What you should know about the Keto Diet

THREE RIVERS — Akins, Dukan, lemon detox, zone, paleo, cabbage—even a baby food diet—and, yes, it’s for adults.
Now comes the ketogenic diet, or keto for short. It has become so popular in recent times one web site lists events and conferences devoted to the high fat, low carbohydrate diet. You can take a keto cruise that leaves from Miami or attend the annual keto awards in Tampa. Heck, you can even share your awkward dating experiences with other keto dieters on Reddit about trying to order a keto friendly meal during a romantic dinner.
Despite the hype around the keto diet as being something new, it actually has been around for a while—used, for example, as a treatment for epilepsy in children since the 1920s—according to an article published by the Harvard Medical School.
To help explain the keto diet are registered dietitians at Three Rivers Health in clinical nutritional services: Theresa Montmorency and Amanda Lovell. Each holds a master of science degree in nutrition.
William Allen Baltz: Let’s start with the basics. What is a carbohydrate, complex carbohydrate, protein and fat, and how does the body process and use each of these foods?
Theresa Montmorency: The foods we eat are composed of different nutrients that our body needs in large amounts. These are called macronutrients and include carbohydrate, protein, and fat. Carbohydrate is the main energy source for the body that is broken down into glucose and absorbed into the body for energy. It mainly comes from foods that have sugar naturally or added sugar.  Fiber is a carbohydrate but does not contribute to calories or a source of energy. Sugar and fiber are found in fruits, vegetable and grains. Sugar is also in milk products, syrups, desserts, and most processed foods.
Complex carbohydrates are carbs that have less of an effect on blood sugar and are typically high in fiber, while simple carbohydrate are more refined and may include added sugars, resulting in a greater spike in blood sugar. Complex carbohydrates come from food such as whole grains, whole fruits, starchy vegetables (corn, peas, and potatoes), milk, yogurt, beans, legumes, and pulses. In contrast, simple carbohydrates include foods such as soft drinks, fruit juices, chips, cookies, crackers, biscuits, candy, and other desserts and snack foods.  
Protein is an essential nutrient found in all of the cells of the body. It is composed of amino acid units that are important building blocks for the growth and repair of muscle, tendons, skin, hair, and blood vessels. Protein is found in a variety of foods including meat, fish, beans, dairy, nuts, seeds, eggs, and whole grains.
Fat is a nutrient that is important for absorption of fat soluble vitamins (A, D, E, and K). There are different types of fats: saturated, unsaturated (polyunsaturated and monounsaturated), and trans fats. Fats are found in oils, milk, butter, cheese, nuts, seeds, fish, meats, and coconuts.
WAB: Continuing with basic background information, what is type 2 diabetes? Why is overweight and obesity linked to type 2 diabetes?
TM: Type 2 diabetes is a condition characterized by consistent high blood glucose concentrations that has resulted from a combination of insulin resistance and-or decreased insulin secretion. Insulin is a hormone released from the pancreas that is necessary for the storage of glucose or use for energy.
Along with family history, obesity and physical inactivity are major risk factors for acquiring type 2 diabetes. A decrease in insulin sensitivity and secretion has been seen with abdominal obesity. With excess fat accumulation, there has been shown to be an increase in flux of free fatty acid to the liver, leading to an increase in insulin resistance. These defects then contribute to the development and progression of diabetes.
WAB: What is the ketogenic diet and why is it called that? Is it like other diets, for example, Atkins?
TM: A ketogenic diet is defined as a high fat, low carbohydrate, moderate protein diet that forces the body to breakdown fat and protein for energy instead of glucose. This puts your body in ketosis, hence the name ketogenic, which mimics a state of starvation or fasting.
The Atkins diet is similar to the ketogenic diet due to its low carbohydrate features, however the ratio of macronutrients is different. While there are different versions of the Atkins that can be followed, one of the less strict versions is around 55 to 65 percent fat, 20 to 30 percent protein, and 10 to 15 percent carbohydrate. In contrast, the ketogenic diet is typically at least 75 percent fat, 10 to 20 percent protein, and 5 percent carbohydrate.
WAB: 75 percent fat seems like a lot of fat. Please comment.
TM: I always educate my patients on why a 75 percent fat diet may not be the best for their health especially if they have a family history for heart disease. Educating them that they should not be getting their fat from red meat and more from nuts, seed, plant oils, and avocados may steer them away from the keto diet.
WAB: Tell me more about ketosis? How does it work?
TM: After drastically reducing carbohydrate intake for three to four days, glucose reserves become depleted and the body is required to find an alternative source of energy. The body then puts out excess ketone bodies from fat, which are used by the tissues for energy. This is also the natural metabolic process that the body uses to adapt during starvation.
WAB: What are the pros and cons of the keto diet?
