The ketogenic diet (KD), characterized by its very low carbohydrate and high-fat content, has become a popular strategy for weight loss and managing certain health conditions. This article examines the potential benefits and side effects of the keto diet, along with important considerations for its use.
What is the Ketogenic Diet?
A ketogenic diet is a high-fat, very low-carb diet that typically restricts carbohydrate intake to 20-50 grams daily. This drastic reduction in carbs forces the body to switch its primary energy source from glucose to fat. When the body breaks down fat, it produces molecules called ketone bodies, which then serve as an alternative fuel. This metabolic state is known as ketosis.
The classic ketogenic diet, often used to manage seizures in children, involves consuming four times as many calories from fat as from carbohydrate and protein. While very strict versions are used for hard-to-treat epilepsy, less restrictive forms are employed for obesity and diabetes management. Ketogenic diets have also been explored for migraine headaches, Parkinson's disease, and polycystic ovary syndrome (PCOS), although scientific evidence supporting these uses is still limited.
It's crucial not to confuse the Modified Atkins Diet, a type of ketogenic diet, with the general Atkins diet. Similarly, the ketogenic diet itself should not be confused with "keto diet pills," as they produce different effects.
How the Keto Diet Works
Ordinarily, the body uses glucose, derived from carbohydrates, as its primary energy source. However, when carbohydrate intake is severely restricted, the body turns to stored fat for fuel through a process called ketogenesis, or ketosis. This process yields ketones, which become the body's alternative energy source.
Read also: Easy Low-Carb Cheese Crackers
Initially developed in 1921 by Dr. Russel Wilder for pediatric epilepsy management, the ketogenic diet traditionally involved a 4:1 ratio of fat to carbohydrates and protein, with fat providing up to 90% of caloric intake. All variations of the diet involve severely restricting carbohydrate intake to less than 50 grams per day.
Following carbohydrate deprivation and depletion of glycogen stores, the body undergoes metabolic changes to provide energy through gluconeogenesis and ketogenesis. Gluconeogenesis can sustain energy needs for about three days on a low-carbohydrate diet, after which additional energy sources become necessary.
Potential Benefits of the Keto Diet
Diabetes Management
The ketogenic diet can improve blood sugar control in individuals with type 2 diabetes. Studies have shown that following a ketogenic diet leads to reduced blood sugar levels.
Epilepsy Management
A strict, high-fat, very low-carbohydrate ketogenic diet can reduce seizures in some individuals with hard-to-treat epilepsy. This was one of the earliest recognized benefits of the diet.
Weight Loss
Limiting carbohydrate intake to less than 50 grams daily on a ketogenic diet can lead to a 10% to 30% reduction in body weight within one year. However, it remains unclear whether this approach is more effective than other calorie-restricted diets.
Read also: Keto Calorie Counting: A Detailed Guide
Potential Benefits for Mental Health
Emerging research suggests the ketogenic diet may offer benefits for psychiatric conditions. A Stanford University study explored the impact of ketosis on individuals with bipolar disorder and schizophrenia. Participants received 60% of their calories from fat, 30% from protein, and only 10% from carbohydrates (capped at 20 grams per day). The study found that after four months, 80% of participants experienced improvements in both the metabolic side effects of their medications and their psychiatric symptoms. They also experienced weight loss and a reduction in visceral adipose tissue. While these results are promising, it's important to note that this study was small and brief. Larger, longer-term studies are needed to confirm these findings and assess the sustainability of the positive outcomes.
Polycystic Ovary Syndrome (PCOS)
The ketogenic diet has shown promise in positively impacting women diagnosed with polycystic ovarian syndrome (PCOS). PCOS is often associated with insulin resistance, hyperinsulinemia, and hyperandrogenism. Research indicates that a ketogenic diet can lead to significant decreases in fasting serum insulin, LH-to-FSH ratio, and free testosterone in women with PCOS. Furthermore, it can result in notable weight loss and a reduction in BMI.
Type 1 and Type 2 Diabetes
Following a very-low-carbohydrate ketogenic diet can offer benefits to patients with both type 1 and type 2 diabetes. Studies have demonstrated that adherence to a ketogenic diet in type 1 diabetics is associated with well-controlled HbA1c levels and minimal glycemic variability. Similar benefits of a very-low-carbohydrate ketogenic diet apply to patients with type 2 diabetes as well.
Side Effects and Risks
Common Side Effects
The ketogenic diet is generally considered safe for most adults when followed for up to one year. Common side effects include:
- Constipation
- Fatigue
- Dizziness
- Headache
- Weakness
- Nausea
- Diarrhea
- Stomach pain
The long-term safety of the ketogenic diet in adults remains unknown, and it's crucial to maintain a balanced diet with nutrient-rich foods.
