Expat Life

Nutrition myths busted! The Ketogenic diet

A reader wrote to ask where in Cuenca he could buy “ketosis strips” to test his urine for ketones since he had decided to “pursue a ketosis diet.” He noted that purchasing a ketone testing machine is much more expensive, so I assume he’s looking to save money.

Well, I thought, you can try the pharmacy! After all, finding ketones in your blood is a “sick state.” Ketone strips were designed for people with diabetes to test if their blood sugar was dangerously high, a sign of uncontrolled diabetes. Finding that ketones are spilling over into urine signals a medical urgency, to avoid falling into metabolic ketoacidosis. Ketoacidosis is the leading cause of death of people with diabetes who are under 24 years of age. Read more here.

While the popular weight loss ketogenic diet is not the same as metabolic ketoacidosis, deliberately eating to promote ketosis is not new either. Developed almost 100 years ago to help treat epileptic children with epilepsy, today, it’s still a useful therapy for this condition.

What Is The Ketogenic Diet?

This is a very high fat, low protein and very low carbohydrate diet that forces the body to produce ketone bodies that replace glucose as an energy source.  Ditching carbs, and making your body burn fat for fuel makes you feel less hungry, possibly linked to the ketone bodies produced and possible decrease of the hunger hormone, ghrelin. Read more here.

How it works:

Ketosis is a normal metabolic process that results when your body is starved for glycogen, or stored glucose. Another way to put yourself into ketosis is to fast — or starve.  We’ve all experienced how we feel when we haven’t eaten for hours, and we may develop “fruity breath” and have a headache and feel light-headed.

Before I continue, I’ll say that yes, the ketogenic diet can help you lose weight. So can any number of other “diets” that restrict certain foods or food groups. More about that later.

What do you eat?

Mostly fat. And more fat. Lots of fat — up to 80%, even 90% of your calories from fat.

Carbohydrate is severely restricted to only 2-5% of calories. Protein is also very restricted to only 10-15% of calories.

Keto Foods?

While there is no absolute ketogenic diet (each person’s response to strict carbohydrate is different) one website, the Ketodietblog.com, advises to eat “freely” of fat, saturated fat like lard, beef tallow, chicken fat, duck fat, goose fat, clarified butter/ghee, butter, and coconut oil.  This blog recommends eating grass-fed meat, wild-caught fish and seafood, pastured pork, poultry and eggs, gelatin and offal (the internal organs of an animal used as food like heart, kidney, liver, brains.)

Carbs are restricted to non-starchy vegetables including leafy greens, some cruciferous veggies, and mostly-water veggies like celery, asparagus, and some squash.

No fruit, except avocado… uniquely high in fat.

How much carbohydrate you can eat depends on your calorie needs.  For example:

1500 calories daily x 5% from carbohydrate = 75 calories

75 calories divided by 4 calories per gram = 18.75 grams – round up to 19 grams

What does 19 grams of carbohydrate look like? Since you’re not eating any fruit, dairy, grains, bread, potatoes or starchy vegetables, it depends on the crunchy vegetables you choose. Keto fans have borrowed from Dr. Robert Atkins’ book, and differentiate between total carbs and “net carbs”, which is carbohydrate minus grams of fiber.  So, for example, 1 cup of broccoli contains 6 grams of total carbs and 2.5 grams of fiber. Subtract 2.5 grams of fiber from the 6 total grams of carbohydrate to get approximately 3.5 grams of net carbs.

In order to achieve ketosis, you must be very strict.  Some websites even advise avoiding certain brands of toothpaste because they may contain sorbitol or other caloric sweeteners.

Once you’re in ketosis and producing ketone bodies (which you determine by testing your urine with those ketostrips), you can occasionally eat some grain-fed animals, some other high fiber vegetables, nuts, seeds, and some soy. Some sites say full-fat cheese is OK as long as you don’t exceed your carb limit.  Others say not.

Sure, the ketogenic diet can produce weight loss. Even a chocolate diet can produce weight loss. When you adopt a program that strictly requires you to eat only certain foods, and eliminate foods, you will lose weight. That has been shown over and over, ad infinitum. In fact, research shows that the more you “go on” a diet, the more likely you are to remain overweight. Read more here.

Except for children with epilepsy, the ketogenic diet is a fad diet — and it fits the definition like a glove. I’ll quote from Encyclopedia.com.

Fad diets are generally used by consumers to shed a great amount of weight in a short period of time. They are usually based on the erroneous belief that a particular food or food component can cause rapid weight loss or cure a disease. Another tenet of fad diets is that certain foods are harmful and therefore should be avoided completely. Fad diets usually result in short-term weight loss — but most people gain the weight back after discontinuing the diet.

