Pros & Cons Of The Keto Diet

The Great Keto Debate

There are mixed views regarding the true role of the ketogenic diet in health and weight loss. Some sources cite benefits such as immediate weight loss and long-term health, while other sources assert that it is unsustainable in the long run and can actually have negative effects on the body. To set the record straight, three experts were invited to discuss the pros and cons of the ketogenic diet: osteopathic and sports rehabilitation specialist Dr. Christopher Amen, registered dietitian-nutritionist Jackie Iannone from The Rite Bite Nutrition, and “It Is What It Is” podcast host and fitness enthusiast Cody Kelly. Hopefully with the rich and extensive input of these health and fitness professionals, more light can be shed on the legitimate effects of the ketogenic diet, and whether or not it is worth subscribing to.

The ketogenic diet was developed in the 1920s to control seizures in children with epilepsy. It is essentially a high fat (about 70-80%), low carbohydrate (5-10%), and moderate protein (10-20%) diet that aims to drive metabolism into a state of ketosis, which shifts the primary fuel source of the body from glucose to fat. This diet reached the mainstream in recent years due to the successful weight loss met by celebrities on this diet. However, it is worth remembering that although this may have worked for some, it may not be applicable to all as there are different variables and factors that go into weight loss or body transformation, as a whole.

While the ketogenic diet has been proven to have positive effects, some experts themselves would not subscribe to it. At the very least, there has to be a medical understanding of what the individual’s body can and cannot tolerate, which varies from person to person. In the context of weightlifting and bodybuilding, the data is split right now. Somebody may claim to have lost a large amount of weight, but the safety, correctness, and sustainability of the method may be questionable, and it is the sustainability of the ketogenic diet that is often up for debate.

Metabolism and the keto diet

To understand how the ketogenic diet works, it is important to have a grasp of the mechanism of metabolism. Initially, the body uses glucose as its main energy source. When the glucose stores are depleted, the body tries to make more glucose and when it cannot produce enough, it switches to alternative means of metabolism. In ketosis, the body breaks down stored fat to form ketone bodies, which is another form of energy that the body can use. The brain’s most preferred source of energy is glucose, but in its absence, the next best thing would be in the form of ketone bodies.

Now, the important part about that is how that works in epilepsy management. The theory is that because glucose is the only source of energy that the brain relies on, it results in a hyperexcitable state which can trigger seizures, resulting in epileptic disease. Therefore, by limiting the glucose in the brain and switching to ketone bodies instead, it may actually decrease the risk of epilepsy. Apart from this, there are many other dietary deficiencies as well in which ketone bodies play a significant role.

These inherent regulatory systems in the body are crucial for survival because they ensure that the body’s needs are always met to stay healthy. This is one of the critiques faced by the ketogenic diet, as it forces the body into a constant state of starvation. The simple answer to the question of whether the keto diet is good is unequivocally, yes. It is similar to prescribing any type of medication to anybody; there are associated risks, there are people who respond well to it while others do not. Issues of compliance are also similar, like when a diabetic patient may have difficulty consistently taking their insulin injections four to six times per day. Otherwise, it would be best to put them on a different medication which they can take less frequently and therefore more easily comply with. Similarly, the ketogenic diet is another tool in the weight loss bag for a certain population.

What is the ‘keto flu’?

There is such a thing known as the “keto flu,” wherein the body is not getting the right amount of energy and manifests with transient symptoms. The initial source of energy is simply glycolysis, which is the breakdown of glucose for energy. When the body is deprived of carbohydrates, blood sugar levels will then drop. To counteract this, the body taps the glucose stored in the liver and muscles called glycogen, which only sustains the body for about a day. When those sores have been depleted, that is usually when keto flu symptoms arise. Blood sugar levels are low, glucagon (the hormone that stimulates glucose production) levels are elevated, and insulin (the hormone that breaks down glucose) is super low, all of which are ideal conditions for the development of diabetes. When glucagon is sustained for a period of two to three days or sometimes up to a week, the body begins to break down fatty acids, resulting in ketone bodies, hence ketogenesis. The ketone bodies will then supply the body’s energy needs. Glucose is the preferred energy source of the body because it is more readily utilized by the body compared to ketone bodies. In terms of energy production, ketone bodies produce significantly more energy. This is why some people have described greater mental alertness and increased energy levels throughout the day. The “keto flu” is transient in most people, and again, nothing is black and white. Some people cannot tolerate it, such as in diabetic ketoacidosis, wherein the effect may be likened to a permanent keto flu and can have debilitating effects on organ function. Therefore, healthy ketosis and unhealthy ketosis are very different things.

