The Science Behind Ketogenic Diet: Exploring Benefits and Risks

What is the ketogenic diet?

The ketogenic diet consists of a high-fat, moderate-protein, and low-carbohydrate eating plan where approximately 70–80% of calories come from fat, 10–20% from protein, and less than 10% from carbohydrates.

Carbohydrates are typically the main energy source for the body, but in the absence of carbs, the body starts breaking down fat into ketones for energy instead. This process is known as ketosis, which is the main objective of following a ketogenic diet.

Understanding ketosis:

Ketosis is a metabolic state where the body utilizes fat as its primary fuel source instead of carbohydrates. This occurs when carbohydrate intake is significantly reduced, leading to a limited supply of glucose (sugar) for the cells, which is the main energy source.

To achieve ketosis, following a ketogenic diet is the most effective approach. This typically involves restricting carbohydrate consumption to approximately 20 to 50 grams per day and increasing the intake of fats from sources like meat, fish, eggs, nuts, and healthy oils.

It is also important to moderate protein intake, as excessive amounts can be converted into glucose, potentially slowing the transition into ketosis.

In addition, practicing intermittent fasting may expedite the process of entering ketosis. There are various methods of intermittent fasting, but the most common one involves limiting food intake to an 8-hour window each day and fasting for the remaining 16 hours.

To determine whether you have entered ketosis, there are tests available that measure the amount of ketones produced by your body. These tests can be conducted using blood, urine, or breath samples.

Specific signs may also suggest that you have reached ketosis, such as heightened thirst, a parched mouth, frequent urination, and reduced hunger or appetite.

To reach ketosis, the diet usually restricts carbohydrate consumption to under 50 grams per day. This amount is significantly lower than the average daily carbohydrate intake recommended for the majority of individuals, which ranges from 225 to 325 grams per day.

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What should I eat and avoid on a keto diet?

  Foods that are typically allowed on a ketogenic diet include:

  1. Meat and poultry
  2. Fish and seafood
  3. Eggs
  4. Nuts and seeds
  5. Non-starchy vegetables (e.g. leafy greens, broccoli, cauliflower)
  6. High-fat dairy products (e.g. butter, cream, cheese)

Foods that are typically restricted on a ketogenic diet include:

  1. Grains (e.g. bread, pasta, rice)
  2. Starchy vegetables (e.g. potatoes, sweet potatoes)
  3. Fruit (except for small amounts of berries)
  4. Sugar and sweetened foods (e.g. candy, soda, baked goods)
  5. Most processed foods

Health Benefits of the Ketogenic Diet:

Weight loss support:

Ketogenic diets are known to aid in weight loss by increasing metabolism and decreasing hunger. This is due to the satiating nature of foods in the diet and their potential to lower appetite-inducing hormones. As a result, adhering to a keto diet can lead to reduced cravings and weight management.

A study conducted in 2013, which analyzed 13 randomized controlled trials, revealed that individuals on ketogenic diets shed 2 pounds more than those on low-fat diets within a year.

Similarly, another review of 11 studies showed that participants on a ketogenic diet lost 5 pounds more than those on low-fat diets after 6 months.

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Improved skin health (acne):

Acne can be triggered by various factors, including diet and blood sugar levels. Consuming a lot of processed and refined carbs can disrupt gut bacteria and lead to fluctuations in blood sugar, ultimately impacting the health of your skin.

Potential cancer risk reduction:

The impact of the ketogenic diet on preventing or treating specific types of cancer has been thoroughly investigated by researchers.

According to a study, the ketogenic diet can potentially serve as a safe and effective supplementary treatment when used in conjunction with chemotherapy and radiation therapy for certain cancers. This is due to its ability to induce higher levels of oxidative stress in cancer cells compared to normal cells, ultimately leading to their demise.

A 2018 study suggested that the ketogenic diet’s ability to lower blood sugar levels could help reduce the risk of insulin-related complications. Insulin, which regulates blood sugar, has been linked to certain cancers.

While some research shows the potential benefits of the ketogenic diet in cancer treatment, more studies are needed for a comprehensive understanding of its effects on cancer prevention and treatment.

Enhanced heart health:

When adhering to the ketogenic diet, it is crucial to opt for nutritious food choices. Research indicates that incorporating healthy fats like avocados instead of less healthy options such as pork rinds can potentially enhance heart health by lowering cholesterol levels.

A comprehensive review conducted in 2017, which analyzed studies involving both animals and humans following a keto diet, revealed that some individuals experienced a notable decrease in total cholesterol, LDL (bad cholesterol), and triglycerides, along with an increase in HDL (good cholesterol).

Elevated cholesterol levels can heighten the risk of cardiovascular issues. Therefore, the cholesterol-lowering impact of a keto diet may help mitigate the likelihood of heart-related complications.

