TABLE OF CONTENTS

One of the latest growing and famous diets is the Ketogenic or Keto diet.  This diet has been gaining momentum due to its core feature of being a low-carbohydrate and high-dietary fat regimen.  In addition to low carbohydrates, the diet entails some amount of protein.

However, the diet is not a recent occurrence, as research contends that it has been around since 1921 when it was used by Russel Wilder (a physician) to treat epilepsy (Masood, 2022). But what is this diet all about? Is it for everyone? Let’s discuss!

The Discussion

The ketogenic diet consists of the consumption of foods with high fats, little protein (moderate) and very little carbohydrates.  Its low carbohydrate consumption is one of the major attractions of this diet (Masood, 2022).  Protein, fats, and carbohydrates are called – macronutrients. Macronutrients are usually required by the body in large amounts for energy as well as to maintain the systems and structures of the body. 

The amount of these nutrients that are consumed as part of a ketogenic diet is typically broken down as follows – fifty-five to sixty (55% to 60%) percent of fat intake, thirty to thirty-five (30% -35%) percent protein and five to ten (5% to 10%) percent carbohydrates (Masood, 2022). Therefore, if one is on a two thousand (2,000) Kcal per day diet, which is the usual standard recommendation, then your daily carbohydrate intake on this diet may be as low as twenty (20) grams to a high of fifty (50) grams per day (Masood, 2022).

The diet is largely seen as one that can help with weight loss, particularly due to its low carbohydrate intake.  However, this was not usually the premise of this diet. No way, as reports denote that it was first used by its pioneer, Russel Wilder in 1921 to treat epilepsy (Masood, 2022). He is credited with coining the term ‘ketogenic diet.’ (Masood, 2022; Wheless, 2008).

According to research, there are several types or variants of the ketogenic diet.  The first and most studied variant is that of the ‘classic Ketogenic (4:1) by weight, of dietary fat to the overall combined diet.  The (4:1) ratio describes a situation where, for every five (5) grams of food consumed, four (4) of those grams will be attributed to fat and one (1), to protein. This very-low-carbohydrate diet usually consists of one getting at least ninety (90%) percent of their energy from fat, with two to four (2-4%) percent carbohydrates and six to eight (6-8%) percent energy from protein (Roehl and Sewak, 2017).  

The next type of Ketogenic diet is that of the Classic Ketogenic (3:1), which is similar to the ‘classic, 4:1’ version. However, in this case, macronutrients are distributed as follows – eighty-five to ninety (85-90%) percent fat, two to five (2-5%) carbohydrates and six to twelve (6-12%) protein (Roehl and Sewak, 2017). 

The third type of ketogenic diet is the ‘modified ketogenic’ which resembles that of the ‘Atkins diet.’ This type of ketogenic diet comprises sixty to sixty-five (60-65%) percent energy from fat, five to ten (5-10%) percent carbohydrates and twenty-five to thirty-five (25-35%) percent protein (Roehl and Sewak, 2017).  Next, you have the General Ketogenic diet, which is reportedly typically employed in scientific studies and where carbohydrate intake is usually limited to less than fifty (50) grams per day. However, the intake of fat and proteins may vary. As such, this type of Ketogenic diet usually comprises seventy to eighty (70-80%) percent fat, and less than ten (10%) percent carbohydrates with protein being varied (Bueno et al. 2013; Kirkpatrick et al. 2019). 

The final type of ketogenic diet is the low carbohydrate version.  The typical carbohydrate recommendation for this type of ketogenic diet is less than one hundred and thirty (130) grams per day. The percentage of energy from fat and protein usually varies with ten to twenty-five (10-25%) percent carbohydrates (Bueno et al. 2013; Kirkpatrick et al. 2019).  Therefore, it is purported that these types of low-carbohydrate ketogenic diets may not be able to induce ketosis (the main indicator) due to the very low carbohydrate requirements (Institute of Medicine, 2006).