TM: The pros—you may see significant weight loss, possible improved diabetes management, and management of epilepsy. Cons—you may experience constipation, the “keto flu,” which includes a headache, lightheadedness, nausea, and fatigue, and this is a very strict diet that can be hard to sustain.
WAB: Can the human body get all or most of the essential nutrients it needs to function properly and stay healthy from the keto diet?
TM: The keto diet greatly decreases or eliminates important food groups such as whole grains, fruits, vegetables, beans and legumes, which have all been shown to be beneficial to overall health. These food groups contain an abundance of vitamins, minerals, fiber, and antioxidants that our body thrives on. Therefore, nutrient deficiencies may be likely in the long term.
WAB: Can the keto diet raise cholesterol to unhealthy levels? If so, what are the possible health risks of this?
TM: While on the ketogenic diet, there is the potential for cholesterol levels to raise. A lot of research, however, actually shows that triglyceride and HDL cholesterol levels improve, while LDL and total cholesterol stays the same. However, most of the studies assessed levels after a year or less, so the long-term effects are not clear and should be monitored.
WAB: Do you know people who have gone on the keto diet and, if so, what have been the results?
TM: I go to a gym where people have tried keto to win the challenge the gym is sponsoring, but after the challenge the weight came back because they stopped the keto diet. Changing your diet is hard no matter how you change whether it’s keto or eating more veggies. Why spend time and energy on habits that are unrealistic? We also do not know the long-term effects the keto diet has on our health.
WAB: Can the keto diet help type 2 diabetics lower and control sugar?
TM: Research shows that low carbohydrate diets, including the ketogenic diet provide greater blood sugar control for type 2 diabetics and may provide improved insulin resistance. When the body transfers from using carbohydrates for energy to using ketones for energy, there is a decreased need for insulin and therefore a decrease in the secretion.
WAB: Can the keto diet help non-diabetics who want to lose weight quickly and keep the weight off?
TM: The ketogenic diet has been shown to provide significant weight loss—long-term sustainability, however, is questionable. The ketogenic diet is very strict and hard to sustain, so if the person loses weight and then goes back to their old way of eating, then the weight will likely come right back on. Additionally, it is important to keep in mind that this is not a fix-all solution to health and weight loss.
WAB: Does the keto diet affect men and women, youths, adults, geriatrics differently or the same?
TM: I have not come across any research that looks at the different age groups and genders for the keto diet—besides using the ketogenic diet for epilepsy in children. Men and women working full-time jobs with families to take care of make it extremely hard to follow a restrictive diet that their whole family has to follow. I am sure each mom and dad wants to instill healthy eating habits on to their children. Working on healthy habits they are going to need their whole life like eating fruits and vegetables, drinking water, and staying active may be more effective then teaching them how to stay on a restrictive diet.
WAB: Tell me more about the issue of sustainability? Overall, do you believe there is a better alternative to the keto diet?
TM: The keto diet is not a very sustainable diet. With such a high fat focus and low carbohydrate focus, it is very restrictive. When people feel the diet they are following is restrictive, there is a high chance of rebounding right back to those foods that were being avoided. This then results in weight gain and frustration. This diet can also take away some enjoyment from eating and actually add stress, if surrounded by people who are enjoying a piece of cake or other high-carb food, snack or beverage. It may also be difficult for families who do not all follow this same way of eating, because additional meals or food items may need to be prepared to fit the ketogenic meal requirements.
I think a better alternative to the keto diet is to focus on balance and including more whole foods that are nutrient dense including fruits, vegetables, whole grains, low-fat dairy, lean proteins, and healthy fat. In combination, limiting intake of added sugars, saturated fats, and sodium from sources such as soda, juice, fast food, processed snacks and desserts.
WAB: Do you recommend the keto diet to your patients? If so, who and under what circumstances or health conditions, if any?
TM: We do not typically recommend the keto diet to any of our patients. However, since there has been great success seen with using this diet for epilepsy, this would be an instance that we would recommend it.
WAB: In my limited research, I have come across medical doctors who are recommending and treating their patients with the keto diet? Have you come across this, too?
TM: Yes, we have seen medical doctors request patients go on the keto diet for weight loss. When we meet with the patient and discuss their goals and lifestyle often times it is not realistic for the patient to practice a keto diet. It is more likely they will be able to stick to a low carbohydrate diet then keto. Sure, they would probably lose weight faster if they practice keto, but what I have seen is that the weight comes back on as soon as they stop following the restrictive diet. If the patient wants to try the keto diet, I help them with a two-week meal plan. When they come back for a follow-up they either feel sick with headaches and fatigue or they feel depleted because they were not able to follow the diet. Both situations make the patient feel bad physically, mentally or both, and it creates this unhealthy relationship with food.  
WAB: Thank you.

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