Keto- It’s all the Rage, Right!?

Why Keto was Created & Initial Remarks:

The ketogenic diet was introduced in the 1920s to treat seizures in infants and has continued to serve a unique role in the medical world as a therapeutic treatment for pediatric epilepsy. The diet has proven to effectively reduce symptoms for this population. 

Somehow, the diet has evolved to become a mainstream “tool” for weight loss with claims to prevent Alzheimer’s disease, support cardiometabolic health and help manage diabetes. 

Aside from these health claims is the concerning evidence that most people who claim to be “keto” are not actually following a ketogenic diet and are not metabolically in a state of ketosis. The result? Lots of Americans following a high fat diet while restricting fruits, vegetables, grains and beans… yikes!

How Keto Works:

Carbs are the favorable fuel source for body tissue. When we deprive the body of carbs (<50g/day for most), we first force our body to use glycogen (stored carb in muscle and liver). Once we exhaust our stored energy from carbohydrate, we begin utilizing what are often referred to as “starvation pathways”, gluconeogenesis and ketogenesis. 

In gluconeogenesis, we’re using whatever non-glycogen chemical compounds we can to produce glucose. These compounds include amino acids(alanine and glutamine), glycerol and lactic acid. Our body does not convert fat to carbohydrate. Therefore, when glucose production from alternate sources(gluconeogenesis) cannot keep up with our body’s demand, we enter ketosis. I like to think of ketosis as our body’s emergency gear. It’s as though our body says “oh my gosh! I am so low on gas that I can’t even fuel my brain! We must enter a state of energy emergency!”

This is when ketone bodies takeover as the primary energy source. 

I’m not going to go into insulin secretion and other hormonal changes that occur, but if you have specific questions, feel free to shoot me a private message. The key thing to mention is that the hormonal changes that do occur support a rapid increase in the breakdown of fat for energy. 

How to Know if You’re in Nutritional Ketosis:

When in nutritional ketosis, blood ketone levels typically fall between 0.5 and 3 millimoles/L. Breath and urinary tests can also be used but blood testing is the gold standard method. It takes about 4-7 days for most to transition into ketosis. Once you’ve transitioned, you must keep carb intake low enough AT ALL TIMES. This means no “cheat” meals, no birthday cake and no beer/wine nights with friends. 

 What is the Keto Diet Like? 

A ketogenic diet is high in fat(~60%), moderate in protein(~30%) and very low in carbohydrate(<10%). These percentages vary, but in order for most people to stay in a metabolic state of ketosis, protein needs to stay low enough so that the body can’t sustain itself using gluconeogenesis’ catabolic protein —> carbohydrate conversion pathways. 

According to the newly released 2020-2025 USDA Dietary Guidelines for Americans, a healthy diet should emphasize fruits and vegetables, whole grains, reduced fat dairy and lean proteins. The guidelines also recommend limiting calories from saturated fat to <10% beginning at age 2. 

Many nutrient-rich foods are sources of carbohydrates, including fruits, starchy vegetables, whole grains, beans, milk and yogurt. On a keto diet, carbs from all sources are severely restricted. With the goal of keeping carbs below 50 grams per day, keto dieters often consume very little of any of these food groups. This raises a big concern of nutritional deficiencies for these dieters. 

Sooo is This an Effective Tool for Weight Loss?

When followed correctly, a very low carbohydrate and high fat ketogenic diet HAS been proven to be very effective for RAPID weight loss. I should note that, in its early stages, a significant amount of this weight is water. It is the weight loss that sells this diet to so many. Research comparing 13 trials showed that ketogenic diets can result in more initial weight loss compared to other dieting methods. However, after peak weight loss (around 5 months in), dieters started regaining weight. I always preach that our bodies are incredibly smart and adaptable. We can try and outsmart them but they usually catch on to us, and in the case of keto, it seems our bodies do just that. When you exit ketosis, your body is coming out of a state of starvation and I would expect insulin sensitivity to be at an all-time high. What does this mean? Our bodies become REALLY good at storing energy. What does this mean? You’ll likely gain the weight back and have to regain your body’s trust…. Womp womp.

What Else can Keto Treat?

With regards to the keto diet as a tool for sustainable weight loss and other health benefits, the jury is still out. 

Keto was the most researched diet of 2019. Some studies suggest that this eating pattern may be helpful for not only short-term weight loss but managing diabetes and warding off Alzheimer’s disease. When reading articles, please keep in mind that it is too soon to know much about the long-term effects of the diet. There is a clear divide between the publicity hype and the fact-based research.

