After nearly three years of using a KD (ketogenic diet) to help manage my COPD I feel I’m fairly well qualified to talk about how this diet affects my COPD. Over this time, I have had many blood tests and pulmonary function test while monitoring the effects it’s had on my disease. At the time of writing this article I am supplying researchers with my data with the view of my case study being published in a medical journal.
In this article I will try to answer many of the question surrounding the use of KD for respiratory disease. I will also debunk the myths surrounding fat and the use of the KD. From the start I would say the KD isn’t a cure for respiratory disease, nor would I say it is for everyone. What I would say is, do your own research and make an informed decision before either using this diet or dismissing it.
What is ketosis?
Simply put, ketosis is a state your body can be put in by fasting, diet or intense exercise! In order to be in ketosis, you have to deplete your bodies glucose fuel stores, so your body starts using fat for fuel. Fat is metabolised in your liver and converted into ketones which in turn is used as your body’s primary fuel source. Ketosis as a fuel source has a range of benefits which is not seen when our bodies use glucose as fuel.
What is a Ketogenic Diet?
To achieve ketosis using diet, it is important to eat certain foods in certain ratios. This can vary from person to person and is best done in consultation with a dietitian experienced in the use of a ketogenic diet. Guidelines for the ratio of foods are 70% fat, 20% protein and 10% carbohydrates. However, the types of fats, protein and carbohydrates matter. It is important these foods are whole foods and not processed. It is also important to keep to these ratios, as non-compliance will mean not achieving ketosis and the benefits associated with it.
Why a Ketogenic Diet for respiratory disease?
Systemic inflammation is a key driver in most respiratory diseases, so it is important to reduce inflammation as much as possible. The ketogenic diet has been shown in studies to suppress key inflammatory markers associated with respiratory disease. While we know certain foods are anti-inflammatory, that alone will not achieve significant suppression of inflammation. The Ketogenic Diet uses only foods which are anti-inflammatory.
Another important benefit of using the ketogenic diet is the low production of carbon dioxide as compared to diets high in carbohydrates. Many respiratory patients have problems with expelling carbon dioxide, and this can lead to a very poor quality of life. Foods we eat break down into carbon dioxide at differing amounts, with carbohydrates producing the most carbon dioxide followed by protein. Fats produce the least amount of carbon dioxide which will lessen the burden of expelling this by-product on the lungs. This is called the respiratory quotient.
Since I have been on the ketogenic diet, I have seen significant improvements in my inflammation markers and lung function. The initial inflammation tests I had carried out before being in ketosis showed significant systemic inflammation as you would see with other severe COPD patients. My latest inflammatory tests show all inflammatory markers related to COPD are in normal ranges. I have seen significant improvements in my pulmonary function tests including a change in my FEV1 percentage from 27% before the diet to 39% while on the diet.
Fat and heart disease.
Probably the number one comment I hear about the ketogenic diet is, “I can’t do the diet because the fat content will make my cholesterol go up and I’ll have a heart attack.” There are no studies linking either saturated fat or the ketogenic diet with heart disease and after nearly three years on the KD my cholesterol levels are perfect. In fact the study above on saturated fat suggested carbohydrate and polyunsaturated fat intake were associated with greater progression of atherosclerosis which can cause heart attack.
Not all fats are the same, some fats are bad, such as trans fats, while other fats such as saturated fats and monounsaturated fats are considered healthy. The same can be said for carbohydrates, processed carbohydrates are considered unhealthy, while carbohydrates from leafy green vegetables and other non-starchy vegetables are considered healthy.
My own N=1 experiment has shown when I eat a diet mixed with equal fats and carbohydrates, I quickly gain weight and feel unwell. Sadly, many dietary guidelines for COPD recommend a combination of refined and complex carbohydrates with fats. When we look at the study I referenced regarding carbohydrate and polyunsaturated fat, you have to wonder if these COPD dietary guidelines should be reviewed.
The Ketogenic Diet is very strict and hard to adhere too.
If we were brought up eating a ketogenic diet and knew no different, I would suggest changing to what dietary guidelines call, a standard diet, would be hard as well. My experience with the KD overtime has seen me able to be more liberal with the amount of good carbohydrates I eat. It is important to be strict with this diet when first converting over to it, however over time your body becomes more metabolically flexible and you can add more variety to your diet.This doesn’t mean you’ll be adding pizza, pasta, rice and bread back to you daily diet. In saying this, there are now ketogenic pizza’s, cookies and bread available.
There have been times over the last 3 years when I have converted back to a standard diet as part of my own experiment. I can say with certainty this has been detrimental to my health and I have seen a decline in my lung function and inflammation makers. Adherence to any new diet can be difficult whether it’s a KD or a standard diet. You may have heard of the keto flu? This is a period of time your body is adapting to the KD and you can feel quite lethargic. I have experienced this feeling when switching to both a KD and a standard diet. For me it comes down to what is best for my health and managing my disease.
Where form here?
If you are going to use the ketogenic diet, I would suggest doing it in consultation with your doctor and an experienced dietitian. It is vital you measure whether you are in ketosis so you can make accurate comparisons in how you feel before and after. From my own experience I would recommend a minimum of 8 weeks of using the KD. This will give your body the chance to convert over to using fat for fuel as well as time to see any changes in your symptoms.
Having tools to measure symptoms at home can be helpful. There are personal spirometry devices available to measure certain lung functions such as FEV1. Since being on the KD I have regularly measured my spirometry at home to monitor the benefits. Below I will add some studies worth reading. These studies show the relationship between dietary strategies, inflammation and respiratory disease. Happy reading!