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% Intermittent Fasting Keto: How It Works, Benefits, Risks, More Everyday Health MenuNewslettersSearch Ketogenic Diet
Intermittent Fasting on Keto What to Know Before Combining the Diets for Weight Loss
Two trendy approaches promise better results when you do both at once. But is it possible to go on — and stick with — this combined approach?
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By Jessica MigalaMedically Reviewed by Kelly Kennedy, RDNReviewed: January 29, 2019Medically ReviewedDoing intermittent fasting and the keto diet together means eating lots of fat and very few carbs during only certain times of the day.Shutterstock (2)Cutting carbs and fueling the body with fat is only gaining steam. But if you’re someone who’s found weight loss success using this popular approach, called the ketogenic diet (or keto for short), you may be thinking of taking things up a notch and combining keto with intermittent fasting to bust through a plateau or improve your results. Is this something you should try?
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The short answer is maybe, though you should know up front that this combined approach hasn’t been studied or proven to work for weight loss. Experts say it could make sense, though the lack of research means you may want to think twice before delving into this eating approach.
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Combining the two diets gained popularity when intermittent fasting expert Jason Fung, MD, author of The Obesity Code, recommended using keto as a foundation with fasting, explains Lori Shemek, PhD, a nutrition and weight loss expert in Dallas and author of How to Fight FATflammation. Celebs, like Halle Berry, are also said to use the diet, says Dr. Shemek.
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Let’s talk about what each diet is. What Are the Basics of the Ketogenic Diet
Scientists originally designed a keto diet in the ’20s to help control seizures in children with epilepsy, previous research shows.
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This version, called the “classic” ketogenic diet or the “long-chain triglyceride diet” calls for eating 3 to 4 grams (g) of fat for every 1 g of carbs and protein, according to the Epilepsy Foundation. The version of keto many are using for weight loss today is a little different in that it is a high-fat, moderate-protein, and very-low-carb plan. Fat comprises about 80 percent of your daily calories, and you’ll aim to consume between 20 and 50 g of net carbs (carbs minus fiber) each day depending on your personal needs.
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A typical keto diet food list calls for ditching most carbs, even healthy foods such as fiber-rich whole grains and most fruits, while prioritizing fats, such as avocado, olive oil, grass-fed beef, and even bacon occasionally. The idea with this eating plan is to transition your body from one that burns glucose (or carbs) for fuel to one that relies on fat for energy. This state is called ketosis or being keto-adapted.
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The keto diet can undoubtedly lead to quick weight loss in the short term. Nonetheless, critics point out that long-term research (more than two years) on people using keto for weight loss is lacking.
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Also important to note is that many of the claims that keto can treat health conditions other than epilepsy — such as cancer, high blood pressure, polycystic ovary syndrome (PCOS), diabetes, and neurological diseases like Alzheimer’s disease — need more research, per a review published in August 2013 in the European Journal of Clinical Nutrition. RELATED: 11 Health Conditions Keto May Help — and 6 It Won’t
How Does Intermittent Fasting Work
Intermittent fasting is another diet approach where you plan specific times when you are not eating. There are several ways to do intermittent fasting, which some people simply call IF.
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For instance, some people may follow the popular 5:2 IF, where five days are “normal” eating and two are extremely low-calorie (like around 500) “fast” days. Others may not eat for a 24-hour period.
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While others may practice time-restricted eating, such as eating for 8 hours and fasting for 16. When it comes to IF, there’s some exciting research on humans that’s emerging, including the role that the approach may play in treating obesity and insulin resistance (the hallmark of type 2 diabetes), according to a review published in March 2017 in the journal Behavioral Sciences. Yet the authors of that review concluded that there’s “a lack of high-quality evidence” on the health effects of IF and that it’s still unclear which type of IF is best to follow.
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So far, most of the studies of IF (for weight loss or otherwise) have been in animals, not humans, or have been short term. RELATED: Answers to 15 Burning Questions About the Keto Diet
Why Combining Intermittent Fasting With Keto Has Become Popular for Weight Loss
Doing keto or IF can help with weight loss in the short term, though each diet is very restrictive, so they certainly aren’t for everyone. But how about combining them?
