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5 Tweaks To Make The Ketogenic Diet Even More Effective: A Doctor Explains

Anna Cabeca, D.O.
Author: Medical reviewer:
Updated on January 28, 2020
Anna Cabeca, D.O.
Triple board certified OB/GYN
By Anna Cabeca, D.O.
Triple board certified OB/GYN
Dr. Anna Cabeca is a menopause and sexual health expert currently working in Georgia. She received her doctor of osteopathic medicine in gynecology and obstetrics from the Emory University School of Medicine.
Bindiya Gandhi, M.D.
Medical review by
Bindiya Gandhi, M.D.
Dr. Bindiya Gandhi is an American Board Family Medicine–certified physician who completed her family medicine training at Georgia Regents University/Medical College of Georgia.
Photo by Stocksy
January 28, 2020

"Fitting into a size-8 dress again feels great, I sleep better, I'm not snappy with my kids as often, but here's the real deal breaker," my 43-year-old patient Michelle told me on her fourth visit. Excitedly, she continued, "I feel comfortable enough in my own body that my husband and I are having sex again. I'm actually initiating it!"

As an obstetrician-gynecologist who has struggled with her weight in the past, I am surprised by none of Michelle's success. She had arrived at my office about six weeks before, wanting to lose around 40 pounds. Michelle frequently felt tired yet struggled to fall asleep, had a familial history of type 2 diabetes, and her bedroom life had, as she described it, "hit zero."

Yet on that fourth visit—after following a ketogenic diet—Michelle glowed with newfound energy and vigor. Her blood work confirmed glowing health: dramatically improved blood pressure, lipids, insulin sensitivity, and inflammatory markers. Studies confirm a ketogenic diet can create1 those benefits and more. Though the diet was originally designed to help control epilepsy, studies today show ketogenic diets benefit numerous conditions including weight gain2, cancer3, type 2 diabetes4, low energy levels5, and aging2.

What are the benefits of ketosis, and is it safe?

Being in ketosis—the metabolic state that the ketogenic activates—simply means you're not eating enough carbohydrates to provide your body glucose, its primary fuel. Fortunately, your body has an alternative fuel called ketones derived from fat breakdown. In other words, on a ketogenic diet your body harnesses fat as an efficient energy source for your brain, heart, and other organs.

Please don't confuse nutritional ketosis with diabetic ketoacidosis, a life-threatening complication of type 1 diabetes. Nutritional ketosis involves6 the regulated, controlled production where blood pH remains buffered within normal limits. Like many patients, Michelle initially seemed skeptical about this high-fat, moderate-protein, low-carbohydrate diet. But by her second visit (12 pounds lighter and on her way to better health) she had become a believer.

The problem with traditional ketogenic diets

Though they create amazing benefits, ketogenic diets oftentimes create a few drawbacks that sometimes make staying the course difficult. For one, they can increase acid load that shifts urinary chemistry, putting you at risk7 for problems like kidney stones. Too many acidic foods create a "chronic low-grade acidosis," depleting precious minerals like magnesium, calcium, and potassium while adversely affecting your bone health, increasing inflammation, and paving the way for chronic disease. In essence, the body is scavenging minerals to keep the blood pH balanced…at a cost.

That's why I created an adjusted version (Keto-Alkaline™) of the ketogenic diet, which juxtaposes a ketogenic diet's many benefits with a focus on alkaline foods. I emphasize testing, not guessing with urine keto pH strips because what we eat is only a part of what gets us keto-alkaline. It's a lifestyle. Before shifting dietary focus into ketosis, my patients focus on alkaline-rich foods, eliminating many problems ketogenic diets potentially create like bad breath and constipation, helping them easily stay in ketosis. I also have them focus on alkalinizing lifestyle practices like meditation, gratitude journaling and long walks in nature, which all lower the stress hormone cortisol's effects on the body.

What should I eat on the keto-alkaline diet?

Once you're alkaline, you'll shift into ketosis by eating about 56 to 70 percent healthy fats, 20 to 25 percent protein, and about 5 to 10 percent healthy carbohydrates (mostly vegetables). Women tend to need the higher end to really stay alkaline while in ketosis. Michelle loved this way of eating, which included wild-caught fish, coconut, nuts and seeds, and loads of leafy and cruciferous vegetables. "I can't believe I'm losing weight so quickly on these delicious foods!" she told me her second visit. Whether you want to reverse or prevent disease, lose weight, or break a weight-loss plateau, a ketogenic diet can help, and these five hacks will get you started or upgrade your current ketogenic diet.

1. Focus on alkaline foods.

Along with plenty of filtered water, foods like green leafy veggies including kale, beet greens, spinach, chard, and a veggie-blend powder can help you become and stay alkaline.

2. Ditch the acidic foods.

That means alcohol (sorry!), coffee, and most dairy. And this doesn't mean you'll never eat them again (I love my dark chocolate and pinot noir), but you'll need to ditch them temporarily as you shift into alkaline territory. And if you're checking with your pH urine test strips, you'll know if they negatively affect you or not.

3. Give it time.

I give patients a week to become alkaline (don't worry: Like Michelle, you'll lose weight while you're shifting); then we focus on ketosis. Most patients see results almost immediately, but any lifestyle transformation can require a few days to adjust.

4. Try fasting.

You can also up your benefits with modified intermittent fasting (IF). My patients fast 13.5 to 15 hours between dinner and breakfast. It isn't as hard as you might think: You'll be sleeping about eight of those hours, so this modified IF version is (figuratively) a piece of cake!

5. Focus on more than food.

My version of the ketogenic diet also focuses on reducing stress, getting great sleep, increasing movement, having healthy daily bowel movements, reducing environmental toxin exposure, and cultivating positivity. All these contribute to weight loss and optimal health.

So whether you're a keto newbie or want to give your existing diet an upgrade, I'd love to share more about my ketogenic diet that can transform your weight and your health.

Anna Cabeca, D.O. author page.
Anna Cabeca, D.O.
Triple board certified OB/GYN

Dr. Anna Cabeca is a menopause and sexual health expert currently working in Georgia. She received her doctor of osteopathic medicine in gynecology and obstetrics from the Emory University School of Medicine. Cabeca is the creator of many products for hormone and dietary support and is the author of The Hormone Fix, a comprehensive diet and lifestyle plan for women approaching or in menopause. She has been featured on NBC, CBS, and ABC and in the Huffington Post and Reader's Digest.