Ketogenic Diet for Weight Loss

Are you perplexed by the seemingly never-ending promotion of weight-loss strategies and diet plans? In this series, we’ll look at some popular diets and the science behind them.
What exactly is it?
The ketogenic diet, also known as the “keto” diet, is a low-carbohydrate, high-fat eating plan that has been used for centuries to treat specific medical conditions. The ketogenic diet was widely used to help control diabetes in the nineteenth century. It was introduced in 1920 as an effective treatment for epilepsy in children who had failed to respond to medication. The ketogenic diet has also been studied and used in clinical trials for cancer, diabetes, polycystic ovary syndrome, and Alzheimer’s disease.
However, because of the low-carb diet craze that began in the 1970s with the Atkins diet, this diet is gaining significant attention as a potential weight-loss strategy (a very low-carbohydrate, high-protein diet, which was a commercial success and popularized low-carb diets to a new level). Other low-carb diets, such as the Paleo, South Beach, and Dukan diets, are now high in protein but low in fat. The ketogenic diet, on the other hand, is notable for its exceptionally high fat content, typically 70 percent to 80 percent, with only a moderate intake of protein.
How Does It Work?
The ketogenic diet for weight loss is based on the idea that by depriving the body of glucose — the primary source of energy for all cells in the body, which is obtained by eating carbohydrate foods — an alternative fuel called ketones is produced from stored fat (hence the term “keto”-genic). Because it cannot store glucose, the brain requires the most glucose in a steady supply, about 120 grams per day. Fasting, or eating very little carbohydrate, causes the body to first draw stored glucose from the liver and then temporarily break down muscle to release glucose. If this continues for 3–4 days and the body’s stored glucose is completely depleted, blood levels of a hormone called insulin fall and the body begins to use fat as its primary fuel. Ketone bodies are produced by the liver from fat and can be used in the absence of glucose. [1]
Ketosis occurs when ketone bodies accumulate in the blood. Mild ketosis occurs naturally in healthy people during periods of fasting (e.g., sleeping overnight) and very strenuous exercise. Proponents of the ketogenic diet argue that if the diet is followed carefully, blood levels of ketones should not rise to dangerous levels (known as “ketoacidosis”) because the brain will use ketones for fuel and healthy people will typically produce enough insulin to prevent excessive ketones from forming. [2] The rate at which ketosis occurs and the number of ketone bodies that accumulate in the blood differs from person to person and is determined by factors such as body fat percentage and resting metabolic rate. [3]
What exactly is ketoacidosis?
Excess ketone bodies can cause ketoacidosis, a dangerously toxic level of acid in the blood. During ketoacidosis, the kidneys begin to excrete ketone bodies in the urine alongside body water, resulting in some fluid-related weight loss. Individuals with type 1 diabetes are more likely to develop ketoacidosis because they do not produce insulin, a hormone that prevents the overproduction of ketones. Ketoacidosis has been reported in a few rare cases in nondiabetic individuals following a prolonged very low carbohydrate diet. [4,5]
Dietary Guidelines
There is no “standard” ketogenic diet with a specific macronutrient ratio (carbohydrates, protein, fat). The ketogenic diet limits total carbohydrate intake to less than 50 grams per day, which is less than the amount found in a medium plain bagel, and can be as low as 20 grams per day. Popular ketogenic resources recommend an average of 70–80 percent fat from total daily calories, 5–10% carbohydrate, and 10–20% protein. This equates to approximately 165 grams fat, 40 grams carbohydrate, and 75 grams protein for a 2000-calorie diet. Because eating too much protein can prevent ketosis, the protein amount on the ketogenic diet is kept moderate in comparison to other low-carb high-protein diets. Because the amino acids in protein can be converted to glucose, a ketogenic diet should include enough protein to maintain lean body mass, including muscle, but this will still result in ketosis.
There are many variations of the ketogenic diet, but they all prohibit carbohydrate-rich foods. Some of these foods may be obvious: refined and whole grain starches such as breads, cereals, pasta, rice, and cookies; potatoes, corn, and other starchy vegetables; and fruit juices. Beans, legumes, and most fruits are examples of less obvious foods. Most ketogenic diets permit foods high in saturated fat, such as fatty cuts of meat, processed meats, lard, and butter, as well as unsaturated fat sources, such as nuts, seeds, avocados, plant oils, and oily fish. Ketogenic food lists can differ and even conflict depending on where you get your information.