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Could two be better than one? First, in some experts’ view, it does make sense to pair the two approaches.
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The keto diet increases levels of ketones in the body; during times of fasting, ketones are also increased. “The brain will rely less on glucose for energy when in a state of nutritional ketosis.
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Therefore, the transition into a fasted (ketogenic) state during the day eventually becomes seamless after eating low-carb or ketogenic for a few weeks,” says Dominic D’Agostino, PhD, associate professor at the University of South Florida in Tampa and founder of KetoNutrition.org. This is a strategy that practitioners counsel patients on at the Cleveland Clinic’s Functional Ketogenics Program. “Adding intermittent fasting can take things up to the next level,” says the Clinic’s Logan Kwasnicka, a certified physician assistant at the Cleveland Clinic in Ohio.
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That next level may be overcoming a weight loss plateau, as people may eat fewer calories when doing IF. It can also be a natural progression from a keto diet for those who feel satiated eating so much fat (ketosis may also decrease appetite) and aren’t bothered by shrinking their eating window. RELATED: 8 Steps Beginners Should Take Before Trying the Keto Diet
Who Should Try an Intermittent Fasting Keto Approach
Anyone who has been on keto for more than two weeks and — with the okay from their healthcare team — would like to add IF may do so.
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But the keto diet has become popular for those who have prediabetes or diabetes, though “asking these patients not to eat for a significant amount of time can be dangerous,” says Kwasnicka. If you have chronic kidney disease, a history of eating disorders, are undergoing active cancer treatment, or are pregnant or breastfeeding, it’s unlikely you’re a good candidate for this combined diet plan. Even the individual diets (keto and IF) may not be recommended for these populations.
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Check with your healthcare team. Also, if you’re currently following the keto diet and are happy and feel good with the way you’re eating, you do not have to add in IF, she says. RELATED: What Are the Different Types of the Ketogenic Diet, and Which Is Right for You?
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The Right Way to Start an Intermittent Fasting Keto Diet
At the Cleveland Clinic, practitioners do not advise people to start both keto and IF at the same time. “It’s a huge shock to your system to switch from glucose as fuel to ketones, and implementing IF is a significant change,” says Kwasnicka.
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For that reason, people would start with keto. After being on the diet for a couple weeks to months, they might consider IF. It’s also important to choose the correct timing.
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For their patients, Kwasnicka suggests a 12- to 16-hour fast. For many people, not eating 12 hours a day (say overnight from 7 p.m.
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to 7 a.m.) is a natural habit anyway and doesn’t require skipping meals. To start, consider delaying breakfast (starting with an hour and then slowly extending the time) to get your body accustomed to going longer stretches without eating, suggests Shemek. When you’ve adjusted to your new eating pattern, reintroduce breakfast earlier in the day and extend your overnight fasting time, as eating breakfast not only leads to better cognition, but also improved metabolism and insulin sensitivity, according to a study published in August 2018 in the American Journal of Physiology-Endocrinology Metabolism.
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As for the length of time to stay on keto-IF, she recommends doing keto-IF for no more than six months and then transitioning to a more standard low-carb diet. RELATED: 10 Popular Low-Carb Diets, and Their Pros and Cons
A Sample Menu for Keto and Intermittent Fasting
If you’ve gotten the green light from your healthcare team and want to try this combined approach, you might be wondering what you’ll eat (and when). Your instincts are right: This diet is all about the timing.
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Below, here’s what Shemek says three days on the plan might look like when done with time-restricted eating in a 16-hour fast, 8-hour feed pattern. This approach isn’t the only way to do IF — there are many ways to fast. For example, you can also do a 12- or 14-hour daily fast.
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In this plan, you’ll see that snacks are optional. Also keep in mind that your carb, protein, and fat needs to stay in ketosis depend on your individual health.
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Working with a registered dietitian familiar with keto-IF can help you determine those ratios. Day 1
10 a.m. Black coffee and scrambled eggs topped with avocado slices; water all morning
1 p.m.
