Recently, many of my clients have been asking about a ketogenic diet. Is a ketogenic diet safe? Would you recommend it?
Is eating a lot of fat really the best way to lose weight?
Keto devotees believe that if you banish most carbs (including fruit!) and embrace fat, you can lose weight without feeling hungry.
What is a ketogenic (keto) diet?
The keto diet, short for “ketogenic,” involves eating a high amount of fat, a moderate amount of protein and very few carbs — even fruit is off the table. As with any fad diet, adherents tout weight loss increased energy and greater mental clarity among the benefits. But is the keto diet all it’s cracked up to be?
The keto diet was originally designed not for weight loss, but for epilepsy.
In essence, it is a diet that causes the body to release ketones into the bloodstream. Most cells prefer to use blood sugar, which comes from carbohydrates, as the body’s main source of energy. In the absence of circulating blood sugar from food, we start breaking down stored fat into molecules called ketone bodies (the process is called ketosis).
Once you reach ketosis, most cells will use ketone bodies to generate energy until we start eating carbohydrates again. The shift, from using circulating glucose to breaking down stored fat as a source of energy, usually happens over two to four days of eating fewer than 20 to 50 grams of carbohydrates per day. Keep in mind that this is a highly individualized process, and some people need a more restricted diet to start producing enough ketones.
How the ketogenic diet works
The goal of the ketogenic diet is to enter a state of ketosis (meaning that the body’s cells depend largely on ketones for energy) through fat metabolism. In a ketogenic state, the body uses primarily fat for energy instead of carbohydrates; with low levels of carbohydrate, fats can be converted into ketones to fuel the body.
It’s not entirely clear why that leads to weight loss, but ketosis seems to blunt the appetite and may affect hormones like insulin that regulate hunger. Fats and proteins may also keep people fuller than carbohydrates, leading to lower calorie intake overall.
Different Types of Ketogenic Diets
A “typical” ketogenic diet consists of at least 70 per cent of calories derived from fat, less than 10 per cent from carbs and less than 20 per cent from protein. The ketogenic diet, long used to treat epilepsy in children, calls for 90 per cent of daily calories to come from fat, with the amount of protein or carbs varying as long as it’s 4 grams of fat for every combined 1 gram of carb and protein.
There are several versions of the ketogenic diet, including:
• Standard ketogenic diet (SKD): This is a very low-carb, moderate-protein and high-fat diet. It typically contains 75% fat, 20% protein and only 5% carbs.
• Cyclical ketogenic diet (CKD): This diet involves periods of higher-carb refeeds, such as 5 ketogenic days followed by 2 high-carb days.
• Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
• High-protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein and 5% carbs.
However, only the standard and high-protein ketogenic diets have been studied extensively. Cyclical or targeted ketogenic diets are more advanced methods and primarily used by bodybuilders or athletes.
The information in this article mostly applies to the standard ketogenic diet (SKD), although many of the same principles also apply to the other versions.
Can I lose weight on the keto diet?
Yes. Certainly in the short-term, it appears that way. For the first two to six months, there’s evidence that a very low-carbohydrate diet can help you lose more weight than the standard high-carbohydrate, low-fat diet.
The keto diet appears to deliver fast results: The first pounds may seem to slip off. That can be seductive but it’s likely water weight. It’s not like it is going to magically alter your metabolism to where calories don’t matter anymore. And when resuming the carbs, that water weight returns.
Are there side effects of the keto diet?
At first, some can experience some stomach issues and GI distress. Ninety per cent of calories from fat is probably going to be a shock to the system. Have cholesterol levels regularly checked, and replenish the fluids and sodium lost by increased urination and the severe restriction of carbohydrates. If not, within two to four days of beginning the diet, that depletion can bring on the “keto flu” — symptoms like dizziness, poor sleep and fatigue in some people.
On the diet, some people experience “keto breath,” halitosis likely caused by the production of acetone, which is one of the ketone bodies.
Possible side-effects for patients with epilepsy starting the diet include constipation from reduced fiber intake, vomiting, fatigue, hypoglycemia, worsening reflux and increased frequency of seizures. Patients with lipid disorders (like high cholesterol or triglycerides), heart failure and kidney and liver disease take caution if considering the diet. People on blood thinners should take extra care.
