Is Keto a No-Go?
The ketogenic diet began as a treatment for epilepsy and is still widely used in pediatric hospitals, but over the past few decades, it has become exceedingly popular for a very different reason: weight loss. While the research community has enthusiastically embraced the possibility that the ketogenic diet may treat obesity and diabetes, a trio of doctors recently published an editorial in JAMA urging caution. The enthusiasm, they stress, outpaces the evidence.
What Is Keto? In the early 20th century, physicians from the Mayo Clinic discovered that a diet in which 90% of calories came from fat, 6% from protein, and 4% from carbohydrates effectively reduced epileptic seizures. While some dieters follow those same early guidelines, there’s a bit more flexibility in today’s keto plans, with fat intake ranging from 70% to 90%, protein intake falling between 6% and 15%, and carbohydrate intake limited to between 4% and 10%.
How it Works. When carbohydrates (the body’s preferred energy source) are severely restricted, the body burns fat instead. This process causes a build-up of ketones, the acids that make a diet ketogenic. A ketogenic diet is low in carbohydrates, but not all low-carb diets are ketogenic. By allowing a little more fruit, vegetables, and proteins, a less-restrictive low-carb regimen doesn’t always lead to ketosis.
Weight Loss. Without a doubt, a ketogenic diet can help people lose weight—just like a low-fat plan can. While some studies show keto to be more effective and others favor low-fat eating, a broad view of the research, in the form of a meta-analysis of 13 studies, suggests that those who follow a keto plan lose less than one additional kilogram (2.2 pounds) of weight, the editorial authors noted. Another meta-analysis of 32 studies found that keto resulted in less weight loss than a low-fat plan, they added.
Type 2 Diabetes. The JAMA trio next cited a meta-analysis of randomized long-term studies that found no difference in glycemic control when comparing the ketogenic diet with a low-fat diet. While limiting carbohydrates can temporarily improve glycemic control, so can weight loss, they explained, and there is insufficient research to show that the diet itself is beneficial.
The Risks. Aside from not showing clear benefit, the ketogenic diet may also cause harm by omission by depriving adherents of the proven health benefits of carb-rich fruits, grains and vegetables, the authors allege. While everyone agrees that we should strictly restrict refined carbs, the keto diet fails to differentiate between a carrot and a candy bar.
A very high-fat diet can also increase low-density lipoprotein cholesterol and apolipoprotein B-containing lipoprotein, they noted. Additional keto side effects can include cardiac arrhythmias from selenium deficiency, constipation, halitosis, muscle cramps, headaches, diarrhea, pancreatitis, and vitamin and mineral deficiencies.
What This Means for You. Researchers are finding that some people succeed on a low-carb keto plan, while others do better with a high-carb, low-fat strategy. The one thing that’s clear is that individuals respond differently to the same dietary plans, so there is still no consensus on the ideal carbohydrate intake. There is consensus, however, on the types of carbs to avoid: Processed and refined carbs aren’t on anyone’s list of weight-loss or diabetes-prevention tips.
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