The Keto Diet

The Keto Diet
In this episode of Lifestyle Matters.

Can we generate a super fuel in our bodies by eating differently? This week we look at the popular keto diet from a medical perspective.

This diet was originally founded in the 1920s by Russel Wilder to treat epilepsy and it worked! Once anti-epileptic medications were discovered, this diet became less popular until recent times when it became evident that it also helps with weight loss. Truth be told, this diet is still used for some refractory epileptic patients under medical guidance.

A keto diet is essentially a diet we consume to put our body in a state of ketosis. But first, what is ketosis? To understand that we must understand what ketones are.

Ketones are products of fatty acid breakdown e.g., acetoacetate, beta hydroxybutyrate and acetone. These molecules are continuously produced in our bodies in small amounts as part of normal physiological processes.

Ketosis or ketogenesis is a process when our body uses these ketone bodies to provide energy for our cells.

When we eat a well-balanced diet, our body uses carbohydrates as the main source of fuel. So, reducing our consumption of carbohydrates and increasing protein (amino acids) and fat intake allows our body to break down these macronutrients to provide us with energy via processes called gluconeogenesis and ketogenesis respectively.

Ketosis can also happen as part of disease processes e. g . starvation, alcoholism, poorly controlled diabetes and even extreme prolonged exercising. This is obviously dangerous to our health and requires treatment.

Most cells in our body can utilise ketones as a source of energy except our red blood cells and liver. The brain is really good at doing this!

This is how a Keto Diet looks like:

Ketones are called a super fuel because:
100 gm of glucose we can generate 8700 gm ATP
100gm of beta hydroxybutyrate generates 10 500 gm ATP
100gm of acetoacetate generates 9400gm ATP

Apart from being a super fuel, it has various other benefits such as:

  • Treating difficult to control epilepsy
  • Reduce the risk of neurodegenerative conditions e.g. Alzheimer's Disease
  • Reduces insulin production
  • Increases leptin levels (hormone that tells us we are full hence suppressing our appetite) -> weight loss
  • Reduces LDL, TGL
  • Increases HDL
However, there are some limitations to the Keto diet that suggest that it may not be suitable for everyone.
 
Those who have certain enzyme deficiencies e. g. pyruvate kinase deficiency, liver failure, and pancreatitis, should not be on this diet due to the high levels of fat and protein intake. There has been also some research to suggest this diet may result in osteoporosis, kidney stones, fatty liver and gout. Further, most studies on the Keto diet have only been conducted over 6 months which means the long-term implications of the diet are still being investigated.
 
The main point to note is that this is undoubtedly a great diet to follow if it suits one's lifestyle provided there are no medical contra-indications to it. However, once again it is a diet that we would suggest one to adhere to for a short period (6-12 months) as we have sufficient evidence to support this recommendation, for now at least. Post that period, transitioning to a normal well-balanced diet would be advisable. Ideally, following a whole food predominantly plant-based diet would produce the best outcome.
Author: Dr Saveena Nithiananthan
MBBS, FRACGP, IBLM
Savena is a General Practitioner, Medical Educator and member of the International Board of Lifestyle Medicine