Ketogenic Diets: Sorting Through the Pros and Cons
Ketogenic diets are hardly new, but they’ve become increasingly popular in the last few years for weight loss and much more. As a Registered Dietitian Nutritionist, I have used modified ketogenic diets for some patients over the past year and have found some positive outcomes, mainly improvements in cognition.
My overall position is that any form of a ketogenic diet is a therapeutic one. Meaning, I only recommend it when I feel the benefits outweigh the risks and other dietary protocols haven’t proven optimal. Among their drawbacks, ketogenic diets can be tough to follow. They may require patients to go as low as 30 grams of carbohydrates per day, which limits variety within meals including an array of colorful and dark leafy green vegetables. Our food provides much more than macronutrients (fat, protein, and carbohydrates). The plants we eat give us so many of our micronutrients (vitamins and minerals) and various phytochemicals that protect our cells. They also provide a good portion of fiber that is critical for good elimination and detoxification and also nourishes gut bacteria. A healthy gut microbiome (the balance and amount of microorganisms in the gut) dramatically impacts overall health.
The original ketogenic diet was first developed in the 1920’s to help reduce seizures in children with epilepsy, where other treatments had failed, and was found to be quite effective. Since then, the research has been expanding to evaluate the potential benefits in other neurological conditions and in many areas of health. Today there are 115 registered clinical trials examining various ketogenic protocols for diseases including cancers, Alzheimer’s, migraines, and autism. Researchers also have looked at the impact of the ketogenic diet on athletes to improve performance and its potential to help people lose weight.
If you’re curious about a ketogenic diet, here is a quick overview. They are very high in fat— typically about 70% of total calories, low to moderate protein, and very low in carbohydrates. While many modified versions of the ketogenic diet exist, their end goal is the same: to push the body into a state of ketosis. That means rather than using glucose from carbohydrates as its main energy source, the body uses ketones, a byproduct of fat metabolism. Ketones appear to be the preferred source of energy by the brain: one of the mechanisms by which they appear to provide therapeutic benefit for neurological conditions.
Two main areas of the research have focused on cancer and Alzheimer’s. For cancer, being in a ketogenic state will deprive cancer cells of glucose, their preferred fuel. Ketosis can also mimic fasting, which can reduce the oxidative stress load on the body and protect cells from damage. Numerous variables impact this research and make conclusions difficult, but ketogenic diets do show potential for cancer patients. With neurological conditions like Alzheimer’s and dementia, the research has been more promising, especially when MCTs (medium chain triglycerides—a type of fat derived from coconut oil) have been added to the study protocols. MCTs are more efficiently used as calories than other fats.
When it comes to athletic performance and weight loss, the more your body can use fat for energy the better. Athletes can go longer before fatiguing and those who want to lose weight will become more efficient at burning fat stores. However, my health concerns still hold for this population. Athletes are under high oxidative stress conditions that require more nutrients and compounds from plants that act as antioxidants. And when individuals lose weight, especially fat stores, they often release stored toxins that require optimal intake of antioxidants and compounds that support our detoxification pathways. In my experience, you can enhance athletic performance, achieve a healthy weight, and improve overall health just by increasing good quality fat, getting sufficient protein, lowering overall carbohydrates and avoiding refined processed carbohydrates. I don’t believe at this point one has to be in ketosis to meet their goals. And in my over 15 years of doing nutrition consultations, I’ve rarely seen any downside to eating too many veggies!