In this article, we will be exploring the diet as well as some of the popular questions that are asked about the ketogenic diet. These include the science behind it, its possible effect on weight loss and diabetes, how it affects the body as well as how long one practices this type of diet.  We will also discuss any possible side effects or precautions one should consider before venturing on this diet journey.

Exploration and Answers of the Ketogenic (Keto) Diet:

1. The workings of the Ketogenic diet – The low-carb craze
2. Are ‘Ketone bodies’ a good thing for our bodies?
3. The science behind Keto high-fat disposition and weight loss
4. So, can a ketogenic diet help with weight loss and cardiovascular health?
5. Can a ketogenic diet help with diabetes?
6. How long can I be on the Ketogenic diet?
7. Quality matters – Is Keto a quality diet?

The Workings of Keto – The Low-carb Crazed!

The consumption of carbohydrates is listed as a major component of the macronutrients that our body requires daily.  As such, it is considered the body’s primary source of energy production in the body’s tissues. Therefore, if the body is deprived of carbohydrates due to low intake, of say fifty (50) grams or less, then the body’s insulin secretion will be significantly reduced, which will cause it to enter what is known as a catabolic state (Jagadish et al. 2019; Mohorko et al. 2019).

When the body is in a catholic state, it will deplete its stored glycogen, which can then trigger many different metabolic changes. One of the main metabolic changes that can arise due to low carbohydrate intake is ketogenesis as well as gluconeogenesis (Jagadish et al. 2019; Mohorko et al. 2019).

Glucogenesis is the body’s innate or endogenous (biological term) production of glucose in the body, especially in the liver. As such, when the body is not getting sufficient glucose or it drops considerably low, this endogenous production of glucose becomes unbalanced, thus, not being able to meet or keep up with the body’s demands, which then causes it to go into ‘ketogenesis’ which helps to provide an alternate source of energy through the formation of ketone bodies (Masood, 2022).

When the body goes through ketogenesis due to not having sufficient blood glucose, insulin becomes low, which then reduces the stimulus for it to store both fat and glucose. Therefore, if the body is deprived of carbohydrates, then its metabolism remains in the ketotic state or what is called ‘nutritional ketosis.’  According to research, this nutritional ketosis state is quite safe as the body will only produce ketone bodies in small concentrations which will not affect the PH of the blood (Masood, 2022).

Nutritional ketosis is defined as the intentional restriction of the intake of dietary carbohydrates. This is to accelerate the production of ketones and invoke metabolic effects which in turn help to stabilize blood sugar, reduce the release of insulin, and thus improve the effects of insulin resistance (Gershuni et al. 2018).

Are Ketone Bodies Good for our Bodies?

Ketone bodies, which are produced by the liver, are the process that occurs when the body does not have a ready supply of glucose (Laffel, 1999). There are two (2) main types of ketone bodies that are produced by the body, acetoacetate (AcAc) and 3-beta-hydroxybutyrate (3HB) (Laffel, 1999). There is also acetone, which is considered the least abundant of the ketone bodies (Laffel, 1999). 

Our body always has the presence of ketones in the blood.  However, the level of ketones in the body will increase when we fast, or carry out prolonged physical activities (Laffel, 1999). When the level of ketones increases, that signifies that the body is getting low on carbohydrates (Kolb et al. 2021).

A reduction in the body’s carbohydrate levels, in the short term, is assumed to maximize the oxidation of fat for energy (Adam-Perrot et al. 2006) as well as reduce blood sugar levels. This whole process is what is called – ketosis.  According to research, ‘ketone bodies’, when synthesized by the body can be used as an alternate source of energy. As such, the body can use it for energy production for the heart, muscle tissues as well as kidneys (Masood, 2022).

Another benefit of this ketogenic state is that the body will use the ketone bodies for brain health as the ketone bodies can cross the blood-brain barrier and thus provide energy to the brain (Masood, 2022).  Nonetheless, the production of ketone bodies will be dependent on several factors such as one’s resting basal metabolic rate (BMR), body mass index (BMI) as well as the percentage of body fat (Masood, 2022).

