Zuthunglo Odyuo
The ketogenic diet or the keto diet is fast emerging as a popular Go-for it diet. It has gained immense popularity during the last decade. Multiple pinterest boards, instagram pages are zealously dedicated to it and it is heavily endorsed by popular celebrities. When you enter Google search - keto recipes, 24 hour personalized keto diet, keto supplement and more are making fast headway. Permutations of keto diets are burgeoning. Most people have joined on the keto diet bandwagon fueled with numerous positive glowing praises by fanatical keto diet followers.
Although this trend diet appears new to your newsfeed, it has been clinically used as a treatment to reduce seizures in pediatric patients with epilepsy under the supervision of trained dietitians and physicians since the 1920s. This finding lead to examination of other therapeutic uses of ketogenic diet and in carefully monitored settings for some type of Cancer, Type 2 Diabetes, obesity, Polycystic Ovary Syndrome and Alzheimer’s disease, therapeutic ketogenic diet has been tested and applied.
• Seizure disorders: With the introduction of antiepileptic medication the use of ketogenic diet for epilepsy ceased, however for those with drug-resistant epilepsy can reduce seizure frequency by at least 50% with a ketogenic diet but long-term adherence is challenging as food choices are limited and adverse effects are common. Most studies have not been long-term nor conducted with adult participation hence, a need for more research.
• Cancer: A 2020 systematic review by RJ Klement et al, analyzed 13 studies of ketogenic diets as complementary therapy for standard treatments in a variety of cancers. 9 were prospective and 6 were controlled but just 2 were randomized and ketogenic diet prescriptions differed between studies. Adverse diet related events were uncommon and minor and the diet had a beneficial effect on body composition. Findings were mixed on both overall survival and progression-free survival, beneficial effects were seen in four studies. With the potential benefits for body composition, large-scale, well designed, randomized clinical trials are needed to determine the safety and effectiveness of ketogenic diet in cancer treatment.
• Type 2 diabetes: Despite the evidence that ketogenic diets improve glucose control, few data are available about sustainability, safety and efficacy in the long term. A 2020 study by Batch et al revealed that comparison of different meta-analysis, review articles and interventional studies established no uniformity in reported results. Most studies were short duration of intervention, small sample size and high participant dropout rates and as a result cannot be considered applicable to general population.
• Obesity: A 2021 study by N Drabinska et al indicates that recently published clinical trials on ketogenic diet can be efficient for weight management without causing severe adverse effects but, many studies were conducted with very low calorie keto diet regime, where effect on body weight can be related to high caloric deficit, not nutritional composition. To recommend keto diet for weight management, more indepth elucidation of safety and physiological effects of keto diet in obese individuals are needed. Based on 2020 review, within the first 6-12 months of initiating ketogenic diet, weight loss was observed. However, the effects were not seen generally after 12 months of therapy, as changes reported in the studies reviewed were not statistically significant.
• Similarly, ketogenic diet for Polycystic Ovary Syndrome despite demonstrating a positive impact due to small sample size, short intervention time interval it is rendered inadequate in terms of generalizability.
• Significant cognitive improvements in the intervention groups was found in a 2020 review of short term ketogenic diet in older adults for Alzheimer’s disease, however due to lack of long-term data, cognitive gains would be maintained after discontinuation remains unknown. It is crucial to know that ketogenic diet is not yet recognized as a first-line treatment for any of the above mentioned diseases or disorders. Ketogenic diet may indicate as promising but more, strong evidence and extensive studies on long-term and large-scale patients are required to deduce the effectiveness of therapeutic ketogenic diet for diseases. However, this eating philosophy currently is, being acclaimed for its Weight-Loss technique, the “Driving Force” behind ketogenic diet popularity. Let’s take a look at the craze surrounding the keto diet, the myths and misconceptions.
So what is the ketogenic diet?
A ketogenic diet is very low in carbohydrate, with high consumption of fat eating regime and adequate protein intake. The reason for cutting down on carbohydrate is to deprive the body of glucose (the main energy source, obtained by consuming carbohydrate foods) and use ketones (derived from fat by process of ketogenesis) as an alternative source of energy.
