While it may be new to you, the keto diet has actually been around since the 1920’s, when the Mayo Clinic reported its effectiveness for helping epilepsy (that is still the case). Since then, there’s strong evidence that the keto diet helps with weight loss as well as type 2 diabetes, prediabetes, and metabolic syndrome, says Jeff Volek, Ph.D., RD, professor in the department of Human Sciences at The Ohio State University in Columbus, Ohio and co-author of The Art and Science of Low Carbohydrate Living.
A keto diet has shown to improve triglyceride levels and cholesterol levels most associated with arterial buildup. More specifically low-carb, high-fat diets show a dramatic increase in HDL and decrease in LDL particle concentration compared to low-fat diets.3A study in the long-term effects of a ketogenic diet shows a significant reduction in cholesterol levels, body weight, and blood glucose. Read more on keto and cholesterol >
The ketogenic diet is not a benign, holistic, or natural treatment for epilepsy; as with any serious medical therapy, complications may result. These are generally less severe and less frequent than with anticonvulsant medication or surgery. Common but easily treatable short-term side effects include constipation, low-grade acidosis, and hypoglycaemia if an initial fast is undertaken. Raised levels of lipids in the blood affect up to 60% of children and cholesterol levels may increase by around 30%. This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and if persistent, by lowering the ketogenic ratio. Supplements are necessary to counter the dietary deficiency of many micronutrients.
When dietary carbohydrate is broken down into the energy substrate glucose, thereby raising blood glucose levels, the pancreas is stimulated to secrete insulin (the hormone that stores fat and inhibits ketone production). However, when carbohydrate intake is restricted, insulin remains suppressed, and the body’s primary fuel source shifts from glucose to fat, priming the body to enter a state of ketosis. When fat oxidation/breakdown is increased to a certain extent, ketones are made in the liver through a process known as ketogenesis (i.e., keto + genesis = ketone formation). When carbohydrate intake is restricted, blood glucose and insulin levels decrease, which allows fat stores to be broken down rapidly for energy. Most cells in the body can utilize either fatty acids or ketones for fuel, including the brain, which has shown to be more efficient in the presence of ketones rather than glucose.
"I recommend only 5 percent of calories coming from carbs, which usually averages out to less than 30 grams," he says. "I understand why people get nervous and panic, thinking 'Can I even eat a salad?' This is why I recommend tracking only 'net carbs', which are total carbs minus fiber. For example, an avocado has 12 grams of carbs but 10 grams of fiber, which means it has 2 grams of net carbs. Also, green leafy vegetables are very nutritious and contain a lot of fiber, so you can almost eat them as much as you want and stay below your limit.
Although studies have shown that the keto diet can reduce seizures for children with epilepsy, there is no evidence indicating that keto helps with other brain disorders or improves mental cognition, according to Harvard Health Publishing. Some studies show that keto may lower blood sugar for people with type 2 diabetes, but there is not enough long-term research to determine whether it’s safe and effective for diabetics.
Diabetic Ketoacidosis: Diabetic ketoacidosis (DKA) is the variation of ketosis that is responsible for deterring society from considering the adoption of a keto diet for beginners. DKA occurs primarily in those suffering from Type 1 diabetes. The inability to secrete insulin prevents ingested carbohydrates (glucose) from entering our insulin-dependent cells (i.e., muscle and adipose tissue) as a substrate for energy production. Due to this induced cellular starvation, the body will begin to produce ketones at an uncontrolled rate.
If you “slip up” on a ketogenic diet, it is not the end-of-the-world nor does it mean you should continue to be off the wagon. Unfortunately, having frequent “slip-ups” or “cheat days” may prevent you from becoming “keto-adapted.” However, an occasional “slip-up” for someone who is already “keto-adapted” may not be as detrimental. Get back on track and get back in your routine. Find support groups and alternative recipes to avoid these pitfalls and setbacks.
What's more, it's especially important to make sure your keto diet plan is well thought out when you're eating this way because the foods you can choose from are limited. In addition to checking in with a dietitian if you're able, Stefanski recommends that you "talk to your doctor and make sure she or he is aware that you'll be starting a diet that completely changes how your body metabolizes energy." You might also want to check your most recent bloodwork levels for things such as cholesterol, vitamin D, and other indicators of health because these can change while on keto. That's because, for some people, a prolonged keto diet can result in certain nutritional deficiencies or even high cholesterol. But most experts will tell you that the ketogenic diet is not a permanent lifestyle change (as could be the case for something like the 80/20 approach to eating or a Mediterranean eating style).
In addition to the traditional ketogenic and Atkins diets described above, there are modifications that can be implemented to both of these diets in order to produce greater benefits on an individual basis. One such amendment, called the Modified Atkins Diet (MAD), is structured similarly to the Atkins diet where protein and fat are consumed freely but carbohydrate intake is further restricted, providing an intermediary diet between Atkins and ketogenic diet. This approach is commonly being used with great success among children with epilepsy due to its ability to increase the likelihood of adherence to the diet while still minimizing glucose intake from dietary carbohydrates.
Keatley has some…thoughts about those. “Dirty keto is a waste of your time since good habits have not been developed and it is simply too easy to fall back into a high-calorie diet,” he says. If you’re trying to do a lazy keto diet, he recommends following the USDA’s MyPlate instead and monitoring your meals based on proportions vs. macros. “It’s easier, more flexible, and has shown, when combined with moderate exercise, to be effective over the long term,” he says.
Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.
When you approach your normal body weight, the weight loss will slow. Just remember, a “normal” body weight differs from person to person depending on our genetics and environmental exposures and may not fit what we see in the popular media. The weight loss won’t go on forever. As long as you follow the advice to eat when you are hungry, you will eventually stabilize your weight.
Endurance Performance: Traditionally, endurance athletes tend to consume a high amount of carbohydrates in order to “fill up” their fuel stores (i.e. glycogen) for competitions. Thus, a diet where carbohydrates are restricted seems counter-intuitive for these individuals. However, Dr. Jeff Volek’s research showed that once an individual is keto-adapted, not only is their performance the same or better than those consuming high levels of carbohydrates, but their glycogen “fuel stores” are the same as well. Despite consuming a diet lower in carbohydrates, these athletes are able to adapt and utilize a nearly limitless supply of fat as their primary fuel source.
Cramps: Due to the initial release of water when starting a keto diet for beginners, people often forget to replenish and hydrate. Due to this, some may experience “dry mouth.” An effective remedy is to ensure that there is sufficient consumption of water coupled with electrolyte balance. If dehydration persists, an increase in electrolytes may be needed (especially magnesium).