Research also suggests that ketone bodies will help the body maintain an efficient supply of fuel, even if it has experienced a calorie deficit.  Additionally, ketone bodies are said to also help to reduce free radical damage in the body and thus improve its antioxidant capacity (Masood, 2022).  On the other hand, research has shown that ketone bodies, while may have some positive attributes in the body, do have some undesirable immediate effects which include, increased urinary calcium loss, increased low-density lipoprotein cholesterol (LDL-Cholesterol) as well as increased plasma homocysteine levels (Adam-Perrot et al. 2006).  The long-term effects of ketosis, and in general a low-carbohydrate diet, are still being researched.

The Science behind the Ketogenic Diet fat disposition and Weight loss!

There is a popular consensus that a high-fat diet is one of the main causes of obesity as well as the development of several diseases such as diabetes, coronary heart disease and cancer (Masood, 2022).  However, several animal studies where the subjects were fed a high-fat diet, did not show any causal relationship between dietary fat and obesity (Masood, 2022). Nonetheless, a diet constituting mostly high fat and low carbohydrates as that of the ketogenic diet is beneficial to weight loss (Masood, 2022).

As such, research contends that a diet high in sugar is associated with a forty-four (44%) percent increase in the risk of diabetes and obesity as well as a twenty-two (22%) percent increased risk of diabetes mellitus (Masood, 2022).  In fact, in a 2012 study of all cardiometabolic deaths (i.e., heart disease, type 2 diabetes, stroke etc.), the largest mortality dietary factor was a high intake of sodium (9.5%) with the lowest estimated mortality being associated with a low polyunsaturated fat with 2.3%. Surprisingly, a high intake of artificially sweetened beverages had a 7.4% mortality while a low intake of fat, particularly omega-3 fats, had a 7.8% mortality (Micha et al. 2017; Masood, 2022).

You can read more on fat, including the good fats in this detailed article:

• Fat, who me! Understanding the types of fats in our foods!

However, the consumption of low-quality carbohydrates may lead to reduced consumption of healthier foods such as nuts and seeds, fruits, and vegetables as well as unprocessed grains (Masood, 2022).  Additionally, the low intake of fruits, nuts, and seeds, accounted for some of the highest mortality of 8.5% 7.5% and 7.6% percent respectively according to that same 2012 study by Micha and colleagues (Micha et al. 2017; Masood, 2022).

Other systemic reviews and meta-analyses have shown that a diet low in carbohydrates may have a more significant effect on weight loss than low fat- diets, particularly in the long term (more than 1 year) – (Masood, 2022).  As such, a carbohydrate-restricted diet was better able to help an individual maintain an appropriate Basal Metabolic Rate (BMR) than that of low-fat diets.  Therefore, the consumption of quality calories may be able to positively impact the number of calories burned daily.

To this extent, a properly planned ketogenic diet can help in weight loss and maintenance (Masood, 2022). However, if you are performing heavy exercises, it is recommended that your protein intake be slightly increased to prevent the occurrence of what is called, gluconeogenesis (the endogenous production of glucose in the body) (Masood, 2022). 

The degree of increase of protein may be determined by your nutritionist or by you adding small amounts of say, 1.5g per your body weight (Masood, 2022).  While carbohydrates and protein are usually reduced in this type of diet, fats and daily calories are not. However, quality is the key to fats and calorie needs.

So, can a ketogenic diet help with weight loss and cardiovascular health?

A ketogenic diet is beneficial for weight loss and even cardiovascular health, particularly in the short term.  According to research, a 2020 meta-analysis study of thirty-eight (38) studies has shown that a low carbohydrate diet of (less than 40% of energy) from carbohydrates resulted in a small weight loss when compared with low-fat diets of say, less than thirty (30%) percent of energy from fat.

While the reduction in one’s weight may be attributed to a reduction in appetite (Westman et al. 2007), the same effect was observed in those who were on a balanced, yet very low-energy diet.  However, if appetite suppression is a major cause of the reduction in one’s weight on a ketogenic diet, research suggests that a more beneficial alternative may be experienced with a low-fat vegan diet, which may even be more effective than a ketogenic diet (Hall et al 2021).  