With these, it is important then to maintain a balance and be attuned to one’s body. Experiencing these symptoms while following the ketogenic diet may be a warning sign to stop and rethink the appropriateness of this diet for this particular individual. It is best to consult a doctor or nutritionist regarding the most suitable diet for one’s needs, especially when there is an accompanying medical condition present.

How long should I be on the keto diet?

In terms of duration, this diet is recommended until there is a significant amount of weight lost or based on the set goals by a registered dietitian or doctor. Currently, there is insufficient evidence right now regarding the long term effects of the ketogenic diet to support the appropriate duration one should be on it. This is one of the biggest reasons why generally speaking, there will always be that exception to the rule and the ketogenic diet might not be the primary weight loss tool chosen by experts. There simply is not enough data regarding its effects in the long term. Therefore, this can be detrimental to health if prescribed inappropriately. There are currently plenty of other ways that weight loss can be achieved whose long term effects have been thoroughly studied.

What you need to know before you try the keto diet

Although this diet has an overwhelming effect on a large amount of the populace, discipline and commitment to the ketogenic diet should also be considered. Often, people tend to get into a cycle of seeing Hollywood actors and actresses that successfully lost weight while on the diet, reading magazines and articles online, replacing everything on their shelves with high fat, adequate protein, and low carb products, only to get bored and fall off the wagon after two weeks. This can be likened to the earlier example of a diabetic patient and their compliance to their medication. The problem with a lot of individuals is that discipline is often lacking. Human beings crave variety, which makes compliance to a restrictive diet challenging. Most people who started the diet comply with it for about an average of 60 days max, because there simply is not enough evidence to support the sustainability of this diet for the long term. Looking at it as a whole, this is not just a diet but actually a lifestyle. This is an important shift in mindset, and it’s often the people who decide to go all in, surround themselves with like-minded people, and diligently track their progress that are met with the greatest success. However, this is not something most people realize after signing up for it.

Research on the ketogenic diet has shown the mortality rate to be negative, stating that it takes about seven years off one’s life on average. With this risk then, this diet may not be the best weight loss option for everyone. It is recommended for someone with a lot of comorbidities like high blood pressure, high cholesterol, diabetes, and morbid obesity. These individuals would benefit from a short term treatment with a ketogenic diet because of the rapid reductions in weight, insulin resistance, and blood pressure. The adverse outcomes associated with the diet essentially stem from the type of foods that are being consumed, with high sodium being one of the worst outcomes. An individual with very high blood pressure, diabetes, or an underlying heart condition would respond poorly to a high sodium diet, as this would cause water retention and an increase in blood pressure that could lead to congestive heart failure. This is why people with certain medical conditions and poor diets are predisposed to dying over time. However, the benefits of rapid weight loss, lowered blood pressure, and decreased insulin resistance far outweigh any seven year-decrease in mortality for a few people that are on this diet for a long term. If properly prescribed for certain populations with all these comorbidities, the ketogenic diet can rapidly decrease weight loss. They would also benefit from proper transition to a more manageable long term diet with portion control.

In the context of Inflammatory Bowel Syndrome (IBS), the ketogenic diet would not be the first recommendation. Because it is so high in fat, there is a risk of the individual having a lower fiber diet. With IBS, a low fiber diet is occasionally recommended, depending on the individual’s needs and the severity of the condition. In general, poor gut health stems from a lack of fiber in the diet. This is apparent in the ketogenic diet, wherein there is a deficiency of soluble fibers that are fermentable and promote a healthy gut microbiome. It is for this reason that experts would not recommend this diet for patients with IBS.

