The Ketogenic Diet

Author: Dr. Akshay Alawani, INFS Faculty Head

The ketogenic diet, fondly known as the ‘Keto diet’, has gained immense popularity in recent
years. Originally used to treat complicated epilepsy cases, now keto diet has established itself as a proven weight-loss tactic. This diet is much different from other conventional dietary weight-loss strategies. Hence, learn about it before going ahead with it.

What is the ketogenic diet?

Cutting down carbohydrates dramatically from the diet induces ‘ketosis’. Ketosis is a process of creating a fuel known as ketones. In the absence of glucose in the bloodstream, primarily
glucose-dependent organ, our brain, needs ketones to function. Creating a carbohydrate depletion and then maintaining it, is a crucial step in the keto diet. Carbohydrate reduction is compensated with higher protein and fat intake. Fat has to be the primary source of energy.

Is there any particular ratio?

Not really. In experiments, carbohydrate restriction below 50 gram is standard. In versions of the ketogenic diet like Atkins, as less as 20 gm carbohydrates per day is advised in the initial stages. As the scientific experiments are the source of known benefits of the keto diet, and they have used 50 gm as a cap figure, we will recommend the same (1,2) . Include protein as per your standard requirements. However, the primary energy source has to be fats.

How do you lose so much weight in the Keto diet?

There are two primary reasons:

-Initially, you lose a lot of body water which also reflects on your weighing scale. Your body can store glucose in the liver and muscles with water. Depletion of carbohydrates leads to a reduction of this storage too. However, this is not same as fat reduction! This weight will come back speedily once you restore starches in your diet.

-The ketogenic diet reduces hunger (3) . In contradiction to the low-fat diet, hunger suppression is sustainable and pronounced in the ketogenic diet (4) . The reason behind the same is not well understood. It is hypothesised that the reduced insulin levels resulting from carbohydrate depletion or/and ketone bodies are probably responsible for this.

Benefits

  • Weight loss and associated benefits such as reduced-fat percentage, triglycerides and reduced risk of diseases like type two diabetes (5) . This diet is especially useful in the short term. When compared with the standard low-fat diet approach towards weight loss (6) , keto diet caused 5-7% more weight loss in 24 weeks in diabetic and healthy subjects (respectively).
  • It is mentally rewarding after the initial stage of discomfort as it improves cognition (7) .
  • Therapeutic in epileptic patients – pediatric and adult (8) . Even those who did not respond to medicine have got benefitted from this diet.

Drawbacks:

  • Water weight will crawl back eventually, and that can generally be discouraging as per the author’s experience with his clients.
  • Carbohydrate depletion is followed by ketone production. This ‘switch’ is gradual during which the dieters suffer from a temporary condition called as the keto flu. This condition is characterised by symptoms like headache, irritability and fatigue (9) .
  • In general, adherence to the ketogenic diet in the long term is often tricky as it is very different from a standard carb-rich diet (10) . However, there is adequate evidence supporting the 24-week ketogenic program (2) .
  • Issues such as constipation, bad breath and diarrhoea are widely reported (9,11) . The ketogenic diet is said to affect gut microorganisms adversely (12) . Paoli (12) has suggested the inclusion of vegetarian proteins, adequate fibre and probiotics to avoid the same.
  • Ketones compete with uric acid for elimination from kidneys and hence, plausible association with kidney stones (9,13) .

conclusion

In summary, we can say that the ketogenic diet can be a powerful tool to lose weight in the short term, and it is associated with many clinical benefits as well. Nevertheless, the long-term applicability of the same is questionable, and hence, it is not encouraged to follow the same for prolonged duration except if advised for medical reasons.

References

  1. Oh R, Uppaluri KR. Low Carbohydrate Diet [Internet]. StatPearls Publishing; 2019 [cited
    2020 Jun 29]. 1–7 p. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537084/
  2. Dashti FICS FACS HM, Mathew FRCPath TC, Hussein ChB TM, Asfar MB ChB
    FRCSEd FACS SK, Behbahani ChB FRCS FACSI FICS FACS AM, Khoursheed MB
    ChB FRCS FICS MA, et al. Long-term effects of a ketogenic diet in obese patients. Vol.
    9, Exp Clin Cardiol. 2004.
  3. Gibson AA, Seimon R V., Lee CMY, Ayre J, Franklin J, Markovic TP, et al. Do ketogenic
    diets really suppress appetite? A systematic review and meta-analysis. Obes Rev. 2015 Jan 1;16(1):64–76.
  4. Nymo S, Coutinho SR, Jørgensen J, Rehfeld JF, Truby H, Kulseng B, et al. Timeline of
    changes in appetite during weight loss with a ketogenic diet. Int J Obes. 2017 Aug
    1;41(8):1224–31.
  5. Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and
    Reversal of Metabolic Syndrome. Vol. 7, Current Nutrition Reports. Current Science Inc.;
  6. p. 97–106.
  7. Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-Zaid N, Dashti HM. Effect of low-
    calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012
    Oct;28(10):1016–21.
  8. Hernandez AR, Hernandez CM, Campos K, Truckenbrod L, Federico Q, Moon B, et al. A
    Ketogenic Diet Improves Cognition and Has Biochemical Effects in Prefrontal Cortex
    That Are Dissociable From Hippocampus. Front Aging Neurosci [Internet]. 2018 Dec 3
    [cited 2020 Jun 29];10. Available from: /pmc/articles/PMC6286979/?report=abstract
  9. Ye F, Li XJ, Jiang WL, Sun H Bin, Liu J. Efficacy of and patient compliance with a
    ketogenic diet in adults with intractable epilepsy: A meta-analysis. J Clin Neurol.
    2015;11(1):26–31.
  10. McDonald L, McDonald L. The ketogenic diet : a complete guide for the dieter and
    practitioner. [The Author]; 1998. 323 p.
  11. Ting R, Dugré N, Allan GM, Lindblad AJ. Ketogenic diet for weight loss. Vol. 64,
    Canadian Family Physician. College of Family Physicians of Canada; 2018. p. 906.
  12. O’Neill B, Raggi P. The ketogenic diet: Pros and cons. Vol. 292, Atherosclerosis. Elsevier
    Ireland Ltd; 2020. p. 119–26.
  13. Paoli A, Mancin L, Bianco A, Thomas E, Mota JF, Piccini F. Ketogenic diet and
    microbiota: Friends or enemies? Vol. 10, Genes. MDPI AG; 2019.
  14. Scott JT. Factors inhibiting the excretion of uric acid. Proc R Soc Med [Internet]. 1966
    Apr [cited 2020 Jun 29];59(4):310–3. Available from:
    http://www.ncbi.nlm.nih.gov/pubmed/5937678

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