What You Need to Know About the Ketogenic Diet

Kathryn Adel August 14, 2018 Eat Well, Health, Keto, LCHF

The Ketogenic diet is very trendy lately. It is characterized by an extremely low content in carbs (carbohydrates) and a very high content in fat (lipids). After 24 to 36 hours, glycogen stores in the liver and muscles are depleted, insulin secretion decreases, and ketone bodies formation (ketogenesis) becomes the only option to feed the brain.

What is the ketogenic diet?

To achieve this ketogenic effect, carbohydrate intake must be between 20g and 50g per day, mostly from low carbohydrate vegetables. In comparison, a regular diet contains about 175g to 250g of carbohydrates per day. With the ketogenic diet, it is not possible to eat starchy foods or fruits. Fat intake is approximately 75% to 80% of total calories, and protein intake is moderate. The adaptation to ketogenesis is responsible for the side effects often experienced at the beginning of this diet, such as fatigue, nausea, dizziness, headache, difficulty sleeping, constipation, ketosis breath and episodes of hypoglycemia.

Benefits of the ketogenic diet

This diet has been known for decades to be successful for the treatment of epilepsy in children. Recently, people started trying it to treat a number of other conditions. Some recent short-term studies suggest that this diet may promote weight loss, increase resting energy expenditure, decrease appetite or cravings, increase satiety, lower blood pressure, and improve diabetes control as well as the lipid profile (decrease triglycerides and increase good HDL cholesterol). However, it must be understood that these are preliminary studies and that other longer-term studies are underway to better evaluate these effects. Meanwhile, current scientific evidence does not support the general recommendation of this diet except to treat refractory epilepsy.

Risks of the ketogenic diet

• It has been associated with an increase in LDL cholesterol, which has a negative impact on heart health. Favoring good fats could perhaps counter this effect. SOSCuisine’s ketogenic meal plans favour the use of healthy fats.
• It can induce nutritional deficiencies, including B vitamins, beta carotene and vitamin C (largely found in fruits, vegetables, whole grains and legumes) as well as calcium. The contribution of several phytochemical compounds with antioxidant properties is also very limited. It has been shown that beta carotene, vitamin C and polyphenols found in phytochemicals, thanks to their antioxidant properties, exert a protective effect against various pathologies including cardiovascular disease and cancer. SOSCuisine’s ketogenic meal plans are built specifically to minimize the risk of such deficiencies.
• The fiber intake in this diet is often below recommendations, which can increase the risk of colon cancer and affect the gut microbiota. A balanced intestinal microbiota is important for health. A diet low in fiber and carbohydrates and high in fat and animal protein is associated with a reduction in microbiota diversity. It is also associated with a reduction of the good bacteria that produce short-chain fatty acids which are beneficial for health (including for the immune system) and an increase in the bad bacteria associated with obesity, inflammation and chronic disease. SOSCuisine’s ketogenic meal plans offer 15-20g of fibers every day, which can help nourish healthy gut bacteria.
• The long-term effects of the ketogenic diet are not known. This diet is characterized by weak long-term adherence. Thus, if people do not follow the plan in the long term and return to their old ways, they risk putting back on the weight that they lost and often even more.
• The ketogenic diet has the effect of acidifying the body, which can lead to the loss of bone calcium, and, therefore, a demineralization of bone tissue and increased risk of osteoporosis. This state of ketoacidosis can also lead to the development of kidney stones.
• This diet presents risks for people with diabetes or hypertension under medication, since the dose of the medication must be adjusted along the way according to changes in their biochemical parameters.

To be followed under medical supervision

Because of the risks for their health, it is essential that people with medical conditions or under medication (e.g. insulin) be supervised closely by healthcare professionals (Physician, Registered Dietitian, Pharmacist, Nurse). To help these people, or anyone else wishing professional guidance to follow the keto diet, SOSCuisine offers one-on-one consultations with registered dietitians.

References

• Extenso (2018) La diète cétogène et ses effets sur le poids corporel et sur les lipides sanguins, État de la question, 14 pages.
• Naude et coll. (2014) Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PloS ONE;9(7): e100652.
• Bueno et coll (2013) Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr; 130:1178-1187.
• Gomez-Arbelaez et coll. (2017) Body composition changes after very-low-calorie ketogenic diet in obesity evaluated by 3 standardized methods. J clin Endocrinol Metab;102(2):488-498.
• PEN Nutrition (2017) Diet Composition – Low Carbohydrate-Evidence Summary http://www.pennutrition.com.proxy3.library.mcgill.ca/KnowledgePathway.aspx?kpid=25612&trid=25973&trcatid=42
• McKenzie et coll. (2017) A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes;2(1): e5.
• Meng et coll. (2017). Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials. Diabetes Research and Clinical Practice, 131, 124-131.
• Noto et coll. (2016). Long-term Low-carbohydrate Diets and Type 2 Diabetes Risk: A Systematic Review and Meta-analysis of Observational Studies. Journal of General and Family Medicine, 17, 1, 60-70.
• van Wyk et coll. (2016). A critical review of low-carbohydrate diets in people with Type 2 diabetes. Diabetic Medicine: a Journal of the British Diabetic Association, 33, 2, 148-57.
• Mansoor et coll. (2016) Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Br J Nutr; 115:466-479.
• Holland et coll. (2016) Effects of a ketogenic diet on adipose tissue liver and serum biomarkers in sedentary rats and rats that exercises via resisted voluntary wheel running. Am J Physiol Regul Integr Comp Physiol;311: R337-R351.
• Paoli et coll. (2013) Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67, 8, 789-96.
• Murphy et coll. (2015). Influence of high-fat diet on gut microbiota: A driving force for chronic disease risk. Current Opinion in Clinical Nutrition and Metabolic Care, 18, 5, 515-520.9.
• Saslow et coll. (2017) Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition and Diabetes;7:304.
• OPDQ. (2018). L’état de la science en matière de traitement nutritionnel du diabète de type 2 chez l’adulte par les diètes faibles en glucides et rôles des professionnels. Tiré de https://opdq.orghttps://wordpress.soscuisine.com/2018/06/Position-Diabete-Diete-Cetogene.pdf

Author

Kathryn Adel

Kathryn holds a Bachelor Degree in Nutrition as well as a Bachelor and a Master Degree in Kinesiology, all from Laval University. She is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ) and of the American Academy of Nutrition and Dietetics. She holds the Monash University's certification for the FODMAP diet and IBS, and has considerable clinical experience in that area. She is also an accomplished athlete, having ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health.