Keto diet is one of the most famous fad diets in the past few years but this could be an understatement. A very low carbohydrate and high fat keto diet is one regimen that is proven to be effective for rapid weight loss, according to a research done by Masood (October, 2018). This is the reason why people have shown great interest in this kind of diet.
What is keto diet?
A keto diet consists of high amount of fat, moderate protein, and very low carbohydrate. In percentage, this diet would contain 55-60% fat, 30-35% protein, and only 5-10% carbohydrate. This only amounts to about 20-50 grams of carbohydrate per day if we take a 2000 kcal diet.
Origin of the Diet
In 1921, Russel Wilder used the keto diet for the treatment of epilepsy and termed this the “ketogenic diet.” It was used in the world of medicine as a therapy for pediatric epilepsy for almost 10 years however its popularity ceased to rise with the advent of AED (anti-epileptic drugs). Its popularity resurfaced when it was used as a rapid weight loss formula regimen at least on a short-term.
Is the keto diet safe?
Before discussing whether or not the keto diet is safe, it is important to know the basics of carbohydrate metabolism. Carbohydrate is the major source and storage form of energy in body tissues. So, when the body is deprived of this molecule either through starvation or reduction of intake, the body secretes less insulin and thus it enters into a catabolic state. Carbohydrate stored as glycogen will be depleted, and because of this the body will undergo two important metabolic changes namely – ketogenesis and gluconeogenesis.
Simply put, gluconeogenesis is a process where the body endogenously produces glucose from body stores especially in the liver from glycerol, amino acids, and lactic acid. However, when the body could not keep up with the body needs, ketogenesis begins to provide alternative source of energy, and this is usually the result of low insulin production. This is what we call as the physiologic response of the body when there is low carbohydrate source for energy. When this is sustained, this is termed as nutritional ketosis, one that is now being used as the keto diet. This should be differentiated from the life-threatening condition named as ketoacidosis wherein ketone bodies are produced in much larger proportion than in the nutritional ketosis, which alters the normal body pH to an acidotic state.
Therefore, when asked whether keto diet is safe, it is best to answer it in the status the body is currently in.
1. It is safe when the body is under nutritional ketosis. You are physiologically altering the body intake of carbohydrate to about 50g or less and therefore the body’s response would be physiologic as well.
2. It is safe only when the person does not have other medical conditions that would further alter the state of the body’s energy reserves such as those with diabetes mellitus. People who are highly likely to get into the acidotic state than healthy people should never use keto diet as this could lead to life threatening condition later on.
3. It is safe if the individual using it under supervision of a family physician or a dietician, who can identify whether the body’s state is still under nutritional ketosis or is already decompensating.
4. It is safe only when used as a regimen for rapid weight loss rather than for long-term use. Still, research has shown that once the individual has achieved the targeted body weight balance in diet should be resumed thereafter.
5. It is safe when the individual understands the implications of this type of diet and would follow strictly the advice of physician or dietician prior to starting the regimen.
A recent trial done comparing the long-term effects of various dietary regimens for weight loss showed no significant evidence that recommends low-fat regimen. In fact, it is usually the other way around. Those diets containing low carbohydrate often led to much greater weight loss as compared to low fat regimen. This means that restricting the body with carbohydrate often led to more weight loss and significant improvement of the individual’s basal metabolic rate thus leading to more health benefits in the long run. Said another way, the caloric quality consumed on a daily basis will affect how much calorie the body is burning.
Clinical Significance of Keto Diet
A keto diet that is well-formulated – mainly by carbohydrate restriction, limited protein intake, more fat diet – which is implemented correctly will lead to stable glucose production and more rapid weight loss of up to 4.5 kg in just a matter of 2 weeks. Furthermore, this diet has a diuretic effect, which means that the body is excreting excess water. In fact, the initial weight loss early in the implementation of the diet is due to excess water loss, which is followed by fat loss. What is interesting about the keto diet is that lean body muscle is usually spared, thus the individual will retain a lean muscle throughout the regimen implementation. When the nutritional ketosis is sustained, the hunger sensed by the individual diminishes, which reduces the overall caloric intake leading to more weight loss.
Implications
Overweight to obese people who are suffering from metabolic syndrome, type 2 diabetes, and some form of insulin resistance will experience improvements with regards to the clinical markers of their disease when they follow a well-formulated keto diet. Glucose control in these individuals usually significantly improve because there will be reduction in the glucose concentration thus improving insulin sensitivity. In addition, blood pressure and glucose regulation could be improved as well. However, it is important to note that in some cases the level of the bad cholesterol – LDL cholesterol – may increase.
Due to the complex mechanisms involved in keto diet and the deficiency of studies about its long-term effects, it may be premature to recommend this diet to prevent cardiovascular diseases and the development of type 2 diabetes mellitus. However, the recommendation of this diet as a rapid weight loss regimen is not farfetched.
The bottom line is that keto diet researches are still new and the major trials are still underway. This means that there is no available data regarding its safety and efficacy when used in the long-term. Also, it is not generally recommended for the general population and thus proper patient selection should be followed.
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