Doctor’s Tip: Ketogenic diet — good or bad?


The National Institutes of Health recommends that doctors talk to their patients about plant-based nutrition. There are many other diets out there — such as the Paleo diet, Adkins diet, Mediterranean diet and keto diet. All these diets result in short-term weight loss. However, if you’re overweight and want to lose weight, what’s best is a diet that ensures weight loss over the long term and improves health.

As Dr. Greger puts it in his book “How Not to Diet,” “the goal of weight loss is not to lighten the load for your pallbearers.” In this regard, let’s look the currently popular keto diet, which has become big business.

If you are starving or if you fast, your body switches from sugar to ketones as an energy source. It’s been known since Hippocrates that fasting can prevent and treat epileptic seizures. In 1921 a physician researcher at the Mayo Clinic suggested that a diet high in fat and low in carbohydrates — which he called the ketogenic diet — could mimic the fasting state. These days we have anti-seizure drugs like Dilantin, but keto diets are still used occasionally as third-line treatment for seizure patients who are resistant to these medications.



The first question when discussing keto diets is: Do they work for weight loss? The short answer is no. Keto proponents had a theory called the carbohydrate-insulin model of obesity, which was based on the premise that cutting carbs and increasing animal fat in the diet would result in decreased insulin production. The theory was that decreased insulin production would lead to diminished fat storage, less body fat and therefore weight loss. To their credit, keto proponents conducted well-done studies to prove their theory, but they found that participants on the keto diet burned their protein stores instead of fat, and ended up storing more fat instead of less. Participants did lose weight at first, but it was water and protein weight.

The second question is: Are keto diets safe? Again, the short answer is no: 1) Protein loss is harmful. For example, the thigh muscles of keto dieters decreased by several inches on average. 2) The keto diet results in deficiency of several nutrients, leading to diseases such as scurvy. There have been sudden cardiac deaths from selenium deficiency. These deficiencies can be prevented or treated with supplements (here’s where the big business comes in), but something’s wrong and unnatural with a diet that requires supplements. 3) Eliminating carbs including legumes means inadequate intake of fiber — the food source for our gut microbiome. This results in a disease-promoting gut microbiome and in constipation. 4) Diets such as the keto diet that are high in animal fat and animal protein harm artery function, resulting in a 50% higher risk of dying from a heart attack or stroke. 5) Regarding diabetes, the keto diet does lower blood sugars. However, diabetes is not just a disease of blood sugar — other factors such as inflammation play a role. In spite of lower blood sugars, keto diets worsen the underlying disease process of diabetes and its complications. 6) The keto diet impairs athletic performance. 7) Keto diets result in bone loss, presumably due to chronic acidity. 8) Children on a keto diet can have stunted growth and kidney stones. 9) The keto diet increases all-cause mortality — i.e., shortens lifespan.



In summary, the keto diet is an unnatural diet that is not based on good science. It should be avoided unless you have medication-resistant seizures. Listen to the NIH and other national medical organizations and eat what humans evolved over some 25 million years to eat: a plant-based, unprocessed food diet with no salt, sugar or added oil. You will attain and maintain your ideal body weight, and stack the deck in your favor for a longer, healthier life.

Greg Feinsinger, M.D., is a retired family physician with a special interest in heart disease and diabetes prevention and reversal, ideally though lifestyle changes. He’s available for free, one-hour consultations — call 970-379-5718.



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