With Michael J. Gonzalez-Campoy, MD, PhD, Zarabi, RD, and Amy M. Goss, PhD, RD
Given all the buzz, adopting a ketogenic diet may be the perfect weight loss plan, especially if you have diabetes, or want to try this approach to lose those troublesome extra pounds. After all, it’s a very low-carb meal plan that promises effective weight loss while also lowering your blood sugar to the point where you could possibly stop taking medication. By all accounts, the “keto” diet, as it’s widely known, may even reverse type 2 diabetes, at least for some lucky individuals.
Another advantage to the keto diet: It can help reduce systemic inflammation, which can have a variety of negative effects on your entire body.
Unlike some of the other popular low-carb diets, which typically are high in animal protein, the keto diet focuses on getting to the body to burn stored body fat instead of sugar as the main fuel. When body fat is broken down in the liver instead of glucose, s an energy byproduct known as ketones are produced.
Make Certain Your Keto Diet is Well Formulated
While like any diet, you need to find the right proportion and balance of macronutrients (ie, fat, protein, carbs) in order for your body to begin burning accumulated fat rather than stored glucose.
The amount of fat you eat when following a keto diet is quite a bit higher than on most other diets. You’ll want to aim to consume about 60 to 75% of your calories come from dietary fat and 15 to 30% protein, with the remaining calories for carbs, says Sharon Zarabi, RD, director of the bariatric program at Lenox Hill Hospital in New York City.
“There is still some debate on the effects of saturated fats and what constitutes a healthy dose. There has been quite a bit of buzz around grass-fed cows producing cream, dairy, and butter. Ghee has been popular on the market as well, as a clarified form of butter,” Ms. Zarabi says. “It’s really the trans fats that I think people need to understand and the harmful effects on the heart and cholesterol.”
It’s really the trans fats that you’ll want to avoid completely. “Trans fats are highly processed, and heated to a point where they create free radicals in the body, which increase your risk of cancer.,” she says, “Trans fats are found in hydrogenated oils (be on the lookout for this form of fat listed on the ingredients), and these are mostly used in the preparation of processed crackers and packaged foods.”
The best low-carb foods include peppers, cauliflower, greens (eg, spinach, arugula, kale), and zucchini. When starting a keto diet, your goal should be to gradually reduce your carb intake to about 20 grams for at least two weeks but aim for six weeks in order to allow your body to adjust to this fat-burning process.
KETO DIET PLAN
Once you’ve reached ketosis, you will gain the benefits and be able to take a keto holiday (more on this later), which is necessary to manage for as long as you need to.
Working with a dietitian may be the easiest and more efficient way to find the right dietary balance for your physiological needs and overall health.
“The purpose of the keto diet is to push your body into a state of ketosis, where the body uses fat stores instead of its preferred form of energy, which is glucose,” says Amy M. Goss, PhD, RD, an assistant professor of nutrition sciences in the School of Health Professions at the University of Alabama at Birmingham.
The Pros and Cons of Following a Keto Diet
Is it Healthy to Push Your Body into Ketosis?
“The major benefit of the keto diet is that it does work so you lose weight,” says Ms. Zarabi. “But then again, it is a diet and like all diets, it is a short term solution, something you do, then you stop. It is not really a sustainable diet in real life situations. More importantly, your goal is not just to lose weight—anyone can lose weight. The more necessary goal is to keep the lost weight off.”
The keto diet can be an effective way to reduce excess body fat but there are several cons that should be noted by anyone wanting to follow this eating plan, says Ms. Zarabi says. In fact, the keto diet has serious risks. For one thing, it’s high in saturated fat, which has been linked to heart disease. Additionally, a nutrient deficiency and constipation could occur since the keto diet is very low in fibrous foods such as fruits, vegetables, and whole grains.
Liver problems for those with existing liver conditions could possibly worsen since the keto diet puts stress on the liver, and kidney problems could also occur. 4
If you are considering going on the keto diet, work with a knowledgeable practitioner or seek out a registered dietitian with experience in prescribing it and following you to avoid any adverse effects, Dr. Goss says.
Fair Warning: There Are Challenges to Choosing a Keto Diet
- The first few days are extremely difficult as your body tries to acclimate to such a low level of carbs. During this adjustment to burning fat instead of glucose, the side effects will make you feel awful; hence the term, keto flu.
- You’ll be depriving yourself in social situations
- You’ll need to prepare meals ahead and take them with you since you are confined to eating specific foods.
3 Common Mistakes to Keep In Mind When On a Keto Diet
- Use Fat Wisely Rather Than Excessively. While the keto diet means your food choices are geared to a low carb/high fat intake, it does not mean adding fat to everything you eat. You do not need to fall for one of the most trendy keto tricks— adding a pat of butter to your coffee. This might be useful at the very beginning as you transition away from a high carb diet but should not be continued once you are past the initial shift once your body has adapted to this new eating rhythm. Instead, listen to your body for cues. If you are feeling hungry right after a meal, you probably didn’t have enough protein or fat. When followed correctly, a keto-based meal will leave you feeling full and satiated for hours.
- Seek Nutritional Ketosis, Not Higher Ketone Levels. To gain the most benefit from this diet, you’ll want to aim for a level of ketosis between 1.5-3.0 mol/L on a blood ketone meter. You’ll be there when you are eating well-designed meals that carry you through to the next meal without hunger or other adverse symptoms (ie, nausea, insomnia, crankiness, inability to exercise). Higher ketone levels suggest you have more circulating ketones in your blood but don’t confuse this with efficient fat burning, which is the goal of this diet.
- Ketosis Isn’t Forever. It’s recommended that you follow this diet to arrive at a state in which your body adapts to burning fat and glucose stores for fuel. Then you’ll want to take an occasional ketosis holiday, adding a serving of unprocessed, whole grains to allow your body to chance to work less hard. Staying in ketosis long-term—without breaks— can cause muscle aches, nausea, and fatigue.
