What is the Ketogenic Diet?

January 27, 2018

The Ketogenic diet has really hit 2018 with steam. With many people choosing to do this diet, it is important to take a look at the research to see if it is truly healthy. 


Why was the Ketogenic diet originally developed? 


The Ketogenic diet was originally developed in the 1920s for children to aid in the treatment of epilepsy. The Ketogenic diet is now widely accepted as a dietary therapy to control and alleviate seizures, in both adults and children. It typically requires an inpatient stay as well as a team of dietitians and physicians to properly initiate and implement the treatment. This process requires extensive counseling and training on how to weigh foods, measure urinary ketones, modify the diet for special occasions, and ensuring overall nutritional adequacy. Concerns during this process include: inability to maintain adequate nutrition and/or hydration, increased cholesterol, heart problems, kidney disease, liver disease, bone health, and the social constraints of the diet itself.


What is the diet anyway? 


The typical Ketogenic diet is very low in carbohydrate, moderate in protein, and high in fat. A ratio of 4g of fat to a combined 1g of carbs and protein is standard. Without carbs to use as energy, your body will start to break down fat (This is actually a method of preventing starvation). This process produces ketone bodies in the liver. You are “in ketosis” when your body is relying solely on ketone bodies for energy. 


The average carbohydrate consumption on the Ketogenic diet is typically between 20-50g of carbs per day. Carbohydrate foods include: dairy, fruits, starchy veggies (peas, corn, potatoes), all grains such as pasta and bread, sugar, and desserts. To put this in context, a medium banana contains about 27g of carbohydrates. So you would need to keep your carbohydrate intake to less than 2 bananas per day on this diet. 


Since there is so much fat in the diet, it can be extremely difficult to eat enough of it. This diet typically includes butter, cream, bacon and other higher fat meats, nuts, medium chain triglycerides, coconut oil, olive oil and other vegetable oils, and higher fat fruits like avocado and olives.  The type of fat that is consumed may be a cause for concern. The current recommendation for saturated fat is 10% of total calories due to concerns of developing heart disease. Saturated fats include butter, coconut oil, cream, bacon and other high fat meats. Emphasizing heart-healthy fats may be beneficial, but experts disagree on the ideal fat composition of this diet. 


So why is everyone doing it? 


People typically lose weight quickly and gain the results that they desire. 


Why do you lose weight?


There are several reasons why you may lose weight on the Ketogenic diet. It is in part due to the decrease in water weight diuretic effect that occurs from not consuming carbohydrates. Additionally, cutting out carbohydrates drastically decreases the types of foods you can eat. Also, foods high in fat may not be as appealing as foods high in carbohydrates, so you may eat less overall.  Finally, it has been proposed that people who are doing the Ketogenic diet experience less hunger, than those who may be on a calorie-restricted diet alone. All of these result in a calorie deficit which supports weight loss.


Pros of the Ketogenic diet: 


– It doesn’t restrict calories 

– For those with diabetes, it may decrease A1c and improve insulin sensitivity 


Cons of the Ketogenic diet: 


– Restrictive, not sustainable 

– Not enough data to provide support in the long-term

– May develop nutrient deficiencies, particularly B vitamins, electrolytes, vitamin D and calcium 

– Low in fiber. We know that people whose diets are high in fiber have a decreased risk of developing heart disease and diabetes. If you find yourself with bowel issues on this diet, this may be why. 

– Due to the diuretic effect of a low-carb diet, there is an increased risk of developing kidney stones 

– You may experience the “keto flu” which includes symptoms such as fatigue, poor sleep, constipation, dizziness, difficulty exercising, and lightheadedness which may last anywhere from a few days to a few weeks 


When thinking about making dietary changes, it is important to ask yourself if this is something that can be sustainable and if it is safe. As the Journal of the American Medication Association stated, “A diet that lets a person eat fat to satiety—even saturated fat—without relying on calorie counting and still lose substantial weight, treat diabetes into remission, raise HDL levels, and lower triglycerides and blood pressure? It could be game changing for the field of chronic disease—if the benefits pan out in large-scale trials and can be sustained by many.” There is still a lot we don’t know about the Ketogenic diet, particularly in the long-term to guarantee its safety and efficacy, as well as concerns about sustainability. If you are considering doing this diet, please consult a dietitian or a physician before starting.