I have heard so many people say – try keto! You can lose weight and eat all the junk you want!
Constipation, muscle loss, headaches, kidney damage, bad breath—these are only some of the surprising and potentially dangerous side effects of the ketogenic diet.
Last year I used to train with a trainer who kept insisting I should try keto I had lost over 40kg by that time and still have 20 kg to go and he insisted that the only way I would get rid of those last 20 kg was through the ketogenic diet. I must admit as a health care professional this diet was never appealing to me – and I have tried almost everything out there as I was desperate for many years. I never tried it out but I have done extensive research about it which I am sharing with you here today.
History of keto?
The ketogenic diet (KD) is based on the principles that it should be a high fat, low carbohydrate, controlled protein diet that has been used since the 1920s for the treatment of epilepsy. The diet is a medical treatment and is usually only considered when at least two suitable medications have been tried and not worked in controlling epilepsy. Studies have shown that 4 out of 10 children on the keto diet get fewer seizures and are more alert and responsive. In the 1990s this diet was revamped as the son of a famous producer in the USA developed epilepsy that was more adequately controlled with Keto. He invested money into more research about this diet and that’s when interest kept increasing.
What is the keto diet?
The main idea behind the ketogenic diet for weight loss is that if you deprive the body of glucose (sugar)—the main source of energy for our cells in the body, which is obtained by eating carbohydrate foods—an alternative fuel called ketones is produced from stored fat (thus, the term “keto”-genic).
Our brain needs glucose the most. And it needs it in steady supply for our brain to function properly. It is estimated that the brain needs about 120 grams daily because it does not have the ability to store glucose. When we are eating very little carbohydrates or we are fasting, the body first uses up all stored glucose from the liver and temporarily breaks down muscle to release glucose.
If this continues for 3-4 days and stored glucose is fully depleted, blood levels of a hormone called insulin decrease, and the body begins to use fat as its primary fuel. The liver produces ketone bodies from fat, which can be used in the absence of glucose.
When ketone bodies accumulate in the blood, this is called ketosis. Healthy individuals naturally experience mild ketosis during periods of fasting (e.g., sleeping overnight) or during/after very strenuous exercise.
What is ketoacidosis?
When ketone levels get too high it can produce a dangerously toxic level of acid in the blood, called ketoacidosis. During ketoacidosis, the kidneys begin to excrete ketone bodies along with body water in the urine, causing some fluid-related weight loss. Ketoacidosis most often occurs in individuals with type 1 diabetes because they do not produce insulin, a hormone that prevents the overproduction of ketones. However, in a few rare cases, ketoacidosis has been reported to occur in nondiabetic individuals following a prolonged very low carbohydrate diet.
There are many versions of the ketogenic diet with different ratios of macronutrients (carbohydrates, protein, fat). This diet typically reduces total carbohydrate intake to less than 50 grams a day—less than the amount found in a medium-sized plain burger bun—and can be as low as 20 grams a day. Generally, popular ketogenic websites suggest an average of 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. The protein amount on the ketogenic diet is kept moderate in comparison with other low-carb high-protein diets because eating too much protein can prevent ketosis. The amino acids in protein can be converted to glucose, so a ketogenic diet specifies enough protein to preserve lean body mass including muscle, but that will still cause ketosis.
Many versions of the keto diet exist, but all have one thing in common – they ban carb-rich foods. Some of these foods may be obvious: starches like bread, cereals, pasta, rice, potatoes, biscuits, and other starchy vegetables; and fruit juices. Some that may not be so obvious are beans, legumes, and most fruits. Most ketogenic plans allow foods high in saturated fat, such as fatty cuts of meat, processed meats, butter, avocados, plant oils, and oily fish. Depending on your source of information, ketogenic food lists may vary and even conflict.
The research so far
The ketogenic diet has been shown to produce beneficial metabolic changes in the short-term. Along with weight loss, as well as reduced insulin resistance, and improved blood pressure readings. These are benefits people who have done the diet claim to have experienced:
- Decreased food cravings due to the high-fat content of the diet.
- A decrease in appetite-stimulating hormones, such as insulin and ghrelin, when eating restricted amounts of carbohydrate.
- Less hunger.
- Promotion of fat loss
Disadvantages of keto
Apart from the fact that following a very high-fat diet may be challenging to maintain. There are several negative effects of the keto diet on your health.
1. Keto flu
Flu-like symptoms that are not the actual flu. It’s just your body’s natural response to switching over to using ketones as energy and is generally characterized by brain fog, headaches, nausea and fatigue. This under-the-weather feeling is related to plummeting electrolyte levels (like sodium, magnesium and potassium) as your kidneys flush out excess water.
2. Bad breath and bad smell
One of the biggest complaints keto dieters (and their partners) have about the diet is related to their embarrassingly bad breath. Some even say their mouths taste metallic. One of the ketone bodies is acetone (yep the kind you find in nail polish remover). Ketones, like acetone, are released from the body through exhalation, sweating and urination, so smelling like a nail salon is actually a good indication that you’re actively in a state of ketosis.
