Keto Diet 101 for Summer 2022

We’ve all heard about it, it’s all over the media right now and its followers claim a laundry list of benefits comparable only to getting plenty of water and 8-9 hours of sleep. Companies are even selling comprehensive keto diet plans. So let’s take a moment to review what the research says and analyze what a keto diet really is, how it can affect health, both positively and negatively, and even more importantly, is it really good for everybody?

DEFINING THE KETO DIET

Researches usually define a keto diet as one that has a daily consumption of under 50 grams of carbohydrates which will produce high levels of “ketone bodies”, a subproduct of the breaking of fats that can potentially be used as fuel by cells that would normally depend on glucose.

These ketone bodies however can become elevated by various mechanisms, some of which are pathological: 

• Prolonged fasting leads to glucose stores depletion in the body
• Poor blood sugar control in people with diabetes or as a predictor of diabetes. This can lead to a state of ketoacidosis which is a potentially life-threatening emergency.
• Supplementing with exogenous (out of the body) ketones, for example consuming great amounts of coconut fat.
• Prolonged exercise can increase ketone production in the body, especially if under a restricted low carb diet
• Typical ketogenic diets with very low carb consumption and/or including exogenous ketone supplementation. Which is what we’re interested in exploring in this article.

It is interesting to note that the origin of the ketogenic diet is as a treatment for patients with epilepsy in the 1920s and in the 2000s came back to research as a modification of the Atkins diet to treat intractable seizures. So it was created to treat specific neurological conditions.

WHAT IS KETOSIS

Ketosis is an adaptation or state of survival of the body where it switches to using ketone bodies for fueling the cells when glucose levels are too low or we’re under starvation or fasting. 

1. The basic process begins with low levels of glucose that will signal the liberation of fatty acids from our body fat stores and our diet, which might be one of the explanations for why the keto diet seems to be good for body recomposition.
2. These free fatty acids enter the liver cells and are transformed through processes of ?-oxidation, with the help of enzymes and coenzymes, forming the final product of ketones, more specifically two that can be used by the cells in the body: acetoacetate and hydroxybutyrate
3. The liver releases these ketones to the bloodstream where they can be used by cells as fuel, the brain cells being the ones more “hungry” for these ketones.

It’s very important to note that a state of ketosis to fuel our cells is not easily or hastily achieved by the body and usually takes from a few days to even a couple of weeks to achieve the state and varies a lot from an individual to another.

BENEFITS OF ADOPTING THE KETO DIET

Let’s look at the health benefits commonly attributed to the keto diet and the evidence for these claims:

• TRIGLYCERIDE DECREASE: there is strong evidence for 19 studies that show a pronounced and persistent decrease in triglycerides levels in blood in the majority of keto studies, even in the long term.
• FASTING BLOOD GLUCOSE AND BLOOD GLUCOSE CONTROL: there is consistent evidence from 22 studies both short term and long term that a keto diet notably reduces fasting blood sugar and glycemic variability compared to other diets, although they worsen carbohydrate tolerance postprandial. There are also many studies that show lower levels of insulin in the blood both fasting and during the day
• APPETITE CONTROL:  in most studies a keto diet helps decrease hunger throughout the day. The main cause might be an increase in protein intake necessary to sustain a keto diet, but also the effect of ketone bodies in reducing appetite and regulating the hunger hormones.
• FAT LOSS: The evidence is not too strong to promote it as an effective way of fat loss, since many studies do show a good level of fat loss, however, this is explained by a reduction in calorie intake due to restricting or completely eliminating a food group. In studies where the calories were matched the fat loss was not greater than in other diets and eating protocols.

Although there have been a lot of claims of health benefits associated with the keto diet, it is worth mentioning that these effects are not consistent with all individuals, that in some cases take too long to appear, or that can be explained by other simultaneous habit and lifestyle changes: like a reduce in calorie intake due to elimination of a whole food group.

POSSIBLE SIDE EFFECTS AND DRAWBACKS OF A KETO DIET

There are also some important safety and health concerns that should be addressed regarding a ketogenic diet.

• CHOLESTEROL AND LDL: Although overall levels of triglycerides might lower with a keto diet. Many studies show increased levels of cholesterol and LDL (the bad kind of lipids), which might be due to a reduced fiber intake, but is consistent across multiple studies
• SYMPTOMS WHILE GETTING TO A KETOSIS STATE: the process of switching to a ketosis state takes some time and can be quite uncomfortable. Symptoms of nausea and vomiting, bad breath, low electrolyte concentrations in blood, low energy levels and crankiness.
• ABSOLUTE CONTRAINDICATIONS: there are some health conditions where a keto diet is just not an option, for example porphyria or beta oxidation deficiencies.
• RIGIDITY AND DIET ADHERENCE: Ketosis is a state achieved through a highly restrictive diet and that can be easily reverted if ingesting carbohydrates in amounts greater than 50 grams per day. Some supplements, medication, and alcohol contain more carbohydrates than you might think and can throw off the organism and never achieve ketosis. Some people are not well informed about the foods that you can eat and the appropriate protocol and, without knowing,t end up consuming more carbs than intended and not achieve ketosis.

As seen there are some health concerns, if not many, related to the implementation of a keto diet. The most serious being an inappropriate protocol that can lead to not achieving the intended results or to even cause some unwanted side effects like showing signs of bad nutrition like losing bone density and being more propense to getting sick. Thus the importance of following the guidelines of a qualified health professional to ensure proper calorie and nutrients intake to ensure optimal health.

TROUBLESHOOTING THE KETO DIET

There are a few guidelines that you can follow if you want to try the keto diet and see if it has good results for your body and particular lifestyle.

• Many followers of the diet like to check if they are in ketosis with rapid urine testing, this however is not a trusted method as it only shows if you’re excreting ketones through urine, and only measures acetoacetate, not hydroxybutyrate. This makes it useful for diabetes control and ketoacidosis prevention but not for someone trying the keto diet. A blood test prescribed by a physician would be a better method of testing.
• Research must be conducted by anyone who wants to try the keto diet, especially about the foods that can be included in the diet, about macronutrient content in foods and about substituting the calories and nutrients of the eliminated carbs.
• Entering a ketosis state might take a while, be patient but also be critical about what happens to your body. Keep a journal of your symptoms, how you feel and if you’re seeing the results you want, if after a few weeks you don’t see the expected benefits move on and try something else that works better for you.
• Always ask a qualified health professional to give clearance, suggest an appropriate protocol and monitor your progress closely before trying any dietary or lifestyle change. Especially for a diet that was first intended as medical treatment. Be responsible and don’t neglect this step.

KEY TAKEAWAYS

There was a lot of information covered in this article so here are our main takeaways for you:

• A keto diet has a macro distribution of around 20-40 grams of protein, 50-75% fats and 5% of carbs (under 50 daily grams).
• The keto diet was created as a treatment for very specific neurologic conditions.
• A lot of the benefits attributed to the keto diet have research proving its validity, however, the results are not consistent for everyone and might be related with other causes. For example, weight loss and body recomposition on a keto diet might be due to the caloric deficit and not inherent to the diet itself.
• Be mindful of the drawbacks and unwanted symptoms, be extra careful with nutrient and calorie intake to maintain good health, strength, energy levels, performance and bone density.
• If you want to try the keto diet, put your critical thinking hat on, keep a journal of what you eat, how you feel, any symptoms that might appear and if you’re getting the desired results. If you do, keep going, if you don’t, that’s okay, move on and try something more appropriate for your own body and personal situation.
• Always ask a qualified health professional to give clearance, suggest an appropriate protocol and monitor your progress closely before trying any dietary or lifestyle change.