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The ketogenic diet is an old concept that was first publicized in 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. Some of my patients have tried this diet. That is why I decided to write this article and to review some of the available data and facts.
There are many diets that are being introduced on regular basis. However, no diet has been shown to be significantly better than others in maintaining long-term weight loss and providing better health to the individuals.
It is important to understand what the ketogenic diet is and how it is supposed to help with weight loss.
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 situation by not providing it with the essential energy that is required to function. During this period, the sugar reserves of the body are depleted. 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 processing require sugar. When the glucose levels are exhausted and depleted, the body will mobilize the fat reserves for delivering the needed sugar. This process leads to the production of ketone bodies that are utilized by the brain 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 that can also be noticed in patients diagnosed with diabetic ketoacidosis.
Ketogenic diet and weight loss
This diet has been shown to help with weight loss. This effect is expected because of the restriction of the total calorie intake by almost eliminating carbohydrates from food. The consumption of the 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 shown that individuals following this diet could lose up to 4.5% of their body fat over 10 week period.
Epilepsy
There are some data supporting the use of this diet in children with seizure disorders. The mechanism of this process is not well known. However, it has been suggested that the ketones reduce the ability of the brain cells to become excitable and help to keep these cells in a calmer state.
Blood lipid levels
Studies have shown that a 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.
Adverse effects
There are common adverse effects of this diet that 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. It is well established that a high blood uric acid level can result in gout, kidney stones and elevated inflammation in the body.
Bone loss
The ketogenic diet and a diet high in meat and low in vegetables and fruit has been associated with bone loss (osteopenia and osteoporosis). It has been suggested that the acidification of the body results in activation of osteoclasts (cells that break down the bones).
Cancer risk
To maintain good health it’s important to consume an adequate amount of vegetables, fruit and fiber. However, high fat and low carbohydrate diets are often very low in all of these. Due to the lack of longer-term data, the question of whether adherence to a ketogenic diet could increase a person’s cancer risk has not been clearly answered.
My take
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 are 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. However, looking at the data, I’m not convinced that this diet is the ultimate solution that we have been looking for. I am 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 is important. However, we must consider the cost that we are prepared to pay to achieve this goal. Eliminating or limiting the fruit, vegetables and fiber from our foods doesn’t seem to be a wise decision.
It’s well-established that consumption of animal fats can 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 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.
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