Epilepsy and an Icy, New York Sidewalk
What’s the Keto diet? I’ve got a lot of friends doing that.
Yep, me too. One of my friends lent me a book about it which I devoured (without carbs) over several days. Fascinating diet. Keto is short for ketogenic. The idea is that you eat less than 20 to 50 grams of carbs daily and increase your fat intake to about 75% of your calories. In doing so, your body switches its fuel source from sugar (carbohydrates) to fats (ketones), which puts you in a ketogenic state. You avoid carb containing foods like: breads, cereals, grains, pastas, starchy vegetables (sweet potatoes, corn, potatoes), most fruits (juices too), legumes, beans, candy, cakes, pies, etc. . .
Wait a minute! You mean to tell me that people lose weight eating mostly fat? I thought the best way to eat was a low-fat diet?
Unfortunately, since the 1970’s, we’ve been led to believe that a low-fat diet is good for us but it’s simply not true (see my prior post).
But people on the Keto diet seem extreme in the other direction. Don’t you need carbohydrates to live?
Proponents of the diet use the argument that throughout thousands of years of human evolution our ancestors ate this way by chomping on lion meat in the summer and slurping fish fat in the winter. Farming didn’t happen until about 8-10,000 years ago, and our bodies weren’t really adapted to eating carbohydrates like whole grains and Twinkies.
That sounds like a rational argument.
The problem is that we’ve never found Cave-Man-Bob’s medical records. Nor have we ever found cave wall paintings showing Cave-Man-Bob clutching his chest from angina. More likely, Cave-Man-Bob became a low carb meal for some creature before he turned 40 years old.
I am skeptical of this evolution argument for several reasons. Wouldn’t our hunting ancestors have evolved first from plant-eaters? (Hat tip to my medical assistant, Sage). The idea of Creationism would also argue against the low carb-diet as God didn’t put Adam and Eve in the ranch of Eden.
Last time I checked, I didn’t have any relatives living in caves and hunting meat. How did eating Keto start in modern times?
Between 1910 and 1920, the ketogenic diet was used to treat diabetics. Since insulin wasn’t invented until 1921, doctors kept diabetics alive by giving them high fat, no carbohydrate diets. If you fell off the wagon and snuck dessert, you’d literally die by developing ketoacidosis! Dr. Russel Wilder at the Mayo Clinic may have coined the term “Ketogenic diet” and he, along with others, used a similar diet to prevent seizures in kids with epilepsy. This diet was 90% fat and 4% carbohydrates. The diet is still used for epilepsy today.
So, Doctor Grandpa, 1910 is a long time ago. I asked about modern times.
We can thank Dr. Robert Atkins for the modern day enthusiasm for the ketogenic diet. You’ve read his name on food labels before, but who was he? Like all great and humble doctors, he was a cardiologist. He opened a practice in New York in the 1960s and began to gain weight. His search for the right diet led him to the ketogenic diet. He soon began prescribing it for his patients and then published his first book in 1972. Dr. Atkins passed away in 2003 after slipping on an icy New York sidewalk and hitting his head.
Though he popularized eating a “low carb” diet (80-100 grams of carbs daily), his diet is not truly a ketogenic diet. The dietary principles he espoused have predominantly led to the myth that all carbs are “bad.”
Okay, so what’s the difference between the Atkins diet and the ketogenic diet?
The initial part of the Atkins diet puts one in ketosis. This occurs by eating <20 grams of carbohydrates a day (about 1/2 cup of cooked pasta or 34 chocolate M&M’s). In ketosis, your body switches to using fat for fuel instead of sugar. With the Atkins diet, you eventually increase carbohydrates to 80-100 grams day and get out of ketosis. True ketogenic eaters, restrict carbs for life by eating less than 20-50 grams/day. Their bodies remain in ketosis and their source of energy remains ketones: Acetoacetate, Beta-hydroxybutyric adic, and acetone.
Woah! Put that science jargon back in your pocket! Why do people lose weight on the diet?
