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How Effective is the ‘Keto Diet’ for Weight loss?

How Effective is the ‘Keto Diet’ for Weight loss?

The popular 'Keto Diet' involves reducing carbohydrates radically and eating more fat. The thought is that it will be effective at helping people lose weight and burn fat quickly.

Keto Diet

Thinking about starting the ketogenic diet? Shutterstock Images

The Keto Diet Overview

The Keto Diet has gained widespread notoriety around the world in the last couple of decades. It’s been known by many names over the years, the most common being the ‘Atkins Diet,’ which was popularized by American physician Robert Atkins in his book titled Dr. Atkins Diet Revolution.

Some people have sworn by its incredible weight-loss benefits, including Hollywood stars like Halle Berry and Kim Kardashian.

But is it worth the hype?

History of the Diet

The Keto Diet was derived from various earlier researchers who used fasting as a form of therapy, stating that it ‘cured seizures’ in their young patients through providing more energy to fight illness and detoxifying the body[11], [12].

DID YOU KNOW – The Keto Diet started out as a treatment for epilepsy in kids in the 1920s.

The problem with fasting, however, was the there is only so long a person can go, so although there appeared to be some early success, there were also various limitations.

The keto diet was then introduced as a way to mimic fasting through essentially starving the body of glucose forcing the body into a state of ketosis, where ketone bodies (fatty acids) are burned instead of glucose.

It was thought that the keto diet, which is high in fat, moderate protein, and very low carbohydrate, would then be just effective as fasting for patient with seizures but be much more maintainable over a longer-term because they would be getting some degree of nutritional intake[12].

Although there was some level of success with this diet in children with seizures, the long term success was not always so positive, as adherence to the diet dropped and symptoms re-emerged.

Additionally, with the rise in antiepileptic drugs, the use of the keto diet decreased dramatically as most physicians found them easier to provide to patients and very effective[12].

However, with some modifications over the years to make the diet more palatable, the keto diet has come back for the treatment of epilepsy, often in combination with other therapies, in a number of cases with early signs of success[12].

Keto and Weight Loss

There is no doubt that obesity, which is defined as a person with a body mass index (BMI) of 30 or higher, and all of the related medication conditions have increased over the years[6]. Obesity puts an individual at high risk for developing a number of medical conditions including high blood pressure, diabetes, dyslipidemia, atherosclerosis, and some cancers. It can indeed be a serious life-threatening condition and it is estimated that obesity contributes to some of the major overall causes of death in America.

While there are a large number of factors that have contributed to the rise in obesity and it’s associated conditions, the more sedentary lifestyles of most individuals and the changes in our eating habits are among some of the key players.

On the positive side, however, many researchers have found that even modest weight loss, such as 5-10% of a person’s body weight, can significantly lower these health risk factors and have more positive health outcomes[13], [5].

This is where the keto diet started to come in. With obesity rising, people are often looking for a quick fix and with reports of people dropping weight very quickly; it began to catch the attention of the masses and now has created quite a market for itself. The problem lies in the lack of understanding about potential hazards and long-term consequences of this diet.

Biological Process

The traditional Keto Diet involves lowering your intake of carbohydrates below 50g a day, which would be equivalent to having a few pieces of fruit or perhaps just over a cup of rice[8]. Add calories from carbohydrates drops, the proportion of fat consumed raises quite a bit, while protein remains at a moderate level.

When carbohydrates are kept at this level consistently, your body’s reserve of stored carbohydrates becomes depleted and can no longer provide enough energy to meet the demand of the body. When this happens, it is forced to use an alternative fuel source and that is where ketones come in.

The central nervous system, which includes the brain, and some organs use glucose as their fuel of choice. When that is not available, the liver begins the process of ketogenesis to produce ketone bodies from fatty acids to act as another fuel source. This explanation is very much oversimplified for the purpose of this article, but it is this mechanism that enables the body to survive in times of low food intake.

Effectiveness of the Keto Diet for Weight Loss

Does the Keto Diet really work for fat loss? Sure, there are certainly studies to show that weight loss and positive changes in other health markers can occur.

For example, a 2004 study by Dashti, et al followed a group of obese keto dieters over a 24-week period[3]. The results indicated that the subjects experienced significant fat and weight loss overall, and lowered cholesterol levels. Similar results have been seen in a number of studies, at least in the short or medium time lengths[3], [9].

The problem lies is the reasoning behind the weight loss. Researchers are still not certain the main cause of the weight loss when using the keto diet[9]. One common argument is that the keto diet doesn’t provide any special weight loss benefits; it’s simply that most individuals are in a caloric deficit and that is why they lose weight.

Additionally, due to the fact that for every single gram of carbohydrate, you also have about 3 grams of water coming into the cells, switching to a very low carbohydrate diet can be show rapid weight changes in some simply due to a decrease in water weight[1].

On the other hand, some researchers do argue that the keto diet is unique and offers special weight loss advantages[9]. Some of these arguments revolve around appetite reduction due to the satiating nature of fats, changes in appetite-regulating hormones, increases in the breakdown of fats and a greater energy expenditure involved in fat breakdown when compared to carbohydrates.

