Keto. Ketogenic. Ketosis. All of these words refer to the ketogenic diet, AKA a hot (and painfully misunderstood) diet trend.
You ask, ‘Is it for me? Can Keto give me a chiseled physique once and for all?’
We’ll get there, I promise. But first, some key facts:
1. The ketogenic diet is NOT new. It was developed in the 1920’s-1930’s, intended for epileptic seizures when medications fail.
2. The REAL ketogenic diet is a 4:1 fat to carbohydrate AND protein ratio. That’s carbohydrate and protein combined. This extreme ratio is a far-cry from the high-fat, high-protein “keto” diet trending on social media
3. The “keto” trend gracing the fitness community and social media is actually…wait for it…a modified Atkins diet. Sorry to disappoint, but science isn’t always sexy.
Still with me? Let’s take a deep dive into what the keto diet is REALLY about! Buckle up:
First of all, what are ketones? How/when are they made in the body?
Prolonged dietary carbohydrate restriction reduces insulin levels, which results in decreased lipogenesis. Glucose reserves become inadequate for even normal fat oxidation in the TCA cycle (carbs are needed to produce enough OAA to continue the cycle). The CNS lacks adequate glucose supply, as it “prefers” glucose, and it cannot use fat as an energy source; Thus an alternative source is required after 3-4 days of inadequate carbohydrate, and this is where ketone bodies come into play (acetoacetate, b-hydroxybutyric acid, and acetone). Once ketone production in the liver reaches about 4mmol/L, the CNS and body tissues can use ketone bodies as an energy source (b-hydroxybutyrate–>2 molecules Acetyl CoA–>use in the TCA cycle).
(Haven’t read these science terms since high school? Here’s a TCA cycle refresher)
How little carbohydrate may I eat and still achieve ketosis?
Approximately 50g/day, but this is entirely based upon the individual’s daily calorie needs (4:1 fat to carb/pro ratio. NOTE: the “1” refers to carbohydrates and protein COMBINED. We’re talking a 90% fat diet here).
What foods comply with the ketogenic diet?
Butter, oils, bacon, heavy cream, avocados, etc.
Was the ketogenic diet designed for weight loss?
Short answer: NO.
The ketogenic diet leaked it’s way into mainstream diet culture, but that’s not it’s intended purpose. The ketogenic diet is used in the clinical setting to control epilepsy (especially in children) when medications fail. It’s a full-time job with precise calculations necessary to maintain the patient’s blood sugar in the desired ketogenic range. This is done under supervision of doctors and Registered Dietitians.
But I don’t have epilepsy. I just want to lose weight. Is the keto diet for me?
First, the science: While the research is preliminary, adherence to the ketogenic diet MAY result in increased energy expenditure due to the “costly” effect of ketone production and usage. Insulin sensitivity may improve as well, and using this alternate metabolic pathway may lead to changes in “hunger/satiety” hormones ghrelin and leptin. Finally, the protein and fat may have a satiating effect, making the individual less likely to over-consume calories each day.
Let’s be real: The “keto” diet in mainstream diet culture is NOT true keto, but rather an Atkins or modified-Atkins diet (sorry to disappoint…this is nothing magical and nothing new). Pop-culture “keto” is actually a low(er) carb, high fat AND high protein diet. It’s not likely that followers of this diet are actually reaching ketosis (to be sure, you can detect ketone bodies in the blood and urine…but who is really taking the time to do these tests?)
I’m still intrigued, but I have diabetes! Or, I have a history of kidney problems. Is Keto (or a modified-Atkins) for me?
Please see your doctor before attempting this diet. (see “contraindications/risks” in the first listed reference)
What are the risks associated with the ketogenic diet?
Assuming we’re talking about a TRUE ketogenic diet (90% fat), there is a real risk for nutrient deficiency here. Nearly eliminating all high-quality carbohydrate sources (whole grains, most dairy, legumes, fruits and vegetables) puts one at risk for deficiency. Folic acid, B vitamins, iron, calcium, and vitamin D are of particular concern and will likely need to be supplemented. Additionally, lack of dietary fiber means the individual will likely need to take a daily stool softener.
Ok, maybe there are risks involved. But my friend (or Instagram star) swears by it and has lost a bunch of weight!
Here’s the deal. Many factors could be at play here. Some or all of these may hold true for these individuals:
The word “diet” implies that this will end, meaning the weight will come back after you go back to your “regular” way of eating. The goal here is sustained weight loss. Ask yourself: Can I realistically keep this up every day for the rest of my life? Be honest. If the answer is no, then stop. Reevaluate. The diet is not the answer. (See here for more on fad diets: http://www.eatright.org/resources/health/weight-loss/fad-diets)
1. Consuming less than your body needs will result in weight loss (at least in the beginning. I’m simplifying the science here). Consuming more than your body needs will cause weight gain. The exact foods consumed don’t entirely matter (again, simplifying for sake of conversation).
2. Carbohydrates hold water; Therefore reducing carbohydrate intake causes initial rapid water loss. You see this as a drop in the scale number. That’s where those “lose 10 pounds in 2 weeks!” diet miracle claims come from. That wasn’t fat loss, friend, but water loss.
3. Your friend or Instagram celeb might be losing weight because of the social support that “keto” offers. “Keto” offers the Dieter a community and dense of identity and belonging. We know that social support makes us more likely to reach our goals. The food itself doesn’t matter so much, but the sense of community does.
4. Your friend cut out empty calories (calorie-dense but nutrient-poor) like sugary drinks, candy, white bread/pasta, and other overly-processed food. Once in a while these treats are fine! But be real: on average, we indulge on a regular basis.
5. This individual is paying more attention to food intake than ever before, which is contributing to weight loss. Keeping food diaries, taking pictures of food eaten, or even taking time to pre-plan meals holds us accountable to our goals. Suddenly we don’t want “just a few chips” or “just a handful” of cookies if it means we have to consciously log it (that’s an old trick. Try it with your current meals, no keto switch needed).
Ketogenic overview and therapeutic applications (European Journal of Clinical Nutrition): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826507/
Charlie Foundation for Ketogenic Therapy: https://www.charliefoundation.org/explore-ketogenic-diet/explore-2/classic-ketogenic
NY Times: Epilepsy’s Big Fat Miracle: http://www.nytimes.com/2010/11/21/magazine/21Epilepsy-t.html