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The Ketogenic Diet

A deep sadness has overtaken me, and I know why. Two of my sisters have been seduced by the lure of the ketogenic diet. They’ve bought into the hype, and don’t want to hear about the potentially dire health consequences. The ketogenic diet promises weight loss, and it can deliver. One of my sisters has already lost 20 pounds on the diet. Unfortunately, history shows that weight loss on this kind of diet is not sustainable, and most likely those pounds will come rushing back with interest. But the scariest part for me is that the ketogenic diet exposes them to a host of adverse health effects. The sad part is that if they persist on this diet, I will most likely lose them well before their time.

The ketogenic diet (aka keto) has become a hot topic of late, and since it infiltrated my own family, I feel compelled to alert you to the dangers so that you can help others make an informed diet choice.

The ketogenic diet is the latest variation in a long line of low carb, high fat diets. It was originally developed in 1924 as a treatment for refractory epilepsy in children. There is some evidence that it can be an effective treatment for epilepsy and other neurological disorders in children. Low carb, high fat diets had a resurgence in 1972 with the publication of the Dr. Atkins Diet Revolution. That diet didn't turn out so well. People lost weight in the short term, but now, numerous studies show that people following low carb, high fat diets have a much higher risk of mortality from all causes. (1) Dr. Atkins, who followed his own diet, died overweight, with a history of heart attack, congestive heart failure, and hypertension. Nevertheless, spin-offs of this diet keep popping up periodically. We've seen the South Beach, then Paleo, and now the Ketogenic diet.

The idea behind the keto diet is that your body has the ability to burn fat for fuel rather than glucose. In a normal human diet, the body burns carbohydrates as its primary source of energy. The ability to burn fat stores instead of carbs is a survival mechanism that allowed our ancestors to survive temporary periods of famine. When they were deprived of food for several days, their bodies entered a state of ketosis, in which it actively burned fat reserves. Ketone bodies are generated from this process, which helps to sustain brain function and preserve muscle and other vital proteins. So, the intent of the ketogenic diet is to harness this adaptive state on a long-term basis instead of as a temporary defense mechanism. Keto dieters intentionally put their body into a state of ketosis, by reducing carbs and eating lots of fat. They drastically cut carbs to about 10% of their diet, which is about one slice of white bread per day. They get about 20% of their calories from protein, and about 70% from fat.

This is in direct contrast with traditional human dietary patterns. There is no known population, past or present, that has thrived in a state of chronic nutritional ketosis. In fact, the slimmest populations in history ate diets very high in complex carbohydrates (not refined carbs). The healthiest and most long-lived populations that we know of today live in the so-called Blue Zones. (2) The Blue Zone populations thrive on diets that emphasize complex carbohydrates (about 80% of their calories), with 10% or less from protein and 10% or less from fat.

One major problem with cutting down on carbs and eating huge amounts of fat is that most keto dieters obtain the fat in the form of animal products including beef, chicken, fish, and full-fat dairy, as well as refined oil. The picture shows a sample of one dieter's meat stash.

In fact, that’s one of the things that attracts people to the keto diet; they are able to satisfy their craving for fat by eating animal products and processed oil. Unfortunately, excess animal fat builds up in their muscle cells and begins to inhibit insulin from doing its job, which can lead to type II diabetes. And the animal protein that comes with the fat is very high in leucine which is the main trigger for accelerated aging in every part of your body. Leucine promotes the production of the cancer-causing growth hormone IGF-1. This hormone plays an important part of our growth and development when we are youngsters. But when we reach adulthood, the levels of IGF-1 normally diminish. However, consuming animal protein meal after meal causes the IGF-1 levels to rise in the bloodstream which increases the risk of developing cancer.

A high-fat diet also plays havoc with your gut microbiome. The microbiome consists of 100 trillion friendly microbes that live in our gut and help regulate our digestion and support the immune system. When people eat animal products, it promotes the growth of unhealthy microbes. In particular, when they eat red meat, eggs, dairy products, or salt-water fish, it introduces high levels of choline, lecithin, and L-carnitine. These substances change the composition of the microbiome, promoting the growth of unhealthy gut bacteria. These deleterious bacteria, called firmicutes, convert the nutrient choline from eggs and L-carnitine from meat into trimethylamine-n-oxide (TMAO) (3) which is nasty stuff. TMAO changes how cholesterol is metabolized. Specifically, TMAO promotes inflammation and causes cholesterol to attach to the inside of your arteries as plaque. (4) High levels of TMAO are consistently associated with greater risk of cardiovascular disease, strokes, heart attacks, and death.