Additionally, controlled trials have shown that a low-carbohydrate diet was no more effective than other diets that restrict calories (Academy of Nutrition and Dietetics, 2021), or other interventions such as a low-fat, vegetarian diet in reducing one’s weight (Gardner et al. 2007; Dansinger et al. 2005).

Can the ketogenic diet help with diabetes?

While a ketogenic diet has been proven to be effective in improving glycemia (presence of glucose in the blood) in patients with type-1diabetes, it is usually not recommended as an alternative means of treatment due to the reported risks of malnutrition, amenorrhea, sleep quality, hypoglycemia, and reduction in bone density etc. (McClean et al. 2018).

As such, both positive and negative outcomes have been observed in persons with type-1 diabetes.  As for type-2 diabetes, a ketogenetic diet has been shown to suppress appetite, help with weight loss, reduce blood glucose levels as well as improve insulin sensitivity (Colica et al. 2017). This is reportedly only in the short term.  To this extent, long-term studies are needed for the evaluation of any further benefits and risks.

How long can I be on a ketogenic diet?

Many studies have shown the ketogenic diet has short-term benefits as it relates to weight loss. Short-term in this sense was anywhere from a few weeks up to two (2) years (Masood, 2022).  However, researchers continue to investigate its long-term effects on weight loss as well as any adverse effects on the body. One such was that of Dashti and colleagues in 2004.  In this study by Dashti et al (2004), the researchers investigated the ketogenic diet’s short-term effects on weight loss as well as its long-term term effects on physical and biochemical parameters.

The study was conducted over twenty-four (24) weeks with eighty-three (83) obese patients (39 men and 44 women), who had a body mass index (BMI) of 35kg/m2 or greater as well as high glucose and cholesterol levels.  The ketogenic diet of the participants consisted of thirty (30) grams of carbohydrates which came from green vegetables and salads, and eighty to one hundred grams of protein (i.e., meat, fish, eggs, cheese etc.). The participants’ diet also comprises both polyunsaturated and monounsaturated fats. Additional carbohydrates were added to the participants’ diets at the twelve (12) mark of the study.  Additionally, the participants were given a nutritional supplement, in the form of a capsule daily.

The study concluded that the long-term effect of the ketogenic diet was positive, as it significantly reduced the body weight and body mass index (BMI) of the participants.  It was also able to decrease triglyceride levels, low-density lipoprotein Cholesterol (LDL-cholesterol) and blood glucose while increasing the levels of high-density lipoprotein (HDL-cholesterol). Nonetheless, more research was still recommended as it relates to the diet’s consideration as a lifetime regimen.

Quality matters – Is the ketogenic diet a quality diet?

Some of the controversies surrounding the ketogenic diet are reportedly due mostly to the ‘makeup’ of a diet of this nature, particularly in the long term.  As such, research contends that extreme carbohydrate-restricted diets can severely affect the quality of one’s overall diet (Crosby et al. 2021), especially in situations where fruits, vegetables, whole grains, legumes etc. are restricted or eliminated and the consumption of animal products increases and encouraged (Crosby et al. 2021).

According to research, low carbohydrate diets may lack the intake of necessary vitamins and minerals, fibers, and phytochemicals which are typically found in restricted food sources such as fruits, vegetables, and whole grains (Liu, 2013; Slavin and Lloyd, 2012; Patterson et.al. 2020).  Additionally, these diets are usually low in other super-nutrients such as vitamin E, and vitamin A, as well as folate, thiamin, potassium, iron, calcium, and magnesium (Freedman et al. 2001).

Therefore, it is recommended that individuals on these types of diets take a multivitamin supplement, even though it’s always best to get your nutrients from food. However, proper supplementation can be considered an alternative source of nutrients (Bilsborough and Crowe, 2003). Additionally, low carbohydrate diets may also be high in saturated fat and cholesterol (Bilsborough and Crowe, 2003), which can increase one’s risk of certain types of diseases.  

