By Faisal Chaudri, MD
While there has not been enough research about the keto diet’s long-term impact, anecdotal evidence of its short-term benefits has inspired a proliferation of new studies. For one serious condition – childhood epilepsy – the keto diet has been considered a scientifically proven and has been reported in more than half of all cases in some studies, a highly effective treatment for decades.
What is the ketogenic diet?
Fundamentally, it is about severely restricting carbohydrates – down to around 50 grams a day or lower. Typical dietary guidelines call for between 225 to 325 grams of carbs per day for adults eating 2,000 calories daily, which is 45% to 64% of total daily calories. The diet is based in restricting carbohydrates, maintaining protein intake and an increase of foods high in fat.)
This means avoiding almost entirely anything sugary or starchy, including fruit, corn, beans, pasta, rice, carrots, and potatoes. For example, two slices of bread can represent more than 20 grams of carbs and the importance of reading food labels with any and all diets is paramount. Foods you can eat include natural fats, seafood, meat, eggs, and any vegetables that grow above the ground.
The ketogenic diet is considered an extreme diet and will have a major impact on your metabolism, it is best to do it under a doctor’s supervision along with a nutritionist, especially if you have any of the serious health issues listed above. Your doctor will recommend that you work with a nutritionist to be sure you are getting adequate nutrients and may suggest that you take vitamin supplements. There are also a variety of mobile apps available to help you balance nutrients and count carbs.
How the ketogenic diet works
Usually, our cells get energy when we turn the carbs we eat into glucose. Insulin, a hormone produced by the pancreas, helps us use this glucose as energy or store it as fat. When we are deprived of glucose – either by fasting or restricting carbs – we start tapping into body fat for energy. The liver turns fat into ketones, a type of acid our cells can use for fuel. This process is called ketogenesis, and it’s the goal of a keto diet. The fewer carbs you eat, the more quickly you go into ketosis, usually within two to four days of starting the diet.
Please note that ketosis, a very mild and generally harmless increase in blood ketone levels, is different from ketoacidosis, which is an extreme overproduction of ketones that occurs mostly in people with uncontrolled diabetes and results in your blood becoming dangerously acidic. In ketosis, your blood pH (the measure of acidity or alkalinity) stays in the normal range.
Because it is such an extreme diet and the long-term impact is still a question mark, most doctors recommend the keto diet mainly for patients who need to lose weight for serious health reasons.
Preliminary research suggests that the keto diet is highly effective for some diabetics. In fact, your doctor may reduce the amount of insulin you take as you begin the diet because blood sugar levels drop so quickly. Patients also tend to lose weight and body mass more quickly than on other diets. Often their triglycerides drop, and “good” cholesterol increases – all promising signs for preventing stroke and heart disease.
For the same reasons, the keto diet has been used to successfully treat patients with metabolic syndrome, a cluster of symptoms affecting an estimated 23 percent of adults in the U.S. that is known to put them at high risk of cardiovascular disease, diabetes, and stroke.
The keto diet has even, in some cases, reversed fatty liver disease, now a major cause of liver failure associated with high-carb intake and obesity.
Because obesity can also increase surgical risk, the keto diet has been recommended to help patients lose weight quickly to qualify or prepare for surgical procedures.
As with any new diet, there can be some discomfort when you begin the keto diet, including:
- Fatigue: It’s known as the “keto flu,” and most people feel tired and run down in the beginning and may experience headaches. As ketosis kicks in, this often resolves and most patients experience more energy than usual.
- Bad breath or dry mouth.
- Digestive issues, including nausea, constipation, and diarrhea. These usually subside within a week or two, and the best antidote is drinking a lot of water. In fact, hydration is especially important on the keto diet because you lose water weight in the beginning.
- There can be potential long-term negative consequences with the ketogenic diet, which include possible increased risk for kidney stones, osteoporosis, elevations in cholesterol and nutritional deficiencies if a variety of nutrient rich foods are not incorporated.
It’s hard for most people to make dietary changes, but the risk of serious illness can be highly motivating, and some studies have shown that the keto diet is a bit easier to stick to than other diets. It may be easier to follow at many restaurants, for instance, than a low-fat or even a vegan diet because you can usually easily order meat or fish – hold the potatoes, bread, rice, and dessert – with a big pile of vegetables or a salad. There are anecdotes that suggest people on the keto diet lose food cravings and tend to reduce their calorie intake because of this change.
Consistency is important, and the danger of losing a lot of weight on an extreme diet is that gaining it back – yo-yo dieting – is associated with many health risks, including heart attack and stroke. Researchers call for improved long-term plans for keto diet patients, including strategies for transitioning safely to a more normal diet.
Not everyone can tolerate the diet. Some people with kidney disease, for instance, do well on the diet, but it can be dangerous for others. Again, it’s important to have your doctor closely monitor your progress if you have health problems.
Visit MAPMG’s Staying Healthy blog and read more about healthy strategies for weight loss.
Faisal Chaudri, MD, is a board-certified Internist with Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Springfield Medical Center.