I personally don’t feel comfortable supporting the diet for the treatment of any other conditions because the science and the research is so controversial. What I will say is that if you are using the diet to help treat/prevent a disease, I hope you have had it approved by at least 2 medical professionals, have been properly educated on how to follow the diet and are being closely monitored. <3  

Quick Cons!

·      Keto is contraindicated in patients with pancreatic disease, liver conditions, gallbladder disease or removal, fat metabolism disorders, thyroid problems, eating disorders, etc. 

·      Restricting many major food groups and key nutrients. 

·      Very hard to sustain, so long-term compliance is low. 

·      Socially undesirable.

·      Lack of research on long-term health outcomes.

·      Constipation due to high fat and low fiber intake. 

·      “Keto flu”- flu-like symptoms typically experienced for about a week while transitioning into ketosis. 

·      Most dieters are not properly following the diet and are not even in nutritional ketosis.

·      High saturated fat intake is linked to poor health outcomes including increased risk for cardiovascular disease.

·      When considering the research, it’s important to look at the studies in detail. For example, what were subjects fed to meet their fat goals? Olive oil, salmon and avocados? Or bacon and lard? 

Bottom Line & Personal Opinions:

There is no denying that obesity is a major contributor to chronic diseases and ultimately mortality. Even so, I always like to clarify that weight loss does not always indicate improved health. In my opinion(but also based on the science!), establishing and maintaining a healthy diet and lifestyle is always more important than the weight loss itself. For example, heart disease is largely related to obesity. It is also largely related to a high dietary intake of saturated fat. Over the past couple of years, I have visited hospitalized cardiac patients (more than I can count on one hand) who have been previously diagnosed with heart disease, told to lose weight and began following the Keto Diet for weight loss. THIS IS A PROBLEM and this is one reason why I so passionately believe that dietary advice should be given 1. by a registered/licensed dietitian and 2. on an individualized basis. 

So when it comes to Keto, the question for me becomes “is following a keto diet conducive to your physical and mental health OUTSIDE OF WEIGHT LOSS?” I speculate that for MOST, the answer is no. 

Final Words:

If you are following or have followed a keto eating plan, I would love to hear about your experience! I do know people who have had successful weight loss and enjoy following the diet.

Please don’t ever let my opinion prevent you from sharing your personal experiences with me! I try to stay open-minded and always love to learn from your experiences!!!

Sources

1.    Gordon, B. (n.d.). What is the Ketogenic Diet. Retrieved January 20, 2021, from https://www.eatright.org/health/weight-loss/fad-diets/what-is-the-ketogenic-diet

2.    Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2020 Dec 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499830/

3.    LaFountain RA, Miller VJ, Barnhart EC, Hyde PN, Crabtree CD, McSwiney FT, Beeler MK, Buga A, Sapper TN, Short JA, Bowling ML, Kraemer WJ, Simonetti OP, Maresh CM, Volek JS. Extended Ketogenic Diet and Physical Training Intervention in Military Personnel. Mil Med. 2019 Oct 01;184(9-10):e538-e547.

4.    Roehl K, Falco-Walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav. 2019 Apr;93:113-118.

5.    Jagadish S, Payne ET, Wong-Kisiel L, Nickels KC, Eckert S, Wirrell EC. The Ketogenic and Modified Atkins Diet Therapy for Children With Refractory Epilepsy of Genetic Etiology. Pediatr Neurol. 2019 May;94:32-37.

6.    Mohorko N, Černelič-Bizjak M, Poklar-Vatovec T, Grom G, Kenig S, Petelin A, Jenko-Pražnikar Z. Weight loss, improved physical performance, cognitive function, eating behavior, and metabolic profile in a 12-week ketogenic diet in obese adults. Nutr Res. 2019 Feb;62:64-77.

7.    Broom GM, Shaw IC, Rucklidge JJ. The ketogenic diet as a potential treatment and prevention strategy for Alzheimer's disease. Nutrition. 2019 Apr;60:118-121.

8.    Włodarek D. Role of Ketogenic Diets in Neurodegenerative Diseases (Alzheimer's Disease and Parkinson's Disease). Nutrients. 2019 Jan 15;11(1)

9.    Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur J Paediatr Neurol. 2019 Jan;23(1):143-151.

10. Armeno M, Araujo C, Sotomontesano B, Caraballo RH. [Update on the adverse effects during therapy with a ketogenic diet in paediatric refractory epilepsy]. Rev Neurol. 2018 Mar 16;66(6):193-200.