Getting to Know Keto

There’s a huge volume of dietary advice available to us today promising to banish weight gain forever and how to maintain an optimal lifestyle. So what makes the Keto Diet shine as one of the most popular and highly recommended by some of the best nutrition and fitness experts?

Put simply, the Keto Diet focusses on the benefits of a state called ketosis which is reached when you cut down on your carbohydrate consumption. There’s plenty of research to back up the benefits of ketosis but there are an equal number of doubters of the Keto Diet’s restrictive nature and whether it’s good for health over the long term.

Ketosis Clarity

Let’s get clear on the term ‘ketosis’.

When eating a normal Westernised diet your body will breakdown the carbs you eat into glucose which is then used as the preferred source of energy for your tissues and brain. We all maintain approximately one teaspoon of glucose in our bloodstream at one time and any extra is stored in our muscles and liver as glycogen. We also store an extra 3g water per gram of stored glycogen (Vargas-Molina, 2020). Additional to glucose your body will also utilise energy from fatty acids in fluctuating amounts and then protein ideally to a lesser extent.

When eating a low carb diet like Keto, the levels of glycogen reduce and so your body tissues and brain require a back up plan pronto. Enter ketones!

Let’s be clear, a fraction of energy is supplied by ketones at all times but to a much lesser degree than when in ketosis. But, once they become the primary source of energy, this is where the fun science begins and where you are officially in a state of ketosis.

Ketosis doesn’t come about only through a low carb diet. it’s a natural occurrence that happens more often than you probably realise. Ketosis up-regulates after prolonged exercise, fasting and is common in pregnancy and post birth (Puchalska and Crawford, 2017) when glucose is shuttled to the baby over the mother.

Meet The Ketones!

Historically ketones were considered the ‘ugly duck of metabolism’ as they were only noticed in those suffering from a condition called diabetic ketoacidosis, when diabetics couldn’t use carbs for energy so the liver overproduced ketones (Bando, 2018). This is a separate mechanism and is not to be confused with the ketosis you experience with a Keto Diet.

In a healthy individual you don’t ‘overproduce’ ketones, it’s a carefully regulated and normal system.

When on a Keto Diet (approx 10% carbs, 70% fat and 20% protein) your body will increase the production of the three ketone bodies called acetoacetate, beta-hydroxybutyrate and acetone. Beta-hydroxybutyrate, the most studied ketone, appears to be the most useful for providing energy according to current research (Pinto, 2018) whilst acetoacetate is less known as to its function due to its low molecular weight and acetone appears to be a byproduct for excretion.

Ketosis Benefits

Ketosis through the Keto Diet or any other form of carb restriction can be measured in the blood as anything from 0.5-4mmol/L and never goes beyond 8mmol/L in a healthy individual. Whilst at high levels ketones can be acidic, there’s no change in PH of the blood during normal ketosis because the brain can function well within these approximate parameters and so your body will not produce more ketones than needed. The exception are those who experience diabetic ketoacidosis where ketone levels reach 20mmol/L and blood PH decreases becoming more acidic and therefore dangerous.

You can find out if you’re in ketosis from a range of measuring methods including urine test strips, breath analysers and blood spot. Blood spot is most accurate followed by breath tests and finally urine strips. All will give an indication of roughly whether you are in ketosis or not but blood and breath can give real time feedback indicating which foods may have kicked you out of ketosis.

During ketosis research has found it to have the following benefits:

• Reduction of body weight due to use of fat stores for energy and less water retention (Vargas-Molina, 2020)
• Reduction of appetite and cravings
• Reduction in LDL cholesterol (Gershuni, 2018)
• Increased cell autophagy (renewal)
• Reversal of metabolic syndrome – high blood pressure/cholesterol, obesity and insulin resistance (Gershuni, 2018)
• Up-regulates activity of the energy producing mitochondria leading to improved longevity
• Evidence for use to treat epilepsy since the 1920’s
• Treatment of certain types of cancer (Vargas-Molina, 2020) where tumours can only survive on glucose (Bando, 2018)
• Reduction in oxidative damage in the brain (Pinto, 2018)
• Prevention of Alzheimer’s Disease (Pinto, 2018).
• Management of Polycystic Ovary Syndrome (Alessandro, 2015)

The Keto Diet Long Term

Whilst many live happily mostly on a Keto Diet, unless being used for any of the above reasons or recommended by your doctor, it doesn’t need to be done constantly for good health. In fact the foods that are eliminated from the Keto Diet such as root vegetables, fruits, beans, legumes and whole grains are packed with nutrition and add to a happy healthy lifestyle. You should also be suspicious of any diets that you ‘need’ to adhere to 100% of the time.