According to the programs, a ketogenic diet should be followed until the desired amount of weight is lost. When this is accomplished, to avoid regaining weight, the diet can be followed for a few days a week or a few weeks each month, alternated with other days allowing a higher carbohydrate intake.
So Far, the Investigation
In the short term, the ketogenic diet has been shown to produce beneficial metabolic changes. Along with weight loss, health parameters associated with excess weight, such as insulin resistance, high blood pressure, and elevated cholesterol and triglycerides, have improved. [2,7] In addition, there is growing interest in the use of low-carbohydrate diets, such as the ketogenic diet, for type 2 diabetes. There are several theories as to why the ketogenic diet promotes weight loss, but they have not been consistently demonstrated in research: [2,8,9]
Because of the high fat content of the diet, there is a satiating effect with decreased food cravings.
A decrease in appetite-stimulating hormones such as insulin and ghrelin when eating a low-carbohydrate diet.
Ketone bodies — the body’s primary fuel source on the diet — play a direct hunger-reducing role.
Calorie expenditure rises as a result of the metabolic effects of converting fat and protein to glucose.
Fat loss versus lean body mass is encouraged, thanks in part to lower insulin levels.
The following is a synopsis of the research findings:
Potential Drawbacks
Maintaining a very high-fat diet can be difficult. Hunger, fatigue, low mood, irritability, constipation, headaches, and brain “fog” are possible symptoms of extreme carbohydrate restriction that can last days to weeks. Though these unpleasant feelings may pass, remaining satisfied with the limited variety of foods available and being denied otherwise enjoyable foods such as a crunchy apple or creamy sweet potato may present new challenges.
A long-term ketogenic diet has been linked to an increased risk of kidney stones and osteoporosis, as well as higher uric acid levels in the blood (a risk factor for gout). Nutrient deficiencies may occur if the ketogenic diet does not include a variety of recommended foods. It is critical to include a daily variety of the allowed meats, fish, vegetables, fruits, nuts, and seeds to ensure adequate intakes of fiber, B vitamins, and minerals (iron, magnesium, zinc) — nutrients commonly found in foods such as whole grains that are restricted from the diet. Because whole food groups are excluded, working with a registered dietitian to develop a ketogenic diet that minimizes nutrient deficiencies may be beneficial.
Unresolved Issues
What are the long-term (one-year or longer) effects of the ketogenic diet, and are there any safety concerns?
Do the health benefits of the diet extend to high-risk individuals with multiple health conditions, as well as the elderly? For which diseases does the diet’s benefit outweigh the risks?
Is there a long-term impact on health from consuming different types of fats (saturated vs. unsaturated) included in a ketogenic diet, given that fat is the primary energy source?
Is a ketogenic diet’’ high fat, moderate protein intake safe for disease conditions that interfere with normal protein and fat metabolism, such as kidney and liver disease?
Is a ketogenic diet too restrictive for times of rapid growth or increased nutrient requirements, such as during pregnancy, breastfeeding, or childhood/adolescent years?
In conclusion
There is still a scarcity of research on the ketogenic diet for weight loss. So far, the majority of studies have had a small number of participants, have been short-term (12 weeks or less), and have not included control groups. A ketogenic diet has been shown to provide some people with short-term benefits such as weight loss and improvements in total cholesterol, blood sugar, and blood pressure. However, when compared to the effects of conventional weight loss diets after one year, these effects are not significantly different. [10]
The elimination of several food groups, as well as the possibility of unpleasant symptoms, may make compliance difficult. An emphasis on saturated fat foods also contradicts recommendations from the Dietary Guidelines for Americans and the American Heart Association, and may have a negative impact on blood LDL cholesterol. However, it is possible to alter the diet to emphasize low-saturated-fat foods such as olive oil, avocado, nuts, seeds, and fatty fish.
Some people who have struggled to lose weight with other methods may benefit from a ketogenic diet. Because of genetic makeup and body composition, the exact ratio of fat, carbohydrate, and protein required to achieve health benefits will vary between individuals. As a result, if one decides to begin a ketogenic diet, it is advised to consult with a physician and a dietitian to closely monitor any biochemical changes that occur after beginning the regimen, as well as to develop a meal plan that is tailored to one’s existing health conditions in order to avoid nutritional deficiencies or other health complications. A dietitian can also advise you on how to reintroduce carbohydrates after you’ve lost weight.
In the general population, a modified carbohydrate diet based on the Healthy Eating Plate model may provide adequate health benefits and weight loss.
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