This article originally appear in the Lebanon Local and New Era newspapers in August 2019.
In the world of nutrition, there is always a revolving door of what is “hot.” The ketogenic (keto) diet is no exception. These days there are programs and food products geared toward the keto lifestyle. I have been asked numerous times what I as a Dietitian think about it.
This is my attempt to answer as succinctly as possible.The keto diet is rather scientific and technical but here I give you a basic the biology behind the Ketogentic diet, what it does in the body, the foods you can eat, and my own considerations.
The term Ketogenic diet describes a high fat, very low carbohydrate diet. This should not be confused with a high fat, high protein diet. Although there are different styles of the ketogenic diet, the true “mother” ketogenic diet is strictly high fat, very low carbohydrates with normal amounts of protein.
Traditionally, ketogenic diets were used by clinicians to treat the pediatric population for epileptic seizures that were not responsive to any kind of drug therapy. Registered Dietitians would use specific ratios of fat to carbohydrates (4:1) when they created meal plans for patients. More recently, ketogenic diets have been used to initiate weight loss and glycemic (blood sugar) control. The term Ketogenic diet now often encompasses several approaches to a low carb, high fat diet.
What is Ketosis?
Ketosis is actually a natural process that occurs in food deprivation. That’s right. It’s that process that happens after 2-3 days of not eating. By that time, your body has used up all of it’s stored forms of glucose (aka glycogen) from your liver and some muscle tissue. Your body loves glucose and glycogen. It loves to use it as energy by breaking it down into something called AcetylCoA which your cells breakdown even further into energy (ATP).
Glucose is an easy and readily available source of this AcetylCoA. Your brain prefers it to using fat or protein, both of which can also be broken down and used in a roundabout way.
After 2-3 days of deprivation when your glucose/glycogen stores have run out, your body shifts into making the Acetyl CoA from amino acids (parts of proteins) and fatty acids (parts of fat). The keto diet mimics the starvation process of using mostly fats (with some protein) for fuel instead of glucose. Yet unlike actual starvation the keto diet allows you to eat as long as you keep the carbs very low (20 grams) and the fats high.
The Good Things Deprivation Does
Oddly enough, the stress caused by deprivation may actually have some positive effects on the body chemistry and overall health. Mouse studies have some that fasting activated cellular pathways that extended life expectancy, boosted the immune system, reduced inflammatory diseases, decreased the loss of bone density, and decreased incidence of cancer. It also increased resilience to stress and the appropriate processing of damaged cells and the rejuvenation of new ones. Of course, those were mouse studies and we would really like to know if it all works just as well in the human body. More studies with larger test groups NEEDS to be done before a definite claim may be made on all the biochemical benefits of fasting.
While the keto diet was initially used for epileptic seizures, it is now used for a whole host of health issues including weight loss, fertility and diabetes.
So what is a Ketogenic diet?
A ketogenic diet essentially mimics the beneficial actions of starvation while maintaining nutritional markers for calories, vitamins and minerals. It preferentially burns fat as fuel rather than carbs (since you are hardly eating any). There are variations out there but the general rule for a Ketogenic diet is 20- 30 grams of carbs a day. Period. (20 grams is equivalent to about 1 to 1 1/5 slices of bread). Carbs from all sources (including fruits and vegetables) must be carefully calculated. Fats from oils, avocado, dairy products and some nuts are relied upon. Meals are smaller in size because they are calorie dense. Non starchy vegetables and greens are a key source of vitamins.
My Personal Thoughts
Scientifically and when done correctly, the keto diet can help a person manage blood sugar and food cravings, improve sleep and stamina and lose weight. There is NO doubt that it can work when done right.
With numerous benefits and success stories do I think everyone should go keto? No. There can be problematic or difficult issues surrounding it.
One is that the technicality of the diet can make is challenging to do well and effectively. It requires close attention, commitment, and tracking, especially in the beginning. The rigidity of the plan may not only make it difficult for people to adhere to but also makes social settings challenging. It is not to say if you are social you can’t do keto. You can. However, it may dramatically change how a you expresses hospitality and engages in social life. People need to know that doing into it.
As a dietitian I am also concerned with how people are thinking about food. We shouldn’t be overly-consumed in our minds with what we put into our mouths. Diets shouldn’t stop us from doing what we feel we need to do or have the responsibility to do. If it is a help, great. If it encumbers you, then you need to take a second look at it.
However, I believe the largest danger in doing keto, is that the emphasis placed on fats and carbs may draw attention away from the more important issues of nourishing the body and eating real food! Might it be imbalanced (dare I say unhealthy?) to confidently drink keto shakes while worrying that a cup of antioxidant-rich blueberries will pop you out of ketosis?
The science of keto and the subsequent craze has brought to attention the power of well-managed blood sugar—an important principle that can be managed using less dramatic methods than a strict keto diet. (This should be an whole other blog post series in and of itself!). Personally, I do think we eat too many carbs from refined foods. I do think we need to lower the overall intake and change the source of energy carbs we are getting. Yet I do not think we ALL need to go keto to reap some of its real health benefits.
I can’t help but think of the quote from author Michael Pollan, which will forever ring true (and which I will never tire of quoting), “eat food, not too much, mostly plants.”
Whatever diet style you feel is appropriate for you, sticking to real foods (less packaged and processed), not eating in excess (or for extended hours) and emphasizing nutrient-rich, disease-fighting plant foods can do wonders for your health.