The Lowdown on the Ketogenic Diet for Athletes

Ketogenics....isn't that what Michael Jackson wanted to do with his body after he died? Oh yeah, that's Cryogenics. My bad.   Well, I'm sure you've probably heard the term Ketogenics, even if you're not sure what it is.

The diet world is always a flutter with the newest this and the newest that. Actually, there really isn't anything new, it's just a new name for low-fat, high-fat, low-carb, or only eat Twinkies diet.

Many years ago we had the Atkins diet which was low carbs, then we had the Paleo diet which had many eating no carbs and getting in tune with their caveman ancestry, and now we have Ketogenics. All are really pretty similar in theory....Carbs are bad.

Ketogenics is all the buzz because it's often pitched as a beneficial diet for athletes. Being a coach and fitness trainer, I'm often asked about current nutrition trends. While I'm not a nutritionist and in the state of North Carolina I legally can't provide individual nutritional advice, I do try to keep up with the reading to be current on the latest research.

I've had 200 hrs of anatomy and physiology education and 100 hrs of nutritional education. So, while in no way am I an expert, I do have a good basis of understanding of how the body works and functions physically and nutritionally and my ears always perk up when a diet excludes a specific food group.

So when Sanna Delmonico, MS, RDN, CHES wrote an article ""Do Ketogenic Diets Work for Athletes" for the recent issue of IDEA Food and Nutrition Tips (Volume 6, Issue 5), I was very eager to read it.

Basically Delmonico addressed the question, "What do you think about a ketogenic diet for athletes? Does it really improve performance?"

Her response was pretty much what I thought. But first what is a ketogenic diet?  Delmonico describes a ketogenic diet as a high-fat, low-carbohydrate diet, usually including less than 50 g of carbohydrate per day (Paoli 2013). Carbohydrate, which is stored in the body as glycogen, is the preferred fuel for muscle and the brain. When this fuel isn’t available, the body turns to fat for energy and produces ketosis. The theory is that since we store much more energy as fat than as glycogen, athletes have a reliable, steady source of energy if they burn more fat, and this should improve performance.

Medically speaking, the ketogenic diet has been successful in treating epilepsy in children and in some adults and has shown some promise in weight loss  and type 2 diabetes. But, and this is a big but, long term, the ketogenic diet has risks. Continued use of this diet increased the chance of kidney stones, increased blood lipids and bone fractures. This diet also leads to constipation in many because it's so low in fiber. The low fiber component can also lead to increased chances of colorectal cancer.

Delmonico says that research has shown that over time, an athlete on a ketogenic diet becomes more efficient at burning fat. This adaption takes about 3-4 weeks and during that transition time, the athlete will feel very fatigued. So, this transition should be done well before a race training cycle. The thinking is that an endurance athlete like a marathon runner or triathlete would benefit from this because they'd have a longer sustained source of fuel. However, research has shown that while these athletes have become more efficient at burning fat, it hasn't added any benefit to athletic performance. However, higher carbohydrate diets did result in improved performance.

Delmonico concludes that more research is needed on Ketogenic diets for athletes. The positions of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine are that current evidence doesn't support the use of ketogenic diets to improve athletic performance.

Delmonico cautions athletes using the ketogenic diet to keep in mind that decreasing carbohydrate intake also decreases intake of fiber, vitamins, minerals, and phytochemicals from beans, whole grains, starchy vegetables and fruits.

Also keep in mind that the American Heart Association recommends reducing saturated fat to no more than 5 to 6 percent of total daily calories. This would be very hard to do on a Ketogenic diet.

Training? Feeling a Little Run Down?

Runners are notorious for digging a hole and jumping in. We'll push, push, push, thinking that if we just push a little harder, we'll break through that wall hindering us. While sometimes a little push is just what you need, other times, REST is what you need. So how do you tell the difference of when to push and when to rest? Listen to your body, know the difference between, "I don't wanna" and "I can't" and know the signs of fatigue and over training.

Do you feel that burn after a hard workout or a hard run? That's from pushing your body past what it's used to. Challenging yourself to harder more intense workouts (resistance training or aerobic training) over a period of time is called progressive overload. Progressive overload is how you train your body to adapt to the new conditions being put upon it. The key, however, is making sure that along with the progressive overload you are also giving your body time to recover. Ever notice how most marathon plans have you run a 20-miler followed by a day of rest and then the following week's "long run" usually isn't as long. That's progressive overload or stress adaptation. Build up. Back off a little. Build up. Back off a little. Overloading the body and then giving it a chance to recover, adapt, and heal before placing more stress upon it, is a great way to train.

The S.A.I.D. principle (Specific Adaptation to Imposed Demand) refers to the idea that your body adapts to the specific type of stress put upon it. So, when an endurance runner pushes to finish that 20-miler in a specific time frame, his/her body is adapting to that specific type of stress being put upon it.