Keto and exercise

When it comes to a heavy exercise program and the ketogenic diet, there has to be an in-depth analysis as results may vary depending on the person’s physical capabilities, their body weight, their goals, and basically the image that they have, and the trajectory that they want to attain. It is important to find a diet and exercise regimen that is tailor-fit to one’s needs, which takes time, effort, and self-awareness to achieve. Consulting a doctor, dietitian-nutritionist, or endocrinologist in order to come up with a proper health and fitness plan would greatly optimize results. Setting realistic goals are also key in finding the right diet and exercise combination that works best. Experts would recommend heavy lifting with the keto diet as it is one of the best ways to put on muscle mass and change overall body composition really quickly. Incredible results can be achieved if done properly. Matching your physical fitness level to the exercise regimen to be taken on should also be considered. Starting sudden and intense physical activity coming from a sedentary lifestyle could have adverse effects, especially when paired with the keto diet wherein the depletion of glucose shifts the body into a ketotic state. An anticipated effect is feeling weakness or fatigue as part of the “keto flu” due to the breaking down of muscle and fat. Great results can be achieved by pairing this with increasing exercise intensity, as long as there is proper cycling of the right muscle groups and adequate time to recover. In general, a young adult who is overweight but looking to lose weight and put on muscle mass would benefit from a keto diet, plus a heavy exercise program for the short term. Afterwards, they should transition properly back to a long term sustainable diet.

In relation to cholesterol control, the ketogenic diet also exerts an effect. LDL is the body’s “bad” cholesterol, while HDL is good cholesterol. There has been a case wherein a patient without a family history of dysregulated cholesterol levels went on the ketogenic for two weeks and appeared to respond well to it. However, his yearly check-in showed an elevated total cholesterol of 300, when he last tested at 180. In this case, the diet definitely affected his cholesterol levels, causing his LDL levels to skyrocket. Again, there is not enough research to support the long term impacts of somebody on a ketogenic diet. In general, the approved medical nutrition therapy for lowering cholesterol levels is to decrease saturated fat intake, which is difficult for a person following the ketogenic diet, because the diet is essentially composed of fat and options are incredibly limited (avocados, nuts, seeds, and oils). It is a tall order and highly unrealistic to expect somebody to get 70-80% of their calories from just those food groups. Often, these individuals may opt for heavy creams, butters, and red meats to satisfy those needs much better. In short, the ketogenic diet is not the typical medical nutrition therapy for lowering cholesterol, and experts would generally not recommend it.

Keto, weight loss, and metabolism

Weight loss results also vary in a group setting. It is important that everyone commits to the journey and supports each other through the highs and lows. There will be days when motivation will be high and dieting and exercising will come easily. However, there will also be days when the whole process may seem like a chore. If one decides to commit to the regimen as well as find that niche group that is going to support each other’s journey, success will definitely not be too far on the horizon. Regardless of the program subscribed to, it is truly one’s mindset that shifts the daily choices into a lifestyle, making it possible to dodge whatever curveballs may come. The relationship between those who start, those who continue, and those who yield results is based on how well they are able to manage their personal lives and have the grit to withstand any hurdles that come along.

When it comes to metabolism, results also vary. Some individuals are able to lose weight really quickly, and then gain it all back even more, while others simply eat more fruits and vegetables and are able to keep the weight off. Weight will be regained quickly if a high sugar, high carbohydrate diet is suddenly implemented. The body’s goal is to always keep its functions in balance. After a heavy meal, the body’s glucose levels will be elevated. To counteract this, the body will secrete insulin to break down all that glucose. However, in diabetes, the body needs to secrete more insulin to have the same response. Applying the same principle to the keto diet where there is elevated glucagon and low insulin, insulin may not be necessary because there is no need to store anything since the body is in a starved state. Essentially, the body is trying to make energy, not store it. The body will then upregulate all those receptors for the storage of glucose and carbohydrates, and if the intake is done too rapidly, there will be dramatic effects. The person may feel sick since the body is switching metabolism again. Therefore, it is important that carbohydrate and sugar levels are not completely at zero while on the ketogenic diet. Slowly increasing those levels over an extended period of time while continuing to exercise will ensure efficient calorie burning.

