Low-carb Grains on a Ketogenic Diet

Keeping the carbohydrate intake low on a ketogenic diet is of paramount importance. However, this often leads to a common question: “Can you can eat low-carbohydrate grains and stay in ketosis?” And, “Do low-carb grains have a place in a ketogenic diet, or should they be eliminated? Here we discuss different types of carbohydrates, dietary fiber, and low-carb grains to help you decide whether low-carbohydrate grains should have a place in the ketogenic diet.

Low Carb Grains on a Ketogenic Diet

Carbohydrates

Classifying carbohydrates as “good” or “bad” would be oversimplistic. To understand whether a specific food will inhibit ketosis, you need to look closer at the macronutrients value. To maintain a state of ketosis, individuals must consume roughly 20-50 grams of net carbohydrates per day. However, to understand whether low-carb grains have a place in your diet, you will need to take other nutritional properties into consideration. Carbohydrates are typically divided into two categories: simple and complex. Whether a specific food item— or more accurately its properties—can be classified as a 'simple' or 'complex' carbohydrate largely depends upon its physical components. These components include molecular structure and the number of different sugars it contains [1].

Simple carbohydrates

Simple carbohydrates are made up of one or two sugar molecules. Monosaccharides like fructose and glucose, are made up of one sugar. Disaccharides, like lactose and sucrose, are made up of two sugars. Examples of simple carbohydrates are found in soda, candy, breads, and refined foods. Simple carbohydrates of lower molecular weight (LMW) are absorbed quickly into the bloodstream and can be readily degraded by the microbiota living in the upper areas of the gastrointestinal tract. Complex carbohydrates : Complex carbohydrates are made up of three or more sugar molecules of various molecular weights called oligosaccharides or polysaccharides. They are absorbed slowly into your bloodstream, while some with a high molecular weight (HMW) may resist degradation and absorption completely. These types of carbohydrates do not increase net carbohydrate count and are what are called dietary fibers [2]. The amount of dietary fiber a food contains is the differentiating factor between low-carbohydrate grains and high-carbohydrate grains.

Dietary Fiber

Dietary fiber is a complex carbohydrate that plays an essential role in a successful, sustainable ketogenic diet. Fiber intake is associated with reductions in plasma and LDL-cholesterol, attenuating glycemic and insulin response, increasing stool bulk, and improving bowel movements. [ 3, 4 ] High fiber-containing diets are associated with reduced risk of most of the significant dietary problems in epidemiological studies [5] as well as a risk in overall mortality [6]. These include: • obesity • heart disease • diabetes type II • gastrointestinal disorders • constipation • autoimmune disease • irritable bowel syndrome (IBS) • inflammatory bowel disease (IBD) • diverticulitis • ulcerative colitis • colorectal cancer • breast cancer • stroke

Two Types of Dietary Fiber

However, in the last 50 years, we have discovered that there are two types of fiber that have entirely different physiological functions. As more evidence emerges, these differences have become increasingly important in understanding the underlying mechanisms of "Western Disease": Insoluble: Insoluble fiber is a fiber that does not dissolve in water and is not affected structurally by bodily fluids or enzymes. Thus, insoluble fiber remains mostly unchanged in the digestive tract. It moves food quickly through the gastrointestinal tract and regulates bowel movements. Examples of insoluble fibers from whole foods include green leafy vegetables and the skins from most fruits and tubers. Soluble: Soluble fiber, on the other hand, dissolves in water and is transformed into a gel-like substance. Bacteria ferment this gel as a food source in the large intestine, showing prebiotic activity. As such, soluble fibers help to balance the gut flora favorably. Soluble fiber is present to some degree in most edible plant foods. Whole foods examples of soluble fiber include oats, rye, barley, wheat bran, flaxseed, psyllium husk, most root vegetables, onions, garlic, leeks, and many fruits and legumes.