The effect of a Keto Diet long term on humans is unclear. There have been studies to criticise it’s use over the long term. For example a ten year study was conducted on children with epilepsy and the effect of the Keto Diet on their overall health. The feedback after ten years was it was generally well tolerated but constipation was most common amongst the children (Wibisono, 2015). However this is flawed as there was no detail or management of what the children were actually eating over ten years.

A sixty day Keto study was performed on rats, similar to four years of human life. The results showed metabolic acidosis, anaemia and reduced antioxidants (Idris, 2019). However it’s not a fair comparison for human health and rats being fed mostly goats milk may indeed not have very good health after sixty days!

Going Forward

A criticism of Keto is that you might gain the weight lost once you return to a normal way of eating. This is not the case if you return to a healthy diet in between your Keto cycles.

A study conducted on eighty adults showed when cycling Keto with a whole foods Mediterranean Diet there was an overall 10% decrease in body weight after a year. The protocol consisted of twenty days strict Keto followed by twenty days up to 100g carbs followed by four months of the Mediterranean diet, twice in twelve months. Only eight participants didn’t maintain their weight loss after the Keto cycles because they reported approximately 2000 kcal consisting of junk food and not adhering to the Mediterranean Diet (Paoli, 2013).

If you’re looking for a basic guideline as to how long to maintain a Keto Diet for, a minimum of 2-3 weeks to 6-12 months at a time (Paoli, 2013) is safe according to studies. However, choose a time frame that suits you or even just do certain days of the week. There’re lot’s of possibilities, choose the one that you can happily maintain.

Make the Keto Diet a part of your regular diet as and when you need it. We all like to feel trim before a wedding and we all need to clean up our diet after a festive season. Rest assured that the Keto Diet is a safe and effective way to do this along with it’s other benefits.

References

Alessandro, R. et al. (2015). ‘Effects of twenty days of the ketogenic diet on metabolic and respiratory parameters in healthy subjects’, Lung, 193(6), pp. 939–945.

Bando, H. (2018). ‘New era of metabolism from glucose to ketone body with beneficial effects’, J Mol Diol, 1(1).

Gershuni, V.M. et al. (2018). ‘Nutritional ketosis for weight management and reversal of metabolic syndrome’, Curr Nutr Rep, 7(3), pp.97-106.

Idris, I. Et al. (2019). ‘Long term ketogenic diet induces metabolic acidosis, anemia and oxidative stress in healthy wistaria rats’, Journal of Nutrition and Metabolism.

Paoli, A. (2013). ‘Long Term Successful Weight Loss with a Combination Biphasic Ketogenic Mediterranean Diet and Mediterranean Diet Maintenance Protocol’, Nutrients, 5(12), pp.5205-5217.

Pinto, A. Et al. (2018). ‘Anti-oxidant and anti-inflammatory activity of ketogenic diet: new perspectives for neuroprotection in Alzheimer’s Disease’, Antioxidants, 7(5), pp.63.

Puchalska, P., Crawford, P.A. (2017). ‘Multi-dimensional roles of ketone bodies in fuel metabolism, singling and therapeutics’, Cell Metabolism, 25(2), pp.262-284.

Vargas-Molina, S. Et al. (2020). ‘Effects of a Ketogenic Diet on body composition and strength in trained women’, BMC, 19.

Wibisono, W. Et al. (2015). ‘Ten year single center experience of the ketogenic diet: factors influencing efficacy, tolerability and compliance’, National Library of Medicine, 166(4), pp. 1030-1036.