In this article: What keto diet is, who can consider it, the benefits you may get, and the risks involved.
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- Keto diets help significantly in weight loss
- Improve glucose metabolism with improved insulin resistance and better blood sugar control
- Help improve lipid metabolism with decreased LDL and triglycerides and increased HDL
- Significant improvement in NAFLD, treatment enhancement in cancer patients, improved brain function, reduced cardiovascular diseases risk, reduced cancer risk, and better management of PCOS
- Notably, obese people reap the maximum benefits in all aspects, provided they choose more healthy fats and less the unhealthy
The famed health quote by the Greek physician Hippocrates, “Let Food Be Thy Medicine”, is quite relevant even today. The right food will help you sustain good health, and the wrong food would lead to more trouble.
Apparently, many people are aware of the importance of the right food, and hence, much discussion happens over food and diet. And, expectedly, several diets, such as vegan, keto, paleo, Atkin’s, etc., promise weight loss and other health benefits such as managing diabetes and preventing cancer.
Much simplified, it may seem but does weight loss and diabetes management get so simple with following a diet? Probably not.
A lot of studies happen about these diets. Though there are benefits, there are risks involved as well. So before you plunge into following a diet, do a lot of research or, even better, work with an expert.
With that bit of warning, if you have decided to follow the keto diet, here is a brief explanation of the keto diet, who can benefit, and the risks involved.
What exactly happens?
A ketogenic diet is the reverse of the food pyramid consisting of very low carbs, moderate proteins, and high fat.
Normal energy metabolism
A typical diet has about 225-325 grams of carbs. With this diet, the body’s primary source of energy is glucose. When carbohydrates break into sugars, blood glucose increases. Sensing the increase in blood sugar, the pancreas secretes and releases insulin into the bloodstream. Insulin enables the cells in your body to take in glucose to provide energy. Excess glucose is stored as glycogen reserves in liver and muscle cells and as triglycerides in fat cells. This is the normal energy metabolism.
Energy metabolism when on the keto diet
When carbs intake is significantly reduced to about 20-50 grams a day, your body gradually is deprived of dietary sugar and starch, no more being able to get energy from glucose.
Glycogen converted into glucose is released into the bloodstream to continue providing energy to the body. When the glycogen reserves are depleted, your body switches from getting energy from glucose to primarily burning fat for fuel producing ketone bodies. This is when your body enters the state of ketosis.
Interestingly, even the night-time-fasting of 12 hours can switch your body’s metabolism to ketosis. And then, when you eat, it switches back to glucose metabolism.
However, when your carbs are consistently very low, glycogen reserves in the liver, muscles and adipose tissues are all depleted, and your body starts burning fat from your diet.
Such a transition is Nutritional Ketosis. And the process of switching from glycolysis to relying on fat-derived ketones as primary energy is keto-adaptation.
Who can try keto?
The diet was originally developed by a physician in the 1920s to help reduce the frequency of seizures in children with epilepsy. Over the decades, several studies investigated the diet’s other benefits, due to which the keto diet is one of the most popular diets now.
With this diet, blood sugar levels and insulin secretion drop and hence may help people with diabetes or prediabetes. The diet immensely helps in shedding pounds without regaining weight. It also improves the lipid profile and reduces hypertension.
But, the list does not end there. Fatty liver disease, Alzheimer’s, and cancer are a few other conditions that improve with keto.
Read on for a brief account of the benefits and risks you get from keto
Remarkable improvement in Metabolic syndrome markers
The markers of metabolic syndrome include abdominal fat (visceral fat), insulin resistance, hypertension, and elevated triglycerides. Keto diets seem to significantly improve all of these markers and thereby reduce your risk of cardiovascular disease, diabetes, stroke, and Alzheimer’s.
Obesity may cause many diseases such as heart diseases, diabetes, stroke, osteoarthritis, hypertension, PCOS etc.
Keto diets aid in weight loss and greatly help in reducing fat around your waist. Also, unlike some other diets that reduce muscle mass, keto diets maintain lean muscle and the basal metabolism rate.
Further, many people on keto diets experience reduced appetite due to the higher satiety effect of proteins and the possible alterations of appetite-influencing hormones, which help them stay sustained in the diet without craving calories.
