The Ketogenic Diet: Fad or Friend?

Fats for life?

Imagine the smell of a fresh loaf of still-warm sourdough bread wafting from your oven. You cut yourself a thick slice and dollop a generous piece of gooey, fresh brie cheese for the top, letting it melt down onto your fingers as you bring this culinary masterpiece to your mouth. For an instant, you have transformed your downtown Vancouver studio apartment in into a countryside chalet in the Swiss Alps.

Now imagine you must choose: give up the bread or give up the cheese. FOREVER.

You see, there are two types of people in this world: bread people and cheese people—carb lovers and fat lovers. Those of you who choose to give up cheese for the endless comfort of warm toasty bread probably think that the cheese lovers are crazy. As for the fat lovers, bread is but a vessel to indulge in the finest fat-filled delicacies: a cone for your artisanal gelato, a slice of bread to hold your fancy cheese.

I am a diehard carb lover. A world without my mom’s freshly baked challah is simply unimaginable. As for you fat lovers, you probably think I’m crazy. And, I’m pretty sure you are the reason for the latest health trend sweeping the nation: the ketogenic (keto) diet.

How it works

The keto diet is a high-fat, ultra low-carb diet. We’re talking less than 50 grams of carbohydrates per day. If you eat one banana, half a cup of granola, and a dollop of yogurt for breakfast, you’ve eaten more than 50 carbs before 9 am!

Over the past ten years, the keto diet has become increasingly popular and has been framed as a lifestyle-based diet. Other than the allure of eating as much cheese as you want, there are two big claims about the ketogenic diet:

  1. It’s good for your brain.
  2. It’s an effective way to lose weight.

If you’re strapped for time, you can skip to the verdict.

Otherwise, let’s back up a little before we start evaluating this diet’s efficacy. There are three types of molecules that our body can use for energy: carbohydrates, fats, and proteins. Super simplified, each of these three molecules have a primary job in our body. Proteins build our body’s machines (we can mostly ignore proteins for today), fats store energy, and carbohydrates are quick energy packets for our cells.

Carbohydrates are the fastest energy source, but we can’t store as much of this energy over a long period of time. They operate like a solar energy system with a very small battery—when there is sun, there is plenty of power, but when the sun goes down only a small amount of its stored energy remains. If we eat lots of carbohydrates, our body recognizes the extra power coming in and stores that energy in our external backup batteries—fat cells—for long-term storage.

Generally, our body uses carbohydrates as a fast energy source. Our body also measures how much energy it can burn by how many carbs are in the blood, or how “sunny” it is. A house powered by solar energy will use the sun as its primary energy source, and only dive into the battery pack when it’s really cloudy or when the house is using more power than the sun can supply. Same goes for our body—we use our stored fat energy when we eat fewer calories than we burn. If we are eating fewer carbs than we are burning, our body senses that it isn’t as sunny, and starts diving into those fat cells that have stored backup energy.

On a very low carb diet, like the keto diet, our body has virtually no sun coming in to tell the body there is plenty of energy, because all of the energy is coming as fat. We need a new hookup mechanism so that our cells know to use the fat battery packs as their primary energy source—it’s kind of like unplugging the solar panels and directly plugging in the battery to the main power of the house. This alternate wiring—going direct to fat stores for energy—is called ketosis.

But can the house (our body cells) function just as well on battery power (stored fat) as solar power (carbs)? That’s what I want to find out. Let’s delve into the two big keto claims.

Your brain on ketones

It turns out that most cells in our body have no problem running on battery power. Fat fuels most cells just as well, if not better than carbohydrates.

But there is one big outlier: our brain. The brain, being a very important and selective organ, refuses to work off battery power and only runs off direct sunlight—brains cells do not have the capacity to use fats as their energy source.

On a regular diet, this isn’t a problem: our bodies are smart enough to reserve the carbohydrates for the brain, and other cells use fats as energy if need be. On a ketogenic diet, though, there are virtually no carbs to power the brain.

Thankfully, the human body is an incredibly adaptable system that, yet again, reroutes its wiring. The liver takes fats and turns them into smaller molecules called ketones. Ketones are like the thermal energy from the body: similar enough to solar energy that the brain can use it—but with a wiring system is fundamentally different than of carbs. So, does this mean the brain functions normally on ketone power?

The downside

When we go from a regular diet to a keto diet, our body has to do a whack of rewiring. It can take from three days up to multiple weeks for the brain to switch from running on carbohydrates to running on ketones. And, as with any major renovation, it’s not all smooth sailing. The side effects of the changeover are not pretty: they call it the keto flu. Some symptoms include: lightheadedness, dizziness, fatigue, difficulty exercising, poor sleep, and constipation. Once your body gets used to the new wiring, these symptoms go away, as long as you stick to a strict keto diet.

The upside

The ketones that your brain uses on a keto diet mean that you are changing the biochemistry of energy in your brain. For some people with serious medical conditions, this can be very beneficial. The keto diet has been used as an effective treatment for childhood epilepsy since the 1920’s. While scientists still don’t understand how a keto diet reduces seizure frequency, they hypothesize it has something to do with the presence of ketones or the absence of glucose in the brain.