Read also: Magnesium Supplements for Keto
Special Precautions and Warnings
- Pregnancy: There is insufficient reliable information about the safety of the ketogenic diet during pregnancy. The ketone bodies produced during ketosis may potentially affect the baby's growth. It's essential to consult with a healthcare professional before considering this diet during pregnancy.
- Breastfeeding: The ketogenic diet is possibly unsafe during breastfeeding. Following a very-low-carbohydrate ketogenic diet may increase the risk of ketoacidosis. Medical supervision is necessary.
- Children: The ketogenic diet is possibly safe for short-term use in children under medical supervision. However, long-term use has been linked to slowed growth, fractures, and kidney stones.
- Heart Conditions: Use the ketogenic diet with caution if you have a heart condition, as it might worsen certain conditions.
- Diabetes: The ketogenic diet may increase the risk of diabetic ketoacidosis (DKA), a serious complication. Consultation with a healthcare professional is essential.
- Acid Reflux: High-fat ketogenic diets can worsen symptoms of acid reflux.
- High Levels of Fat in the Blood: These diets can increase cholesterol and triglyceride levels, posing a risk for individuals with existing high levels.
- Liver Disease: The ketogenic diet might cause liver injury and worsen liver disease symptoms.
- Problems Breaking Down Fats: The diet may lead to serious adverse effects, including coma or death, in individuals unable to break down fats.
- Kidney Disease: The ketogenic diet may worsen kidney disease and increase the risk of kidney stones.
- Osteoporosis: Long-term use of the ketogenic diet may weaken bones.
- Pancreatitis: The diet may increase the risk of pancreatitis, especially in individuals with a history of the condition or high triglyceride levels.
- Surgery: Inform your healthcare provider about your ketogenic diet before any surgery, as adjustments to medications containing carbohydrates may be necessary.
Interactions
- Diabetes Medications: The ketogenic diet can lower blood sugar levels, potentially causing hypoglycemia if taken with diabetes medications. Close monitoring is crucial.
- Medications That Slow Blood Clotting: The ketogenic diet might slow blood clotting, increasing the risk of bruising and bleeding when taken with similar medications.
- Seizure Medications: The ketogenic diet might reduce blood levels of some seizure medications, potentially increasing the risk of seizures.
- Medications for Seizures and Glaucoma: Combining the ketogenic diet with these medications may increase the risk of kidney stones.
- Valproate: Taking valproate with the ketogenic diet might increase the risk of side effects, although this is rare.
- SGLT2 Inhibitors: Following the ketogenic diet while taking SGLT2 inhibitors increases the risk of ketoacidosis. Consultation with a healthcare provider is essential.
Dosage and Variations
The classic ketogenic diet requires 90% of daily calories to come from fat. However, many less restrictive versions allow 20-50 grams of carbs daily. Variations include the medium-chain triglyceride (MCT) diet, modified Atkins diet, modified Mediterranean diet, and low glycemic index treatment. Consulting a healthcare provider is essential to determine the most suitable ketogenic diet variation for specific conditions.
The Role of Keto Supplements
Given the challenges of adhering to a strict ketogenic diet, many supplements claim to aid in achieving and maintaining ketosis, boosting energy, and promoting weight loss. These include keto pills, powders, and gummies.
Types of Keto Supplements
- Keto Pills: Often contain BHB salts or esters and are marketed as natural weight loss aids.
- Keto Powders: Similar to pills, they contain BHB and may include electrolytes for hydration and ketosis maintenance.
- Keto Gummies: May contain MCT oil or apple cider vinegar, but many do not contain ketones. They are often sweetened with non-nutritive agents like stevia.
Do Keto Supplements Work?
Research on the efficacy of keto supplements is limited. Some studies suggest that exogenous ketones can quickly boost ketone concentrations in the blood, but their impact on weight loss remains unclear. Experts emphasize that these supplements are not a substitute for a well-formulated ketogenic diet.
Potential Risks of Keto Supplements
- Nausea and vomiting
- Gastrointestinal issues like diarrhea
- Low blood sugar
It's crucial to introduce keto gummies or supplements slowly to assess tolerance and avoid adverse effects. Individuals with type 2 diabetes, high blood pressure, or kidney issues should exercise caution when considering keto supplements.
Cautions and Considerations
- Consultation with Healthcare Provider: Before starting any keto diet or supplement regimen, consult with a healthcare provider, especially if you have underlying health conditions or are taking medications.
- Focus on Whole Foods: Emphasize a diet rich in whole, unprocessed foods to ensure adequate nutrient intake.
- Monitor Electrolyte Levels: The ketogenic diet can affect electrolyte balance, so it's important to monitor and replenish electrolytes as needed.
- Be Aware of Potential Scams: Exercise caution when purchasing keto products, particularly those marketed with exaggerated claims or pushed heavily on social media.