If you read about health and diets online, you've likely come across 'keto' or heard of people 'doing keto'. The references here are to a ketogenic diet, a diet that gained popularity in America over the last 10 years and has arrived in India more recently. Some background will help explain its rising popularity.

The best stories have a hero and a villain. A hero who possesses superpowers and a villain who deserves to be banished to hell.

The stories you hear about food are no different.

For the longest time, the villains were 'fats' - they led to weight gain, increased cholesterol, led to heart problems and were to be avoided at all costs. The hero? Heart healthy whole grains (carbs). Backed by aggressive advertising from large American cereal manufacturers, more grains were added to a diet that already had a fair share of it. Thus grew a new line of foods - from breads, cereals, bagels, muffins, corn flakes and oats to cereal bars in beautiful packaging. They went with wholesome tags like low GI, high-fibre and heart healthy. After a few decades of this, America discovered that the health of Americans had never been worse. Not surprising if your daily diet is 80%+ grains.

Sadly, this is true in India as well.

As the realization dawned across the population, there rose a new breed of diets where the roles were reversed. The ketogenic diet is one such diet. The hero - carbs - became the new villain. And the new hero? Fats. With a ketogenic diet, fats are the main component of your diet and carbs are to be avoided at all costs.

The pendulum has swung completely the other way, but the basic story remains one of a hero and a villain. It makes for simple, compelling storytelling. And if you believe the buzz, a ketogenic diet can curb appetite, help you with weight loss and cure nearly any health problem that ails you.

Does this sound too good to be true?

It probably is. Good storytelling is not the same as following good science.

First, some history...

  • It starts with fasting. The health benefits of fasting have been known since 500 BC. Specifically, fasting came to be recognized as a good way to help treat epilepsy (a neurological disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior/sensations, and sometimes loss of awareness.)
  • But fasting is not easy - our bodies (and brain) are wired to ensure we eat enough. This led to the search for a way to mimic the effects of fasting, but without fasting.
  • A diet that was very low in carbohydrates and very high in fat was found to have a similar effect as fasting. This diet was called the Ketogenic Diet.
  • The ketogenic diet has been around since the 1920s and was used to treat children with epilepsy.
  • Today, we have a number of new populations of people whose brains might benefit from a ketogenic diet, such as people with neurodegenerative disorders (including multiple sclerosis, Parkinson’s, and Alzheimer’s).

So is this a new diet? It's been around for a century, so no. But diet peddlers have an incredible knack for re-branding old ideas over and over, and in our eternal confusion about what to eat, we keep falling for it all.

Is the ketogenic diet an extreme diet?

Yes.

A ketogenic diet relies primarily on fat for its calorie requirements, a small portion from protein and minimal carbs.  

Let's look at the specifics.  If you are following a ketogenic diet, do you know what proportion of your daily calorie needs can be met from carbohydrate sources?

5%

That's right, a maximum of 5%.  So, for a 2000 calorie diet, you cannot have more than 100 calories from carbohydrates - that's the equivalent of 1 apple a day.

The rest of the calories (95%) have to come mostly from fat (e.g. butter, cheese, avocado, nuts, oils) and to a small extent protein (e.g. eggs, meat).    

The ketogenic diet is, in fact, one of the most restrictive diets out there.

Why would a healthy person want to try this?

To trick the body into using fat as fuel, also called Ketosis.

What is Ketosis?

In very simple terms:

  • Ketosis is essentially an effect of fasting.
  • When the conditions are right (for instance, during starvation or fasting, or when our carb intake is very low), our body releases fatty acids from our stored body fat and after a few chemical reactions 'Ketones' are released by the liver into the blood. Ketones are a group of organic compounds.
  • Almost any cell in the body that needs energy can grab it from these ketones.
  • So instead of using carbs for energy, you use fat.

Here is an important point to undertand about ketosis. It is not easy to put an adult body into ketosis. You need to be very precise about the fats, protein and carbs you're eating. The most accurate way to know whether you are in fact in ketosis is to measure ketone levels in your blood or urine.

It is likely that many people 'think' they are in ketosis, but never actually get there.

This is understandable given the extreme steps you need to take to get into a state of ketosis. This most often happens when you attempt such a diet without the close supervision of a specialist doctor (usually a doctor who uses the diet to treat Type 2 Diabetes) or an experienced nutritionist.

In this case, people are eating a high-fat, low-carb diet - not a ketogenic diet. You'll still see results when it comes to weight loss, because eating a lot of fat turns your appetite off. So overall you'll end up severely limiting your food intake and lose weight. But none of the other things that you think are happening, are actually happening.

When does ketosis help?

In addition to the medical conditions noted above (like epilepsy), there are very specific situations like Type 2 Diabetes, multiple sclerosis, Parkinson’s, and Alzheimer’s where a ketogenic diet can be useful. But, it is critical that:

  1. it is done under close medical supervision as part of a treatment program; and
  2. it should probably include other tools such as medication or other well-established health procedures.

What about weight loss?

There's no real advantage. Being in ketosis doesn’t seem to have any special advantage for losing body fat.

You may find it easy to eat less when all you can eat is protein and fat. But after a while, you will grow tired of this. Not only that, you may be developing some serious nutrient deficiencies.

For women in particular, lowering carbohydrate intake seems to have negative effects. Women’s bodies go on high alert faster when they sense less energy and fewer nutrients coming in. Many women have found that very low-carb diets don’t work for them and also disrupt their menstrual cycles.

We see this over and over again when people try diets like the ketogenic diet.

It's painful to go through but the dramatic results in just a few months seem worth it. No pain, no gain and all that. But then what? Nothing really, it's a question of whether to endure more of the pain to retain the gains. This is exactly the situation you find yourself in with most 'named' diets. They all work, for a while. Because they all reduce your overall food intake drastically and produce drastic results - in the short term. You learn no skills for real life and are back where you started in 12 months or less. Your confidence, self-esteem and mental health also take a beating in the process. Reminds me of the phrase - people don't fail diets, diets fail people.

More evidence.

Here is the conclusion from a recent paper published in the Indian Journal of Medical Research on Ketogenic diets:

"The biggest problem with extreme diets like keto diets is their sustainability. In our experience, people are initially thrilled with the weight loss and the excellent diabetes control they get, after using keto diets. Slowly, however, they get bored with the diet. Furthermore, many feel weak and frustrated and start increasing the carbohydrate intake, and soon they are back to their original weight and diabetes control. Recent studies also suggest that ketogenic diets may, in fact, induce hepatic insulin resistance. There are also reports of micro-nutrient deficiency and cardiovascular safety. Hence, many more studies need to be done before these diets are widely recommended."

If you'd like evidence from the USA where the diet is most popular, here is a quote from Kevin Hall, Ph.D. a senior investigator at the National Institutes of Health, USA who has studied the ketogenic diet:

“The idea is that low-carb, ketogenic diets cause your body to burn way more calories, resulting in a lot of weight loss, even if you eat more than you were eating before. But our studies, as well as many others, demonstrate nothing of the sort.”

What does this mean for you?

In summary, a Ketogenic Diet is (a) extreme (b) proven to be no better than many other diets and (c) could potentially cause harm. So:

  • Don’t use ketosis to try to cure "stuff".
  • Don’t use ketosis just to randomly “get healthy”.
  • “Medical supervision” does not mean Google.

If you lead a busy life and want a sustainable way to look after your health, you need more than a trending diet. You need a plan. And a good plan will cover food, water, exercise and sleep. It's not complex to figure this out, but you'll find it incredibly hard to focus on what matters when you have the internet leading you down so many false tracks.

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