Ketogenic Diets: what to Know and Do

The ketogenic diet is a high-fat, very low-carbohydrate diet that aims to shift the body’s metabolism into a state called ketosis (this is how the diet derives its name). In ketosis, when carbohydrate intake is low, the body shifts from using glucose to burning stored fat for energy. This process involves breaking down fat into fatty acids and glycerol, which are then converted into ketone bodies (acetoacetate, beta-hydroxybutyrate, and acetone) in the liver. These ketones are then released into the bloodstream and used by various organs, including the brain, heart, and muscles, as an energy source.

The standard keto diet typically consists of approximately 70-80% fat, 10-20% protein, and only 5-10% carbohydrates. The primary goal of the keto diet is to drastically reduce carbohydrate intake so that the body depletes its glycogen (a source of stored carbohydrates) stores and starts breaking down fat for energy. This metabolic state is believed to help with weight loss and other potential health benefits.

Clinical Applications of the Ketogenic Diet

While the ketogenic diet is widely recognized particularly in the media for its weight loss benefits, it also has significant clinical applications, especially in managing various neurological and metabolic disorders:

1. Epilepsy: The ketogenic diet is well-established as an effective treatment for refractory epilepsy (a condition where a person’s seizures are not controlled by anti-seizure medications), especially in children who do not respond to conventional anti-seizure medications.
2. Neurodegenerative Diseases: It has shown promise in managing neurodegenerative conditions such as Alzheimer’s disease and Parkinson’s disease by providing an alternative energy source to glucose, which can be beneficial in cases of impaired glucose metabolism.
3. Traumatic Brain Injury (TBI): The diet may help improve outcomes in TBI by reducing inflammation and providing a stable energy supply to the brain
4. Metabolic Disorders: The ketogenic diet is used to manage metabolic conditions like type 2 diabetes and obesity by improving insulin sensitivity and promoting weight loss
5. Cancer: Some studies suggest that the ketogenic diet may slow the growth of certain types of cancer cells by reducing glucose availability and enhancing the body’s natural defences.
6. Weight Loss: The keto diet may help with weight loss by promoting fat burning and reducing appetite due to increased satiety from fats and proteins.

The Risks and Drawbacks of the Keto Diet

While the keto diet has several potential benefits, it is not without risks. Some of the drawbacks include:

• Nutrient Deficiencies: Due to the restriction of many fruits, vegetables, and whole grains and tubers, individuals on a long-term keto diet may experience deficiencies in fibre, vitamins, and minerals.
• Digestive Issues: The lack of fibre from limited fruit and whole-grain intake can lead to constipation and digestive discomfort.
• Potential Heart Health Concerns: Since the diet is high in fats, there are concerns that prolonged adherence to the keto diet could negatively impact cholesterol levels and cardiovascular health.
• Difficulty Maintaining the Diet: Particularly for those utilising the diet for weight loss, the strict nature of the keto diet can make it challenging to follow in the long term, leading to potential weight regain if old eating habits return.
• Keto Flu: When transitioning into ketosis, some people experience flu-like symptoms, including headaches, fatigue, nausea, and irritability. While these symptoms usually subside within a few days, they could become persistent or recurrent, especially if the transition is not done under proper medical guidance.

How Do Dietitians Manage Individuals on the Keto Diet?

Dietitians manage individuals on the ketogenic diet by starting with a comprehensive assessment of their health status, dietary habits, and goals to tailor the diet to their specific needs. They also educate clients on the principles of the ketogenic diet, including the strategies to maintaining ketosis and the recommended macronutrient ratios (high fat, moderate protein, very low carbohydrate). Creating personalized meal plans that ensure nutritional adequacy while adhering to ketogenic guidelines, recommending foods rich in healthy fats, adequate protein, and low-carb vegetables are also included as part of the care. Regular follow-ups are conducted to monitor progress, address challenges (such as nutrient deficiencies and gastrointestinal issues), and make necessary adjustments to the diet. Dietitians can also provide emotional support and motivation throughout the process.

Should You Try the Keto Diet?

If you are considering the keto diet, it is always advisable to consult with your healthcare provider or registered dietitian before making any significant dietary changes. While the keto diet may be beneficial for some individuals, a well-balanced and sustainable approach to nutrition is the key to long-term health. Tailoring dietary choices to your individual needs, lifestyle, and medical history will ensure the best possible outcomes for your overall well-being.

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Written by Dr. Laurene Boateng (PhD, RD)
Dr. Laurene Boateng is a Registered Dietitian and Senior Lecturer in the Department of Dietetics, University of Ghana. She is the founder and editor-in-chief of Full Proof Nutrition, a website committed to providing reliable, evidence-based, and practical healthy eating advice. Click here to join Full Proof Nutrition WhatsApp channel and send us a mail at fullproofnutrition@gmail.com.

References

1. Bostock, E. C., Kirkby, K. C., & Taylor, B. V. (2020). The current status of the ketogenic diet in psychiatry. Frontiers in Psychiatry, 11, 1-11.
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3. Merra, G., Miranda, R., Barrucco, S., et al. (2021). Very-low-calorie ketogenic diet: a practical guide for the nutritionist. Journal of Translational Medicine, 19(1), 1-17.
4. Neal, E. G., Chaffe, H., Schwartz, R. H., et al. (2008). The ketogenic diet for the treatment of childhood epilepsy: a randomized controlled trial. The Lancet Neurology, 7(6), 500-506.
5. Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789-796.
6. Pilla, R. (2020). Clinical Applications of Ketogenic Diet-Induced Ketosis in Neurodegenerative and Metabolism-Related Pathologies. Proceedings, 61(1), 29. https://doi.org/10.3390/IECN2020-06982