I was asked to briefly discuss my thoughts on the Ketogenic diet (KD). I wrote a blog post in 2013 on whether or not low carb diets were the devil that they are often made out to be. You can read that post here to get yourself warmed up before we dive in to this one. Briefly, the main reason that Ketogenic diets (KD) get a bad rap is that people including many health professionals confuse ketosis (a natural state of fat utilization (burning) by the body) and ketoacidosis (a pathological condition occurring when ketones are produced uncontrollably due to inadequate insulin to regulate this process). A full comparison between ketosis & ketoacidosis requires its own post and I will try to cover that later. In the meantime here is a great description from one of my RD colleague Aglaee who actually gets it.
A Ketogenic diet is the term given to a high-fat, adequate-protein, low-carbohydrate diet in which the macronutrients are broken down as follows: 20% carbohydrates, 65% fat and 15% protein by energy (so a typical 2000 calorie intake that translates to 100g carbohydrates, 144g fat and 75g protein). This breakdown can vary but you get the idea.
Ketogenic diets have been used for almost a century in the treatment of Epilepsy. In fact, today the ketogenic diet is viewed as one of the most effective treatment for epilepsy that is resistant to medications, although I’m not sure why the diet isn’t used over the meds, if that’s the case.
There are also a lot of examples in the literature of diets high in refined carbs & over stimulation of regions of the brain. These dietary habits have been suggested to account for much of the increase in prevalence of mental health disorders that we see today with one study demonstrating a clear link between mental illness & metabolic syndrome. Many of the conditions in addition to Epilepsy that have been linked to poor nutrition (i.e. high refined carbohydrate intake) include, but are not limited to Schizophrenia, Depression, Bipolar Disorder, Dementia and ADHD. Furthermore, ketogenic diet has been shown to improve symptoms in all of these conditions as well.
In addition to the mental health benefits that can be achieved by KD, there are many more metabolic benefits to be gained including the following: a) fat loss due to fat adaptation; b) improved response to treatment by some cancers (i.e. tumor shrinkage) due to our cells ability to adapt to fat, but many cancer cells only using glucose; c) a recent study determined that KD provided 8-9% of brain energy metabolism; d) new evidence suggests that dementia might actually be type 3 diabetes, which is insulin resistance of brain cells, however once your cells undergo fat adaptation, the brain has fuel again.
One review of the evidence suggests that the benefits of KD are due to increased GABA production, increased energy to brain tissue (via adaptation to ketone bodies) and lowered glucose flux across nerve cells, all of which effectively prevent the hyperstimulation effects of refined carbs on the brain due to reduction in glucose flux. More recently, one study suggested that many of the benefits observed from KD could be due to a restriction in intake of methionine and choline above all else.
Whatever the mechanism of action, there is no question that KD is likely in line with our evolutionary biology. Think about it. Carbohydrates would NOT have been available in their current refined forms at all & the unprocessed forms (vegetables & fruits) would have only been available seasonally in the late summer & early fall. That means that the rest of the year we would have likely been ketogenic and even when we were consuming carbs, the overall amount would have been much lower than the current 250-500g daily average of carbs consumed (mostly refined) in the standard western (low fat) diet today. This is NOT in sync with our evolutionary needs & in my humble opinion IS responsible for the Overweight/Obesity epidemic that we are seeing today and additionally the increased prevalence of metabolic diseases that we are encountering as a species are likely due at least in part to this in-congruent lifestyle.
Metabolic diseases include, but are not limited to overweight/obesity, hypertension (weight-related), dyslipidemia (particularly high triglycerides in my opinion), insulin resistance & blood sugar elevations (pre- and diabetes), heart disease, many types of cancer, epilepsy, dementia (type 3 diabetes), as well as rapid aging & hormonal imbalances.
Overall, for anyone looking to correct metabolic dysfunction I would suggest attempting a low carb or ketogenic approach. Often this is best achieved by receiving guidance from a professional with experience in the diet (see my services or someone closer to you). I would also suggest that most people try at least to mimic our evolutionary history by consuming more of their (clean) carbohydrates in the late summer/early fall & then decreasing their daily intake of carbs over the winter & spring months. Furthermore, if you are interested in reducing the rate at which your cells are aging, then a cyclic KD will definitely help with that too. Once you correct your metabolic dysfunction, or if you don’t have any that you know of, then simply lowering your daily carbohydrate amount to between 75 and 150g has been shown to help people become fat-adapted & can lead to a decreased reliance on quick-burning carbs & therefore decreased oxidative stress, inflammation & aging that would all go along with increased burning of carbs. This is illustrated beautifully by the Primal Blueprint Carbohydrate Curve that you can read more about at Mark’s Daily Apple site.
Two important caveats that I will leave you with are:
1) Get all of your carbohydrates (whether ketogenic or just low carb) from unprocessed, REAL FOOD sources including vegetables & fruits mostly;
2) Divide your fat intake to get at least 1-2 g of DHA+EPA combined as your omega 3 (unless more is advised by your Health Practitioner), the bulk of fat comes from healthy oils including coconut, olive oil and avocados, consume nuts sparingly, AVOID industrial seed oils (corn, soy, wheat germ, canola, cottonseed, safflower & sunflower oils).
That’s my take on Ketogenic & low carb diets. I hope you find this info helpful.
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Till next time,
Have a great week!