Also, unlike yo-yo dieting, many do not regain the lost pounds, which has made the keto diet a popular choice for weight loss.
Helps in diabetes management
Diabetes is a global epidemic and is a chronic disease that needs proper management to prevent disease escalation. In recent years, the keto diet has been studied for its potential benefits in diabetes management.
- Lowers blood sugar
Pretty obvious that when your body is supplied with very low carbs, blood glucose is lowered. With better blood sugar control, your HbA1C levels reduce with keto diets.
- Improves insulin sensitivity
Improving insulin sensitivity is one of the important goals in diabetes management.
Insulin resistance impairs the ability of the body’s cells to absorb glucose. When cells do not receive glucose for energy, the body uses the glycogen reserves in the liver, which further releases glucose into the bloodstream. The increased glucose is stored in muscle and fat cells for future use. But the cells are still low in energy because they are not absorbing the glucose. This vicious cycle makes it difficult to manage blood sugar.
Several studies show a direct correlation between a protein (RBP4) and insulin resistance. Higher the protein, the higher the insulin resistance. And studies show that fat around your waist (visceral fat) secretes the protein RBP4 (retinol-binding protein 4).
Keto diets help reduce visceral fat and thus can improve insulin sensitivity in obese people. Further, insulin needs decrease due to reduced carb intake, so those on insulin therapy may lower their dependency on insulin injections.
Reduces cancer risk and is beneficial in cancer patients
According to a study, obesity-related insulin resistance and sustained high blood glucose levels (hyperglycemia) increase cancer risk and cancer-treatment outcomes. With the keto diet, insulin resistance decreases, blood sugar levels remain normal, and hence reduces cancer risk.
Further, cancer cells cannot feed on ketones. Hence keto diets benefit cancer patients as the diet helps reduce tumour size and growth.
Long-term effects of keto diets in obese people include a decrease in LDL and triglycerides and an increase in HDL. Hence, there is a decrease in the ApoB/ApoA1 ratio, a significant marker of cardiovascular disease risk.
Also, an increase in triglycerides is an important factor in insulin resistance. Hence an improved lipid profile reduces your risk of Type 2 diabetes as well.
Since 1920, keto diets have been clinically used in children with epilepsy history to reduce the frequency of seizures. Energy derived from fat significantly reduced the excitability of brain neurons, thus reducing seizures.
The benefits do not end there, though. Further studies have found that keto diets are neuroprotective and can be beneficial in Alzheimer’s disease, Parkinson’s disease, hypoxia, ischemia, and traumatic brain injury (TBI).
One possible reason is the change in energy metabolism.
With age, several bodily functions slow down, including the use of energy. Brain cells become hypometabolic, meaning they lose their efficiency to take in and metabolise glucose.
Energy-deficient neurons communicate less with each other and gradually develop conditions such as Alzheimer’s.
With keto diets, energy is derived from ketones, and hence neurons are more stabilised and improve cognitive functions.
So, be it old age or insulin resistance, energy supply to brain cells is efficient with keto diets, which improves brain health.
Polycystic Ovary Syndrome
PCOS is a common problem in women with mild or severe symptoms, including irregular menstruation, infertility, acne, weight gain, and increased risk of diabetes, hypertension, heart diseases, and endometrial cancer.
Hyperandrogenism or elevated levels of testosterone is the main characteristic of PCOS, and a majority of research shows that hyperinsulinemia (high insulin levels) likely cause hyperandrogenism.
So the cause again routes to insulin resistance, and since the keto diet reduces insulin resistance, it can very likely improve PCOS, too.
Non Alcoholic Fatty liver Disease (NAFLD)
NAFLD is a high-fat accumulation in the liver in people who drink little to no alcohol. Though causes are not clearly known, obesity and insulin resistance are risk factors.
As discussed earlier, keto diets improve insulin sensitivity, lower triglycerides, and reduce obesity.
Further, though short-term evidence, many studies found that the hepatic mitochondrial behaviour is altered under ketosis, which helps improve NAFLD.
No diet is free of risks. For some, the diet might work very well; for some, it does not.
You must be very well-informed before starting on a type of diet. Moreover, long-term evidence of benefits is an important aspect to follow a specific diet.
