Is the Ketogenic Diet the best way to lose weight?
I used to think that the Ketogenic Diet was the ideal way humans should eat. Then, I discovered I was completely wrong. And here’s how I figured it out.
Let’s start at the beginning. At the time I wrote this, I was a fat guy (hopefully not anymore, or that’s bucketloads of eggs in my face (yum!)) I needed to blame something for it! I had been blaming myself for so long that it was quite refreshing to be able to blame something else for a while. Like CARBS!
I used to believe, for quite some time, that it wasn’t fat that made us fat, but carbs. That cholesterol was great for us, and eating the stuff wouldn’t raise our body’s cholesterol level. Everywhere I looked, I saw websites, TED Talks, doctors and fitness professionals talking about keto, ketosis, fat-adaptation and all the other jargon it’s associated with. Calories are not calories! The government is fooling you because they want to make money! Sugar is poison! People who are telling you it’s okay to eat carbs are sadistic assholes who are in the pockets of Big Carb (whatever that is ;)) Sweden’s butter sales are at an all-time high because (assumably) they believe in Low Carb High Fat diets! (Low Carb High Fat, or LCHF, is another term used to diets like Keto). Your body prefers ketones to carbs!
My first step into this ideology was The Slow Carb Diet as described in The 4-Hour Body by Timothy Ferris. He basically said that if you want to be fit by working out just four hours a month, then you need to go on The Slow Carb Diet, which prescribes no dairy, fast carbs (like bread, rice, pasta etc., whole wheat included) or fruits for 6 days a week. Just lots of low GI (glycemic index: a measure of how much food elevates your blood sugar after eating it) veggies, meats, and lentils, beans or pulses. On the 7th day, just go nuts and eat whatever you want.
And it worked. It wasn’t easy to sustain, but it did help me lose a few kilos. With this as a primer, I dug deeper and found the Keto diet had a lot of similarities, but just seemed more extreme.
For a guy who has been fat most of this life, this was pretty compelling stuff. Was everything I knew false? Was this the one reason why I had gained so much weight? Could cutting carbs change my life? The answer seemed to be yes, at least to begin with. But I still tried to look for evidence to the contrary. After all, one of the most critical ways to test a claim is to try and prove it wrong.
What is the ketogenic diet?
Before we jump down the rabbit hole, let’s figure out what the ketogenic diet really is. Neuroscientist Shelly Fan, PhD, sums it up quite well in her blog in Scientific American:
In essence, a ketogenic diet mimics starvation, allowing the body to go into a metabolic state called ketosis (key-tow-sis). Usually, human bodies are sugar-driven machines: ingested carbohydrates are broken down into glucose, which is mainly transported and used as energy or stored as glycogen in liver and muscle tissue. When deprived of dietary carbohydrates (usually below 50g/day), the liver becomes the sole provider of glucose to feed your hungry organs – especially the brain, a particularly greedy entity accounting for ~20% of total energy expenditure. The brain cannot DIRECTLY use fat for energy. Once liver glycogen is depleted, without a backup energy source, humanity would’ve long disappeared in the aeons of evolution.
The backup is ketone bodies that the liver derives primarily from fatty acids in your diet or body fat. These ketones – [Beta]-hydroxybutyrate (BHB), acetoacetate and acetone – are released into the bloodstream, taken up by the brain and other organs, shuttled into the “energy factory” mitochondria and used up as fuel. Excess BHB and acetoacetate are excreted from urine, while acetone, due to its volatile nature, is breathed out (hence the characteristically sweet “keto breath”). Meanwhile, blood glucose remains physiologically normal due to glucose derived from certain amino acids and the breakdown of fatty acids – voila, low blood sugar avoided!
The Science
Let’s get back to my story. I kept looking for nutrition scientists. I could find a lot of people citing science that supported Keto, but I could never see any real scientists supporting it. Where were they? Or were they just Batmanning from the shadows?
All was revealed in an Audiobook by The Great Courses called Nutrition Made Clear by Roberta H Anding, RD, LD, CSSD, CDE. (Here, RD stands for Registered Dietician.)
What’s the Difference between a Dietician and a Nutritionist?
Thanks for asking! And it’s a critical distinction. A Dietician is a person who has studied nutrition and has a qualified degree in it. Usually, they can advise people on what they should eat to optimize their health in conjunction with a doctor’s diagnoses and recommendations. A nutritionist, on the other hand, is simply someone enthusiastic about nutrition and doesn’t have any qualifications to provide credible advice. I, for example, can call myself a nutritionist because I know quite a bit about food. But that doesn’t mean you should believe me. That’s why I always get my information from dieticians and then pass it on to you. (Also, if you ever see me make a claim that I haven’t supported with a scientific reference, let me know in the comments and I’ll provide it.)
She put down all the information there is about every food group and all the macros, and there was nothing about carbohydrates being bad for you, or fat for that matter, or anything else. (The only thing she said we should avoid as much as possible is trans-fats, which are a part of hydrogenated vegetable oils. But that’s for another blog.)
In this course, here’s what she says about keto:
The success of this diet comes from the fact that when most people limit the amount of carbohydrate, they end up decreasing their total calorie intake due to taste fatigue. The initial weight loss is primarily due to dehydration, which does not necessarily reduce your body fat. Low-carbohydrate diets can also cause a significant reduction in lean mass, which reduces your basal metabolic rate.
This diet remains credible to some because you can see some improvement in health. The Atkins diet needs more long-term research on overall health risks.
