The ketogenic, keto, or keto diet has gained a lot of popularity lately, with many blogs and shows devoting time to it. The purpose of this article is to clear up the misinformation surrounding this diet.
This article may be taken as hostile to the ketogenic diet community, but that is all it is. I truly believe that there is no reason for someone not to follow the diet that suits them, whatever it may be, when it helps them to be healthy and it can be sustained over the long term.
But there are many myths and misconceptions surrounding the ketone diet. The more popular it becomes, the more books and articles on the internet write about it, but misleadingly, for the purpose of sales.
So, I decided to write this article to clarify the truth and give some tips and instructions to anyone who wants to keto and stay healthy.
WHAT IS THE KETOGENIC DIET
The keto, or ketogenic, ketogenic or ketone diet, the nomenclature of which varies in the literature, has been around for almost a century. Its journey began as a way of treating epilepsy, as ketones are neuroprotective, although the macronutrient distribution was very different (90/6/4) from modern versions.
The ketones or ketonesomes are β-hydroxybutyric acid (βHB), acetoacetic acid (AcAc) and acetone. These are produced by the liver when the body considers itself to be in a state of starvation (e.g. very intense exercise, fasting, substances that interfere with insulin production such as alcohol, type I diabetes) as an alternative 'fuel' to glucose.
So, by depriving the body of glucose and consuming mostly dietary fat, we make sure that we use ketones as one of our fuels, which in turn need to be broken down into fatty acids to be created, which sounds nice, but, as I explain later, there is a difference between theory and practice.
COMPLIANCE IN THE DIET
While it is true that ketosis helps to some extent with hunger, this is not the case for feeling full from eating, as many people need fibre for that (this is relatively easy to solve, I'll explain later). Even worse, although dietary fat can stimulate some of the hormones associated with appetite control such as CCK, it doesn't seem to be as capable of stimulating GLP-1, GIP and PYY as protein, carbohydrates and fiber.
Thus, adherence to this diet is Hardly than what is presented in books and articles on the internet.
What I want to say so far is simple. Don't expect miracles, but if you find following a ketogenic diet easy, don't be afraid of it. On the other hand, don't keep beating yourself up just because people keep feeding you false hopes if you see that you can't stick to it. Follow what is convenient for you so that you can be healthy. Ketosis is not magic.
KETO AND HEALTH
Contrary to what the gurus would have you believe, keto cannot cure incurable diseases, rheumatism, nor is there any conspiracy theory against it. Most of the health improvements we hear about come mainly from losing weight and avoiding convenience, fast and poor quality foods.
Another part is due to the fact that a whole group of macronutrients is removed. As a result, many known diseases and allergies, such as irritable bowel syndrome, are no longer apparent. Or to put it more bluntly, if I'm lactose intolerant, I'm not cured because I went vegan. And finally, we shouldn't forget that it's always the success stories that are known, not the failure stories.
On the other hand, we don't know enough about ketones to be sure that ketogenic diets are appropriate for the general population when there is no supervision, which leads many to take a conservative stance. What do I mean?
First, ketoacidosis. Although the most common form is Diabetic Ketoacidosis, it can also occur under other conditions, such as in alcoholics, pregnant women and when the body is in high caloric deficit. It is something that does not happen often, but the number of incidents is increasing with the ketone diet now in vogue.
In short, if you're planning to lose weight with keto, it wouldn't be a bad idea to avoid too much alcohol, monitor your calories and use ketone tapes to make sure they're not too high (the opposite of what most sources tell you). Anything over 0.5 mmol/l is ketosis. Don't obsess about the numbers, there is no benefit as I hope you have realised from the previous paragraphs.
Second, long periods of carbohydrate deprivation can lead to insulin resistance. If you don't remember how homeostasis and allostasis work, I would suggest you reread "How our body works I": Pancreatic cells responsible for insulin production adapt to lack of stimulation and become underactive. When this becomes a chronic condition, there is a risk of progression to diabetes.
You should not be afraid though, as there is a solution to both of the above issues: Restriction. It's a term I've used before, in "Basic principles of nutrition Part I". In our case, we can say that we will eat keto on weekdays and carbohydrates on weekends. This way we reduce the chances of ketoxidation and don't put the pancreatic beta cells into inactivity.