3. Hair loss
While hair loss isn’t inevitable on the keto diet, it’s also not uncommon. Vitamin and mineral deficiencies (specifically zinc and biotin), and unfavourable shifts in the microbiome due to the restrictive and high-fat nature of the diet can all lead to hair loss.
One of the biggest health concerns with the ketogenic diet is the lack of carb-rich whole grains, pulses, fruits and starchy vegetables all of which contribute fibre to your diet. Not surprisingly, many keto dieters experience constipation.
While constipation is more common, disruptions in the intestine are still regular occurrences. A lot of keto dieters are big fans of adding coconut oil or MCT oil (a supplement of concentrated medium-chain triglycerides from coconut or palm kernel which has been promoted by influencers lately) to their smoothies and protein shakes. The problem is that while MCTs are a type of fat that our bodies process more quickly—providing energy bursts while also helping keep off weight gain—too much can overload your kidneys and not get processed properly. The result? well, you better stay close to a bathroom.
6. Kidney stones
Kidney stones develop when a hard mass of crystals develops in the urinary tract. Kidney stones are often very painful. When too many ketones build up in the bloodstream, the urine becomes slightly acidic, which can put stress on the kidneys and potentially raise the risk of developing kidney stones. in addition to this, it was found that people consuming a diet high in protein may also become dehydrated, which concentrates the urine and may contribute to kidney stone development. The higher amount of acid in the blood can also lead to gout.
Many people experience sleep disturbances especially during the first few weeks on this diet.
8. Weight regain and development of dangerous dieting patterns
The keto diet can also lead to a yo-yo effect with weight because people have difficulty staying on a restrictive diet permanently.
That can have other negative effects on the body even long term as yo-yo dieters have been shown to have higher mortality rates.
Furthermore, it can result in some muscle loss which eventually slows down the metabolism as well.
9. Disruption in the menstrual cycle
Around 45% of women on the keto diet report having irregular periods, while others say their monthly cycle vanished altogether after adopting keto. One of the main hormones in play here is oestrogen, which is responsible for regulating the menstrual cycle. Oestrogen levels vary as weight drops quickly. Lower estrogen levels have certain side effects that go along with that, such as vaginal dryness, and increased risk of osteoporosis that has also sometimes been linked to keto.
Unanswered Questions about Keto
- What are the long-term (one year or longer) effects of, and are there any safety issues related to, the ketogenic diet?
- For which disease conditions do the benefits of the diet outweigh the risks?
- As fat is the primary energy source, is there a long-term impact on health from consuming different types of fats?
- Is the high fat, moderate protein intake on a ketogenic diet safe for disease conditions that interfere with normal protein and fat metabolisms, such as kidney and liver diseases?
- Is a ketogenic diet too restrictive for periods of rapid growth or requiring increased nutrients, such as during pregnancy, while breastfeeding, or during childhood/adolescent years?
- Can Keto affect fertility?
Lately, Facebook has been bombarded with ads about these so-called miracle keto pills. The expensive supplements are made with ingredients such as ketones designed to suppress appetite, electrolytes for the dehydrating effects of the diet, and even caffeine.
Some suggest that ketone supplements can mimic ketosis and raise blood ketone levels without changing your diet.
However, that’s not exactly how your body interprets it.
The purpose of the ketogenic diet for weight loss is to produce ketones from stored fat as an alternative fuel source.
Taking ketone supplements may prevent body fat from being used as fuel, at least in the short term..
Studies found that ketone supplements may hinder weight loss efforts. Since they play tricks on hormones by suppressing appetite and can actually lead to weight gain in the long term.
Until more research is available, there’s no real support for using ketone supplements as a weight loss aid.
My advice: Don’t Become Weight Obsessed
As a health care professional and having lost 47kg myself My advice is to keep food in perspective
There is no magic bullet for long-term weight loss. For long-term weight control, a Mediterranean style diet focused on fruit, vegetables, whole grains, beans, fish, and olive oil, is one that can be healthy for life.
Cutting refined carbs and replacing them with fresh fruits, vegetables, and lean protein, cutting processed foods, and avoiding too many additives will keep you healthy in the long term.
Do not skip meals because your body goes into overdrive the next time you eat. That can actually cause you to eat more, not less.
A ketogenic diet could be an interesting alternative to treat certain conditions and may accelerate weight loss. But it is hard to follow and it can be heavy on red meat and other fatty food. We also do not know much about its long-term effects, probably because it’s so hard to stick with that people can’t eat this way for a long time.
It is also important to remember that “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality. Instead of engaging in the next popular diet that would last only a few weeks to months (for most people that includes a ketogenic diet), try to embrace change that is sustainable over the long term.
Stay away from fashion magazines. They make us feel inadequate. If you are even considering an insane approach to weight loss, go for a walk … right now! It’ll clear your head.