The ketogenic diet (KD), characterized by high fat, moderate protein, and very low carbohydrate intake, has gained considerable popularity as a weight-loss strategy. While it has demonstrated benefits for weight management and certain health conditions, it's crucial to understand its potential effects on the body's acid-base balance and gastrointestinal health. This article explores the relationship between the keto diet and acidity, addressing common misconceptions, potential risks, and strategies for mitigating adverse effects.
What is the Keto Diet?
The keto diet involves drastically reducing carbohydrate intake (typically to 25-35 grams per day) while increasing fat consumption. This metabolic shift forces the body to enter a state called ketosis, where it begins to burn fat for energy instead of glucose. The liver oxidizes fatty acids to produce ketone bodies (β-hydroxybutyrate, acetoacetate, and acetone), which serve as an alternative fuel source for the brain and other tissues.
Acid Reflux and the Keto Diet: Addressing a Common Concern
Some individuals on the keto diet experience acid reflux or heartburn, leading them to believe that the diet is the cause. However, it's important to distinguish between correlation and causation. While certain foods may exacerbate acid reflux symptoms, diet is generally not the underlying cause of acid reflux disease (GERD).
The primary cause of acid reflux is a weak anti-reflux barrier, which can be influenced by factors such as hiatal hernia, poor esophageal motility, and delayed gastric emptying. Whether you consume fatty foods or simply drink water, acid reflux is more likely to occur if this barrier is compromised.
If you have been taking proton pump inhibitors (PPIs) for GERD for an extended period, it is advisable to undergo a thorough evaluation to address the root cause of the problem. Restoring the anti-reflux barrier can allow you to enjoy the keto diet or any other dietary pattern without experiencing discomfort.
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Nutritional Ketosis vs. Diabetic Ketoacidosis: Clearing Up the Confusion
It's crucial to differentiate between nutritional ketosis and diabetic ketoacidosis (DKA), a life-threatening complication of type 1 diabetes. In DKA, ketones are produced rapidly, overwhelming the body's acid-base buffering system. Nutritional ketosis, on the other hand, involves a regulated and controlled production of ketones, during which blood pH remains within normal limits.
The Potential for Acidity on a Traditional Keto Diet
While the keto diet minimizes carbohydrate consumption, which can contribute to an increased acid load in the body, traditional keto diets may also be acidic due to a neglect of alkaline foods. An increased acid load (caused by too many processed carbs - as well as too many high-fat proteins) actually shifts urinary chemistry. Urinary magnesium levels, urinary citrate and pH decrease, while urinary calcium, undissociated uric acid and phosphate increase, putting you at risk for problems like kidney stones. Consuming too many acidic foods creates a “chronic low-grade acidosis” that depletes precious minerals like magnesium, calcium and potassium from the body, while adversely impacting bone health, increasing inflammation and paving the way for chronic disease.
The Importance of Alkaline Foods
To optimize pH levels and maintain a balanced keto diet, it's essential to incorporate alkaline foods. These foods can help buffer the acidity produced by ketone bodies and high-fat proteins.
Practical Strategies for Balancing Acidity on Keto
- Prioritize Alkaline Foods: Include plenty of non-starchy vegetables like leafy greens (spinach, kale), avocados, cucumbers, and zucchini in your keto diet.
- Limit Acidic Foods: Be mindful of acidic foods such as Brussels sprouts, alcohol, coffee, and most dairy products. While you don't have to eliminate them entirely, consume them in moderation.
- Consider Intermittent Fasting: Intermittent fasting can help promote ketosis and may offer additional health benefits.
- Monitor Urine pH: Use pH and ketone urine test strips to monitor your alkalinity and ketone levels. This can help you determine if your diet is adequately balanced.
- Gradual Transition: Introduce dietary changes gradually to allow your body to adapt.
- Monitor Body Temperature: A keto-alkaline diet should increase your metabolism. That’s why I want you take your temperature about 10 minutes before getting out of bed. Ideally, it will be about 97.6 F. A lower temperature could indicate a thyroid issue and the fact your metabolism isn’t functioning optimally.
Addressing Potential Nutrient Deficiencies
Since the keto diet restricts several foods, especially nutrient-dense fruits, whole grains, and legumes, it may fail to provide recommended amounts of vitamins and minerals. In particular, some studies suggest that the keto diet doesn’t provide enough calcium, vitamin D, magnesium, and phosphorus.
To mitigate this risk, prioritize nutrient-rich, keto-friendly foods and consider supplementation if necessary.
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A Case Study: Keto Diet, Vinegar, and Acidosis
A recent case study highlighted the potential risks of combining a ketogenic diet with acetic acid (vinegar) ingestion and metformin use. A 43-year-old female with a history of type 2 diabetes, hypertension, GERD, and other conditions presented with severe acidosis after starting a keto diet and regularly consuming apple cider vinegar while taking metformin.
The patient's condition was likely exacerbated by the combination of factors, including aggressive carbohydrate restriction, frequent vinegar ingestion, and an increasing dose of metformin. This case underscores the importance of seeking professional guidance before making significant dietary changes, especially if you have underlying health conditions or are taking medications.
The Importance of Professional Guidance
It is imperative that trained healthcare providers supervise patients seeking weight loss if they want to engage in either of these options to avoid potentially serious complications. Obese patients seek medical information and help with weight management from various sources including television, online, and social media platforms. These sources may provide unreliable information which may translate into patients engaging in new dietary habits without consulting medical professionals.
Potential Dangers of the Keto Diet
While the keto diet can be effective for weight loss and managing certain health conditions, it's important to be aware of its potential dangers:
- Keto Flu: As your body adapts to using ketones and fats as its primary energy source, you may experience flu-like symptoms at the beginning of the keto diet.
- Kidney Stones: Eating a lot of animal foods on the keto diet can lead to more acidic urine and a higher risk of kidney stones. This acidic state can also worsen the progression of chronic kidney disease.
- Constipation: Due to its carb restrictions, the keto diet is often low in fiber. This may trigger constipation and negative effects on gut health.
- Nutrient Deficiencies: Some studies suggest that keto provides insufficient vitamins and minerals, including potassium and magnesium. Over time, this could lead to nutrient deficiencies.
- Hypoglycemia: Individuals with type 1 diabetes may be at a high risk of more episodes of low blood sugar (hypoglycemia).
Keto and Gut Health
Since the keto diet restricts carbs, it can be difficult to meet your daily fiber needs. Some of the richest sources of fiber, such as high carb fruits, starchy vegetables, whole grains, and beans, are eliminated on the diet because they provide too many carbs. As a result, the keto diet can lead to digestive discomfort and constipation.
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A 10-year study in children with epilepsy on the ketogenic diet found that 65% reported constipation as a common side effect. What’s more, fiber feeds the beneficial bacteria in your gut. Having a healthy gut may help boost immunity, improve mental health, and decrease inflammation. A low carb diet that’s lacking in fiber, such as keto, may negatively affect your gut bacteria - although current research on this topic is mixed. Some keto-friendly foods that are high in fiber include flax seeds, chia seeds, coconut, broccoli, cauliflower, and leafy greens.
The Keto Diet for Weight Loss
Ketogenic diets and reducing carbohydrate intake will lead to weight loss through different mechanisms including appetite suppression, increased lipolysis, and changes in lipid metabolism as well as gluconeogenesis. Acetic acid ingestion has also been proposed to be beneficial in weight management.
One study looked at the effects of a 24-week keto diet based on 30 grams of daily carbohydrate intake by obese patients. Researchers found that the keto diet significantly reduces body weight and body mass index (BMI), while also improving lipid profile and blood glucose levels without any significant side effects.