Contrary to what the popular books say, you can consume more than 50g of carbohydrates every day without going out of ketosis. Even more if you exercise or are active, provided you are in a caloric deficit or don't consume large amounts of protein. If the calories you lose from exercise are more than the calories you get from carbohydrates, and they are evenly distributed across meals, there is no way you are out of ketosis. Usually, 150g of carbohydrates, considered a low carbohydrate diet and capable of raising the βHB to ketosis levels. In short, there is no reason not to have fruits, berries and vegetables in your life. Find your own daily goal using ketone measuring strips.
Similarly, when carbohydrate intake is low, protein can go up, which is recommended as it has a positive effect on appetite. For the sake of argument, I include two classic studies by the pioneer of the ketogenic diet Stephen Finney, one on a hypocaloric diet, where protein was at 1.2g/kg and another one in eucaloric diet, where the protein was 1.75g/kg. It's really hard for protein to kick you out of ketosis if your carbohydrate intake is low, contrary to what you usually hear.
MICRONUTRIENTS AND PLANT FIBRES
Another common misinformation is that the vitamins you need will be reduced. This is especially true for minerals (e.g. calcium, magnesium, iron) and folic acid (vitamin B9), while contrary to what is said, the needs for vitamin C remain about the same, while the needs for B12 increase. Vitamin B1 (Thiamine) deficiency is common in ketogenic diets and which in the long run can bring about diseases such as Wernicke's encephalopathy and Berry-Berry disease. And let's not forget the minimal intake of phytochemicals, such as polyphenols and carotenoids, which have been shown to have multiple benefits to the body.
Also, fibre is essential. There is no research that does not link at least 14g per 1000Kcal with benefits in all areas of health. And this is one of the reasons why book authors tell you that fiber has no calories, when this is not true. You can get a supplement if you want, but I would suggest glucomannan pasta, as it can be extremely effective in terms of making you feel full from eating, as long as you rinse it and boil it well to get rid of the characteristic smell.
KETO AND FAT LOSS
Keto is not intended to give you any "metabolic advantage" or "edge". Anyone who has tried to do research to prove this has failed, at least in humans. The latest example is Gary Taubes' mega-million-dollar foundation, in whose latest research scientists had to "hide" evidence and change methodology to reach this conclusion.
Even the big words that advertise that following it will make you burn more fat are disingenuous. Obviously when you eat more dietary fat, it will result in more fat being oxidized. There is no magic to it. There has never been any evidence that isothermal, equal amounts of protein diets can have different results in fat loss. Only in water loss.
SOURCES OF DIETARY FAT
As a conclusion I left the fat sources. Although I can't talk about such a difficult subject as lipidology in one paragraph, once again book authors are lying by saying that you can safely eat saturated fat by sewing conspiracy theories. If there are any people motivated to lie it is those who have to imagine machinations to sell books, not the hundreds of scientists with continuous research for nearly half a century who agree.
In fact, from person to person there can be big differences how much the ketogenic diet affects LDL-c levels. It is irresponsible and dangerous in order to advertise your diet as easy to claim that all one has to do is avoid carbohydrates and eat a lot of fat without worrying about saturated fat consumption.
Finally, high phytosterols, trans fats, high salt and processed meats should be avoided, while it is advisable that fat sources are rich in omega-3 fats. So:
- Butter: Avoid
- Margarine: Avoid unless you're sure they don't contain trans fats
- Vegetable oils: Try to have olive oil as your primary cooking oil, although as a rule try to avoid fried foods
- Red meat with fat: Try to avoid
- Lean meat: Yes
- Processed meat: Avoid
- Fatty Fish: Essential
- Fish in general: Avoid processed, high-salt fish
- Allied products, pastes and pastes of nuts: Try to avoid overconsumption
- Nuts and seeds: Essential
- Eggs: Yes (moderate egg consumption is associated with an increase in HDL-cbut there are other factors to consider)
- Milk and yoghurt: Yes
- Cheese: Yes if low in salt and fat otherwise moderate consumption
- Avocado: Yes, although generally low in omega-3 fats
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