In recent years the ketogenic diet (or keto diet) has attracted a lot of attention as a potential way for weight loss. Given the obesity pandemic this is understandable, however what is the safety of such diet? Over the course of this article I hope to briefly explain what is a ketogenic diet, its potential benefits and concerns.
What is a ketogenic diet?
As the name suggests, a ketogenic diet is a diet with the goal of promoting ketosis. But what is ketosis?
The cells in our body need energy to function. This energy (ATP) is produced inside the cell by the mitochondria. The mitochondria can use different sources of fuel to produce this energy: carbohydrates, fats or proteins.
Usually the easiest pathway for the cells is to use carbohydrates for energy production as they are easily absorbed, easily processed, and easily stored in the liver in the form of glycogen, and after that they are turned into fat. Conversely, this also means that if there is lack of carbohydrates the next step will be the utilization of fat for the production of ATP. During the processing of this fat, ketones are produced. With that in mind, people interested in burning fat started proposing a ketogenic diet, which in essence would mean willingly restricting the carbohydrate intake (some people would say to no more than 50g of carbohydrates a day) as an attempt to promote ketosis and burn fat, therefore reaching weight loss.
Image from: JAMA
What are the uses of a ketogenic diet?
The ketogenic diet has also been used for things other than weight loss.
Believe it or not it has been noted that some patients with epilepsy, particularly in the pediatric population, have a reduction in the number of seizures if they are in a ketogenic diet. For that reason this diet has been used by some people with difficult to control epilepsy with fair results in that regard. It was also proposed to be a treatment for diabetes as the weight loss promoted by it significantly reduces insulin resistance which is the main problem for type 2 diabetics. Small studies recently have also suggested that it may be beneficial in regards to cancer and Alzheimers disease.(1-6)
Is a ketogenic diet effective for weight loss?
Yes it is. The ketogenic diet has been compared with other diets such as low fat diet and it does produce weight loss results. There are also a number of people around that can provide their experiences with the diet and there is almost a consensus regarding the fact that the diet does produce indeed a decent amount of weight loss in a reasonably small amount of time. (7)
However, of course, the problem with any diet is the adherence and the long term commitment to lifestyle modification. Someone that is not willing to make dramatic changes in their eating habits is unlikely to benefit from any kind of diet in the long run.
Are there any short and long term concerns?
In the short term, when starting a ketogenic diet (in the first two weeks in particular) people may complain of fatigue, hunger (obviously), muscle pain, and gastrointestinal issues (abdominal cramps and constipation). This myriad of symptoms is often called keto-flu by some. People may also notice excessive urination, which is usually related to the metabolic and fluid shifts that are happening inside the body such as the use of the glycogen storage in the liver. The symptoms usually improve significantly after some weeks in ketosis. It is very important for someone in a ketogenic diet to stay well hydrated and ensure a proper intake of solutes (sodium, potassium, magnesium) to reduce some of the effects mentioned above.
Regarding the long term concerns, some studies have suggested that a ketogenic diet may be correlated with an increased mortality (this was also observed with high carbohydrate intake). Some have also expressed concerns regarding potential nutritional deficiencies in the long run given the fact that the person on a ketogenic diet constantly is avoiding some starchy vegetables that may contain important vitamins and minerals.
Should you be on a keto diet?
I am sorry to disappoint anyone, but after looking at the above information, the answer is: it really depends. The decision to start or not a ketogenic diet has to be individualized. The potential benefits of weight loss have to be balanced with the potential harms of some nutrient deficiencies and maybe even some increased risk of long term mortality.
Probably a reasonable approach would be to use the ketogenic diet as a tool in a larger weight management box rather than a single solution. Someone wishing to lose weight can consider doing a ketogenic diet for a period (lets say 2-3 months) in addition to other weight loss strategies such as caloric restriction and intermittent fasting. The ketogenic period will definitely help the weight loss during that time and because it is being done for a limited period it is unlikely to result in significant nutrient deficiencies or long term increase in mortality.
Needless to say, before starting any dramatic dietary changes, I would definitely suggest a visit to a dietitian and a physician familiar with nutrition to assess where your metabolism is at that point.
7. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition Volume 110, Issue 714 October 2013 , pp. 1178-1187.
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