People who tout the benefits of the keto diet assert that it makes your brain clearer, that it can reduce the risk of Alzheimer’s disease, and that it can improve other neurological disorders, but there are no clinical trials or any research on human patients to support these claims.

There is no doubt that the keto diet has positive effects for the brain if you have pediatric epilepsy. People who tout the benefits of the keto diet extrapolate this wildly, asserting that the keto diet makes your brain clearer, that it can reduce the risk of Alzheimer’s disease, and that it can improve other neurological disorders. There are no clinical trials or any research on human patients to support these claims. While people claim that the ketogenic diet reduced their “brain fog”, it may just be a brain that finally feels normal again after succumbing to the keto flu.

For now, there is nothing to suggest that the keto diet is beneficial for your brain or your thoughts.

Losing weight on the keto diet

Dieting with ketones

The keto diet for weight loss is a different may have some more validity. But let’s get one thing straight: you can only lose weight if you eat fewer calories than you consume.

I hear and read people say that the keto diet helps you lose more fat because you use fat as your energy source—because in ketosis you are burning fat as your main energy source so it means you’ll start losing all your fat storage, right? Wrong!

Don’t forget that on the keto diet, you are also eating plenty of fats and proteins. One of the most appealing traits of the keto diet is that you aren’t restricted to how much you eat—as long as you don’t go over your daily allotment of carbohydrates. However, you won’t lose weight on keto, or any other diet, unless you eat fewer calories than you expend. Using that simple equation, it’s likely just as effective to lose fat on a diet full of fruits, veggies, and other complex carbohydrates.

The upside

The keto diet is not some magic formula to burn infinite fat while eating as much bacon as you want. That said, there is research to suggest that the keto diet may prove to be an efficient way to lose weight, especially for people who have trouble keeping large quantities of weight off. The ultra-high fat diet seems to keep people feeling full for longer and people seem to lose more weight and keep it off on the keto diet compared to other diets. That’s because there have been metabolic changes observed in study participants of the ketogenic diet: it seems that more so than other diets, the keto diet doesn’t lower your metabolic rate, which means it is easier to lose weight without feeling hungry all the time. However, many of these studies are conducted with participants who are obese and aiming to lose a 100 pounds or more. To date, the efficacy of the ketogenic diet hasn’t been studied in people who wish to lose a moderate to low amount of weight.

Most research on the benefits of the keto diet have focused on people with Type 2 Diabetes, and the results are very promising. Since the keto diet reduces a reliance on insulin, it seems that on a keto diet insulin resistance can decrease over time, and the need for diabetes medication can be lowered. For prediabetic people, the ketogenic diet is also a promising way to reduce the risk of developing diabetes. Don’t forget, though, that these studies focus on patients who successfully follow the keto diet and were extensively trained by dieticians—in the real world, the biggest challenge for anyone is sticking to the keto diet.

The downside

The biggest pitfall of the keto diet is how difficult it is to follow. The ketogenic diet is not a walk in the park. Do you know how hard it is to avoid carbs? (For me it’s impossible. Have you tasted bread?). It is not your body’s default state to work in ketosis, so as soon as you eat enough carbs to convince your body the sun is shining, you will leave a state of ketosis, and you’re body will basically have to start over again. All the studies that have examined the effectiveness of the keto diet have had doctor- or dietician-curated diet plans and high levels of monitoring of the participants to ensure they are sticking to the diet and that their body is, in fact, in ketosis.

This isn’t a willy-nilly do-it-yourself diet— the keto diet involves some serious training of your body and your lifestyle. You should talk to a health practitioner before switching to a keto diet.

On keto, it’s also challenging to get the right amount of certain minerals and nutrients and not to overdo your intake of saturated fats.

Additionally, this diet is pretty hard on the cellular machinery in your body. If you aren’t on the keto diet as a treatment to a health condition, it isn’t recommended to stay on for more than nine months.

This isn’t a willy-nilly do-it-yourself diet— the keto diet involves some serious training of your body and your lifestyle. You should talk to a health practitioner before switching to a keto diet.

The verdict

For some medical conditions: like epilepsy, Type 2 diabetes, or obesity, the keto diet may be an effective treatment. In this case, you should be working closely with a healthcare professional to ensure that the keto diet is sustainable and safe for you.

However, for a generally healthy individual, the keto diet may be overrated.

There is very little evidence that mental clarity or brain function improves on a keto diet. If you want to lose weight, the keto diet could be an effective way to reduce your appetite and keep the weight off, but only if you eat fewer calories than you take in—sorry but that probably means you’ll have to take it easy on the bacon, chicken wings and even the brie. Moreover, I can’t understate how difficult it is to maintain a strict enough keto diet that will keep your body in a state of ketosis over any long period of time.

No matter what, you should consult a medical practitioner before starting the ketone diet—it’s not a diet to take lightly!

And, if the evidence-based science has left you feeling on the fence about the keto diet, try a warm slice of my mom’s award-deserving challah to help make up your mind.

 

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