The ketogenic diet, often shortened to keto, has surged in popularity as a weight-loss strategy. It was initially developed in the 1920s as a treatment for pediatric drug-resistant epilepsy, aiming to reduce seizures when medication alone proved insufficient. The diet involves consuming high-fat, low-carbohydrate foods to induce a metabolic state called ketosis. In ketosis, the body shifts from using glucose (sugar) to fat as its primary fuel source. While various styles of keto diets exist, they all share the common goal of severely restricting carbohydrate intake.
Understanding the Keto Diet
The keto diet aims to force your body into using a different type of fuel, burning fat. Because the keto diet has such a high fat requirement, followers must eat fat at each meal. In a daily 2,000-calorie diet, that might look like 165 grams of fat, 40 grams of carbs, and 75 grams of protein. The keto diet reduces your total carb intake to less than 50 grams a day. This is the equivalent of a cup of white rice. The keto diet excludes carb-rich foods like grains, beans, fruits and starchy vegetables.
Types of Ketogenic Diets
Several variations of the keto diet exist, each with slightly different macronutrient ratios and guidelines:
- Classic Ketogenic Diet: This is the original and most studied form, requiring precise measurements to achieve a 4:1 ratio of fat to combined protein and carbohydrates. It necessitates avoiding carb-rich foods and relies heavily on a food scale.
- Modified Keto Diet: This diet uses a ratio closer to 3 grams of fat for every 1 gram of combined protein and carbohydrate, often emphasizing higher protein intake. It remains restrictive but offers slightly more flexibility.
- User-Friendly Keto Diet: This is the most popular and approachable version, generally avoiding starchy foods and high-carb desserts. While less strict, it still requires careful attention to carbohydrate intake.
Potential Benefits of the Keto Diet
The keto diet has garnered attention for several potential health benefits, though it's crucial to consider that research is ongoing, and results can vary.
Weight Loss
Research suggests the keto diet can aid weight loss by reducing overall calorie intake. The diet's limited food choices may naturally curb overeating. People also report feeling less hungry than on other types of restricted diets. However, transitioning off the keto diet without regaining weight can be challenging due to the tendency to revert to high-carb foods. On paper, burning fats by eating more of them is enticing, which is why the keto diet has become popular. The keto diet allows many people to eat the types of high-fat foods that they enjoy, such as red meats, fatty fish, nuts, cheese and butter, while still losing weight.
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Blood Sugar Management for Type 2 Diabetes
The keto diet can help stabilize blood sugar. Low carb diets have been a mainstay of diabetes management, and they were recommended well before injectable insulin became available. One 2019 study found that a keto diet reversed type 2 diabetes in some participants, and after a 2-year follow-up, many participants had improvements in their diabetes blood markers. Among participants, there was a diabetes remission rate of 17.6%.
Neurological Benefits
The keto diet has a history of use in treating epilepsy, particularly in children. Researchers are also exploring its potential in addressing age-related cognitive decline and Alzheimer's disease. The benefits may stem from ketone bodies, particularly beta-hydroxybutyrate. The ketogenic diet regulates brain metabolism, mitochondrial homeostasis, and inflammation in Alzheimer's disease by increasing mitochondrial function and reducing oxidative stress.
Other Potential Benefits
KD has been shown to effectively lead to weight loss, reduction in hyperinsulinemia, and improvement in insulin sensitivity. In women with PCOS, KD can lead to decreases in glycemia, fasting insulin, testosterone, and insulin sensitivity. The therapeutic impact of the ketogenic diet on tumors, such as neuroblastoma, acute myeloid leukemia, and glioblastoma, is attributed to its ability to downregulate GPR109A expression, activate mTORC1, and reduce glucose uptake at the tumor site.
Risks and Considerations
Despite potential advantages, the keto diet poses several risks and requires careful consideration.
Nutrient Deficiencies
The keto diet's carbohydrate restriction limits the consumption of fruits and vegetables, potentially leading to nutrient deficiencies. Because the keto diet is so restricted, you’re not receiving the nutrients - vitamins, minerals, fibers - that you get from fresh fruits, legumes, vegetables and whole grains. Most people following a strict keto diet should take a multivitamin with minerals to ensure they're meeting those vitamin and mineral needs.
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Potential Negative Effects on Heart Health
Studies show mixed results in studies that examine the specific effects of the keto diet on heart health. This is likely because much of it depends on individual food choices. The American Heart Association recommends limiting saturated fat intake to less than 6%. “In practice, many people eat high amounts of saturated fats, which could increase your risk of heart disease,” says Dr. Cheema. While high-fat diets can elevate LDL (“bad”) cholesterol, the type of saturated fat matters. The bottom line is that having more fats in your diet can lead to higher cholesterol.
Gastrointestinal Issues
Constipation is a common long-term complication due to low fiber intake. Fiber is a form of carb that is digested not by our human cells, but by the microbes in our gut. Fiber is found in beans, whole grains, and certain fruits, which are also high in carbs.
Bone Health
There can be issues with bone health when people switch to low-carb keto diets. Researchers see that markers for bone breakdown are higher and markers for bone building are lower.
The "Keto Flu"
When people start the keto diet, they go through the keto flu. Keto flu symptoms appear a few days after starting the diet. These include feeling foggy, irritable, nauseous and tired. This eventually goes away once your body adjusts to your eating changes.
Kidney Problems
The kidneys help metabolize protein, and McManus says the keto diet may overload them. The keto diet may not be appropriate for everyone, specifically people with kidney disease. There is some suggestion that it can make kidney disease worse over time.
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Psychological Distress
When you micromanage your food intake by tracking how much you eat, it disconnects you from what your body is asking for. You start using outside numbers to determine what to eat instead of listening to your body. Monitoring food so closely can lead to psychological distress, such as shame and binge eating.
Other Risks and Considerations
Strict diets like keto could also cause social isolation or disordered eating. The keto diet could cause low blood pressure. Following a keto diet can also cause your blood sugar to drop, which can be dangerous for people living with diabetes. The diet is limited and/or contraindicated in patients with liver failure, pancreatitis, inborn disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyria, and pyruvate kinase deficiency.
Alternative Approaches
Intermittent Fasting
Intermittent fasting is an approach that allows you to receive the benefits of ketosis while still eating a varied and balanced diet. By cycling between periods of eating and fasting, your body enters “mild ketosis” during the fasting phase. Unlike the keto diet, which requires strict food restrictions, intermittent fasting lets you enjoy a variety of nutrient-dense foods, such as fruits, vegetables, whole grains and legumes, during eating windows.
The MIND Diet
Short for "Mediterranean-DASH Intervention for Neurodegenerative Delay," this diet is similar to the Mediterranean diet, but with stricter requirements for what you can eat. It emphasizes eating more vegetables, fruits (specifically berries), high-fiber foods, beans, nuts, seafood, poultry and olive oil. The MIND diet can possibly help reduce the cognitive decline associated with aging.