The Keto Diet: Do The Risks Outweigh The Benefits?
How many times have you heard someone say, “I’m doing keto”, then put a stick of butter in their coffee or eat a bag of pork rinds? Have you ever questioned, “Is this healthy?” If you answered yes, you would not be the only one.
The Ketogenic (“Keto”) Diet has been very popular for many years because it can promote a rapid weight loss in a short period of time while allowing you to eat large amounts of fat. You may ask, “What’s the catch?”
To succeed at this diet, or to truly put your body into ketosis, you must severely restrict your carbohydrate intake. That means, minimal amounts of pasta, rice, bread, fruit, beans/legumes, potatoes, etc. A true keto diet aims to limit carbohydrate intake to less than 30 g per day of total carbohydrates. Thirty grams of carbohydrates is the equivalent of less than 1 cup of pasta OR 1 potato OR 2 slices of bread, in total, in a 24-hour period. This doesn’t include the small amounts of carbohydrates you get in other foods like vegetables.
Before getting into specifics of this diet, let’s cover some of the basics first:
History of Keto
What is Ketosis?
Comparison of Various Keto/Low Carb Diets
Benefits of Keto
Risks of Keto
Let’s Get Started!
The History of The Ketogenic Diet
The Ketogenic Diet (KD) has been used for centuries to treat specific medical conditions but became popular in the 1920’s when modern physicians began using it as a treatment for seizures. Doctors found that seizures decreased when patients were in a fasted state, meaning they hadn’t eaten in several days. The ketogenic diet mimics the metabolism of fasting in the body. As medications to treat seizures increased, the use of the diet decreased but is still used in those patients whose seizures are resistant to medications.
It is not fully understood how the diet decreases seizure activity but it is known that the ketones produced are able to cross the blood brain barrier and can decrease the “excitability” of the brain. Therefore, the KD has also been studied for uses in psychiatric disturbances and cognitive impairment like in bipolar disorder and Alzheimer’s Disease. We could fill many more blog discussions with this information, and maybe we will, but not today.
For now, let’s focus on the KD specifically in relation to weight loss.
What is Ketosis?
Our bodies prefer to use glucose to make ATP or energy from the food we eat. It uses what it needs then stores the rest for later in the form of glycogen (glucose storage) in the muscles and liver as well as in the form of fat. The most efficient way to create energy is from carbohydrates. They are the easiest and quickest to digest to form glucose. Protein and fats can also be used for energy but without diving in too deep and boring the heck out of you, it is not as easy of a process.
The term keto is short for ketogenic because when carbohydrate intake is limited, the body is forced into using fat rather than glucose as a primary source of energy. The fat is broken down into ketone bodies, this process is called ketosis. Most tissues and organs can use ketone bodies as an alternative source of fuel. When glucose is not readily available, the brain will use them as a source of energy. Unlike other organs in the body, the brain has an absolute minimum glucose requirement. Therefore, when you skip meals or get extra hungry, you may feel “brain fog”.
When following the KD, if too many carbohydrates or too much protein is consumed, the body will not be forced into ketosis. This can affect results if true ketosis is desired. Testing urine or blood for ketones is used as an indicator of dietary adherence.
There are a variety of low carbohydrate dietary regimens but not all of them will promote ketosis. See the chart below for comparisons of these diets to the standard macronutrient balanced diet typically recommended.
These percentages don’t hit home until you actually think of them based on a typical 2000 Calorie Diet.
Benefits of The Keto Diet
The grand majority of people go on the KD specifically for it’s magical, quick and easy weight loss. Not all dieters lose weight while following the keto plan but many lose large amounts in a short period of time. The weight loss can promote decreased joint pain due to less weight and stress on joints. If weight is lost around the middle, there can be less fat around the organs (visceral fat mass). This may decrease blood pressure and risk for other chronic diseases which is increased with higher visceral fat mass.
Since the KD is low in carbohydrates, it can promote lower and better controlled blood sugars. For diabetics and non-diabetics, this may equate to a lower hemoglobin A1C. Even in non-diabetics, while on the keto diet, the body does not require as much insulin due to a decreased carb intake. This may also mean a decreased amount of insulin needed for diabetics who take insulin. But be wary, it could also lead to hypoglycemia. Keep reading as we discuss risks of the diet below.
