Going Keto

Truth, Dare, or Death and Disease?

Recently, a ketogenic diet has been having its spotlight sweeping the nation in the trending world of the latest fad diet.

Despite the excitement of the diet we need to consider a few questions before mistaken enthusiasm leads to a waste of time, money, and potentially worse, your health.

Whenever we come across nutritional information, the latest trending cure, or the personal journey to get shredded we have to say, “show me the evidence.” Anyone flirting with the idea of adopting a new diet ought to keep reading, and ask real questions to get factual answers: What is a ketogenic diet? Is a ketogenic diet safe? And Do I recommend it? 

“Man prefers to believe what he prefers to be true.”

Great Scientist, Francis Bacon

Despite the recent hype from celerity exposure, the preconceived notions, all the cherry picked and slant information, a ketogenic diet is not something new. In medicine, it has been used for almost 100 years now as a therapy for drug-resistant epilepsy. But the studies and treatments have not gone without side-effects involving complication such as kidney stones, kidney failure, sudden deaths, and more.

Much of what the diet is composed of today, was already popular in the 1970s. Pick up any of Dr. Atkins material and see that he used this very low carbohydrate diet for weight loss that began with a very strict two-week ketogenic phase. From there it would follow that other fad diets would start using similar approaches for weight loss. 

Theres is no population in the Blue Zones that have thrived on a ketogenic diet. Contrary to popular belief not even the Inuit survived or thrived on a nightly fair of seal blubber, whale sirloin, and caribou jerkey while being in the reportedly nirvana-like state of ketosis. Turns out that idea is more of an “Eskimo Myth” that was disproven over and over since the 1930’s. 

The totality of evidence from actual clinical investigations, autopsies, and imaging techniques is that they have the same plague of coronary artery disease that non-Eskimo populations have, and the Eskimo actually have twice the fatal stroke rate and don’t live particularly long.

Dr. Michel Greger, Nutritionfacts.org

The Inuit of Greenland and Canada certainly ate those things because farmers markets are not necessarily readily available in the Arctic, but it came at a sacrifice of their longevity and health. 

What is a Ketogenic Diet?

Right to it, it is a diet that shifts cells to utilizes ketones where blood sugar is normally preferred. The body releases these ketones into the bloodstream to act in absence of blood sugar, which normally comes from carbohydrates in food; the body’s main source of energy. The absence of circulating blood sugar from food, almost tricks the body into a mechanism of starvation. The body starts breaking down stored fat into molecules called ketone bodies and the body goes into a state more commonly known as ketosis, hence the name Keto- and Ketogenic Diet. Once the body is in a state of ketosis, most cells will use ketone bodies as the main source of energy just until, we start eating carbohydrates again. It usually takes a course of two to four days of eating 20 to 50 grams of carbohydrates for the body to shift from using glucose to breaking down stored fat as a source of energy. Generally two to four days, because the process is highly individualized and the restriction may vary from person to person to produce enough ketones, and to enter a state of ketosis. 

What does a Ketogenic Diet Look Like?

A ketogenic diet is rich in protein and fats due to the lack of carbohydrates. A typical diet could include plenty of meats, processed meats, eggs, sausage, beef, fish, butter, cheese, dairy, oils, nuts, seeds, and high fat fibrous vegetables like avocados. Most whole grains, legumes, and fruit are severely restricted and will most likely set you over the limit of carbohydrate consumption. Even some vegetables contain too much starch to be allowed in the diet.

The state of being in ketosis is so fragile and most will proclaim to be on a ketogenic diet because they are eating more of these foods. A large misunderstand comes from the complete state of restriction of carbohydrates to keep the body in the actual state of ketosis. Quiet often, much of the population claiming to be on a ketogenic diet are consuming more of whats considered  “Paleo,” a diet composed of high fats, high protein, and low-carbohydrates.

For example, the carbohydrate level to remain in a state of ketosis is equivalent to just 2-1/2 cups of raw broccoli reaching your limit for the day and an extra 1/2 cup serving would set your carbohydrates over and out of a state of ketosis. Broccoli is also not a high fat item so usually is not top of the menu for those going “Keto.”

Is a Ketogenic Diet Healthy?

Almost 100 years ago studies published astonishing results showing a ketogenic diet reduces seizures in children, sometimes effectively as medication. There are no human studies to date, that prove this diet has any other possible neuroprotective benefits associated with cognitive conditions.

The primary reason most people use a ketogenic diet is commonly associated with goals of achieving some form of weight loss. There is evidence to suggest a more rapid and immediate weight loss however, the evidence suggest that the effect is short-term and the difference in weight loss seems to diminish in returns over time.

Beyond short-term weight loss, there is evidence to suggest blood sugar control for people with type 2 diabetes, but only again, short-term. Controversy comes when the safety and efficacy and the intervention of a ketogenic diet calls cholesterol levels into play.

Increased cholesterol raises the risk of dying from heart disease. Few studies show a drop in cholesterol, but those studies did not control for whether it was the actual ketogenic diet, the caloric restriction, or the weight-loss that produced the lower cholesterol levels. This is a problem because any form of caloric restriction will provide weight loss and weight loss is associated with a drop in cholesterol levels.

