THE KETO DIET: MEH, WHO NEEDS CARBS?

Ahhhh the wonderful world of trendy diets. We have all seen those models on Instagram or those famous patrons in Hollywood that claim ALLLLL their success came from 60 days of some specific new diet program they have been following, all the while failing to credit the two-a-day workout sessions that they also were posting on their insta-stories weekly during that same time.

In the future, there will be much more content related to the best diets to follow for weight loss and overall “heart health” (you know, the thing you see on the cover of the Cheerio’s box). Today, we are going to focus on one of the most debated diets out there: the KETO DIET.

WHAT IS THE KETO DIET?

Serious “keto-ers” will tell you there are a couple different types of the ketogenic diet, but we will stick with the standard criteria for any diet to reach keto status.

The basic principle of the keto diet is that you limit your intake of high-carbohydrate foods, and replace them with foods that are high in protein and fats, with an emphasis on high-fats.

The keto diet runs on the premise of placing your body in what is called “ketosis”. When your body is deprived of carbohydrates, it is inherently deprived of glucose (sugar). When there is no sugar available, the body will instead revert to burning off something called ketones for energy.

A ketone is simply an alternative fuel source derived from fat and produced by the liver when the body is in a state of deprived sugar...i.e., a state of ketosis.

NOTICE: Sugar, glucose, and carbs will all be used interchangeably from this point on.

In order to reach this ketosis state, it is recommended that the daily intake of sugars be less than 50 grams in total. In case you were wondering what the heck a gram looks like, 50 grams of sugar is essentially no more than the content within 2 or 3 apples (depending on which grocery store you frequent for produce).

WHAT IS ALLOWED AND WHAT IS FORBIDDEN?

Below are a handful of foods that are recommended to be eliminated in a keto diet, due to their high levels of carbohydrates. Once you read this list, you’ll turn to the keto-ers and yell “BOOOOOO, party poopers!!”, or at least you may want to, cause trust me, I do.

1. Sugary foods - sodas, fruit juices, cakes, desserts, etc.

2. Grains - pasta, rice, cereal, breads

3. High carb vegetables - potatoes, sweet potatoes, carrots, etc.

4. Fruits - apples, pears, grapes, and any high in sugar

5. Some condiments - ketchup, BBQ sauce, Zaxby’s sauce (that one really really hurts)

6. Alcohol…yes party people, time to sober up - beer, whiskeys, vodka, etc.

Below are a handful of foods that are allowed by the keto diet. Now I’m a fair man, so I will admit, there is still some really good stuff left for this list.

1. Meat and fish - red meats, bacon, chicken, turkey, fish, shrimp, etc.

2. High-fat foods - eggs, butter, cheeses, whip cream, cream cheese, etc.

3. Healthy oils - extra virgin olive oil, coconut oil, etc.

4. Nuts - walnuts, flax seed, peanuts, cashews, almonds

4. Low carb veggies - green vegetables, onions, tomatoes, etc.

5. Any food high in protein - supplements, nuts, meats, beans, etc.

HOW DOES CHOLESTEROL PLAY INTO THIS?

As you continue to read, it is important to first review some common bio-markers that are present in your blood that indicate healthy levels of fats and sugars in your body. These are things that you most likely have heard your doctor talk at your yearly check-up.

LDL (Low density lipoproteins): known as the “bad cholesterol” because of its propensity to carry cholesterol and fat cells to the walls of your arteries and stick, resulting in arteriosclerosis, high blood pressure, and potential severe cardiovascular disease.

HDL (High density lipoproteins): known as the “good cholesterol” because of its role in carrying fat cells out of your body, to be expelled as waste.

Triglycerides: these are slightly different than cholesterols because they are more active forms of fat in your blood that are used for energy; however, when unused, they can be stored as bad fats in your muscles, organs, and blood.

Blood sugar: the amount of sugar that is present in your blood, with blood sugar being one of the body’s favorite sources of energy due to it being readily available and relatively easy to breakdown.

You know the deal, I’m here to give you the evidence driven by research, so the following information has been thoroughly researched and has scientific evidence to back it up….meaning I did not take into account what Kim Kardashian or some other Instagram model had to say about their love of the keto diet (you’re welcome).

4 PROS OF KETO

1. This is one diet in which you can actually eat as much as you want (within reason, of course). Even when you eat more calories in a day than you burn, you still can lose weight.

