Confused by Ketones, Ketosis, Ketogenic Diet, Keto? Fear Not Hoomans!
Co-Founder & CEO, Valiant Pet Nutrition
*What is Ketosis?
In the modern canine diet, the dominant fuel for the body is sugar/glucose metabolized from carbohydrates. To survive in varied conditions, all living beings are physiologically adapted to use more than one form of fuel: glucose and ketones. During fasting, starvation, vigorous exercise, and caloric restriction (when glucose and insulin are low,) the metabolism naturally shifts towards the breakdown of fat into usable energy, called ‘ketone bodies,’ or ‘ketones’ This fat can be derived directly from the diet or adipose tissue stored throughout the body (aka body fat.)
The lowering of glucose and insulin plus the elevation of ketones in the blood produces the healthy and natural metabolic state called ketosis. It was once believed that dogs could not achieve ketosis; however, modern research shows that dogs do enter ketosis, though it may take longer to achieve. Blood glucose levels tend to lower at the same rate as humans on the diet; however, blood ketone levels do not elevate as high compared to humans.
At KetoPet, our nonprofit partner, they observed an overall average blood glucose level of 62.7 mg/dL and blood ketone level of 0.7 mM BHB. Some medications, like prednisone, can spike blood glucose, making it challenging for a dog to enter into ketosis.
What is a Ketogenic Diet?
A ketogenic diet (KD) is a nutritional strategy that intentionally manipulates the macronutrient ratio of carbohydrates, fats, and proteins to induce a state of ketosis. The average American doggo diet (kibble) is greater than 45% carbohydrate. The KD shifts the carbohydrate component to less than 10% and increases fats to 60-80% of total daily calories. Thus, a KD is high in fat, adequate in protein, and low in carbohydrates.
For our doggos, a KD can range from 69%-90% fat, 17%-9% protein, and 1% carbohydrates, depending on the dog and purpose. KD’s with higher percentage fats (87% +) are favored for seizure control in dogs with epilepsy; however, these higher percentages are not needed to induce ketones, nor do they appear to significantly increase ketone levels in the blood. KetoPet observed that dogs routinely entered ketosis using an 82% fat/ 17% protein/ 1% formulation.
After a period of time (120-days minimum), dogs may be able to maintain ketosis on a lower formulation (69% fat/17% protein/1% carbohydrates) allowing for more protein intake however, each dog was different. Optimization of carbohydrate and protein intake must be validated through dietary monitoring, dietary modification, and ketone and glucose testing to determine what works best for each dog.
As compared to other low carb diets, like Atkins, the KD requires only adequate protein. Like carbohydrates, the body can convert excess protein into sugar, thus disabling ketogenesis. Commercially packaged dog foods can contain up to 80% of calories from carbohydrates. Nutritional facts panels on pet foods do not list carbohydrates (or sugars for that matter), which makes it difficult to determine how much digestible carbs a product contains without sending it to a lab for detailed analysis. Even products that claim to be grain-free and raw can still contain high amounts of carbs in the form of fruit, root veggies, added sugars or fructose, soy and pea tapioca & potato flour's Therefore, all processed kibble diets are too high in carbohydrates to induce ketosis.
In implementing a Ketogenic Diet in dogs, some commercially available raw food products, or a meticulous home-made diet, can allow pet owners to implement the Ketogenic Diet at home. The math required to calculate the meal plan at home, however, can be daunting. KetoPet has created a free eBook and online keto calculator that helps pet parents formulate ketogenic meal plans for their doggos. KetoPet
Despite the clear therapeutic potential of the KD, the success of KetoPet is largely attributed to strict protocols that were followed. I am not suggesting pet owners follow all the protocols of KetoPet, unless you have a staff of veterinarians and vet techs at home! But, The KD can contribute to success at home when protocols and adjunctive therapies are implemented consistently. Following are some examples:
- Engaging your veterinarian as your partner in your doggos keto journey
- Elimination of carbohydrates and glucose sources found in non-keto foods and treats
- Repeated blood glucose and ketone testing at home or by your veterinarian
- Dietary adjustments based on glucose/ketone results and canine body composition
- 20-30 minutes of metabolic conditioning twice daily. Daily exercise increases heart rate and burns calories
- Use of standard of care when deemed appropriate by your veterinary
"The keto diet is too expensive". The wonderful thing about partnering with KetoPet is that they have a free calculator you can use that will give you a keto recipe you can make at home. This makes feeding keto affordable. On those days, where you are pressed for time or traveling, you can use a pre-packaged keto food.
“It causes excessive weight loss.” KDs cause a purging of excessive water stores, loss of white fat and gain in brown fat, thus altering body composition. Loss of retained water (sometimes as much as 10-15% of body weight) is sometimes perceived as excessive weight loss. Rigorous weight monitoring and dietary adjustments prevent excessive weight loss.
“The KD causes constipation.” Loss of excessive water stores causes losses in electrolytes. A lack of appropriate electrolyte supplementation can potentially lead to side effects.
“Raw foods are full of salmonella & pathogens.” All forms of food may contain pathogens. According to FDA and CDC publications, dry kibble is the only category of pet food validated to of caused illness in humans, sickening 190 humans. FDA references also indicate that 24% of dogs shed salmonella in their feces, regardless of diet; 56% of dogs fed salmonella do not shed it in feces; and that only 0.6% of dogs fed salmonella exhibit any symptoms. Healthy dogs tolerate moderate levels of pathogens well.
Dogs with suppressed immune systems are statistically less likely to be exposed to pathogens when fed commercially available raw foods than kibble. Grocery store meats are more likely to harbor pathogens, as they are intended to be cooked for human consumption. Therefore, care must be taken to attain clean sourcing and nutritional adequacy when creating homemade diets.
“The KD can cause fatty liver disease.” Deterioration of hepatic function can result in abnormal bile flow and accumulation of toxins in the bloodstream. High fat consumption does not cause hepatic deterioration. However, a KD may exacerbate previously diagnosed fatty liver conditions.
“The KD causes ketoacidosis.” When insulin is not present, or there is resistance to it, glucose levels rocket above 300mg/dL. Alternatively, ketosis or fasting results in glucose levels averaging 50-100mg/dL. Additionally, ketoacidosis causes the body to uncontrollably produce ketones, with levels reaching 15-25mM vs the maximum of 7mM induced by ketosis.
“Fats increase cholesterol, triglyceride and atherosclerosis risk.” The majority of recent studies have suggested that the KD can lead to significant benefits in biomarkers of metabolic health, including blood lipid profiles. In these studies, the KD positively altered blood lipids, decreasing total triglycerides and cholesterol while increasing the ratio of HDL to LDL.
Pet owners must understand that even a small quantity of carbohydrates, excess protein, or overfeeding can rapidly inhibit ketosis. Furthermore, enhanced ketone production and utilization can take up to several weeks (keto-adaptation.)
Until next time,
*Excerpt from an upcoming article in Innovative Veterinary Care Journal. https://ivcjournal.com/