When the body is deprived of carbohydrates and depletion of glycogen stores, the body undergoes metabolic changes to provide an energy source for the body through gluconeogenesis and ketogenesis. Gluconeogenesis can be sustained only for few days and when glucose availability drops, additional energy sources are needed to meet the metabolic requirement of the body and brain. This is where ketogenesis begins in order to provide alternate source of energy in the form of ketone bodies. As long as the body is deprived of carbohydrates, the metabolism remains in ketotic state. This forces the body into a state of “ketosis”, a metabolic state that breaks down fats for energy instead of carbohydrates. The nutritional ketosis state is considered quite safe (if followed carefully) and greatly differs from ketoacidosis- a life threatening condition.
The ketogenic diet involves restricting carbohydrate to less than 50g per day and can be as low as 20g per day, which amounts to around 20g of carbohydrate in medium banana and can probably accomplish the amount with a single apple or a couple of bread slices. This is how restrictive carbohydrates are when following precise ketogenic diet to a T.
There is not one “standard” ketogenic diet with specific ratio of macronutrients. Generally macronutrients are divided into 60% to 70% of daily calories from fats, 5% to 10% carbohydrates and 20% to 30 % protein. Getting this percentage of calories from fat is not easy and as a results unhealthy source of fats maybe included in the diet that could have harmful long-term consequences. The ketogenic diet has gained vast popularity due to the enhancing and enticing concept of breaking fats for energy and initiating a weight loss but only for short term.
Extreme carbohydrate restriction can profoundly affect diet quality, curtailing or limiting on fruits, vegetables, whole grains and legumes and increasing consumption of animal products. Very low carbohydrate diets are often low in thiamine, folate, vitamin A, vitamin E, vitamin B6, calcium, iron, potassium, fiber and phytochemicals found in fruits, veggies and whole grains. Even when on nutrient dense foods, ketogenic diets are reported to have multiple micronutrient shortfalls often lacking in vitamin K, linolenic acid and water soluble vitamins.
Ketogenic diets are low in fiber, which can adversely affect gut health. In the absence of healthy carbohydrates and dietary fiber, gut microbiome would not produce short-chain fatty acid (SCFA). Prebiotics are foods for probiotics, without Prebiotics, probiotics would starve and eventually perish. And prebiotics are foods that are rich in fiber and healthy carbohydrates like fruits, vegetables, legumes and whole grains. A diet devoid of healthy carbohydrates can disrupt gut microbial diversity, resulting in serious health consequences.
Carbohydrates get a negative reputation because many of us are eating the not so healthy ones and people tend to overload on refined carbohydrates as they are the base of many junk foods, including, candy bars, soda, chips and sweets to name a few. These refined sugar and refined carbohydrates are unhealthy and may lead to many lifestyle disorders like obesity and as a result, all carbohydrates including the healthy ones like whole grains, fruits and vegetables bear the brunt of the blame for weight gain.
Common short-term side effects resulting from the initiation of ketogenic diet is referred to as “keto flu”, with symptoms like fatigue, headache, nausea, constipation and low exercise tolerance, which typically resolve after a few days to weeks as the body adjusts to the low ketogenic state. Dehydration, hepatitis, pancreatitis, hyperuricemia, hypercholesterolemia, hypomagnesemia and hyponatremia can also occur. Long term side effects include decreased bone mineral density, nephrolithiasis, cardiomyopathy, anemia, micronutrient deficiency and neuropathy of the optic nerve.
Ketogenic diets have a low long-term tolerability and are not suitable for many individual. Though you may very well lose weight, you will gain the weight back when you go off the diet because following a ketogenic diet is hard. You have to be disciplined, vigilant and hyperfocused on every food choice. You cannot even simply eat an extra apple because that may push you out of “ketosis”. This is not only a matter of strong will but a question of means, time, energy and resources.
Available research on the ketogenic diet for weight loss is still limited. Most studies so far have had a small number of participants and were short-term. Though ketogenic diet showed benefit of weight loss, these effects after one year when compared with the effects of conventional weight loss diets, are not significantly different. Current evidence suggests that for most individuals, the risks of such diet out-weight the benefits.
To summarize, there is no shortcut to healthy eating. And perhaps not being in ketosis is not so bad after all.
The writer is Clinical Dietitian at Nagaland Multispecialty Health and Research Center (NMHRC) Dimapur Find Odyuo in Instagram @dietitian.food.stories
