By
Jaclyn London, Good Housekeeping
[post_ads]Two weeks ago I wrote about why the ketogenic diet is total B.S.,
and the internet didn't take it too well. People on Facebook called it
"false," "intellectually disingenuous," and even straight-up "terrible."
One reader even devoted a whole blog post to dissecting the information line-by-line.
The keto diet — a low-calorie, high-fat eating plan touted by celebrities and Instagrammers alike — aims to activate the metabolic process called ketosis,
when our bodies use fat for energy instead of sugar. Followers say it's
helped them lose weight and gain energy, and they still get to eat
bacon and butter.
My response: The ketogenic diet may work for you personally
right now, and if that's the case, then go for it — as long as you
inform your physician about your diet, medical history, and medications.
It's your choice to eat keto and make it work for you.
But from a public health standpoint, making a sweeping generalization in support of this diet would be negligent.
It's my job as a registered dietitian (RD) to evaluate all the research
in the context of scientific consensus, study strength, and long-term
risk factors. Collectively, the existing information indicates that the
keto diet can lead to nutrient deficiencies and prove difficult to
adhere to long-term.
Still,
I read through every response to my original article. I've included
some of those comments below, ones that represent common opinions about
the keto diet, to elaborate on where I stand:
1.
"There's a ton of research on ketogenic diets."
"This
article is so intellectually disingenuous. The author obviously spent
little time researching ketone production and its use through all of
human evolution. Keep eating sugar and promoting the S.A.D. diet. It's
killing people perfectly well." — Brett R.
You're right that there is some research on the ketogenic diet, but not much looks at the long-term effects on overall health and weight maintenance.
The best studies conducted for more than one year looked at the impact
of keto on pediatric seizure disorders. The benefits for epilepsy in
these cases outweigh the potential risks.
In fact, one 10-year study conducted on keto and epilepsy management in children found
the following side effects: constipation (65%), high triglycerides
(40%), high cholesterol (29%), diarrhea (19%), lethargy (17%), iron
deficiency (15%), and vomiting (13%).
As for the Standard American Diet (SAD), I am absolutely not
suggesting that we don't have big challenges when it comes to healthier
eating habits, but my less-than-enthused stance on keto isn't because
I'm comparing it to SAD. Rather, I think it's important to
compare a keto plan to its weight-loss counterparts, like the
well-substantiated Mediterranean diets and its spin-offs, like DASH,
MIND, and TLC. Those plans incorporate wholesome, nutrient-dense foods
that encourage improved eating patterns and manageable weight loss.
2.
"It's not just butter and coconut oil."
"I
do not subsist in butter and coconut oil. Nor am I bored eating bacon
and cheese omelettes and prime rib. I make sure I take supplements so my
systems function like clockwork. We have lost a total of 113 Lbs
between the 3 of us which is a whole lot more than 'water weight.'" — Theresa G.
It's true that the diet is not just butter and coconut oil, but it's still quite high in saturated fat. A lack of boredom doesn't imply that it's a health-promoting plan either.
You
said it yourself: You take a supplement to protect yourself from
deficiencies, including (but not limited to) iron and zinc. You're also
at risk for missing potassium, magnesium, folic acid, and beta carotene.
Know that the FDA
doesn't oversee supplements, so you may not be getting exactly what you
pay for. Plus, certain nutrients consumed as supplements can also have a
pro-oxidant effect, meaning they do more harm than good. The end
result: Increased risk of chronic disease, including heart disease and some cancers.
I'd
also encourage you to have a look at photos tagged #keto on social
media: beverages loaded with heavy cream, cheeseburgers without buns,
and lots o' processed meat. So while it's possible to consume foods both
compliant with the diet and nutritious, the messaging surrounding keto
is the perceived ability to eat tons of fast food and skimp on sprouts.
3.
"It's outdated to say that 'low-fat' is good for weight loss."
"I
don't eat keto however the research in this article is terrible. It
supports the outdated notion that low fat is good for you...a little
secret it's NOT. Since America's diet has shifted from high fat to low
fat, diabetes and heart disease has become an epidemic. Fats are not
killing us, sugar is. Keto is not going to harm your body, but
continuing to eat processed foods is." — Jessica P.
I
couldn't agree with you more that extremism in our diet culture has
created undeniable issues as a result of low-fat, high-carb processed
foods. But the point of the keto debate is not comparing it to junk food, but rather the benefits of a Mediterranean-style eating plan.
Yes,
diets high in refined sugars and breads are linked to obesity, but
turning from one extreme to another is not the solution to the obesity
epidemic.
