In today's world, where weight-loss strategies and diet plans are constantly being promoted, it's easy to feel overwhelmed. Among these, the ketogenic or "keto" diet, a low-carbohydrate, high-fat eating plan, has gained considerable attention. This article explores the effectiveness of keto supplements and the keto diet itself, providing a comprehensive overview for those considering this approach.
The Ketogenic Diet: A Historical Perspective
The ketogenic diet has a long history of medical use. In the 19th century, it was used to manage diabetes. By 1920, it became an effective treatment for epilepsy in children when medication proved ineffective. The diet's recent surge in popularity as a weight-loss strategy can be attributed to the low-carb diet trend that began in the 1970s with the Atkins diet. Today, diets like Paleo, South Beach, and Dukan are high in protein but moderate in fat.
How the Keto Diet Works
The main idea behind the ketogenic diet for weight loss is to deprive the body of glucose, its primary energy source, which comes from carbohydrate foods. When glucose is limited, the body produces an alternative fuel called ketones from stored fat. The brain, which requires a steady supply of glucose (about 120 grams daily), turns to ketones for fuel when glucose is scarce.
During fasting or very low carbohydrate intake, the body initially uses stored glucose from the liver and breaks down muscle to release more glucose. After 3-4 days of this, insulin levels decrease, and the body starts using fat as its primary fuel. The liver produces ketone bodies from fat, leading to a state called ketosis. Mild ketosis occurs naturally during fasting or strenuous exercise. Proponents of the keto diet claim that carefully following the diet will prevent ketone levels from reaching harmful levels (ketoacidosis), as the brain will use ketones for fuel, and the body will produce enough insulin to regulate ketone formation.
The rate at which ketosis occurs and the number of ketone bodies that accumulate vary depending on individual factors like body fat percentage and resting metabolic rate.
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Ketoacidosis: Understanding the Risks
Excessive ketone bodies can lead to ketoacidosis, a dangerous condition where the blood becomes excessively acidic. During ketoacidosis, the kidneys excrete ketone bodies and body water in the urine, causing fluid-related weight loss. This condition is more common in individuals with type 1 diabetes who do not produce insulin. However, rare cases have been reported in non-diabetic individuals following a prolonged very low carbohydrate diet.
Macronutrient Ratios in the Ketogenic Diet
There isn't a single "standard" ketogenic diet with a specific ratio of macronutrients. Typically, it reduces total carbohydrate intake to less than 50 grams a day, sometimes as low as 20 grams. A common guideline suggests 70-80% of total daily calories from fat, 5-10% from carbohydrates, and 10-20% from protein. For a 2000-calorie diet, this translates to approximately 165 grams of fat, 40 grams of carbohydrates, and 75 grams of protein. The protein amount is kept moderate because consuming too much protein can prevent ketosis.
Foods to Eat and Avoid on a Keto Diet
Many versions of the ketogenic diet exist, but all restrict carb-rich foods. Obvious foods to avoid include starches from refined and whole grains (breads, cereals, pasta, rice, and cookies), starchy vegetables (potatoes, corn), and fruit juices. Less obvious foods to avoid are beans, legumes, and most fruits.
Most ketogenic plans allow foods high in saturated fat, such as fatty cuts of meat, processed meats, lard, and butter, as well as sources of unsaturated fats, such as nuts, seeds, avocados, plant oils, and oily fish. Fats are emphasized at each meal and snack. Some dairy foods may be allowed, but those high in lactose sugar (cream, ice cream, and full-fat milk) are restricted. Protein intake remains moderate, and certain fruits like berries are allowed in small portions.
Understanding "Net Carbs" and "Impact Carbs"
"Net carbs" and "impact carbs" are terms often used in ketogenic and diabetic diets. These unregulated terms, invented by food manufacturers as a marketing strategy, appear on food labels to suggest that the product contains less "usable" carbohydrate. Net carbs or impact carbs refer to the amount of carbohydrate directly absorbed by the body and contribute calories. They are calculated by subtracting indigestible carbohydrates (insoluble fibers and sugar alcohols) from the total carbohydrate amount. However, these calculations are not exact because the effect of sugar alcohols on absorption and blood sugar can vary. The total calorie level remains unchanged despite the net carb calculation, which is an important factor in weight loss.
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Short-Term Benefits of the Ketogenic Diet
The ketogenic diet has been shown to produce beneficial metabolic changes in the short term. Along with weight loss, health parameters associated with excess weight, such as insulin resistance, high blood pressure, and elevated cholesterol and triglycerides, have improved. There is also growing interest in using low-carbohydrate diets, including the ketogenic diet, for type 2 diabetes.
Research Findings on the Ketogenic Diet
Research on the ketogenic diet has shown some promising results. A meta-analysis of 13 randomized controlled trials found that overweight and obese participants on ketogenic diets experienced a small but significantly greater reduction in weight, triglycerides, and blood pressure, and a greater increase in HDL and LDL cholesterol compared with those on low-fat diets after one year.