Nonetheless, the review emphasized that the beneficial effects of the diet on heart health are contingent on the quality of one’s dietary choices. Hence, it is imperative to consume nutritious and well-balanced meals while adhering to the ketogenic diet.

Brain protection and cognitive function:

According to a review conducted in 2019, certain studies propose that the ketones produced during the keto diet offer neuroprotective advantages, thereby enhancing resilience and safeguarding the brain and nerve cells. Consequently, adopting a keto diet might aid in the prevention or management of conditions like Alzheimer’s disease.

Nevertheless, further investigation is required to fully comprehend the impact of a keto diet on the brain.

Improved PCOS symptoms:

Polycystic ovary syndrome (PCOS) is a hormonal disorder characterized by excessive male hormones, irregular ovulation, and the presence of polycystic ovaries. The consumption of a high-carbohydrate diet can have negative consequences for individuals with PCOS, leading to skin issues and weight gain.

Unfortunately, there is a lack of extensive clinical research on the effects of the ketogenic diet, specifically on PCOS. However, a pilot study conducted in 2005 observed the progress of five women over a period of 24 weeks. The findings of this study indicated that following a ketogenic diet resulted in improvements in various PCOS markers.

  1. weight loss
  2. hormone balance
  3. ratios of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
  4. levels of fasting insulin

Another review of studies from 2019 revealed that a ketogenic diet showed positive outcomes for individuals with hormonal imbalances such as PCOS and type 2 diabetes. Nonetheless, it was noted that, due to the wide range of studies, it was not advisable to suggest a ketogenic diet as a universal treatment for PCOS.

Potential Risks and Complications:

The ketogenic diet offers various health benefits, but it’s important to note that sticking to this diet for a prolonged period can negatively impact your health. It could elevate the chance of specific health issues, for example:

  • kidney stones
  • excess protein in the blood
  • mineral and vitamin deficiencies
  • a build-up of fat in the liver

The keto diet may lead to negative side effects commonly referred to as keto flu. These effects can include:

  • constipation
  • fatigue
  • low blood sugar
  • nausea
  • vomiting
  • headaches
  • a low tolerance for exercise

At the onset of the diet, these symptoms are particularly prevalent as the body adapts to its fresh energy source.

  • Some populations should avoid the keto diet, including:
  • people with diabetes who are insulin-dependent
  • people who have eating disorders
  • those with kidney disease or pancreatitis
  • women during pregnancy and breastfeeding

Individuals with type 2 diabetes who are prescribed sodium-glucose cotransporter 2 (SGLT2) inhibitors should avoid following a ketogenic diet. This particular medication raises the likelihood of developing diabetic ketoacidosis, a serious condition that elevates blood acidity levels.

Practical Tips for Adopting a Keto Lifestyle:

Adopting a ketogenic diet can seem daunting at first, but with the right strategies and tips, you can make the transition smoother and more sustainable. This section provides practical advice to help you succeed on your keto journey, from choosing the right snacks to navigating dining out.

Healthy Keto Snacks:

Snacking can be challenging on a ketogenic diet, especially if you’re used to carb-heavy options. Here are some healthy and keto-friendly snacks to keep you satisfied between meals:

Nuts and Seeds: Almonds, walnuts, and chia seeds are great options. They are high in healthy fats and low in carbs.

Cheese: String cheese, cheddar cubes, or slices of brie can be both satisfying and keto-friendly.

Avocado: Half an avocado with a sprinkle of salt or filled with tuna salad makes for a nutrient-dense snack.

Vegetables with Dip: Celery, cucumber, and bell peppers paired with a high-fat dip like guacamole or ranch dressing.

Hard-Boiled Eggs: Easy to prepare and portable, hard-boiled eggs are a perfect snack.

Olives: Packed with healthy fats, olives are a convenient snack option.

Keto Bars: Look for bars specifically designed for ketogenic diets, ensuring they are low in carbs and high in healthy fats.

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Tips and Tricks for Success:

Transitioning to a ketogenic diet requires planning and patience. Here are some tips and tricks to help you stay on track:

Meal Prep: Preparing your meals in advance can help you avoid the temptation of non-keto foods. Plan your meals for the week and prepare them ahead of time.

Stay Hydrated: Drinking plenty of water is crucial, especially since the ketogenic diet can have a diuretic effect. Aim for at least 8 glasses of water a day.

Electrolytes: Ensure you’re getting enough electrolytes, such as sodium, potassium, and magnesium. This can help prevent the “keto flu,” a set of symptoms some people experience when they start a diet.

Read Labels: Be vigilant about reading food labels to check for hidden sugars and carbs. Many processed foods contain ingredients that can kick you out of ketosis.

Variety: Keep your diet interesting by trying new keto recipes and incorporating a variety of foods to prevent boredom and nutritional deficiencies.

Listen to Your Body: Pay attention to how your body responds to the diet. Adjust your macros if necessary, and consult a healthcare provider if you experience persistent negative symptoms.