With ongoing weight loss as a result of the keto diet (or any diet), metabolic rate will slow down since the body is not geared to lose weight as a survival mechanism. In fact, it is much easier to gain weight than it is to lose weight, which is why it’s incredibly difficult for any individual to start a journey like that. Now, when it comes to metabolic rate on the keto diet specifically, unfortunately, there is still just not enough research to really say one or the other. Any diet that puts the body in starvation mode will trigger mechanisms to counteract this as a form of protection. Because of this, placing the body in this state of starvation may not really be the best way to instill weight loss. In truth, most individuals are not actually really following a true clinically ketogenic diet. Most of the time, they actually just follow a low carbohydrate, high fat, and high protein diet. This becomes an issue if an individual is consuming more than 10-20% of those calories from protein, as this shifts the fuel source to amino acids in order to produce glucose from them. In this state, most people will not reach ketosis. This does have efficacy in terms of weight loss, and is not as dramatic in terms of what a ketogenic diet would do long term. But overall, most people subscribe to a modified version of the keto diet.

In a high protein diet without much fat, the body will start burning muscle as there is nothing to oppose it or keep the protein low. If muscles are being burned off the body, that will help boost basal metabolic rate because muscles are way more dense than fat and burn calories at a higher rate. Ultimately, keto is going to deplete muscle mass. The idea is that one cannot have too much protein where it is enough to sustain the energy for the day. If protein levels are insufficient to sustain the energy requirements for the day, the body will use ketone bodies for energy to the brain and other vital organs. Essentially, the body will not break down muscle for energy if it has fatty acids or proteins from the diet. Because it will not be breaking down muscle mass, muscle mass will increase drastically which will increase the basal metabolic rate.

Doing a modified keto diet

On the topic of a modified keto diet, people tend to “cheat” by eating any kind of food as long as it is high in fat, instead of paying attention to the more organic sources from which fat can be derived from. People would prefer something at a micro level that is readily accessible and cheaper, such as a bag of chips or a cup of pudding ounces on the basis of it being high fat, instead of opting for avocados, nuts, oils, or butters. Hence, “dirty keto” is a real thing. A modified version of just any type of diet is real, which may stem from a lack of discipline and difficulty maintaining a certain level of consistency. This is simply human nature, which is something everyone struggles with.

However, some experts would still not recommend this diet simply because there are so many better ways to lose weight. From a dietitian’s perspective and medically speaking, it does hold promise. Ideally, an individual on the ketogenic diet would lose weight fast, and then be transitioned over to a more stable diet. Unfortunately, it does not always work that way. The behavioral aspect of the equation should also be considered, apart from food as well. This poses a lot of issues when putting someone on such a restrictive diet because a lot of the time, this is the main reason why 95% of diets fail. The nature of the diet may be too restrictive for some individuals to really commit to. A good question to ask before starting any diet or program is to ensure that this is something that they can do for the rest of your life. This is a commitment. This is not the latest fad diet where, once placed on the diet and weight is lost, the individual goes back to their previous lifestyle. This is why anytime a particular food group is removed, people have difficulty assimilating it back into their diet when it is reintroduced. Ultimately, the goal is to cultivate a sustainable relationship with food. Another misconception to dispel is that complex carbohydrates should be avoided, when in fact whole grains actually promote gut health. In essence, it may not be necessary to remove anything from one’s diet, just modify the amounts consumed and incorporate regular exercise. On paper, the keto diet, along with most other diets, will aid in weight loss, but what matters most is finding a diet that is sustainable for the individual.

Overall, the ketogenic diet would greatly benefit specific populations. For the morbidly obese population with multiple comorbidities such as high blood pressure and high cholesterol, it is recommended to follow the program with someone who is knowledgeable about the diet, applies it correctly, and implements a realistic exercise regimen in order to attain optimal results. The consequent weight loss will be beneficial as it will significantly decrease the risk of further disease to the heart, lungs, liver, and brain. While there are drawbacks to the ketogenic diet, the benefits of losing that weight far outweigh the risks associated with it, which can be minimal if the diet is properly implemented. To the general population, the ketogenic diet is recommended with a regimented exercise program for a short period of time with good compliance. It is best not to start this diet if there is no real resolve to do it properly. If you are unsure, it would be best to consult a specialist such as a doctor or dietitian-nutritionist in order to come up with a program that is tailor-fit to one’s individual needs.