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Lunch Large leafy green salad topped with 2 tablespoons (tbsp) of olive oil, vinegar, and 3 ounces (oz) grilled salmon
3 p.m. Snack (optional) ¼ cup Macadamia nuts
6 p.m. Dinner Chicken leg (with skin), ¼ cup of cooked wild rice, and 2 cups of zucchini cooked with olive oil
Day 2
10 a.m.
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Plain hot tea, a keto-friendly smoothie, water all morning
1 p.m. Lunch 3 oz grilled chicken breast, half a plate filled with broccoli and cauliflower drizzled with 1 tbsp olive oil, 1 whole avocado
3 p.m.
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Snack (optional) Unsweetened coconut chips
6 p.m. Dinner 3 oz seared tuna cooked in olive oil on a bed of Asian coleslaw, topped with a drizzle of olive oil and sesame seeds
Day 3
10 a.m. Black coffee with keto chia pudding; water all morning
1 p.m. Lunch 3 egg omelet stuffed with peppers (½ whole pepper) and spinach (1 cup) cooked in 1 tbsp olive oil, topped with ½ an avocado, side of ½ cup sliced tomatoes
3 p.m.
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Snack (optional) Olives
6 p.m. Large kale salad (3 cups) with 3 oz shrimp drizzled with 2 tbsp of olive oil and vinegar of your choice
RELATED: What Are the Best and Worst Fats to Eat on the Ketogenic Diet? The Possible Health Benefits of a Keto Intermittent Fasting Diet
There isn’t research on the health effects of doing keto and IF together, but it’s clear that ketone levels increase when the plans are combined.
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This may help accelerate weight loss, says Dr. D’Agostino. Still, everyone responds differently, so this may not be true across the board, he says.
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Shemek has all of her clients use keto or the IF and keto combo. “My clients are typically all prediabetic and overweight.
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Once they see and feel what eating in this way does for them — including regulating their blood sugar levels — they are able to stay on an IF and keto plan easily. The success of the combined approach reinforces their committment,” she says. One interesting way that low-carb IF diets are being studied outside of weight loss is for cognitive health.
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Richard Isaacson, MD, director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and NewYork–Presbyterian in New York City, says that doing a low-carb, time-restricted IF may be beneficial for “calming down insulin pathways and letting the brain benefit from cleaner burning [ketone] fuel,” which may offer benefits for people with Alzheimer’s disease. In fact, Dr. Isaacson personally does an 8-hour feed, 16-hour fast four to five days a week.
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This strategy, he says, may also help limit fat accumulation around your waist. “A bigger belly [may] mean a smaller memory center in the brain,” he says. Not to mention, more visceral (belly) fat is associated with a higher risk of chronic ailments such as heart disease and type 2 diabetes, according to an article published in January 2012 in the British Journal of Radiology.
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Are There Any Known Health Risks of Doing Keto and Intermittent Fasting Together
As for long-term risks, “people with seizure disorders (what keto was developed to treat) have been on the ketogenic diet for decades and demonstrate excellent health,” D’Agostino says. Though, like any diet, it all depends on what foods you’re eating.
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A keto diet rich in bacon and butter is different from one rich in avocado and olive oil, and poorly planned keto can lead to nutritional deficiencies. Because adding IF may make you cut calories too drastically, you may also lose too much weight or lean mass (muscle) if you take the restriction to the extreme.
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To maintain muscle mass, he recommends consuming 1 g per kilogram of body weight in protein every day. RELATED: What Is Keto Cycling, and Is It the Key to Success on the Keto Diet?
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The Bottom Line on Combining the Keto Diet With Intermittent Fasting
The keto diet is a restrictive high-fat diet, and intermittent fasting restricts the number of hours you will be eating. There is a lack of research on each diet alone, along with this combined plan, so it’s unclear exactly what you’re getting into if you try them individually or together. If you decide to give the diets a go, know that they are extremely restrictive, so it may be difficult to stick with the low carb count and confined eating window.
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(Even children who follow keto to help control epilepsy have a hard time adhering to the plan!)
Before deciding to follow keto and IF together, be sure to consult your healthcare team. Your provider can help you determine whether this combined diet plan is a good fit for you, and then they can help you adjust any meds you’re on to help increase your chances for success in the safest way possible.
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