The keto diet and health: what is the evidence ?

These days, it seems to me, everywhere you turn there is a new diet fad going around. Lately, I’ve been hearing more and more about the ketogenic, or keto diet being the new panacea for weight loss. It struck me as very interesting because, as a physician, I have seen the ketogenic diet used in the medical field for several years in pediatric patients who have refractory epilepsy. Refractory epilepsy refers to patients who have seizure disorders that don’t respond to the usual medications. This diet has actually produced great results in many people. I had never considered it as an option for weight management as it is a high fat diet. I felt very conflicted about it, so I decided to investigate further and see what the research says.

Let’s start with a little background

How long has the ketogenic been around?

This is not something new! It turns out, it has been around almost 100 years!! In 1921 Dr. Russel Wilder, a clinician and scientist specializing in diabetes, coined the term “ketogenic diet” and used it to treat epilepsy during a time when we had no medications available for treatment. That is just amazing in my book.

Ketosis

Ok, so in order for you to have an effective keto diet, your body has to reach a state called ketosis. So what exactly is ketosis? Here comes a little biology lesson, which I will try to keep as simple as possible.

To be in ketosis your body has to switch from using carbohydrates to using fats for energy. For most of us, carbohydrates, which are broken down into glucose or “sugar”, are the major source of fuel for our body. Insulin is a hormone that is released by our pancreas to help our bodies absorb and utilize this glucose.

When you limit your intake of carbohydrates to 50 grams or less per day, your body reduces the release of insulin and with this, two metabolic processes occur.

The first one is called gluconeogenesis, which simply means that the body starts making glucose in the liver instead of getting it from carbs. As the glucose availability decreases even further, we enter ketonegenesis, or ketone formation. Then, these ketone bodies replace glucose as the primary fuel for our body. As mentioned above, insulin is in charge of making sure our bodies can use glucose as fuel and stores any extra as fat. When our glucose is low, our insulin levels naturally decrease, which is great in the fat storage department (among other benefits of having low insulin secretion).

Most our major organ systems can use ketone bodies as fuel. This includes the heart, kidneys, brain and muscles. At the cell level, either the glucose or the ketone bodies must be converted into a chemical called adenosine triphosphate (ATP) in order for it to be used as energy by our cells. ATP is basically the gasoline for our cells.

By the way, you don’t need to just do a high fat diet to achieve ketosis. Ketosis is a natural state that occurs when we fast. If you want to know more on fasting, check out our intermittent fasting post.

Ketones or glucose?

Is one better than the other? Well, there is one that is able to produce more ATP to feed our cells. Ketone bodies are often called the “super fuel”. One hundred grams of the two main types of ketone bodies can produce between 9,400 and 10,500 grams of ATP versus 100 g of glucose which produces 8,700 grams of ATP.

How does the keto diet work?

As you probably already figured out, it is a high fat, low carbohydrate diet. It is also moderate-protein. It is approximately 55%-60% fat, 30%-35% protein and 5%-10% carbohydrates. If a person consumes 2000 calories, that means your carb intake will be between 20-50 grams per day.

There are several ways of doing this, most people talk about one of three types of keto diets: the long chain triglyceride (LCT) based diet, the medium chain triglyceride (MCT) diet and the modified Atkins diet. MCT’s are more efficiently absorbed and quickly transported to the liver than the LCT’s (we talk about MCT’s and LCT’s on this coconut oil post), so you can reach faster ketosis with lower fat intake. The modified Atkins doesn’t restrict protein or calories at all and is said to be less restrictive than the others.

If you are looking to learn more about the diet itself, check out the Keto Clarity. It is a great resource as it also tells you how to get started with recipes and shopping lists.

What conditions is it used for?

Cancer

Research has shown that cancer cells are highly dependent on glucose to grow and multiply. So, scientists have tested the hypothesis that by taking away the glucose you could “selectively starve” cancer cells.

Several case reports support this argument in humans, including one looking at 16 patients with advanced metastatic cancer which reported positive results from a restricted ketogenic diet in tumor progression and blood parameters.  As per usual, we will need more rigorous studies to see if there is indeed a sustainable anti-cancer effect from the keto diet, but in theory it seems promising! There are actually ongoing clinical trials studying this, so hopefully we will have more data soon.

Neurological disorders

As previously mentioned, the data in terms of ketosis and helping with refractory seizure conditions is quite conclusive. It doesn’t work for every patient, but it has made a significant difference for many patients.

Although not fully understood, one theory is that since glucose is the preferred fuel for brain cells, the more glucose, the more “energized” or “excitable” these cells become. Excitable brain cells are likelier to “spark” seizures in patients.

There are some human and animal studies suggesting that keto diets may be helpful in other neurologic conditions, including Alzheimer’s disease, Parkinson’s disease and amyotrophic lateral sclerosis (ALS).

Weight Loss

In the last few years, more evidence has come regarding the actual ill effects of high carbohydrate diets and its role in the current health crisis we have in developed countries, including obesity, diabetes and heart disease.

At the same time, we continue to collect evidence that fat may not be the villain it was once said to be. In fact, I would not be surprised if slowly, over the next 10+ years, our entire understanding of what “healthy eating” truly means, completely changes.

There are multiple studies looking at the effects of low-carb/high fat diets on weight and blood sugar. One recent study looked 283 obese adults with diabetes and after 10 weeks on the ketogenic diet, they saw the improvements glucose control numbers, a reduction in the dose or elimination of diabetes medications, and a mean body mass reduction of 7.2% from baseline.

In addition, and even more interesting (at least to me 😮), other studies show ketogenic type diets to have positive effects improving lipid profiles, including blood triglycerides, total cholesterol reduction and increases in high-density lipoprotein (HDL: the good cholesterol). They do however seem to increase the bad cholesterol (LDL) in blood, but more on that below.

So, it seems to be very helpful for weight loss and controlling metabolic syndrome. I personally know several people who have lost significant amounts of weight on it.

Potential problems

So is it all fame and glory? Well, of course not. I have yet to see a diet that is 100% perfect. 🧐

There are certain patient populations who should not undertake the keto diet. This includes patients with problems of the liver or pancreas. As always, talk to your doc first.

Also, upon initiation of the diet, people often report feeling flu like symptoms or gastrointestinal problems. These usually resolve in a few days to a week. Longer term problems can include fatty liver, kidney stones, problems with long term adherence and elevation of the blood lipids (fat).

A word on the elevation of bad cholesterol: this may not be a deal breaker. It seems ketogenic diets changes the properties of that bad cholesterol, making the particles bigger. Bigger particles mean it is less “sticky” to the walls of our arteries and less likely to stay stuck there, cause obstruction and bring about heart disease.

What do I think?

I think this has a lot of potential benefits and if you are trying to lose weight and nothing has worked, this is definitely worth a try for a while. I do worry about potential side effects if this became your forever diet, but I hope as more and more people use it, we will be able to get more answers. We have had many seizure pediatric patients on a keto diet for years and I must say I haven’t seen many of these side effects.

Ultimately, I will have to try it out and see how my body and blood lipids change. I already eliminated all non-fat and low-fat products from my diet years ago, as we realized these products are actually not healthier. They tend to be full of chemicals and sugar to make them palatable, so they are actually worse for us. Plus, fat causes satiety, that is, it will make you feel full. So, you can feel fuller longer with less quantities. I also feel the quality of the fat you eat is important. Avocados, fish oils and olive oils are all good examples of healthy fats.

I hope this gives you yet another tool in your health kit! Have you tried the keto diet? Drop a comment below and share your experience!

Enjoy the rest of your day, I’ll see you next week!

Happy ketosis 😜