The high intake of fat can promote that feeling of fullness, otherwise known as satiety. This may suppress hunger and prevent overeating which helps decrease that feeling of deprivation that many diets cause.
As discussed above, the KD was originally created as a way to decrease seizure activity. For those patients struggling with seizures that don’t respond to medication, this diet may be a life line.
Some research has shown benefit in psychiatric and cognitive illnesses including bipolar disorder and Alzheimer’s Disease. As we discussed above, the process of ketosis and forcing the brain to use an alternative fuel can decrease the brain’s excitability.
Now, let’s discuss the risks…
Risks of Keto Diet
First, I want to make sure to discuss my biggest concern about doing the keto diet. This involves diabetics, especially those who are Type 1 or insulin dependent. This diet will decrease the amount of insulin needed and may cause hypoglycemia (low blood sugars). It can also cause metabolic irregularities where ketone production is increased and ketone clearance from the body is decreased. If you are a diabetic, I would highly recommend a discussion with your doctor prior to starting this diet.
Do NOT follow the keto diet if you have a history of pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, porphyrias or pyruvate kinase deficiency.
After starting the Keto diet, you may experience the “Keto Flu” anywhere from 2 days to a week or so after starting. This is where you may have headaches feel tired, dizzy, nauseous and/or constipated. This may be related to lack of hydration or electrolytes as well as a lack of carbohydrates. Make sure to drink plenty of fluids which contain sodium and potassium to maintain electrolyte balance.
This diet is often lacking in many vitamins, minerals, fiber and phytochemicals. A multivitamin, multimineral and fiber supplements may be helpful to prevent deficiencies. This is a concern over the long term as fiber is so important in maintaining gut health as well as promoting regular bowel movements. The KD diet restricts so many of the wonderful plant based antioxidants found in fruits, whole grains, beans/legumes and starchy vegetables which are all high in fiber.
Foods like butter, high fat meats and seafood, full fat dairy, eggs and other animal products which are high in saturated fat make up a large part of this diet. For those with a personal or family history of cardiovascular disease, this diet is not recommended. Some studies show decreased levels of cholesterol and LDL levels but others show the opposite. If you have a history of elevated blood lipid markers, discuss with your doctor.
This extreme restriction makes long term compliance, as with any other restrictive diet, low. Once transitioning off of the KD, weight gain can be rapid so it is important to try to transition back to consuming more carbohydrates slowly.
Exercise and adequate protein intake is so very important to maintaining muscle mass while losing weight. The true KD is low in protein intake, not to mention it can make exercise more challenging due to lack of carbohydrate to fuel the muscles. Your body can adapt and there are many athletes who follow a keto diet and have taught their bodies to use fat as primary fuel source. Speaking from personal experience, as well as listening to my clients who have done keto, exercise can be a struggle due to fatigue with activity. Check out our blog on carbohydrate consumption and exercise to learn more.
The last point I would like to make involves any diet which promotes a rapid weight loss. Dietitians always get a bad rap for recommending the 1-2# per week weight loss rule but it is for a good reason. When weight loss is slow, coupled with activity and adequate protein intake, muscle can be maintained. When weight loss is rapid, without adequate protein and exercise, muscle is lost. Unfortunately, when a diet fails and rapid weight regain occurs, it is likely in the form of fat. We know that muscle burns more calories than fat. When all is said and done, the dieter is likely burning less calories in a resting state than before they started the diet.
Conclusion
The Ketogenic Diet can definitely cause weight loss, no doubt but there is not a lot of research on the long term effects. It can be very restrictive but many would rather choose to restrict carbohydrates than fat. It is not truly meant to be a long term solution because of its restriction of such a wide variety of foods. It tends to be high in full fat animal products containing large amounts of saturated fat so it is important to be aware of your cardiovascular health and numbers. Since it is so low in carbohydrates, blood sugars may be lower so if you are diabetic, please be aware of your numbers!
I would love to hear your personal experiences, positive or negative, and thoughts on the Keto diet, please comment below!!
References:
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