Keto-Curious? What to Know Before Trying Keto

Proponents often tout low-carbohydrate diets as quick and relatively easy ways to lose weight. In addition to weight loss, some low carbohydrate diets, like the ketogenic diet, have been shown to potentially help other health conditions such as diabetes and heart disease.

Key takeaways:
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    Low-carbohydrate diets have been documented for hundreds, if not thousands, of years.
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    The ketogenic diet differs from other low-carbohydrate diets because it focuses on fat as the primary energy source.
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    Studies show many benefits to the ketogenic diet, specifically managing diabetes, heart disease, and weight loss.
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    Risks associated with this diet include short-term side effects known as the “keto flu” and long-term adverse effects, including liver and kidney problems.
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    The keto diet isn’t for everyone and should be rotated with other diets to prevent nutrient deficiencies and long-term problems.

Although there are documented benefits to the ketogenic diet, there are also risks associated with this eating style. If you’re curious about the ketogenic diet, keep reading to see if this diet could be right for you.

What is the Keto diet exactly?

Our bodies run on two primary types of energy — sugar and fat.

Sugar breaks down into glucose and is the preferred form of energy for most cells in your body. However, when your body runs out of glucose, it begins to burn stored fat for energy by forming ketones.

The process of making these ketones is called ketogenesis, where the ketogenic diet got its name.

When your body undergoes ketogenesis, it puts you in a state of ketosis, where you consistently use your stored fat as the main energy source. It’s for this reason that this diet causes such quick weight loss!

It is important not to confuse ketosis with ketoacidosis. Both describe elevated ketones in the blood; however, they are very different. For instance, ketosis is considered a safe biological response to low-carbohydrate intake when you fast, for example. However, ketoacidosis is a dangerous condition. It occurs when too many ketones build up to make your blood acidic, which is a potentially life-threatening complication.

What is protein’s role in all of this? Moderating protein consumption is important in the keto diet because proteins convert into glucose when consumed in high amounts, which can hinder the ability to achieve ketosis.

How to know if you’re in ketosis

Urine, blood, and breath tests are commonly used to check if you are in ketosis by measuring the amounts of ketones in your blood. Dr. Howard LeWine, M.D. of Harvard Health, says, “It typically takes two to four days to reach a state of ketosis”.

Watch out for the “keto flu” in the initial weeks of ketosis.

Signs and symptoms of keto flu include:

  • Diarrhea;
  • Constipation;
  • Vomiting.
  • Poor energy and mental function;
  • Sleep issues (insomnia);
  • Decreased exercise performance.

To minimize these effects, opt to slowly reduce your carbohydrate intake over 2-4 weeks to train your body to burn more fat before eliminating carbs.

Be sure to talk with your doctor about your specific nutritional needs before experimenting with the keto diet.

Specific metrics important in the ketogenic diet

The original diet outlined by Dr. Wilder followed these guidelines:

  • 4:1 ratio fat-to-carbs and protein.
  • 90% of caloric intake from fat.
  • Carbohydrate restriction, less than 50 g/day.
  • Protein limitation to less than 1 gram per pound of body weight (1.5 grams protein per pound of body weight for those heavily exercising).

“For most people to begin using stored fat as fuel, they need to limit daily carbohydrate intake to fewer than 20 to 50 grams depending on body size. For comparison, a medium-sized banana has about 27 grams of carbs”, says Dr. LeWine of Harvard Health.

These original guidelines have been differentiated into several versions in recent years. However, the Standard Ketogenic Diet (SKD) proves to be the most widely used and supported by research.

Keto-friendly foods:

  • Wild seafood, especially seafood rich in omega-3 (wild salmon).
  • Free-range and grass-fed meats.
  • Free-range or heritage eggs.
  • Non-hydrogenated oils (extra virgin olive oil, avocado oil, coconut oil, etc.)
  • Nuts & seeds.
  • Organic/grass-fed dairy.
  • Low-carb veggies (leafy greens, onions, mushrooms, etc.)
  • Avocados.
  • Tofu, seitan, tempeh.

Benefits of the keto diet

Metabolic changes, high blood sugar, and insulin resistance are all aspects of diabetes. There is also a link between obesity and diabetes mellitus (type 2 diabetes), so losing weight can potentially lower the likelihood of developing diabetes. The keto diet has been shown to lower blood sugar, improve insulin sensitivity, and increase weight loss and so it is a useful tool in managing diabetes.