Like many other diets, Keto diets lack such long-term evidence for the health benefits they may provide and certainly have some risks.
Some of the known possible risks involved when following the keto diet are:
#1 Keto flu
Adaptation to Nutritional Ketosis involves a few short-term adverse effects that may last for a few days. The symptoms are flu-like and hence the name keto flu.
In the initial days, before your body transitions to fat-burning, your body still expects energy from glucose. So, of course, you will feel sluggish, tired, less motivated, and irritated.
Also, as your body moves into ketosis, the excess ketones produced are excreted in your urine, and along with ketones, you will be losing salts such as sodium and potassium. This may cause dehydration, leading to nausea, vomiting, and diarrhoea.
Typical symptoms include,
- Bad smelling breath
Orthostatic hypotension and a sense of hunger, especially in the first few days of transition, are other symptoms that usually go away once ketosis sets in.
So, you must always remember keto diet may make you dehydrated and cause a loss of electrolytes. In which case, keto flu symptoms can kick in. Thus, drinking more water than usual and a conscious intake of salt is absolutely essential.
#2 Not for pregnant women and women trying to get pregnant
As discussed earlier in this article, the keto diet helps manage PCOS and may treat infertility, helping you conceive a baby.
However, because the keto diet cuts out a wide variety of fruits, vegetables, and grains, it is not safe for pregnant women and women trying to get pregnant unless you are under the guidance of a keto diet expert.
Further, it can be quite unsafe for unplanned pregnancies and may result in neural tube defects in the foetus due to folate deficiency.
#3 Kidney stones
A disclaimer here: a well-planned keto diet would not harm your kidneys. In rare cases, keto dieters may get kidney stones. A diet high in protein can cause uric acid to go up, resulting in kidney stones.
Further, it is observed that urinary excretion of oxalate increased significantly with keto diets. And since oxalate combines with calcium forming kidney stones, you must be watchful.
Adequate hydration and moderate protein will prevent kidney stones. However, if you have existing kidney problems, a keto diet may stress your kidneys more.
#4 Decreased bone mass
As discussed in the previous paragraph, you risk losing more calcium in the urine, which may decrease your bone mass. Hence, poor bone health is often tied to keto diets; however, there is scarce evidence.
Importantly, studies observe that a high calcium intake can maintain a calcium balance and may keep bone health intact.
#5 Nutritional deficiencies
Since the keto diet is all about macronutrients, your body may lack several micronutrients, such as potassium, magnesium, calcium, iron, and vitamins B, C, and E.
#6 Low sugar episodes
Your blood sugar level should be maintained at an optimal level; otherwise, it will result in low blood sugar or hypoglycemia.
Even when your body is in fat-burning mode, your body takes care to maintain your blood glucose levels.
However, when on a keto diet, there are chances of low sugar, particularly in people with diabetes on insulin medication.
#7 May onset Non-alcoholic fatty liver disease
While keto diets have short-term evidence in lessening NAFLD, there is a risk of elevated liver enzymes leading to NAFLD in people who did not have the condition before. This possibly is due to unhealthy fat intake, such as saturated fats. Though keto allows saturated fats, it is good to choose unsaturated fats such as avocado and olive oil to avoid NAFLD.
#8 May not improve insulin resistance in lean people
Reducing abdominal fat has a remarkable effect on improving insulin sensitivity. So, keto can positively influence insulin resistance in obese but may not be in the lean. Hence, keto diets may not improve insulin sensitivity in non-obese people.
#9 Unhealthy fat choices may increase LDL
Since a major portion (about 70-80%) of the keto diet comprises fats, watching which type of fat goes into your plate is important.
Saturated fats may negatively affect the lipids and increase LDL and triglycerides. So, choose healthy fats to reap the benefits of the keto diet and avoid the risks of bad cholesterol.
The bottom line
Keto diets are remarkably beneficial for sustained weight loss. The diet is also helpful in diabetes management, improved metabolism, improved lipid profile, and better cognitive functions.
Despite the impressive benefits, the keto diet may be harmful to some people in the long term due to the risks involved.
Hence, considering the diet for a short period to achieve specific health goals seems fine. But to follow it long-term, you need to work with a keto diet specialist to avoid adverse consequences.