As a registered dietitian, patients frequently ask me what the best diet is for them, based on their individual health issues and nutrition goals. With so many different diets to choose from—and plenty of fad diets that rage and then disappear—it’s understandably difficult to sort through all the information and make an informed choice about what to eat.
By now, who hasn’t heard of the ketogenic diet? Once touted for being restrictive, impossible, and even dangerous, this diet is now everywhere. There’s also a lot of misinformation about what a keto diet actually is, and many are left wondering: What foods are allowed? Can the diet help alleviate certain symptoms? Will it greatly restrict my current lifestyle if I try it?
The ketogenic diet is known as a high-fat, moderate-protein and low-carbohydrate diet. In the clinic, this translates to at least 80 percent of total calories coming from fats. For someone who’s eating 2000 calories a day, that is 1,600 calories coming from fats alone. To accomplish this, you must avoid foods like fruit, bread, pasta, crackers, cookies, sugar, tomatoes, milk, yogurt, and potatoes (just to name a few) and focus instead of eating avocados, olive oil, olives, salmon, butter, chia and flaxseeds, cruciferous vegetables, and nuts like walnuts, almonds, and macadamia.
Put simply, an effective ketogenic diet is classified by low serum blood glucose and high circulating blood ketones. The diet works by decreasing circulating glucose, which has several downstream effects, including decreased inflammation, increased energy, increased cognition and weight loss.
While personal and professional opinions on the keto diet vary greatly, one thing is clear: It’s not the best fit for everyone. Compliance is a huge limiting factor, this diet can be a bit socially isolating, and for some people it can be hard to tolerate due to individualized GI side effects. Also despite the diet being around for almost a century, very little long-term research has been done on it.
That said, there are certain groups that can definitely benefit from a ketogenic diet, including:
Originally, the main purpose of the diet was to help children who had uncontrolled seizure activity, despite being treated with anti-seizure medication. And people who are on anti-epileptic drugs can still benefit by going on the diet; they could even potentially reduce their dose of anti-seizure medications with the addition of the ketogenic diet.
How does this work, exactly? Think of your mind as an engine. When it gets flooded, seizures can happen. When you have low blood sugar and eat a high-sugar meal, sugar in the form of glucose floods into the brain and can create seizures. Those who consume a high-fat diet will experience steadier energy levels and less opportunity for "engine flooding." Recently, Dr. Elaine Hsiao at UCLA has postulated the mechanisms behind how the diet changes the brain’s neurochemistry to make it a less favorable environment to have seizure activity.
People with type 2 diabetes tend to have hyperglycemia (high blood sugar levels) and insulin resistance. This causes high-circulating blood glucose that "starves" the cells of energy, which, in turn, creates a strong feeling of hunger. The ketogenic diet restricts blood glucose and allows the body to use ketones as its alternative fuel source. By doing this, the body naturally has lower blood glucose. When the body’s glucose is decreased consistently over time, it can help cells become "re-sensitized" to the insulin. This allows the body to better utilize its energy derived from glucose. If you’re taking glucose-lowering medications, I concur with other experts who study the effects of keto and diabetes and believe it should only be used under the supervision of a doctor and an R.D. Low blood sugar can be dangerous and is common on this diet—and this effect is amplified if you are on medications that lower your glucose!
For most individuals, the ketogenic diet is effective at facilitating weight loss . When glucose is stored in the body, it’s stored as a molecule called glycogen. With each gram of glycogen that is stored, approximately 3 to 4 grams of water are stored with it. This means that when you’re eating a carbohydrate-restricted diet, such as a ketogenic one, your body uses its own glycogen stores to keep up with the body’s glucose demands during times of fasting or periods without eating food. This will lead to a large amount of water-weight loss when starting the diet. This, along with the consequential electrolyte shift—the body having to adjust to the secondary fuel source, ketones—cause what some people call the "keto flu." Symptoms include fatigue, stomach pain, fogginess, irritability, nausea, muscle cramping, and lack of concentration. By restricting carbohydrates to 20 grams of net carbs daily, weight loss can be quite rapid in the first few weeks of the diet.
The newest topic regarding the ketogenic diet is in cancer and cancer therapies, especially in the case of brain tumors. This is due to one scientist’s theory that cancer cells consume a large portion of glucose to supply the cells with the energy they need to grow. And we do know that cancer cells have an affinity for using glucose, which results in a dependence on glucose as an energy source. When eating a ketogenic diet, you end up decreasing the amount of blood glucose in the body, using ketones instead. This can help stop or decrease cancer cell growth and movement.
The research of Dr. Adrienne Scheck and Dr. Angela Poff, two pioneers in the field of ketogenic diets and brain tumors, has shown very positive effects of the keto diet in mice with brain tumors. In one study, the mean survival time was increased 56.7 percent in mice with metastatic cancer who followed the ketogenic diet. They have also looked at how the ketogenic diet may sensitize cancer cells to the effects of radiation therapy and chemotherapy. In mouse models of glioma, the ketogenic diet demonstrated a synergistic effect, working together with radiation and chemotherapy to make it more effective.
Most people think that they must consume carbohydrates to be a competitive athletes, but I’m here to turn your world upside down by telling you they’re not necessary! When you’re eating mostly carbohydrates (which means 50 percent of your total calories or more coming from grains, fruits, and veggies), you are considered a "glucose burner." But if you are lean, you have fewer glucose reserves to tap into when food intake is sparse. That means that to participate in a physical activity, you must always have a steady source of fuel in order to maintain optimal performance and keep up with energy demands. A high-carbohydrate diet ensures that glucose and carbs are the dominant fuel source for the exercise. When your reserve tank decreases, so does performance.
When you are in a state of ketosis, however, your body is not dependent on carbs or glucose for your cells to make and sustain energy. When you’re following a ketogenic diet and are fat-adapted (meaning you have been in ketosis and maintaining that state for quite some time), you can use your ketones as fuel instead or glucose. Two top researchers in the field of low-carb and performance, Dr. Jeff Volek and Dr. Stephen Phinney, have shown that when fuel is scant, the body can tap into its own adipose, or fat tissue, to keep the engine going for longer and steadier periods of time. After this transition, your body can train harder, recover faster, and stay active for longer. Their studies have also shown that muscle proteins are the last to be broken down , which means the ketogenic diets will spare your muscles and still be able to sustain you.
If you’re thinking about starting the ketogenic diet, make sure to ask yourself: "What are my goals?" If it is an appropriate adjunct to your cancer-related therapy or a way to get off or decrease your blood-glucose-lowering medications, I think it’s a useful diet to start on a trial basis, with supervision. No, keto isn’t a diet that benefits everyone or is a panacea for all diseases and health problems, but the results from people who have the conditions listed above and those that are getting results are intriguing. If keto fits your lifestyle, goals, and treatment plan, it’s an effective tool to help elevate your health.
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