Countless studies stated that even with higher calorie intakes, the subjects on the keto diet continuously lost more weight than subjects on a calorie-restricted, conventional diet. However, there is a catch to this that we will see later-on.

2. The keto diet, due to the contents of the nutrients being taken in, is very appetite suppressing, making it actually easier to eat less food. Now you may say “hold up there, you just told me that I could eat MORE and lose weight, and that contradicts the point you just made”. I would say yes, you are correct, but you are missing the point.

Though you can eat more with the keto diet and still lose the weight, due to the appetite suppressing nature of the diet, you won’t feel the need to eat as much food. If you are wanting to reduce your food intake, the keto diet may help you in this area.

3. You naturally have higher HDL levels, which is that “good cholesterol” that we talked about above. Now, this is sort of a given, and it actually poses some negatives. HDL is a fat. Thus, if you eat more fat, you will have more HDL in your body, which is good, yay.

But remember those LDLs, the “bad fats”? Well, if your HDL levels increase by eating fatty foods, then your LDL levels are going to additionally increase at the same rate…because again, you are eating more fats. This really shouldn’t be rocket science to anyone.

4. In the short term, roughly 3-6 months, the research supports the use of the keto diet over that of any other low-calorie, low-fat diet for purely weight loss. This has been validated in countless studies covering obese individuals in a vast array of populations, including men, women, and adolescents.

So yes, what you have heard is in fact true, purely as a quick weight loss plan, the keto diet is one of the better options available to you. However, you know me, I love me some long term effects. So keep reading to see why it may not be the best long term.

8 CONS OF KETO

1. Look, your body wants carbs. Ok, it may not be fair, but it’s the truth. It is very hard to stay disciplined and eat within a keto diet for long periods of time. Of the countless research studies that I read, one major limitation of the results was reported by the authors in every single one: participant adherence.

In all these studies, the adherence rates tanked, and the drop-out rates were sky high after roughly 5-6 months, meaning that people were not sticking with this diet (or any other diet in these articles, to be completely fair) for a very long period of time.

2. If you suddenly stop the keto diet, you are actually more likely to gain weight faster than if you were to stop in the middle of a low-calorie conventional diet. This can be seen in an article from G. Foster et al. in 2003.

This particular study was comparing a keto diet with a low-calorie conventional diet, with effects on weight loss after 3 months, 6 months, and 12 months. A chart from that article indicated that as subjects were abandoning their diets around the 6 month mark, the subjects in the keto diet group were gaining weight more rapidly when reassessed at the 12 month mark.

Strangely, this indicates that maybe the keto diet has some sort of bizarre “rebound effect” when your body finally intakes carbs at a normal level again.

3. Eating out is a pain. Now, I will admit, this con is more of a personal opinion. This, obviously, cannot exactly be “fact-checked” by research.

When you’re out to eat and your buddies or girlfriends are drinking beers, chomping down on a big burger with fries, and dipping their pizzas into ranch dressing….all while you are eating a turkey salad with flax seeds, eggs, extra cheese, and balsamic vinaigrette dressing (ok, yes, that may have been an over-theatrical example, but you get the gist)….that can make for a pretty lame night out.

4. You won’t exactly be Albert Einstein when adhering to the keto diet. Little do people know, there is only two nutrients that the brain can use to be effective (well, really only 1 and a half). One of them, the primary, is glucose. The second, is ketones.

However, the brain was not meant to survive and function for an extended period of time on just ketones. It is a very poor energy source for the brain. Your brain can survive on them, but it really doesn’t like to.

When you don’t eat carbs, you don’t get the glucose to your brain that it needs for basic cognitive function, much less advanced cognitive function.

So, for you college students who are trying to burn off those extra couple of beers you drank last weekend before you go on your beach trip, and you think the keto diet is the one for you, just be sure you aren’t in the middle of exam week. You won’t be at your sharpest.

5. For those that are elite athletes or are just active people who need constant motivation and energy for optimal performance…yeah you can forget about that with the keto diet.

As mentioned before, your body during activity LOVES glucose. However, when in ketosis, your body is going to be highly deprived of that beloved blood sugar, resulting in lethargy, decreased performance, decreased motivation, more difficulty in gaining muscle, and other physical issues that could cause you to fall behind in competition.

6. Again, this is just a personal one, but I’m sorry, I just struggle to get behind any kind of diet that might push kids away from eating fruits and (some types of) vegetables. Our young people today don’t need ANOTHER excuse to not eat their fruits and veggies.