The problem is many athletes (aerobic or anaerobic) don't give their bodies time to adapt before imposing more stress on their bodies. The create a recovery deficit....that hole they've dug and can't get out of. They're constantly stuck in the recovery period or worse, they become injured. This is called overtraining.

Often I hear a runner say, "but it's in my plan" or "but my plan says." Runners often mistake a training plan for LAW. A training plan is merely a guide to help you reach your goal. A training plan sis like a travel plan...a map. Change will most likely need to be made along the way. A plan doesn't know the factors you may be dealing with in a given week...the stress of the job, lack of sleep from a sick child, dealing with allergies, that pothole you stepped in and twisted your ankle, that unplanned work trip thrown at you. Some times life has a different plan for you than what your race training plan had in store of you. A training plan is based on an ideal world. A training plan also, does not know how long your particular body may need to recover after that first 20-miler. The plan is your map. You are the driver and your running coach is your AAA consultant.

Some common signs of over training include:

• persistent achiness, stiffness, or pain in the muscles and/or joints (beyond the typical delayed onset muscle soreness felt a couple of days after a workout)
• waking up with an elevated pulse (good idea to take your waking resting pulse frequently to give you a base from which to compare)
• lack of energy
• fatigued and/or achy muscles
• frequent headaches
• feeling lethargic or sluggish
• drop in athletic performance
• not able to complete your normal workout
• depressed, moody, unmotivated
• nervousness
• lack of sleep and/or appetite
• weight loss
• lowered immune system

An elevated pulse is also a good indicator of possible overtraining or even sickness such as a respiratory infection. If your waking resting pulse is elevated more than a few beats, you could have an infection or be suffering from overtraining. In either case, taking a day off may be the best thing. Rest is the best thing for overcoming overtraining. If rest doesn't do the trick, schedule an appointment with your doctor.

Other Causes of Fatigue When Training Include:

Improper Hydration can also be a source of fatigue. Most people in general don't get enough water (2-3 liters) each day. If you fall into that category and you're also not replacing the water you're losing through perspiration from running, you're risking dehydration. A sure sign of dehydration is fatigue. In addition to your normal daily hydration requirements, you should drink 12-16oz of water about an hour before your run. One good way to determine how much you need to drink after your run is to weigh yourself before your run (without your running shoes), then weigh yourself immediately after your run (without your running shoes). For every pound lost, you should drink 16oz of water. Don't have to drink all that immediately after your run. Drink some and then make sure you get in the remainder within a few hours after your run. No need to weigh before and after every run, but if you do it on a mild day and once on a really hot/humid day, then you'll have a frame of reference to help you determine how much to drink after runs in various conditions.

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If you're running less than an hour, water is perfect. If you're running an hour or longer, a sports drink will be a better choice especially on hot/humid days because it will help replace vital electrolytes (mainly sodium and potassium) lost through sweating.

Alcohol consumption should be decreased during training. Excess alcohol consumption can increase your chance of dehydration in several ways. Alcohol decreases your body's production of anti-diuretic hormone. This hormone is used by the body to reabsorb water. Having less of this hormone causes you to urinate more increasing your fluid loss. Side Note: The average beer is about 4-5% alcohol. When you drink a 200ml beer, you don't just urinate 200ml of water, but more like 320ml of water which calculates out to 120ml of dehydration. (Sorry, for the bad news.)  

Lack of Sleep is a big-time cause of fatigue. Your body does most of it's repair and rebuilding while you sleep. If you're not getting enough sleep, then you're not giving your body time to heal. Plain and simple. Sleep requirements can vary from person to person. Teenagers need about 9 hours on average (mine seem to need about 15!). Most adults need 7 to 8 hours a night for the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day. Fatigue can result when your normal sleeping hours are shortened for whatever reason—stress of a new job, a new baby, or that heartburn you got from the 5-meat pizza you ate just before bed. If you're not getting your normal amount of sleep, then you need to back off on your training until your sleep hours are back to normal.

Low Iron Levels can be another cause of fatigue. If you've ruled out other possible causes of fatigue, it may be worth having your doc take a blood test to check your iron levels. This can especially be problematic for some women during their menstrual cycle. Sometimes just a change in diet can help boost your iron levels, but sometimes an iron supplement may be needed. (Check with your doctor before taking an iron supplement.) Good food sources of iron include: turkey, clams, enriched breakfast cereals, beans/lentils, pumpkin seeds, blackstrap molasses, canned beans, baked potato with skin, enriched pasta, canned asparagus.

Sometimes you may not experience the fatigue during your run. For some the fatigue may come after the run. Insufficient Post-Run Re-Fueling can be the culprit. If you've had an intense workout, it's normal to feel tired, but if you're feeling fatigue that just won't go away, you may not be giving your body enough refueling carbs and protein after your run. A good rule of thumb is to consume a 4:1 ratio of carbs and protein within 30-45 minutes of finishing your workout. Oddly enough, lowfat chocolate milk has the optimal ratio of carbs to protein to help refuel tired muscles.