Therefore, people with kidney failure (those usually with type 2 diabetes) or those at risk of developing cardiovascular disease, should either refrain from pursuing this type of diet or do so under the supervision of a medical professional (Alharbi and Al-Sowayan, 2020).

What are some of the side effects of the Ketogenic diet?

Ketogenic diets, especially those that are very restrictive, may reportedly cause fatigue, nausea, headache, constipation, acidosis and even hypoglycemia (Roehl and Sewak, 2017). These effects are usually observed though in the early days or few weeks of following the diet.  Other serious side effects such as hypercholesterolemia, hypomagnesemia etc. may also occur (Włodarek, 2019; Kang et al. 2004).

Research has also shown that self-administered ketogenic diets can cause a temporary group of symptoms known as the ‘keto flu’ (Bostock et al. 2020). These groups of symptoms include nausea, dizziness, gastrointestinal discomfort, brain fog, loss of energy, irregular heartbeat and even the feeling of fainting (Bostock et al. 2020).

Some of the long-term side effects of a ketogenic diet include anemia, loss in bone mineral density, nephrolithiasis, and even issues with the optic nerve (Włodarek, 2019; Hoyt and Billson,1979).  As such, it is recommended that a ketogenic diet be professionally administered as it may not be sustainable for many people. 

Additionally, reports contend that it has low long-term tolerability (Kosinski and Jornayvaz, 2017; Brouns, 2018).  Additionally, diets low in carbohydrates have been associated with an increased risk of all-cause mortality (Noto et al. 2013).  Research has also denoted that it may be contraindicated with patients who suffer from conditions such as pancreatitis and liver failure, among others (Masood, 2022).

 What can I eat on a ketogenic diet?

Like with many diets, certain foods are encouraged and others, are discouraged, and the ketogenic diet is no exception.  The type of foods or ratio of particular macronutrients will depend on the type of ketogenic diet.  However, ketogenic diets in general usually recommend foods such as eggs, concentrated fats (Qian et al. 2019), bacon, leafy greens, berries, beef and chicken (for protein), heavy whipping cream, cream cheese, nut milk (which is the only type of milk products allowed), avocadoes (which can be used as a substitute for mayonnaise), butter (regular or grass-fed) and chicken broth, low carbohydrate flour such as almond flour, etc. These are some of the foods that are recommended for your pantry as they will become future staples.

Here is a simple ketogenic bread recipe which you can try. Plus, it requires just a few ingredients.

• Easy, ready in little over a minute, Keto Bread!

 Illustrative Summary

Here is an illustrative summary of the Exploration and Answers to the Ketogenic (Keto) diet questions.  

Let’s Sum Up!

The ketogenic (Keto) diet has been shown to have some positive feedback as well as those that bring it into the realm of controversies.  However, the diet is not a new kid on the block as research has shown that it has been around for years. Nonetheless, in its earlier years, it was used to reduce the frequency of seizures for persons suffering from epilepsy.  In recent years, the diet has been promoted for obesity, diabetes and even liver disease.

Like with many things, it has some side effects and is generally discouraged for long-term practice, especially due to insufficient research.  Additionally, research recommends that it be practised under the supervision of a medical professional, especially if you suffer from ill health.

So, have you ever heard of the ketogenic diet? Or have you ever tried it? Share it nuh!

 You can read more on fats, macro and micro-nutrients and diets in general in these articles:

• Let’s Talk Diet – The Mediterranean Diet – Benefits, What it Entails and How to Do It!

• Fat, who me? Understanding the types of fats in our foods!

• Intermittent fasting -Five (5) scientific benefits plus how to do it!

• Recipe: Easy, Ready in little over a minute, Keto Bread!

• Understanding ‘Micro’ and ‘Macro’ Nutrients – Getting to the nut of the matter!

Editor’s Note: Article updated on July 9, 2024.

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