A systematic review of 26 short-term intervention trials evaluated the appetites of overweight and obese individuals on very low-calorie or ketogenic diets. Participants reported less hunger and a reduced desire to eat compared with baseline measures, suggesting changes in appetite hormones and the influence of ketone bodies and increased fat and protein intakes.
A study of 39 obese adults on a ketogenic very low-calorie diet for 8 weeks found a mean weight loss of 13% and significant reductions in fat mass, insulin levels, blood pressure, and waist and hip circumferences. Ghrelin levels did not increase during ketosis, contributing to decreased appetite.
Another study of 89 obese adults on a two-phase diet regimen (6 months of a ketogenic diet followed by 6 months of a Mediterranean diet) showed a significant mean 10% weight loss with no weight regain at one year.
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Potential Risks and Side Effects
Following a very high-fat diet may be challenging to maintain. Some negative side effects of a long-term ketogenic diet include an increased risk of kidney stones and osteoporosis, and increased blood levels of uric acid, a risk factor for gout. Nutrient deficiencies may also arise if a variety of recommended foods are not included. It is important to include a daily variety of allowed meats, fish, vegetables, fruits, nuts, and seeds to ensure adequate intakes of fiber, B vitamins, and minerals.
Limitations of Current Research
Available research on the ketogenic diet for weight loss is still limited. Most studies have had a small number of participants, were short-term (12 weeks or less), and did not include control groups. While the ketogenic diet has shown short-term benefits in some people, including weight loss and improvements in cholesterol, blood sugar, and blood pressure, these effects are not significantly different from conventional weight loss diets after one year.
Practical Considerations
Eliminating several food groups and the potential for unpleasant symptoms may make compliance difficult. An emphasis on foods high in saturated fat also goes against recommendations from dietary guidelines and may have adverse effects on blood LDL cholesterol.
The exact ratio of fat, carbohydrate, and protein needed to achieve health benefits will vary among individuals due to their genetic makeup and body composition. Consulting with a physician and a dietitian is recommended to monitor biochemical changes and create a tailored meal plan.
Keto Supplements: An Overview
Given the challenges of maintaining a strict keto diet, manufacturers have created keto supplements that claim to boost energy, burn fat, and accelerate weight loss. These supplements often contain ketone beta-hydroxybutyrate (BHB), a compound produced by the liver from fats.
The theory behind these supplements is that taking extra ketones may help the body lose weight by using ketones for energy and burning fat. Some supplements are also marketed to help alleviate the "keto flu," but there is no evidence to support this claim.
Types of Keto Supplements
The three most common types of keto diet supplements are:
- Keto pills: These often contain BHB salts or BHB esters and are promoted as natural weight loss supplements.
- Keto powders: Similar to keto pills, keto powders contain some form of BHB and may include electrolytes to help with hydration and ketosis.
- Keto gummies: Some keto gummies contain apple cider vinegar, which is claimed to boost metabolism, but there is limited scientific evidence to support this. Some may also contain MCT oil.
Third-Party Testing
When choosing keto supplements, look for products that have undergone third-party testing to ensure that the ingredients listed on the label are accurate. However, keep in mind that third-party tests do not check for efficacy.
Do Keto Pills Work?
There is not enough research to support the claim that keto pills, powders, or gummies will help you achieve ketosis or promote weight loss. Some studies suggest that exogenous ketones can quickly increase ketone levels in the blood, but their effect on weight loss is still unclear.
The body seeks to maintain an even level of ketones, and when it senses that ketone levels are high, the liver may stop making its own and flush out excess ketones in the urine.
Potential Risks and Scams
In addition to health concerns, there is a risk of scams with some keto products, particularly those heavily promoted on social media. Be cautious of marketing text that uses phrases like "quick fix," "guaranteed results," and "scientific breakthrough."
Because dietary supplements are not regulated by the FDA, it can be difficult to know if you are getting what you pay for. If you choose to purchase a keto supplement, do your research and ask the company for evidence that the supplement does what it claims.
Keto Gummies: A Closer Look
Keto gummies are made with exogenous ketones, which are ketones from an outside source. While they may help continue the process of ketosis, they don't put you into ketosis in the first place.
Most keto gummies contain medium-chain triglycerides (MCTs) and may also include gelatin or natural sweeteners like stevia. Potential benefits include increased weight loss, improved athletic performance, and decreased appetite, but research is limited.
Potential risks of keto gummies include nausea and vomiting, gastrointestinal issues, and low blood sugar. It's important to introduce them slowly to see how you react, and consult with a healthcare provider before trying them.
Is the Keto Diet Worth It?
Before considering the keto diet, ask yourself why you are doing it and if it is really worth it. Very restrictive diets are hard to follow and may not be sustainable. Much of the initial weight loss on the keto diet is water weight, not fat.