Expect to take supplements: nutritional deficiencies are unavoidable when excluding a whole family of antioxidant vitamins and minerals, not to mention fiber.  And consider the environmental impact of a mostly animal fat diet.  Read more here.

And speaking of supplements, in my experience, fad diets are also defined by how many products are associated with it — how many “keto diet gurus” have webpages and sell products.  You can buy “oral exogenous ketone supplements” like “Keto Bomb” to help get you into ketosis.  For only $35.99 you too can enjoy a scoop of powder with a proprietary blend of sunflower oil powder, medium chain triglycerides, saffron extract (bulb) and avocado oil powder.  Not to mention artificial flavors, and matodextrin.

According to Environmental Nutrition, People on ketogenic diets can lose weight, at least in the short term, although scientists aren’t entirely sure why. It’s thought that production of ketones may help control hunger or improve the breakdown of fat. But there are risks and side effects involved in losing weight this way. Ketones are meant to be an emergency back-up system for your body, not a long-term energy source. They increase the body’s acidity, which can lead to low blood phosphate levels, decreased brain function, and increased risk for osteoporosis and kidney stones. People on ketogenic diets report higher rates of headaches, bad breath, constipation, diarrhea, general weakness, rash, insomnia, and back pain.

Both Precision Nutrition and Science-Based Medicine have published comprehensive and referenced articles describing the hype and hope of this diet.

PhDs Krista Scott-Dixon and Helen Kollias, in their detailed examination of this diet for Precision Nutrition, write:
being in ketosis doesn’t seem to have any special advantage for losing body fat (rather than just weight), especially if we consider the lifestyle and behavior aspect to this.

You may find it easy to eat less when all you can eat is protein and fat. But after a while, you may grow tired of bringing your own whole salmon to parties, and wonder what the other 95% of the grocery store is up to. You may start to have fantasies about a threesome: you, Oreos, and chocolate sauce. Not only that, you may be getting some serious scurvy and other nutrient deficiencies.

For women in particular, lowering carbohydrate intake seems to have negative effects.

Women’s bodies go on high alert faster when they sense less energy and fewer nutrients coming in. Many women have found that the low-carb diet that worked great for their husband not only didn’t work for them, but it knocked out their menstrual cycle on the way out the door.

Verdict: We don’t recommend the ketogenic diet for sustainable fat loss.

All diets work …temporarily.  Regardless of what diet you “go on” to lose weight, unless you make permanent changes to your lifestyle, if you “go off” your diet and resume your usual diet, you’ll regain the weight, and probably more. Make some smart modifications to your usual diet, and never “go on” a diet again!  Read my column to find what’s the best “diet” for permanent weight loss (hint: it’s not someone else’s diet).

Sources:

Diabetes Care. Hyperglycemic Crises in Adult Patients With Diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699725/

Environmental Nutrition. Ketosis Fad Diet Alert. https://www.environmentalnutrition.com/issues/38_9/youshouldknow/Ketosis-Fad-Diet-Alert_152840-1.html

Frontiers in Psychology. Ketosis, ketogenic diet and food intake control: a complex relationship. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313585/

Journal of the International Society of Sports Nutrition. Prevalence of micronutrient deficiency in popular diet plans. https://jissn.biomedcentral.com/articles/10.1186/1550-2783-7-24

NYTimes.com. Why You Can’t Lose Weight On A Diet. https://www.nytimes.com/2016/05/08/opinion/sunday/why-you-cant-lose-weight-on-a-diet.html?mcubz=0

PrecisionNutrition.com. The Ketogenic Diet: Does it live up to the hype?
http://www.precisionnutrition.com/ketogenic-diet

Science-Based Medicine. Ketogenic diet does not “beat chemo for almost all cancers.”

Ketogenic diet does not “beat chemo for almost all cancers”

Susan Burke March

Susan Burke March

Susan Burke March, a Cuenca expat, is a Registered and Licensed Dietitian, a Certified Diabetes Educator who specializes in smart solutions for weight loss and diabetes-related weight management. She is the author of Making Weight Control Second Nature: Living Thin Naturally — a fun... Read More

  • Brian Rigby (MS, CISSN) at “Climbing Nutrition” is oriented to, uh, climbers, which most of us aren’t. (Not me! I’m too old! And I have other excuses if you need them! Etc.)

    But he also covers nutritional subjects in the kind of depth that leaves even me a little dizzy, which is good, because when that happens it means that I’ve learned something.

