Period.’ And by this, he means chronically elevated insulin levels.

Across the span of human evolution, insulin production became the mechanism by which the body could choose which form of energy to burn, fat or glucose, depending on what foods were available. When we have a healthy metabolism, the body produces sufficient amounts of insulin to remove any excess glucose from the bloodstream so that it can’t harm us. In times of starvation (winter, in ancient times), this enables us to switch into a fat-burning mode to provide more energy. But when there’s lots of food available, we become insulin resistant in order to store extra food as fat.

The problem is that in modern society we have access to, and consume, far more carbs than our ancestors – even our parents! And in combination with a high carbohydrate intake, insulin resistance can lead to major issues. Glucose isn’t getting into the cells, so it builds up in the bloodstream. The pancreas is getting signals that there’s still too much glucose and therefore keeps producing insulin. Eventually, this can cause type 2 diabetes and other metabolic disorders.

Elevated insulin and disease

The evidence is mounting that chronically elevated insulin levels are implicated in causal pathways in many modern diseases such as diabetes, cancer, cardiovascular disease and neurological issues. In his book What the Fat?, Professor Grant Schofield emphasises that it’s not only dietary factors that affects our level of insulin resistance, but many other lifestyle aspects like stress, poor sleep, smoking, sun exposure, pollutants, toxins, our activity levels or genes. But reducing insulinogenic foods (i.e. foods that raise insulin, like sugar, carbohydrates and certain proteins) from our diet, keeping an eye on our ratio of omega-6 to omega-3 and correcting micronutrient deficiencies is the first step to managing – or indeed, hopefully preventing – some of the most prevalent chronic conditions.

Are you sensitive to carbohydrates? How can you find out whether you could benefit from a low-carb approach if you haven’t been diagnosed with a chronic illness? On her website www.diagnosisdiet.com, Dr Georgia Ede has a good tool called the ‘Carbohydrate Sensitivity Quiz’ that might give you a good insight. She asks the following questions:

1 Do you feel sleepy or foggy two hours or less after eating a meal or snack that contains sugars or starches?

2 Do you tend to gain weight around your middle instead of in your hips and thighs?

3 Does your weight fluctuate a lot?

4 Do you feel hungry when you shouldn’t need any more food?

5 Do you frequently crave sweets, starches or dairy products?

6 Do you wake up in the middle of the night and have a hard time getting back to sleep unless you eat something sweet or starchy?

7 Do you get irritable, restless, tense or anxious in the early evening before dinner?

8 Do you have a hard time controlling how much sugar or starch you eat?

9 Do you have symptoms of hypoglycaemia if you don’t eat every two or three hours? (Typical hypoglycaemic symptoms include feeling shaky, panicky, irritable, anxious or lightheaded when you’re hungry.)

10 Are you an ‘emotional eater’?

11 Do you gain weight easily?

12 Do any of the following diseases run in your immediate family?

• Obesity

• High cholesterol

• Type 2 diabetes

13 Do you often binge on sweets, starches or dairy products?

14 Are you obsessed with food?

15 Do you prefer sweets and starches over all other types of food?

16 Do sweets and starches make you feel temporarily less depressed or less anxious?

17 Do you feel you need to carry food with you wherever you go?

18 Are you very hungry first thing in the morning?

19 Do you tend to get panicky or hungry while exercising?

20 Women only: Do you feel much more emotional in the days prior to your period?

The more questions you can answer ‘yes’ to, the more it indicates that you may be sensitive to carbohydrates and would perhaps benefit from lowering your intake. If you’re concerned that you may be on the way to developing some health problems, you can ask your doctor to do a glucose tolerance test, a fasting insulin level or a haemoglobin A1C test.

If you’re like us and you suffer from a so-called ‘chronic degenerative disease’ (sounds lovely, doesn’t it?) and you’d like to take a proactive role in the management of your condition, we strongly suggest you consider a low-carb/ketogenic diet. Below is an overview of the current evidence for various diseases. As you can see, some of the evidence is only emerging but research papers are published on a regular basis that confirm the benefits.

The benefits of fat: The evidence is mounting

After reading all this, you might ask why more people aren’t adopting this dietary approach and, more importantly, why more doctors aren’t recommending it. We believe that it will take time to shift the current mindset of ‘fat is bad and carbs are good’ and to move away from the food pyramid/healthy eating plate that is at the core of most government policies across the globe. Most mainstream health organisations recommend restricting dietary fat to less than 30% of total calorie intake, but in the past 12 years, an increasing number of randomised controlled trials (the gold standard of science) have successfully challenged the low-fat dietary approach (Yancy et al, 2004).

Well-designed longitudinal studies are expensive and complex but are necessary to cause a paradigm shift in the medical establishment. Most current studies on the benefits of low-carb diets are short term, although we know that it is safe to be in ketosis for long periods of time (Dashti et al, 2014).

But things are starting to change, albeit slowly. In June 2014, Time Magazine published an article called ‘Ending the war on fat’ and the Academy of Nutrition and Dietetics, the world’s largest organisation of food and nutrition professionals, has decided to remove cholesterol from the ‘nutrients of concern’ list and saturated fat will be ‘“de-emphasised” from nutrients of concern, given the lack of evidence connecting it with cardiovascular disease’ (Siri-Tarino et al, 2010). That there is increased interest in the topic is demonstrated by research papers like ‘Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base’ (Feinman et al, 2015), which has been the most downloaded nutrition article from Science Direct for some time now.

There is also a steadily growing number of motivated and talented doctors and researchers on the case who are keen to make a difference in people’s lives. This will help provide the research and expertise we need to make the low-carb/ketogenic lifestyle a recognised approach in the treatment of many chronic illnesses alongside conventional therapies.

We used Nutritics software and the help of a nutritional therapist, Melissa Turner, to do Domini’s recipes. Patricia used Nutritics (www.nutritics.com) to do her own analysis. Sometimes the portion or serving amount looks odd. That’s because for dishes like the tapenades or dressings, it’s hard to say how much someone will use. Therefore, we have reduced the serving size to something resembling a tablespoon or two, with the idea that you will pay attention to the portion amounts if that’s what you are interested in. For the ketogenic section of the book, quantities and serving sizes obviously become a lot more important. A tablespoon of olive oil doesn’t weigh the same as a tablespoon of mustard, for example, and coconut oil can be hard to measure in anything other than grams. These varying quantities will inevitably cause confusion. In the low-carb section, you will see the number of grams in brackets afterwards. This is what the nutritional information is based on, because half an avocado is not exact enough. You might also notice that sometimes the percentages in the pie charts do not exactly add up to 100% – this is due to rounding.

References

Dashti, H.M. et al (2014) ‘Long-term effects of a ketogenic diet in obese patients’, Experimental and Clinical Cardiology, 9(3), pp. 200–205.

Feinman, R. et al (2015) ‘Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base’, Nutrition, 31(1), pp. 1–13.

Yancy, W.S. Jr et al (2004) ‘A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: A randomized, controlled trial’, Annals of Internal Medicine, 140(10), pp. 769–777.