The Lowdown on the Ketogenic Diet, Part 3
The ketogenic diet is rapidly gaining new followers, so we sat down with Scott Bergman, DC to get the scoop on this popular lifestyle option. This is part three of a series, where we learned how, when, and how often intermittent fasting can be incorporated into the ketogenic diet. Always work with a healthcare practitioner prior to starting a new diet plan.
Intermittent fasting seems to be a popular element of the ketogenic diet. Do you recommend this for all patients?
The ketogenic diet and intermittent fasting work very well hand in hand. The research on fasting shows evidence of stimulating metabolism, balancing hormones, mental clarity, and obviously weight loss. So eventually I try to move all of my patients into some form of fasting, either intermittent fast, extended fast, cyclic, a combo, or specific intervals of fasting.
I am careful about moving somebody into fasting too quickly. I’ll take a Functional Medicine approach to provide some metabolic stability before incorporating the fasting protocols. That seems to make it a little easier.
At what point should patients start doing intermittent fasting?
It depends. What are the goals for the patient? Is it to lose weight, and how much weight? Is it for performance and energy or endurance or muscle growth? Or are there clinical applications? Then the other factors are the patient’s commitment and compliance. So some people we start right away because I can get them into ketosis very quickly, and their commitment and compliance are at 100%. Sometimes you need to first let them build some trust in what you’re recommending. Then we can move them into fasting.
How often do you recommend people fast, and for how long?
Again, it depends on their commitment and compliance. We’ll start incorporating intermittent fasting, which is anything from a few times per week to a higher frequency; sometimes people fast daily because they found that they just love the lifestyle. Many people lead super hectic lives and don’t want to take the time to eat breakfast anyway. Some people, it’s a 24-hour fast one time a week. Sometimes we’ll do a prolonged fast for up to five days. We can do that every month or every other month.
Sometimes we’ll cycle the fasting. I’ll call it a “keto fast and feast of 6-1-0,” where they might follow six days of a ketogenic diet, one day of fasting, and no feast, or we can do a 5-1-1 or a 4-2-1, or a 3-2-2. It just depends on what our specific goals are and what people want to accomplish.
What would a typical day look like for someone who wanted to try intermittent fasting on a keto diet?
We could start off with a 16-hour fast and then 8-hour feeding. I’ll ask people to eat dinner, try to finish about three hours before bed. If you’re done eating at 7 PM that night, you would wait until 11 AM the next day. I’ll recommend drinking 8-10 ounces of just water as soon as they wake up. They can also have a black coffee or tea during the fast. Then in that feeding period, usually have about two meals in that eight-hour period, so in this case, from 11-7 or 12-8.
What are the advantages to fasting in the morning versus the late afternoon (if any)?
One of the studies that I came across in the Journal of Nutrition showed that you lose more weight when you eat in the morning and fast in the afternoon, but you maintain more muscle mass if you fast in the morning and eat in the afternoon.1 So, for the most part, I recommend fasting in the morning. It seems to be a little easier for people. The compliance is better. People are accustomed to eating dinner, and often when they wake up, they’re rushing around, whether it’s exercising or getting their kids ready for school or getting ready for their commute; they’re okay with skipping breakfast anyway.
- Keim N et al. Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen. Journ Nutr. 1997;127(1):75-82.
About Scott Bergman:
Scott Bergman, DC is a chiropractor, board certified naturopath, and certified Functional Medicine practitioner in Walnut Creek, California. Since 1993 Dr. Bergman has been the director of Chiro Kinetics, an integrative health clinic combining Chiropractic care, rehabilitation, pilates, core yoga therapy, Functional Medicine, and biological resonance. For 25 years, Dr. Bergman has presented edifying health, nutrition and fitness information internationally in business, education, and community settings. Dr. Bergman completed his chiropractic training at Los Angeles College of Chiropractic.
Scott Bergman is a paid consultant and guest writer for Metagenics.