We know
that extreme diets such as keto may induce weight loss. However, recent
studies indicate that the extreme fat intake required to bring the body
into ketosis may also have negative effects. A 2015 review published in Nutritional Neuroscience found
that keto can increase risk of diabetes, heart attack, and strokes in
children treated for epilepsy — risks considered less significant than
enduring seizures, but ones not beneficial for the overall population, 49% of which is at risk for heart disease.
Another meta-analysis published in the British Journal of Medicine in
2013 evaluated ketogenic diets versus low-fat diets for long-term
weight loss. It found that keto works for weight loss short-term and may
lower blood pressure, but it can also increase LDL cholesterol.
The
authors also say their own research analysis overlooked key indicators
of health: Liver function, vascular function, cardiovascular events, and
kidney function. In other words, we don't necessarily know the harm
that ketogenic diets can cause.
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4.
"I've lost weight and kept it off."
"Works
great for me. I lost all the weight I wanted to lose and have kept it
off. I like eating this way and I've felt better than I ever have!" — Heather S.
Your eating habits are personal, and if you wan to lose weight, then you should follow
the plans that work best for you! That said, it's still crucial that
you look into whether or not you're meeting all of your nutrient needs
in food form in order to remain healthy over time. The
fact that there's not much research on the overall sustainability of
ketogenic diets is what prevents many nutritionists from recommending it
universally.
That
said, if a particular eating plan causes immediate weight loss, and
subsequent gain once you stop, that's not solving any medical or public
health issues long-term.
Diet-induced
weight fluctuations factor in heavily when healthcare professionals
give advice, especially because RD's like me always look to apply the
most current, well-researched
scientific data to whomever we counsel. A big component of that is
weighing benefits versus risks, and what we do know is that there may be
some risky long-term effects of frequently gaining and losing weight.
Extreme diets promote doing just that.
It
may be more helpful to put into this context: If we were talking about a
medication instead of food, would you consider it sound advice to say
that taking a certain drug "might be safe, but definitely not safe for everyone, and it may only work temporarily and cause damage to other biological systems?" Not so much.
 |
5.
"This diet reversed my type 2 diabetes."
"I
have been on keto for almost a year. I was on the verge of being placed
on insulin with diabetes 2. Since having started keto I have lost
50lbs. My HDL has gone up and my LDL has gone down as have my
triglycerides. My blood pressure is the best that it has ever been. My
A1C is at a 5.3 and I have gotten off my high blood pressure meds and
cholesterol meds and my numbers continue to be great." — Sebastian T.
First
of all, congratulations! Significant weight loss is a tremendous
accomplishment, and I applaud you for getting where you are now.
To
your point, this is where the benefits come in: Losing more than 10% of
your body weight when you're overweight or obese can significantly
improve your metabolic state of health, regardless of how you got there!
With that in mind, it's likely your type II diabetes "reversed" course thanks to the weight you lost — not the diet itself.
However, if you are diabetic
and considering a ketogenic diet, it's essential that you know this:
"Ketogenic diets may help some people with type II diabetes lose weight
and therefore reduce blood sugar, but they're not safe for everyone with diabetes," says Dr. Elise Brett, Associate Clinical Professor in the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai Hospital. "One should always check with a doctor before starting this type of diet."
Many
diabetes medications actually require eating some carbohydrates to
ensure they work. "Diabetes medications avoid low blood sugar reactions,
and people who take insulin and/or [medications] called SGLT-2
inhibitors may put themselves at risk for a life-threatening condition
called diabetic ketoacidosis (DKA) in which ketone levels in the blood
reach dangerously high levels," Dr. Brett adds.
While
some keto studies have shown improved blood glucose levels, nearly all
of the research conducted to-date states that the strict parameters have
a side effect of decreased adherence over time.
If
keto's too restrictive to maintain for forever, it can lead to weight
cycling, or gaining and losing a lot of weight when "dieting" versus
when you're not. This can lead to impaired glucose tolerance, chronic
inflammation, and possibly higher cardiovascular disease risk.
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The Bottom Line
The
more interest grows in the topic (on either "side" of the debate!), the
more research will occur. But let's zoom out before we zealously
advocate for any diet limited in plant-based foods. Cutting back on
these nutritious foods for the purpose of weight loss can propagate
myths about balanced diets. It also creates continued confusion and a
culture of extremism that's not suitable or sustainable for everyone.
To make real,
long-term changes, we can't rely on restriction. We have to approach
health and weight loss with an understanding of our own lifestyle, and
shift toward healthier eating habits through behavior changes that last a
lifetime.