    So carbs. Rigby wrote a good post in 2015 on balancing energy sources titled “Don’t Be a (Carb) Hater”, which taught me a lot. I’m eating much more fat these days and feeling better for it, but there is a limit. The post is at http://www.climbingnutrition.com/diet/dont-be-a-carb-hater/ and worth a look.

    He also wrote a more recent and more technical 3-part series titled “An In-Depth Look at Energy Metabolism” for anyone who wants to get really dizzy on facts.

  • Dona

    I have to say I have used the “Lean for Life” diet to lose weight and it is based on ketones as well. It is developed by the Lindora Medical Clinic in United States. I never found any of what you have said to be true. I did not find I had less energy, in fact had much more. No headaches, back pain or anything like that. There are no great amounts of fat required to eat, in fact it discourages excess fat and encourages many green leafy and other vegetables and fruit and nuts and lean protein. Yes like anything you can buy products produced by the clinic but it is totally not necessary. You can buy the book in paperback or ebook and participate online with support or do it on your own which worked well for me. They also encourage setting fitness goals even if it is just walking 10,000. Steps per day and starting at whatever level your doctor recommends. I just believe you may have gone overboard on your criticism of this diet in general. Maybe the ones you looked at were really off base but the “Lean for Life” program has a lot of good information and the book walks you through the science and progress of each day. It is also very affirming as you work through it. Thanks

    • Hi Dona, Lean for LIfe is a diet. It’s a medically/nutritionally supervised program, with structured meal plans, and a lot of coaching. It works. And you make an investment in it, meaning you buy the book or you buy the program. ALL diets work. ALL structured programs work. That’s not my criticism of the “keto” diet, which I wrote about since it’s such a fad diet, and people are undertaking it without anticipating eating a more varied and inclusive diet. And of course, if you read my columns, activity is always a part of any healthy lifestyle program. I’m with you! Susan

  • LadyMoon

    I have seen myself as ‘fat’ since I was 9 years old, so I’ve done my share of dieting. What I have found useful in going on yet another diet is to do it for two weeks, it kick-starts my getting off whatever bad habits I’ve been engaging in and makes me wake up–be more conscious of my eating.

    • StillWatching

      This makes me sad, especially the part that may have been caused by insensitive males and societal pressures in general. Hang in there, Moonie.

  • Anthony Castiglia

    Hi Susan, You have missed the point on the use of the ketogenic diet. It is NOT only for weight loss and a fad but has had excellent results in Alzheimers, epilepsy and most importantly in controlling insulin resistance which is probably the biggest cause of chronic diseases and cancer. This fact has unfortunately been missed by science based medicine.

    • OK, please cite the evidence. Also, the column does link to a comprehensive scientific review of the claims for the ketogenic diet, some which you include in your post. And of course, I do mention the link between ketogenic diets and epilepsy (right in the third paragraph of my column).
      If you have some research that shows that this diet is beneficial for Alzheimer’s (do you mean to prevent Alzheimer’s? or treat?) please share. The two expertly written columns that I link to are good reads (check my column) and from Precision Nutrition they especially note that yes, eating almost no carbs can help with controlling blood glucose and insulin – of course. But, and here’s my takeaway, “If you’re a “regular person” who just wants to be healthy and fit:
      Enjoy reading about ketosis if you like. Try it, if you’re curious. But you can be perfectly fit, lean, and healthy without it.
      Don’t believe everything you read on the internet. (Except this article, of course.) Remember that the plural of “personal anecdote” is not “scientific data”. Be a critical reader and consumer.”

      • lisa

        May I suggest you sign up for the remaining videos (recap at end of event) about Alzheimer’s. It is free. http://event.awakeningfrom alzheimers.com/trailer-2c/

    • StillWatching

      Castiglia, you are anathema to everything scientific. Your scanning bias that allows you only to read material that feeds your preconceived notions is truly sad. I have never seen you provide a link to a scientific study that supports any of your pseudoscientific nonsense.

  • justinmango

    it is NOT a “fad” diet as the author has stated . As almost always , ms diet czar only uses points that support her , usually , shallow and uninformed POV. This diet has been used by serious athletes and performance junkies for 30 years and has just recently come into ” fad” as you say for weight loss because that is what people do , eventually , with anything good. IT IS NOT for everybody , probably not for most old people , but folks like aubrey marcus , mark sisson and all the 1000s of other people seriously interested in optimized human performance have a completely different take than Ms. diet czar and would frankly be offended that she boils down such an amazing way to look at the body , our addiction to carbs and all THAT means as merely a ” FAD”

    • Ken

      Justinmango – Please remind us one more time of your credentials in food, nutrition and dietetics?
      Didn’t you read the article? It’s just another diet.
      I know a lot of Vegan body builders and athletes.
      The plural of anecdote is not Data. It’s anecdotes.
      Susan is just trying to get people away from the “Diet Mentality.”