Overall, the research is inconclusive as to the specific effectiveness of the keto diet. One thing we do know for sure is that in order to lose weight, a consistent caloric deficit is key, whether that is done using the ketogenic diet or any other dietary protocol[7]. Secondly, we also strongly need more time and more research to address the long term safety and effectiveness of such an extreme diet.

Is the Keto Diet Safe?

Due to the extreme nature of this diet, it is important that individuals are aware of some downsides and risks to the diet. It is important to note that there are a number of studies suggesting this diet is safe to use but often that is very misleading.

In controlled studies, the diets of subjects are tightly regulated to the extent that they are often provided with meal plans and also vitamin and mineral supplementation.

Remember that experts run these trials and they know what to provide to keep their subjects healthy as they test out their theories. In the real world, however, many individuals are unaware of extra requirements that the body may need during the time of using such an extreme dietary protocol and also how to transition out of it[3].

When starting the diet, there is a common group of symptoms, called ‘keto flu,’ which can include headaches, dizziness, weakness, fatigue, and constipation.

Although seemingly mild, these unpleasant symptoms can place a person at risk depending on the situation[3]. Once in ketosis, you may experience other side effects such as bad breath, nausea, headaches, fatigue and constipation[7], [10].

If not done carefully, some other potentially more risky consequences can occur. Some studies have reports liver and kidney complications, bone issues, raised triglyceride and cholesterol levels, mineral and vitamin deficiencies along with their associated complications and heart issues[9], [10].

Is the Keto Diet right for you?

As the nature of this diet is extreme, I would first consider whether it would fit your life. Remember that most research has suggested no real difference in dieting success if you are low carbohydrate or not, so determine if you a very low carb approach would be right for you. The second thing you need to consider is if you see yourself being adherent to this type of dietary protocol.

Most Registered Dietitians do not recommend this diet to clients because of the risk factors and very low consistency and remember that for weight loss success, consistency is one of the top requirements[2].

If you do want to try it for yourself, it is highly recommended that you seek out a professional who understands the ketogenic diet and the things that are needed to supplement with to help to ensure that you are kept safe and healthy[9].

It is also important to remember that the research for the long term effects and safety is still not conclusive and for certain populations, such as pregnancy, people who take insulin, oral diabetes medication, or diuretics, it is not recommended to use this dietary protocol[4]. Instead, talk to a Dietitian to help make a better plan suited to your goals while being mindful of your health.

Feedback:

13 sources

1. Astrup, A., Larsen, T. M., & Harper, A. (2004). Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?. The Lancet, 364(9437), 897-899.
2. Campos, M. (July 2018) Ketogenic Diet: Is the Ultimate Low Carb Diet Good for You? Harvard Health Publishing. Retrieved online at https://www.health.harvard.edu/blog/ketogenic-diet-is-the-ultimate-low-carb-diet-good-for-you-2017072712089
3. Dashti, H. M., Mathew, T. C., Hussein, T., Asfar, S. K., Behbahani, A., Khoursheed, M. A., Al-Sayer, H. M., Bo-Abbas, Y. Y., … Al-Zaid, N. S. (2004). Long-term effects of a ketogenic diet in obese patients. Experimental and clinical cardiology, 9(3), 200-5. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/
4. Fabe, J (2019). Pitfals of the lifestyle ketogenic diet. Retrieved from https://www.hamiltonhealthsciences.ca/share/lifestyle-ketogenic-diet/
5. Goldstein, D. J. (1992). Beneficial health effects of modest weight loss. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity, 16(6), 397-415.
6. Mokdad, A. H., Ford, E.S., Bowman, B.A., et al (2001). Prevalence of Obesity, Diabetes, and Obesity-Related Health Risk Factors, 2001. JAMA, 289(1),76–79. doi:10.1001/jama.289.1.76
7. O'Connor, A. (2019, August 27). Is the Popular Ketogenic Diet Good for You? New York Times, p. D4(L). Retrieved from https://link-gale-com.subzero.lib.uoguelph.ca/apps/doc/A597501746/AONE?u=guel77241&sid=AONE&xid=f4a698e8
8. Owen OE, Morgan AP, Kemp HG, Sullivan JM, Herrera MG, Cahill GF Jr (1967). Brain metabolism during fasting. J Clin Invest, 46, 1589–1595.
9. Paoli A. (2014). Ketogenic diet for obesity: friend or foe? International journal of environmental research and public health, 11(2), 2092–2107. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945587/
10. Wheless, J. W. (2001). The Ketogenic Diet: An Effective Medical Therapy With Side Effects. Journal of Child Neurology, 16(9), 633–635. https://doi.org/10.1177/088307380101600901
11. Wheless J.W. (2004) History and Origin of the Ketogenic Diet. In: Stafstrom C.E., Rho J.M. (eds) Epilepsy and the Ketogenic Diet. Nutrition and Health. Humana Press, Totowa, NJ
12. Wheless, J.W. (November 2008). History of the Ketogenic Diet. Special Issue: Ketogenic Diet and Related Dietary Treatment, 49(8), 3-5. Retrieved online at https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2008.01821.x
13. Wing  R.R., Lang  W., Wadden  T.A., et al. (2011). Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 34, 1481–1486.
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Chelsea Cross, RD

Chelsea is a Registered Dietitian (RD) who graduated from the University of Guelph in 2018. Her education has been quite the journey be...

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