The pursuit of effective weight loss solutions has led to the exploration of various methods, including the ketogenic diet (KD) and related products. Among these, "keto sprays" have emerged, claiming to aid weight loss by inducing ketosis. However, it's crucial to examine the scientific evidence and potential risks associated with such products, especially considering the documented presence of hidden drug ingredients in numerous weight loss supplements.
Understanding Ketosis and Ketogenic Diets
The ketogenic diet (KD) is characterized by a reduction in carbohydrates (CHO), usually to less than 50 g/day, high fat, and moderate protein content to induce a state of nutritional ketosis. The hallmark of nutritional ketosis is blood ketone (BK) levels of 0.5 to 3 mm/L. KD mimics a condition of fasting without the negative consequences of starvation, resulting in a shift in the body's main energy source from glucose to ketone bodies (KBs). During periods of low CHO intake, glycogen depletion occurs, and blood glucose and glycogen stores are minimized. Consequently, resulting in the induced production of water-soluble KBs or ketones]e.g., Acetoacetate, Beta-Hydroxy- Butyrate (BHB), and Acetone], by the liver from fatty acids (FA) as a source of energy.
By inducing ketosis, patients had mitigation of seizure activity and improvements in cognitive function, highlighting the capacity for ketones to provide energy to the brain. Therapeutic KD, unlike any low carbohydrate diet (LCD), consists of limited carbohydrate (CHO), mostly to a maximum of 50 gr/day, high fat, and moderate protein content. However, total CHO can be lowered to 30 gr/day to adapt more effectively to the body’s use of KBs. Concurrently, dietary fat increases to 70-80% of total calories, while protein comprises 20%.
The Appeal of Keto Sprays
Keto sprays are marketed as a convenient way to initiate or enhance ketosis without strict dietary changes. They often contain exogenous ketones, such as ketone salts (KS), with the intention of elevating BHB concentrations. By mimicking fasting through carbohydrate (CHO) restriction, KD shifts energy utilization to ketone bodies (KB) instead of glucose.
Research on Ketogenic Diets and Weight Loss
There is no doubt that there is strong supportive evidence that the use of ketogenic diets in weight-loss therapy is effective; however, there are contrasting theories regarding the mechanisms through which they work. The possibility that modifying food intake can be useful for reducing or eliminating pharmaceutical methods of treatment, which are often lifelong with significant side effects, calls for serious investigation.
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Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors.
Current literature on KD interventions for obesity weight loss monitored by KB show reduction in different outcomes, including body weight, body mass index, waist circumference, visceral adipose tissue, fat mass, and body fat percentage. Minor decreases in lean body mass and skeletal muscle mass were noted without resistance training. Variability existed in adherence (KB markers), CHO intake (7-27% of daily energy), diet duration (28 days to 12 months), and follow-up frequency (weekly to biannual). KD interventions improves weight-related outcomes in participants with obesity but presents challenges in lean body mass reduction without resistance training and adherence variability.
Potential Benefits of Ketogenic Diets
Weight Loss: KD has benefits for glycemic stabilization, as it is low in carbohydrates, thus stabilizing insulin levels and blood sugar. For people with type 2 diabetes, KD outperforms low-fat diets for managing weight, blood sugar, and insulin. Specifically, KD improves insulin sensitivity by reducing the insulin resistance index and fasting insulin levels.
Improved Metabolic Health: Beyond weight loss, KD reduces oxidative stress and neuroinflammation, improving brain health. It shows potential for reducing alcohol consumption, cravings, and withdrawal symptoms. It may also support people with food addiction due to its documented effects in reducing food cravings, thus lessening dependence on ultra-processed foods.
Appetite Regulation: KD suppresses the hunger hormone ghrelin and increases the release of satiety hormones. These effects are thought to be mediated in part through ketone bodies, such as β-hydroxybutyrate (BHB), which influence appetite-regulating hormones and may contribute to the reduced sense of hunger.
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Cautions and Risks
Hidden Drug Ingredients: A significant concern is the presence of undeclared and potentially harmful drug ingredients in weight loss supplements. Numerous public notifications have been issued regarding products like FATZorb, Toki Slimming Candy, LipoFit Turbo, and many others, found to contain hidden drug ingredients. These ingredients can pose serious health risks and should be avoided.
Nutrient Deficiencies: One commonly cited limitation of KDs is their potentially low micronutrient content, which could lead to nutrient deficiencies if not managed properly. For instance, while thiamine deficiency has been reported in some cases, other consistent deficiencies have not been widely observed in the literature.
Muscle Mass and Bone Health: Concerns have been raised about muscle mass and bone health in individuals following KDs, especially for those engaging in prolonged CHO restriction. The reduced availability of CHO may impact muscle glycogen stores and exercise performance, potentially influencing muscle maintenance.
Renal Function and Gut Microbiota: Research on the potential impact of KDs on renal function is limited, especially given the higher protein intake typically associated with the diet. This raises concerns about kidney stress or damage, particularly for individuals with pre-existing kidney conditions. Another area that requires further investigation is the effect of KDs on gut microbiota.
Endocrine Changes and Special Populations: Endocrine changes are also a potential concern, as the restrictive nature of KDs and altered hormonal environments may affect reproductive health, thyroid function, and other hormonal systems. KDs are not recommended for certain special conditions and populations. For instance, children following such a strict diet may experience developmental issues, fatigue, and an increased long-term risk of CVD disease.
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Alternatives to Keto Sprays
For individuals seeking the benefits of ketosis, a well-formulated ketogenic diet under the guidance of a healthcare professional is a safer and more sustainable approach. This involves:
- Prioritizing Whole Foods: Basing the diet on whole, unprocessed foods such as eggs, meat, fish, plant oils, non-starchy vegetables, avocado, olives, and nuts.
- Monitoring Macronutrient Ratios: Ensuring appropriate macronutrient ratios (high fat, moderate protein, very low carbohydrate) to maintain ketosis.
- Supplementation: Addressing potential nutrient deficiencies through supplementation, as needed.
- Regular Exercise: Incorporating regular resistance training to preserve muscle mass.