Low Carb Grains

The amount of soluble and insoluble fiber a food contains is the differentiating factor between low-carb grains and high-carbohydrate grains. This is because total dietary fiber impacts the net carbohydrates of the food itself. Since fiber is indigestible, and not broken down into simple sugars like starch and sugar, it does not count toward your daily total carbohydrate allotment. The average person needs to stay within 25-50 grams of net carbohydrates per day to remain in ketosis. So, when considering whether low-carbohydrate grains have a place in your diet, it is essential to look at how many net carbs they contain by subtracting total fiber from the total carbohydrates to arrive at the net carbohydrate count. For the net carbohydrates and their quantification for a particular food, use this simplified formula: Total Carbohydrates – Total Fiber = Net Carbohydrates. Most grains and pseudo-grains are not low in carbohydrates, and it is often suggested that they are avoided altogether. However, this is an unnecessary requirement. Some low-carb grains are better than others in the context of a ketogenic diet, offering variable amounts of soluble and insoluble fiber: • Oatmeal • Bulgur • Wild Rice • Quinoa • Couscous • Millet • Barley • Brown Rice • Wheat germ • Whole Wheat bread Here we examine these low-carbohydrate grains for their soluble and insoluble fiber content to help you determine which low-carb grains are right for you.

Grains, Pseudograins	Serving Size	Total Fiber	Total Soluble Fiber	Total Insoluble Fiber	Total Carb per serving	Net Carb per serving
Oatmeal	1 cup	4.00	2.10	1.90	25.3	21.3
Bulgur	1 cup	7.90	6.60	1.30	33.8	25.9
Wild Rice	1 cup	2.90	2.60	0.30	35	32.1
Quinoa	1 cup	9.30	8.10	1.20	42	32.7
Couscous	1 cup	2.70	2.10	0.60	36.4	33.7
Millet	1 cup	6.50	5.30	1.20	41.0	34.5
Barley	1 cup	8.50	6.70	1.80	45.5	37
Brown Rice	1 cup	3.50	3.30	0.20	44.4	40.9
Wheat germ	1 cup	14.6	11	3.6	60	45.4
Whole Wheat bread	1 Slice	0.20	0.10	0.10	11	10.8

Do Low-Carb Grains Have a Place in the Ketogenic Diet?

The importance of dietary fiber cannot be understated in a healthy ketogenic diet. However, it is challenging to meet the suggested dietary requirements for fiber (30 grams per day for adults) [7] using grains alone, especially on a ketogenic diet. It is also difficult to get the soluble fiber required to maintain healthy gut flora regulation for a prolonged period from the addition of grains alone [8]. That said, there are alternative sources of soluble fiber that do not take away from your daily carbohydrate allowance, like gum arabic, maltodextrin, guar gum, or xanthan gum. And, studies still suggest that grains may play an essential role in the cultural acceptance of a ketogenic diet [9]. Even though the efficacy of the ketogenic diet is well established in the management of drug-resistant epilepsy in children, it is still only being recommended to a few selected areas in the world. One factor contributing to this boundary is the cultural acceptance and viability of the ketogenic diet given local food preferences. In fact, severe restriction of grains makes the ketogenic diet unpalatable, posing a threat to long-term adherence to a ketogenic diet. Thus, allowing certain amounts of grains in the context of culturally accepted foods improve the long-term sustainability of the ketogenic diet, while offering fair quantities of soluble and insoluble fibers. In other words, science suggests that low-carbohydrate grains have their place in the ketogenic diet. However, other sources of soluble and insoluble fibers will also need to be considered to aid in the long-term efficacy of the ketogenic diet and reduce adverse effects.

Other Considerations:

While the inclusion of low-carbohydrate grains can potentially add many benefits to a low-carbohydrate diet, it is vital to ensure that you do not have an autoimmune condition. Grains and pseudo-grains may exacerbate such conditions and should be avoided. In these cases, alternative sources of fiber should be considered, and a doctor should be consulted prior to beginning the ketogenic diet. Some have expressed concerns over grains and grain-derived ingredients in Keto Certification. For the aforementioned reasons, grains and grain-derived ingredients are allowed in Keto Certification. Keto Certified standards do not require that a product be grain-free. Further, of the 32 Randomized Controlled Trials (RCTs) on the ketogenic diet published since 1918, none of the studies suggested that grains be eliminated from the diet. However, it was noted that their consumption should be well regulated for carbohydrate content. Nevertheless, Keto Certified products must still meet the predetermined requirements for macronutrient content. For individuals who wish to adhere to a ketogenic diet and want to abstain from even low-carb grains, lab-tested Grain-Free certification, and the Certified Paleo programs do not allow grains.