      • StillWatching

        Now just a minute Mr. Ken. It is a well known scientific fact that just-a-mango had a week long class in nutrition back in the 50’s. Why are you badgering him?

    • StillWatching

      “Usually shallow and uninformed POV”?

      Jajajajajajajaja. Have you read any of the citations in every single one of Susan’s well researched articles? Clearly, what you mean to say is that Susans articles don’t agree with your unsupported and totally unscientific allegations. I don’t see any in your current post and it seems that every time you are called on to provide them, you disappear.

      Do you even know what a peer reviewed scientific journal is?

    • Mrs. Diet Czar to you, Mango 😉

      Oh yes, our addiction to carbs. More buzz words indicating you have not read my columns and have your own agenda. Your “all or nothing” reasoning from everything from “diets” to lumping all carbohydrate into one four-letter word is so transparently ignorant – talk about your uninformed and shallow point of view! But I do invite you to read the column and previous columns that I write using research and science that absolutely differentiates between refined carbohydrate foods and whole fresh foods. Susan

      • justinmango

        i do not respect your obviously biased opinions .

    • Devon_Nullman

      And , your , points , are , derived , from , what , source , pray , tell , ?

  • Anthony Castiglia

    Dear Susan,
    In response to your comments, I will just have the following to say. Stating that a study is science based is wonderful but who funds the so called “scientific” study. You are advocating a paradigm which is not very successful. If it is successful, why does the WHO rate the health in the USA in the 30’s especially with our wealth and resources. I stopped evaluating the so called scientific articles years ago because of many being biased and often having “gag” orders if the article does not have the result desired. I do get my information from online seminars which have no bias and do not have incentives in gaining monetary compensation. There were 2 recent online seminars one on the Ketogenic Diet and the other on the disastrous results of eating GMO foods especially those treated with glyphosate which destroy the shikimate pathway in plants as well as humans. A ketogenic diet decreases the mTOR pathway which helps to prevent cancer. It is obvious that I am wasting my time on a closed mind but perhaps you might be interested in learning about the pathways I mentioned above!!

    • Too funny, Anthony. All scientific studies are invalid except the ones that you deem credible? I disagree.

      Regarding the keto diet, which you have morphed into a treatise on the effect of GMO foods – somehow…. Wonder how many of these keto people are eating cows who only eat non-GMO corn? An interesting question. You don’t have to answer. 😉 Susan

      • Anthony Castiglia

        As usual, you took my comment out of context. I DID NOT say all scientific studies are invalid. I did imply that it is important to see who funded the study!! As far as my comments on GMO foods are these not part of diet? You still have not answered me as to why the USA with all its resources and scientific studies is still ranked in the 30s for health care. Is it possible that your information and treatments are keeping us there?? I do enjoy engaging persons with open minds which is not the case here!!

    • StillWatching

      This has to be one of the more incredible statements I’ve ever read:

      “I stopped evaluating the so called scientific articles years ago because of many being biased…”

      In other words, you admit you abandoned science years ago because you encountered some studies that you felt were biased. Aren’t you ashamed to admit that publicly, in writing?

      Your claim that your new source of information ———– online seminars————have no bias is commical. Apparently, you form that belief based entirely on faith. Frankly, castiglia, you are beyond hope.

    • Devon_Nullman

      Humans do not have a shikimate pathway.
      David M. Sabatini, M.D., Ph.D., Professor of Biology, Massachusetts Institute of Technology doesn’t agree with you that a decrease in mTOR helps prevent cancer. He says maybe it does but that’s a long way away and the possible side effects of manipulating mTOR are formidable. I’ll take his word over yours for now. How about “A ketogenic diet decreases the mTOR pathway which MAY help control epilepsy and other seizure disorders”

      • Thanks for sharing that info. I also notice that he doesn’t say (as Castaglia says) that decreasing the mTOR pathway “helps prevent cancer.” But that’s flying around the internet too. Susan

  • lisa

    There is a free Alzheimer’s event online which discusses various studies and protocols for Alzheimer’s. I watched it last year and I believe this years is a re-run of that event. One of the programs discusses the benefits of a ketogenic diet. I tried to list the event web address in a reply to Susan, but it was deleted after moderation. Go figure.
    Look for awakening from alzheimers dot com through a search engine and you should be able to find and sign up for this free event.

    Lisa