In addition, a comparative study published by the American College of Physicians found those on the keto diet experienced improved insulin sensitivity by an impressive 75%!

Improvement in insulin sensitivity can help a multitude of other endocrine conditions characterized by impaired insulin sensitization, such as PCOS (polycystic ovarian syndrome), metabolic syndrome, and prediabetes.

The keto diet has also been shown to help improve risk factors associated with heart diseases, such as high blood pressure and elevated triglycerides and cholesterol.

The keto diet is one the most effective for weight loss, especially the loss of body fat. A study published in Nutrition & Metabolism found that after eight weeks, participants who followed a ketogenic diet lost nearly five times as much body fat as those who ate a low-fat diet.

Additional promising benefits of the keto diet include:

  • Use in neurodegenerative disorders (like Alzheimer’s disease).
  • Prevention of seizures in epileptics.
  • Reduced appetite.

These benefits are very promising, although more studies need to be conducted to fully understand the long-term effects of the ketogenic diet. See your doctor before considering any significant dietary changes.

Risks of the keto diet

Whenever you remove a macronutrient group from your diet, you are exposed to potential risks — the ketogenic diet is no exception. Although it has been shown to have many benefits, these benefits are short-lived and should be cycled with phases of healthy carbohydrate reintroduction to prevent any long-term negative effects.

The keto diet can be difficult to adhere to, with one of the biggest obstacles being compliance. Researchers are learning that maintaining “body weight after weight loss is usually a major problem”, which means benefits may not last if the weight loss doesn’t stick.

One of the most obvious risks is an increase in saturated fat, which is linked to an increased risk of heart disease. Registered dietitian Kathy McManus, director of the Department of Nutrition at Brigham and Women's Hospital, recommends “That you keep saturated fats to no more than 7% of your daily calories because of the link to heart disease…the keto diet is associated with an increase in "bad" LDL cholesterol, which is also linked to heart disease”.

She goes on to say that nutrient deficiency is also a common risk. When you’re not eating a wide variety of fruits, vegetables, and grains, you might be missing out on essential vitamins and minerals, especially magnesium, choline, selenium, Vitamins C, A, D, and Bs (mainly folate and biotin).

If you have a preexisting liver condition, the additional stress of producing ketones consistently may exacerbate these problems.

Some additional potential risks of the keto diet include:

  • Constipation due to lack of dietary fiber.
  • Brain fog, confusion, and irritability due to low blood sugar.
  • Kidney stones and other kidney problems.

Cautions and contraindications

The ketogenic diet is contraindicated (should NOT be done) in people with:

  • Liver failure;
  • Pancreatitis;
  • Fat metabolism disorders.
  • Any carnitine or carnitine enzyme deficiencies;
  • Porphyrias or pyruvate kinase deficiency.

The keto diet is so popular because it works if your goals are weight loss, diabetes management, and heart disease prevention (among other health benefits).

However, these positive outcomes don’t come without their risks. In addition, many of these are only short-term benefits — many not lasting longer than two years. Experts widely agree that the keto diet is difficult to adhere to and that cycling through different diet plans and eating carbs in moderation is often more sustainable for long-term health.

“In the short term, a keto diet is probably safe. But over time, it's tough to keep off the weight this way,” says Howard LeWine, M.D. of Harvard Health.

Dr. Marcelo Campos, M.D. of Atrius Health, and writer at Harvard Health agrees thatA balanced, unprocessed diet, rich in very colorful fruits and vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and lots of water seems to have the best evidence for a long, healthier, vibrant life”.

To further back this up, a study published in Nutrients, found that a “combination of a biphasic [Keto] diet separated by longer periods of maintenance nutrition, based on the traditional Mediterranean diet, led to successful long-term weight loss and improvements in health risk factors in a majority of subjects and compliance was very high which was a key determinant of the results seen”. This way of eating proved more sustainable and achievable by those involved in the study.

The keto diet has both benefits and risks. Benefits can be short-lived, so cycling keto with a Mediterranean diet might be the best approach for long-term health. Either way, talking to your doctor will help determine if the keto diet is right for you!

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