There are three main reasons the ketogenic diet leads to weight loss: 1. More calories are likely needed to use fat/protein for energy; 2. Less hunger when eating fats/protein; and 3. Decreased appetite from being ketogenic.
Okay – so what do they eat?
High-fat foods like butter, coconut/olive oil, lard, avocado, nuts, and seeds. Vegetables, including onions, celery, cucumbers, zucchini, cauliflower, asparagus, and broccoli. Proteins, such as eggs, beef, chicken, pork, fish, lamb, and shellfish. Some fruits are okay like berries, cherries, grapefruit, and kiwi. Dairy sources include cheese, full-fat yogurt, and cottage cheese. For sweeteners they use things like Stevia and Xylitol.
After a few days, I’d probably eat 34 chocolate M&M’s with a zero on the end! Is eating Keto worth the effort?
In the short term, it promotes weight loss and studies show it improves blood sugar, improves cholesterol, and lowers body markers of inflammation.
Sign me up! I’d like my T-bone steak medium-rare puuullleaze!
Not so fast. The above study evaluated 17 studies — most of which were only several months in duration. One main conclusion was: “The effects on long-term health are UNKNOWN.”
One popular lifestyle physician’s website promotes the diet using a study that was only 24 weeks long. Scary, right?
Look, there’s a lot of companies and health clinics promoting the ketogenic diet and low carbohydrate diets. These diets must be better than any other way to lose weight, right?
Studies show that over the course of two years, there is no difference in weight loss between balanced diets and low carbohydrate diets. One promoted advantage of the ketogenic diet, however, is that those dieters feel less hunger than other diets.
Weight loss is the same huh?! So has any study shown the keto diet to be harmful?
I call Dr. Robert Atkins to the witness stand. At the age of 70, Dr. Atkins suffered a heart attack. When he passed away several years later, the medical examiners report suggested he not only had heart disease, but also congestive heart failure and hypertension. It doesn’t look good when the guy who started the Atkins empire suffered from heart disease.
Children who’ve been on the ketogenic diet long term for epilepsy are next to the witness stand. Studies show they have an increase in kidney stones, osteoporosis, cholesterol, and impaired growth.
Adults aren’t kids. What long-term harm is seen in adults?
There are adult studies but they evaluate low-carbohydrate diets (<40% calories from carbs) and not necessarily true ketogenic diets (<5% calories from carbs). The signals from these studies are not good for low-carb diets. In a review of 17 studies involving over 272,000 people, the lower the amount of daily carbohydrates, the higher the risk of death. Another observational study showed that people who ate too few carbs (less than 40% of total calories) or too many carbs (greater than 70% of their total calories), had a higher rate of death. This study did observe that those who ate 50-55% of their calories from carbs lived the longest.
What if I’ve had a heart attack? Would eating a keto diet help me then?
One study showed that heart attack survivors who ate a low-carb diet along with a high intake of animal fat had more death from heart disease.
I’ll just point out the problem with your science. These studies aren’t really looking at true ketogenic diets — just diets low in carbohydrates, and high in proteins.
You’re spot on right. Like I said, the long-term, well-done, comparison studies of the ketogenic diet aren’t out there.
Just summarize for me. Would you recommend the Keto diet?
I think we need some humility about food and disease. Obviously, the whole idea of a ketogenic diet has challenged prevailing medical thought. There are, however, some worrisome signals from studies about low carb eating.
In the end, there is a diet that DOES prevent heart attacks. In a randomized controlled study of heart attack survivors, one heart attack was prevented in every five people that ate a Mediterranean diet. This diet encourages fish, poultry, whole grains, eggs, fruits, vegetables, beans, nuts, seeds, legumes, and olive oil. It also discourages processed/refined foods as well as red meats.
Maybe one day, they’ll do the same study with the ketogenic diet. Wouldn’t that be fascinating if it worked? Until then, it’s your choice if you want to be a guinea pig.