From here, I stumbled upon some exercise and fitness scientists who had the same view on the ketogenic diet, which is that it’s okay if you find you prefer to eat that way and that it’s sustainable for you, but it’s not magical. In fact, the long-term weight-loss benefits are the same as on a balanced calorie restricted diet.
These scientists and evidence-based fitness proponents are Layne Norton, Sohee Lee, Brad Schoenfeld, Jeff Nippard, Dr Spencer Nodalsky, Michael Mattews and Bret Contreras. Check them all out! They have fantastic content that’s fascinating to read, watch and listen to, and is all backed by science and experience.
Keto Myths
Instant Weight loss!...?
Many people who start the keto diet say the results are instantaneous! Which is impressive. And it’s true! But not because you’re losing fat. It’s because you’re losing water.
This is because carbs, in the form of glycogen, bond with water in your body – to the ratio of 1 gram of glycogen holds 3 grams of water. As your glycogen stores go down, so does your water weight. In the case of keto, it’s a drastic drop. Plus, the metabolic process of producing ketones also results in water loss. So, if you do want to get on the keto train, make sure you drink lots of water with it.
But the long-term effects are no more than for a low-fat diet. According to the DIETFITS Randomized Clinical Trial, where they took 609 people and split them into low-fat and low-carb groups and measured their progress over the course of 1 year. At the end of the year, the differences in the average weight loss between the two groups were minute.
Keto make your brain awesome
If most ketofanatics are to be believed, yes. In fact, the ketogenic diet has been used since the 1920s to effectively treat children with epilepsy. In more recent studies, the diet seems to help people with Alzheimer's and Parkinson’s disease and maybe even Bipolar disorder. But these were small trials for short periods of time.
Keto fans claim they have better focus, more clarity and all around more awesome brains, but none of it has been studied in clinical settings yet. And taking someone’s word for it is just not good enough.
Why, you ask? Because people can be mistaken. People can imagine they’re thinking more clearly when they really aren’t. And there’s no way to know if they’re the ones tripping on something funky while others aren’t. Unless, you put everyone in a randomised, placebo-controlled trial. Because we need to figure out if it’s the placebo effect or not.
So, ultimately, we really don’t know or sure. We need to study this further, but until we do, we give this a meh-be.
But...insulin bro!
A lot of people think that if you stop eating carbs, your insulin levels will drop, your metabolism will go into high gear, and you start burning fat like a rocket engine. But that’s been debunked by many studies and is totally bogus.
Keto makes you a better athlete!
No. It doesn’t. Simple. Many different studies have tested this, and the results are either negative or inconclusive. Of course, lots more needs to be understood, and more studies are needed but don’t get into Keto thinking it’ll turn you into Usain Bolt or Sachin Tendulkar.
Keto facts: what keto is actually good for...maybe
Brain diseases
The ketogenic diet has proven quite helpful for a variety of neurological disorders, with different implications and effects. It’s a vast topic, but suffice it to say, if you or a loved one have epilepsy, Alzheimer’s, Parkinson’s Disease or something similar, talk to your doctor about it before making any dietary changes. A lot of these findings are preliminary or in animal studies, so they shouldn’t be taken as gospel. However, it has shown a lot of promise in treating epilepsy in children. ALWAYS TALK TO YOUR DOCTOR BEFORE DOING ANYTHING! Within reason, of course.
Cancer
Ketogenic diets have been shown to reduce tumour sizes in some cases and slow the progress of the disease in others, and it has also shown no effect in yet other studies. The bottom line: we just don’t know enough yet. Cancer is complicated. And it’s not only one disease, but it’s also a large group of disorders, triggered by different things, presenting in different ways and each with different characteristics. No one treatment can be the solution. If you, or someone you love, has cancer, please see a doctor and follow their advice. Go to several doctors and make sure you’re on the right treatment regimen. But don’t depend on diets or WhatsApp forwards for your medical information.
Diabetes
The ketogenic diet may help in managing blood sugar at least for the short term, but the long-term effects are still not clear. In fact, it may even increase the risk of Type 2 Diabetes.
Conclusion
The bottom line is, we don’t know anything for sure yet. The main benefits of the keto diet seem to be the same as a calorie restricted diet if you lose weight on it. But is it sustainable for you? Is it something you can imagine doing for the rest of your life? Then go ahead and go keto!
But for many people, it isn’t sustainable. And consuming massive amounts of meat and fat have been connected to heart disease and other problems. So, if it’s not something you can do for the rest of your life, don’t start. You’ll get the same results out of a well-balanced diet that’s slightly restricted in calories.
If you're wondering where I've ended up, I'm still learning about different tools I can use to lose weight. Right now, I'm doing a modified version of intermittent fasting (I'll write about this soon). I'm not a fanatic about it, but it seems to suit my lifestyle and remains sustainable for me. I'm losing weight slowly but steadily and will continue tweaking as I go on.
That’s what I learned the hard way, though. It wasn’t carbs that made me fat. It’s the calories. And that’s the case for everyone who is overweight. The bottom line is, you need to find something you can stick to, that suits your lifestyle. In other words:
The best diet for weight loss is the one you can stick to.
Which diet do you follow? Are your reconsidering your position on keto? Do you think I’m wrong? Let me know in the comments.
Dig Deeper
https://blogs.scientificamerican.com/mind-guest-blog/the-fat-fueled-brain-unnatural-or-advantageous/
https://theoutline.com/post/6133/the-keto-diet-is-a-recipe-for-disaster
https://www.vox.com/science-and-health/2018/2/21/16965122/keto-diet-reset