If you read above the recommended foods to stay away from to remain in ketosis, you will notice that the keto diet limits your intake of most types of fruit…yes…fruits. I’ll just let that speak for itself.

7. In all studies comparing the long term results of the keto diet, being 12 months or longer, there is no significant difference in weight loss between those on the keto diet compared to those on a low-calorie conventional diet.

There they are, the long term effects coming to head. I told you, as someone with a physical therapy mind, I love me some long term effects. This was the catch that I mentioned above. The keto diet is great if you are looking for a diet to get on board with for a limited amount of time that will lose you weight fast.

However, if you are looking for a diet with more permanent effects that you can carry on with for an extended period of time, the keto diet is probably not what you’re looking for (actually, it’s just not).

8. Side effects, side effects, side effects. Some of them I have already mentioned, but let me take you through the world of someone who eats within the keto diet for an extended period of time. Strap in, there are some doozies.

For starters, you will experience smelly breath and weird, fruity smelling urine due to the changes in minerals and electrolytes present in your system (however, is the fruity urine thing REALLY a con?). Imbalances in your mineral counts not only affect your breath and urine smell.

These imbalances can, depending on how severe, require you to have to take mineral supplements, for example probably sodium, potassium, and magnesium supplements.

Additionally, diarrhea is highly common. This is most likely due to the fact that your gallbladder, an organ with a large role in digesting fats, is so overwhelmed with fat that it can’t function properly.

Adding to that problem is the fact that the keto diet usually is associated with lower levels of dietary fiber (you know, that thing they always talk about that makes old people poop better).

Finally, the biggest side effect of them all: death. Now relax, I’m not saying the keto diet is going to kill you. Just hear me out here.

There was a study of roughly 25,000 people across the United States that claims those who limited their diet to low-carb intake had roughly a 32% higher risk of death than anyone on higher-carb diets.

Now, as I always like to say, one study is by no means enough to make a conclusion. You typically need a multitude of studies to make a definitive conclusion.

However, regarding this study, I cannot ignore that it includes a subject size equal to that of a small town (granted, a very very small town, but you get it). In the world of research, in which lots of studies only include 50 to maybe 200 subjects on a good day, 25,000 is a lot of subjects. For me, it’s enough to carry a significant amount of weight.

AFTER ALL THAT, WHAT’S THE TAKE HOME?

Take home #1: If you are looking for quick weight loss and a diet to subscribe to for 3-5 months or so, the keto diet actually might be the one for you. There are numerous studies I read (25, to be exact) that claimed the keto diet showed greater weight loss results than a conventional, low-calorie low-fat diet.

However, it is key to note that of the studies I read, 9 of them demonstrated differences that were not statistically significant, meaning the numbers weren’t different enough to be considered substantial. Nevertheless, there was still greater weight loss with the keto-dieters.

One news article I read stated that even some well-known keto diet patrons have stated that the keto diet should not be followed for more than a couple of months before it should be put on hold, and wait to be started again. It is very much an on-off type of diet.

Take home #2: The keto diet has to absolutely be done the right way, or else it can be very dangerous and unhealthy, especially for people with diabetes, resulting in something called ketoacidosis (storage of too many ketones) which can easily damage the liver, kidneys, and (most importantly) the brain.

We have gone over all the side effects already, so hopefully you will believe me when I say you absolutely have to be careful when implementing this dietary change.

Take home #3: If you are looking to build up a bunch of muscle and be “swole”, the keto diet is 100% not for you. We have seen from numerous studies that the keto diet can result in lower motivation to exercise, lower exercise performance, and compromised muscle gain.

Take home#4: The keto diet is in fact, relatively safe, but not always. If you do end up starting the keto diet, don’t let people hate on you by screaming “whoaaa that’s so dangerous, I’ve heard”. The chances are high that they don’t know the research. There are side effects and risks, yes, but it’s by no means “dangerous”.

However, to that point I will say, if you plan on doing the keto diet for more than 6 months or so, then yes it probably is a little risky. As we have seen, the keto diet is much more effective and safer if you diet for a couple of months, take a break for another couple of months, and then start again.

DISCLAIMER

Because the body is so so so so so so so complex (I can’t say “so” enough), there is A LOT that we haven’t and can’t cover in this post alone, regarding why the body reacts exactly the way it does, and how the keto diet can or can’t be used depending on what disease someone may have.

With that in mind, please be sure to consult with a registered dietician or nutritionist if you are planning to start the keto diet and are concerned with a couple of things specific to you.