The ketogenic or keto diet is an old concept that was first publicized in the 1920s. However, interest in this diet has been accelerating over the past 15 years.
The foundation of the ketogenic diet is based on fasting, low carbohydrates, and high-fat nutrition. Few of my patients have tried this diet and that’s why I decided to write this article and to review the available data and facts.
Although there are numerous diets to choose from, no diet has shown to be notably better than others in maintaining long-term weight loss and providing better health to individuals.
That said, I think it’s important to understand the ketogenic diet and how this diet could help with losing weight.
Ketogenic diet: how does it work?
This diet begins with 3-4 days of fasting or a very low carbohydrate intake of less than 20 g a day. This process mimics starvation. The individual puts his body into a crisis by not providing it with the essential energy required to function.
During this period, the sugar reserves of the body are at a very low level. This is because sugar is the primary source of energy in the body and hunger/fasting will use the reserves during these 3-4 days.
Our brain and fat metabolism require sugar. When the glucose level goes down, the body will mobilize the fat reserves for delivering the needed sugar.
This process leads to the production of ketone bodies that the brain could use as the new energy source. The excess ketone bodies are excreted in the urine and some are breathed out, resulting in characteristic “fruity breath”. This is a typical smell similar to patients diagnosed with diabetic ketoacidosis.
Ketogenic diet and weight loss
This diet has been shown to help with weight loss. This effect is because of the restriction of the total calorie intake by practically eliminating carbohydrates from food. The consumption of a high amount of fat could also result in longer satiety and reduced food intake.
In the short term, the majority of the weight reduction is due to water loss. The loss of body fat will occur if the diet is maintained over the long term.
Studies have reported that individuals following this diet could lose up to 4.5% of their body fat over 10 week period.
Some data are supporting the use of this diet in children with seizure disorders. The mechanism of this process is not well known. However, one theory suggests that ketones reduce the ability of the brain cells to become excitable and help to keep these cells in a calmer state.
Blood lipid levels
High fat and low-carbohydrate diet might result in improvement of HDL-cholesterol (high-density lipoprotein cholesterol) or good cholesterol and triglycerides. However, this effect has been attributed to weight loss rather than the diet itself. The effect of this diet on LDL-cholesterol (low-density lipoprotein) or bad cholesterol is more controversial.
Common adverse effects of this diet include constipation, fatigue, nausea, bad breath and taste, insomnia, headache, and dizziness.
High blood uric acid level
This diet can cause a significant increase in the blood uric acid level. High blood uric acid levels can result in gout, kidney stones and elevated inflammation in the body.
The ketogenic diet and a diet high in meat and low in vegetables and fruit could cause bone loss (osteopenia and osteoporosis). Researchers suggest that the acidification of the body results in the activation of osteoclasts (cells that break down the bones).
To maintain good health it’s important to consume an adequate amount of vegetables, fruit, and fiber. High fat and low carbohydrate diets are often very low in all of these. However, the evidence that a ketogenic diet could increase a person’s cancer risk is lacking.
The increased interest in the ketogenic diet has followed the recent wave of demonizing carbohydrates as the main cause of obesity and weight-related issues in our society.
We experience these swings every few decades from one extreme to another. There was a time when fat was the enemy. We’re now back to blaming carbohydrates for all of the bad things happening to us.
The ketogenic diet is one of many diets that promise long-term weight loss and long-lasting health. Looking at the data, I don’t see enough evidence to believe that this diet is the ultimate solution that we’re looking for.
I’m especially concerned about the restrictive approach of this diet to nutrition. Not all carbohydrates are villains.
I understand that reducing total calories and achieving weight loss are important. However, we must consider the cost that we’re prepared to pay to achieve this goal.
Eliminating or limiting the fruits, vegetables, and fiber from our foods doesn’t seem to be a wise decision.
The consumption of animal fats shown to increase the inflammation in our body and promote heart attack and stroke.
Most studies on different diet compositions are short-term. They don’t include long-term follow-ups. Therefore, we don’t know what happens to a person who is on a high-fat diet over a long period of time.
When we look at different diets, we know that energy restriction independent of the nutritional composition will improve the blood sugar levels merely by promoting weight loss and limiting the calorie intake.
Therefore, choosing a diet should assist us in maintaining long-term balanced health and not be based on pure short-term success.
Any of the steps that we decide to take to improve our health, should assure better health of each part and function of our body. Health is about the well-being of our entire body.
In my opinion, it isn’t wise to improve one thing and at the same time damage or impair the functions of other parts of the body.