Patients with kidney disease need to be cautious because this diet could worsen their condition. Additionally, some patients may feel a little tired in the beginning, while some may have bad breath, nausea, vomiting, constipation, and sleep problems.
KETO DIET TIPS & TRICKS FOR BEGINNERS
1. Start Simple
Keep it simple, especially when you are starting out. The best way to start keto for beginners is to use a simple framework for your meals:
Pick a protein – Chicken, beef, pork, turkey, fish, seafood, protein powder, eggs, etc.
Pick a (low carb) veggie – Cauliflower, broccoli, zucchini, brussels sprouts, cucumbers, bell peppers, etc.
Add fat. Butter, oil, lard, ghee, cheese, bacon, avocado, mayonnaise, nuts, etc.
2.Examine Your Relationship With Fat
To prepare for a high-fat diet, which can be uncomfortable at first, start making small adjustments to what you eat every day, like ordering a burger on lettuce leaves and subbing green veggies for fries.
Instead of potatoes or rice with your meal, opt for a nonstarchy veggie. Start cooking with more oil, such as olive or avocado oil. Realize that old dieting habits — like making a plain skinless grilled chicken breast — just don’t make sense on a keto diet because you won’t get enough fat. Slowly start pushing out carbs and getting in fat. If you’re afraid of fat, a ketogenic diet won’t work for you.
3. Switch Up Your View of Protein
One of the most common misconceptions about the keto diet is that you can eat as much protein as you’d like. But this is not a diet where you watch carbs only — you also have to keep your protein intake moderate. Protein can be converted into glucose, and therefore overeating protein can take your body out of ketosis. Think of your ratios as a small portion of meat topped with a generous amount of fat, rather than the other way around.
4.Know What Side Effects to Expect (for Example, the ‘Keto Flu’)
For all the attributes of a ketogenic diet (like weight loss), there’s one big side effect you have to be prepared for: the keto flu, discussed before.
Along the same lines, you’ll want to be sure to take it easy with exercise for the first week or two as your body adjusts to burning more fat rather than carbs for fuel.
5.Acknowledge When Keto Might Not Be Right for You
Because you can’t eat beans or lentils on a ketogenic diet, and nuts and seeds are even limited due to their carbohydrate content, you’re really just left with some tofu and will need to rely on low-carb protein powder. There is a good possibility this won’t pan out. “I don’t see this as a sustainable diet due to the extreme restrictions”.
In addition, there are medical conditions that should make you think twice about starting keto — or at least talk to your doctor before trying it out. Those include people on insulin, as well as those on oral and noninsulin injectable medications for high blood sugar. Even struggling with GI issues may be a barrier to starting. Last consideration: If existing personal dietary restrictions require you to avoid foods like soy, eggs, nuts, dairy, or seafood, a ketogenic diet may be too limiting for you.
6.Have an After Plan, Because Keto Isn’t Meant to Be a Long-Term Weight Loss Solution
A keto diet is not a forever diet. It’s designed to be short-term. Some people go on a keto diet a few times per year, others will use it to lose weight and change their eating habits.
For some people, going on a keto diet is an effort to change those poor habits, but there’s the risk of falling back into your old ways once the diet is over.
Your ultimate goal should be “to shift your diet to a healthier pattern that involves eating less bread, less pasta, less flour, and less sugar,” as well as more nonstarchy veggies. Think about what that will look like for you once the keto diet is over.
How will you use this temporary diet as a springboard to bettering your long-term health?
Is a ketogenic diet healthy?
Not precisely! Low-carb diets like the keto do appear to lead to some short-term weight loss, but they’re not significantly more effective than any other commercial or self-help diet. And they don’t appear to improve athletic performance.
A ketogenic diet could be an interesting alternative to treat certain conditions and may accelerate weight loss. But it is hard to follow, and it can be heavy on red meat and other fatty, processed, and salty foods that are notoriously unhealthy.
Because it lacks carbohydrates, a ketogenic diet is rich in proteins and fats. It typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables. Because it is so restrictive, it is really hard to follow over the long run. Carbohydrates normally account for at least 50% of the typical diet. One of the main criticisms of this diet is that many people tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables.
Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term. A balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life.
Advice we can all agree on: Eat healthily. There is no quick fix !
By Priyanshi Bhatnagar