This study shows that participants on a ketogenic diet had increased levels of good and bad cholesterol. There are only a few studies that show high cholesterol at the beginning, only to see cholesterol fall a few months later. There are not a whole lot of long-term research to analyze its effects over time on diabetes and high cholesterol, the best we have is a meta-analysis that points to no benefit for diabetes long term. It is important to not that the only place cholesterol is found in diet is with the consumption of animal products.

Critical Criticisms of the Diet

  1. The ultra low carb diet makes it super restrictive to other foods which makes it hard to follow over the long run where Carbohydrates currently make up 50% of the Standard American Diet (SAD). 
  2. People tend to eat too much protein and poor-quality fats from processed foods, with very few fruits and vegetables. 
  3. Patients with kidney disease need to be cautious because this diet could worsen their condition. 
  4. Patients reportedly have suffered from kidney stones, restricted growth, fatal cardiac arrhythmias, pancreatitis, higher cholesterol levels, and many more.
  5. Additionally, some people have reported feeling a little tired in the beginning, bad breath, nausea, vomitting, constipation, and sleep problems. 

Takeaways From a Ketogenic Diet

It may be an interesting alternative to medicine in treating certain conditions, and may also be associated with an accelerated weight loss, but these aspects should not come at the mortgage of our health. 

Study upon study has shown increased death with low-carb diets. The Ketogenic diet being the supreme in low-carb dietary restriction. What we do know is that a diet heavy on red meat and many other processed (animal or non-animal) fatty, salt laden foods are associated with increase risk for all cause mortality. A study published in The Lancet associated higher mortality rates for those with diets relying primarily on animal based foods, such as pork, beef, lamb, and yes, chicken. We all ready know the increased risk of dying from studys that compare eating animal based protein such as dairy and eat, vs plant based protein from a variety of vegetables. 

For this reason it is one of the most un-sustainable ways of eating. Not only for health, but for the impact it may have on the environment due to the association of heavy animal product consumption, animal agriculture, and green house gas emissions, meat is most daintily heat.

The ultra-low-carbohydrate restriction, necessary for maintaining the body in a long-term states of ketosis, makes the diet very hard to follow, and may lead to the promotion of unhealthy eating behaviors that eventually lead to even more weight gain and associated chronic diseases.

Diets simply do not work and it is particularly important to point out that “yo-yo diets” that lead us to rapid weight loss fluctuations are associated with increased mortality as well. Anyone can lose weight in the short term on nearly any diet, but diets don’t seem to work in the long-term. Usually this is because they come with the compensation of our health.  Instead of being wrapped up in the Diet Fiction and engaged in the next popular diet that can only last a few weeks, to a month, or a short period (yes this includes most peoples ambitions to take on a ketogenic diet) why not embrace the diet that comes at no compromise of your health and is the most sustainable long-term solution for losing, managing, and maintaining weight. 

The Optimal Diet for Human Consumption

A Diet rich in very colorful fruits and vegetables, whole grains, fruits, berries, beans, legumes, nuts, seeds, and more water seems to have the best available evidence for a long, healthy, vibrant life. A Plant-Based Diet is among the only type of diet that has been shown to be sustainable long-term, perhaps because not only do people lose weight but they often feel so much better.

A nutrient-dense approach combined with foods low in energy-density may in fact be a way to Eat More and Weigh Less. Fewer calories per pound already adds up to less. A small drop in energy density can lead to a small drop in weight, and the greater the decrease in energy density, the greater the weight loss. This would include a diet heavy on starch, fruits, and non-starchy vegetables. A high energy-dense food like Bacon packs a lot of calories in a small package with a relatively low nutrient-density. Compared to a bagel, which is a medium energy-density, fruits and vegetables have the lowest energy-density with the highest nutrient-density. The CDC offers more examples here.  

Contrary to the popular belief that a plant-based diet may be deficient in vitamin in minerals, one study on a ketogenic diet fount deficiencies in every vitamin and mineral analyzed except for B12. Where even just a vegetarian diet that is meat free proves higher intakes of nearly every nutrient: more fiber, more vitamin A, more vitamin C, more vitamin E, more of the B vitamins (thiamin, riboflavin, & folate), more calcium, more magnesium, more iron, and more potassium. At the same time, they were also eating less of the harmful stuff like saturated fat and cholesterol. And yes, they got enough protein.  

Compared to the ketogenic diet that excludes fruits, vegetables, legumes, and whole grains, according to the editor-in-chief of the Journal of the American Dietetic Association asked, “What could be more nutrient dense than a vegetarian diet?” it is no wonder the risk of dying goes up when you leave these foods off the plate.

We don’t need a “diet”; we need a new way of eating that we can comfortably stick with throughout our lives. If that’s the case, then we better choose to eat in a way that will most healthfully sustain us. That’s why a plant-based diet may offer the best of both worlds. It’s the only diet, for example, shown to reverse heart disease–our number one killer–in the majority of patients, as described in my video: One in a Thousand: Ending the Heart Disease Epidemic.

Dr. Greger Nutritionfacts.org

As it turns out, the issues of weight, obesity, and our leading killers of all cause mortality does boil down to an egg. Eating animal products is highly associated with chronic diseases. Eating any diet just for weight loss at any sacrifice of your health is like putting gasoline on a fire. You have a long life to live and you don’t want a short quick blaze of heat just to get warm for the day and then be left with no fire. To date the best available balance of evidence concludes that this diet will leave worse off than you started.