Another effect of a high fat diet containing lots of oil is that refined oil damages the endothelial cells that line your arteries and veins. (5) Healthy endothelial cells allow your blood vessels to expand and contract properly. Damaged endothelial cells lead to atherosclerosis and heart disease.

The attractive argument for Keto goes something like this: “If I put my body in a state of ketosis, it will burn all the fat. I will have low cholesterol, and since my body is burning all the fat, I can eat whatever I want.” Sounds good, right? But Dr. Randy Bivens M.D., executive VP of Life & Health Network, explains that it doesn’t work like that. Burning fat is not a clean burn. It kicks out all kinds of pollutants. That’s why people on a keto diet often smell like acetone. And the brain relies on burning glucose for its fuel. Other parts of the body can burn ketones, but the brain can’t. (6)

Despite all the negative effects, the attraction to this high fat diet persists, and people are making money hand over fist by aligning themselves with the keto diet. It’s a message that nearly everyone wants to hear. Who doesn’t want to hear that the foods they are addicted to will help them lose weight? And you can imagine how the meat, dairy, and egg industries would be delighted to promote the keto diet. Book publishers, magazine editors, newspapers, and newscasts will all want to join in the fun. Do you remember the splash made by the 2014 Times Magazine cover story “Butter is back!” People want to hear good news about their bad habits. No wonder keto is a hot topic as money interests join the “feeding” frenzy.

Before going down the keto path, take a close look at what Sarah Ballantyne, Ph.D., a medical researcher, has to say in her article The Pros and Cons of a Ketogenic Diet.(7) Dr. Ballantyne is firmly in the low-carb camp, but takes a pretty unbiased stance in this article. The article describes some benefits of the Keto diet, especially in regards to neurological disorders, but it also lists 26 adverse reactions to the keto diet that are reported in the scientific literature. And these reactions are not just side effects. They are unwanted, unexpected, and dangerous reactions to this diet. A few of the adverse reactions are:

• Gastrointestinal disturbances

• Inflammation risk

• Thinning hair/hair loss

• Kidney stones

• Muscle cramps or weakness

• Impaired concentration/cognition and mood

• Nutrient deficiency

• Acute pancreatitis

• Myocardial infarction (heart attack)

• Menstrual irregularities

• Premature death

Dr. Ballantyne has compiled a comprehensive collection of links to current research (both pro and con) on the keto diet: Keto Literature Review (8). This is a very useful collection for anyone wanting to gain a broader understanding.

People that value their health should be cautious about considering a keto diet. A recent study published in The Lancet suggests that following a low carb diet like the keto diet could shorten your life expectancy by four years. (9) Following a keto diet to lose weight is a bit like smoking cigarettes or adopting a cocaine habit to lose weight. Sure, you might lose weight, but the associated health risks are just too great. With a plant-based diet, you not only lose weight, but you improve your long-term health. In fact, a plant-based diet is the only diet that has been proven to reverse and prevent heart disease. Not Keto, not Paleo, or any of the other low carb, high fat diets.

This is a case in which you don’t want to mess with Mother Nature. She designed our bodies to burn carbohydrates as a primary source of fuel. Mess with that formula, and she retaliates. Dave Barry has an interesting take on Mother Nature and our natural fuel source:

“Mother Nature clearly intended for us to get our food from the "patty" group, which includes hamburgers, fish sticks, and McNuggets- foods that have had all of their organs safely removed.”

The question that people need to ask themselves before embarking on a keto diet is this, “is my weight more important than my health?”

Check out this video Carnivore Diet Insanity by Dr. Pam Popper. It is eye opening.

One final thought. Our individual health is of primary concern, but looking at the bigger picture, we are all passengers on spaceship Earth. Many of us take shorter showers, drive electric cars, and/or recycle to reduce our carbon footprint, but what we eat can have a vastly greater impact on the environment. For example, a 2014 study published in Climatic Change revealed that a high meat diet causes about 2 ½ times more carbon emissions daily than a vegan diet (15.8 lbs of CO2 per day compared to 6.4 lbs per day), and it is very likely that a typical keto diet emits even more. (10) If we want to maximize our individual contribution to saving the planet, we need to eat a plant-based diet.


(6) iThrive interview transcript with Dr. Bivens

(10) Dietary green house gas emissions, Climatic Change 2014

To your health!

David Kater

Author of:

Handbook to Higher Health Consciousness: How to Transition to Plant-Based Eating to Heal Yourself and the Planet

The greatest wealth is health.

~ Virgil.

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