Support Systems: Join a community of people who are also on the keto diet. This can provide motivation, support, and practical tips from others’ experiences.

Eating Out on a Keto Diet:

Dining out can be one of the most challenging aspects of maintaining a ketogenic diet, but it’s entirely manageable with a bit of planning and savvy choices.

Research Restaurants: Before heading out, check the menu online to find keto-friendly options. Many restaurants offer low-carb or gluten-free choices that align with the keto diet.

Ask for Modifications: Don’t hesitate to ask the server for modifications. Request dishes without the carb-heavy sides or ask for substitutions like extra vegetables or a side salad.

Focus on Protein and Fat: Choose dishes centered on protein and fat, such as steaks, grilled chicken, or seafood, and pair them with low-carb vegetables.

Avoid Sauces and Dressings: Many sauces and dressings contain hidden sugars and carbs. Opt for olive oil and vinegar for salads, or ask for your dish to be prepared with butter.

Be Mindful of Portions: Restaurant portions can be large. Consider splitting a dish or taking half home to avoid overeating.

By incorporating these practical tips into your routine, you can navigate the challenges of a ketogenic lifestyle with confidence and ease. Whether you’re at home, snacking on the go, or dining out, these strategies will help you stay committed to your keto goals while enjoying a variety of delicious foods.

Frequently Asked Questions:

Can I ever eat carbs again?

Yes, you can eat carbs again, but it depends on your goals and how strictly you want to follow the ketogenic diet. Some people incorporate “carb cycling,” which involves eating higher-carb meals periodically. Others might allow themselves occasional high-carb treats for special occasions. However, if you return to a high-carb diet consistently, you will likely exit ketosis and lose the benefits associated with the ketogenic state.

Can I build muscle on a ketogenic diet?

Yes, building muscle on a ketogenic diet is possible. Focus on consuming sufficient protein and engaging in resistance training. Some athletes and bodybuilders successfully build muscle on keto by carefully planning their macronutrient intake and ensuring they get enough calories from fat and protein.

How much protein can I eat?

Protein intake on a ketogenic diet should be moderate, typically around 20–25% of your total daily calories. Too much protein can be converted into glucose through a process called gluconeogenesis, which might interfere with ketosis. Aim for about 0.6 to 1.0 grams of protein per pound of lean body mass, adjusting based on your activity level and goals.

What if I am constantly tired, weak, or fatigued?

Feeling tired or fatigued, especially in the early stages of the diet, can be due to the “keto flu.” This is a group of symptoms that some people experience when transitioning to ketosis, including fatigue, headaches, and irritability. To mitigate these symptoms:

Ensure adequate hydration and electrolyte intake.

Gradually reduce your carbohydrate intake instead of making a sudden, drastic change.

Allow your body time to adapt to using fat and ketones for energy.

If fatigue persists, consult a healthcare professional to rule out other potential issues.

My urine smells fruity. Why is this?

A fruity smell in your urine is due to the presence of acetone, a type of ketone that is excreted in urine and breath. This is a common sign that your body is in ketosis. The smell should diminish as your body becomes more efficient at using ketones for energy.

My breath smells. What can I do?

Keto breath, caused by the excretion of acetone, is a common side effect. To manage this:

Stay hydrated to help flush ketones out of your system.

Maintain good oral hygiene, including brushing your teeth and using mouthwash.

Chew sugar-free gum or mints to mask the odor.

I have digestion issues and diarrhea. What can I do?

Digestive issues, including diarrhea, can occur when starting a ketogenic diet as your body adapts to a higher fat intake. To alleviate these symptoms:

Increase your fiber intake with non-starchy vegetables.

Gradually increase your fat intake to give your digestive system time to adjust.

Consider taking a probiotic supplement to support gut health.

If digestive issues persist, it might be helpful to consult with a healthcare professional or a dietitian.

What Is the Difference Between a Keto and a Ketogenic Diet?

The terms “keto diet” and “ketogenic diet” are often used interchangeably. Both refer to a low-carb, high-fat eating plan designed to induce ketosis, a metabolic state where the body burns fat for fuel instead of carbohydrates.

How much weight can I lose in one week on keto?

Weight loss varies among individuals and depends on factors like starting weight, adherence to the diet, and individual metabolism. Some people experience rapid weight loss in the first week due to water loss as glycogen stores are depleted. On average, a safe and sustainable rate of weight loss is 1-2 pounds per week after the initial period.

Is keto good or bad for you?

The ketogenic diet has both potential benefits and risks. It can support weight loss, improve blood sugar control, and provide other health benefits for some individuals. However, it may not be suitable for everyone and can have side effects such as nutrient deficiencies, digestive issues, and increased cholesterol levels in some people. It’s essential to consider your health status and goals and consult with a healthcare professional before starting the diet.

By addressing these common questions, you can better understand how to manage and succeed on a ketogenic diet and make informed decisions about your health and nutrition.



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