Adhering to the keto diet puts your body into a state of ketosis, which sounds similar to ketoacidosis. However, don’t confuse these terms as ketosis and ketoacidosis are two very different physiological states, Dr. Goss explains.
Know the Difference Between Ketosis and Ketoacidosis
“Ketosis is a normal physiological response that occurs when you eat a high fat, low carb diet, while ketoacidosis is more pathological,” she says. “It happens in people with diabetes whose blood glucose is very high (hyperglycemia). You can’t put yourself into ketoacidosis the way you can put yourself into ketosis.”
When in ketosis, the body begins to burn stored fats for energy, and this results in the build-up of acids, known as ketones, in your blood. A person following the keto diet aims to burn unwanted fat by actually pushing the body to rely on fat, not carbohydrates, for energy. This process occurs when there isn’t enough glucose available to burn, so the body turns to stored fats instead.
You are likely to realize that your body has achieved ketosis because you may have a dry mouth, increased thirst, and find yourself needing to urinate more frequently, Dr. Goss says. “You are ridding your body not only of ketones but electrolytes such as sodium, potassium, and magnesium,” which may lead to dehydration, she says, so drinking plenty of fluids will help reduce any problems even if it means more trips the bathroom. “Bad breath is also commonly noticed as a result of the body trying to eliminate acetones produced during ketosis.”
Ketoacidosis most commonly arises with people with diabetes. Diabetic ketoacidosis occurs in response to a severe lack of proper insulin activity whereas alcoholic ketoacidosis is a harmful metabolic condition arising when someone consumes alcohol but no food, explains Michael J. Gonzalez-Campoy, MD, PhD, medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology, in Eagan, Minnesota. Either way, this is a dangerous situation.
“Both alcoholic ketoacidosis and diabetic ketoacidosis create medical emergencies due to the rapid change in the body’s acid-base balance,” Dr. Gonzalez-Campoy says. “The rapid drop in the pH of the blood, which is called acidosis, can depress the nervous system and muscle function, causing a person to become unconsciousness due to vascular collapse.”
Common complications of diabetic ketoacidosis include very low blood sugar, or hypoglycemia, and swelling of the brain (cerebral edema). As such, when a person is in ketoacidosis, there is such a high level of ketones produced that can push a person into cardiac arrest (heart attack) or kidney failure. Hence, the very important reason for taking occasional keto breaks go give your body a bit more nourishing carbs.
The Story Behind How the Ketogenic Diet Came to Be
The ketogenic diet was originally formulated by doctors to help treat people with epilepsy, and it was found especially effective in children who didn’t respond to medication.1,2 Indeed, the keto diet has been found to reduce the frequency and intensity of seizures, which are common complications of this condition.
This high fat/low carb diet may also help improve certain other neurological disorders like Alzheimer’s disease and Parkinson’s disease,3 according to the Epilepsy Foundation. More than half the children with epilepsy who were put on the diet experienced half as many seizures, while 10 to 15 percent of the patients who followed this diet became seizure-free.
The keto diet has also been studied as a possible cancer therapy. In a study focusing on people with cancer who followed the ketogenic diet as a medical therapy,4 the authors reported: “There is a great need for complementary approaches that have limited patient toxicity while selectively enhancing therapy responses in cancer versus normal tissues.
Ketogenic diets could represent a potential dietary manipulation that could be rapidly implemented for the purpose of exploiting inherent oxidative metabolic differences between cancer cells and normal cells to improve standard therapeutic outcomes by selectively enhancing metabolic oxidative stress in cancer cells.”
In another study looking at ketogenic diets as a treatment for cancer,5 this research team concluded, “based on the results of rigorous preclinical and clinical studies performed thus far, the KD would appear to be a promising and powerful option for adjuvant therapy for a range of cancers. Cancer-specific recommendations await the findings of randomized controlled clinical trials.”
Proponents of the keto diet say that when and followed precisely, it does not “starve” the body. “A well-formulated keto diet includes all the food groups and therefore provides adequate intake of micronutrients,” says Dr. Goss. “There is ample scientific evidence from randomized clinical trials supporting the therapeutic effects of the diet in treating a number of chronic disease conditions besides epilepsy, including type 2 diabetes [node/59538], non-alcoholic fatty liver disease, even obesity.”
She adds that the research supports the safety and effectiveness of following a keto diet even in older adults with obesity as it seems to help improve body composition and improve metabolic health.6 “We saw significant reduction in body fat while lean mass was preserved and significant improvements in insulin sensitivity and the lipid profile in response to a ketogenic diet when compared to a standard ‘balanced’ diet,” Dr. Goss explains.
Anyone who takes medications for diabetes or hypertension should consult with a physician before starting on the keto diet, she adds. And it is not for everyone: Individuals who are dependent on insulin (those with type 1 diabetes) should never follow the keto diet, says Dr. Goss.
Additionally, since ketosis can be harmful to a fetus, the keto diet should be avoided during pregnancy. “Also, ketones are harmful to patients who cannot correct the metabolic acidosis caused by them, ie, those with liver, kidney, or pulmonary disease,” Dr. Gonzalez-Campos adds.
The keto diet is not for children or adolescents either, and a long-term complication can be growth retardation in children.5
If you decide to follow the diet, you’ll want to have an individualized meal plan, stresses Dr. Gonzalez-Campos. “The best possible clinical outcome is for each individual to meet her nutritional needs from well-balanced meals,” he says. “Ideally, we should all have the benefit of medical nutrition therapy and we should all avoid extremes in nutrient restrictions.”
Last updated on 02/26/2019
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