Many of my clients have recently been inquiring about the keto diet for weight loss. What is a keto diet? Is the keto diet safe ?, Would you recommend the keto diet ?, Can we easily follow the keto diet? Is there any risk ?. Despite the constant marketing hoopla, the ketogenic diet is a fairly old idea.  

What is Keto Diet?

The keto or ketogenic diet is very low in carbs and high in fats. It was developed in the 1920s to help treat severe epilepsy in children. Since then, the keto diet moved to the mainstream as a low-carbohydrate and high in fat diet for weight loss and reducing cardio-metabolic risk factors. 

How does Keto diet help in weight loss?

A keto diet requires you to eat fewer carbs. After a week of this diet, 

• Your body is forced to burn fat instead of glucose (sugar) for fuel—a state known as ketosis.
• Your liver starts packaging fats into chemicals known as ketone bodies (or ketones for short) to serve as an alternative fuel for your brain.
• Since the stored fats are used, you will lose weight faster.
• A high level of ketones often helps reduce seizures, explaining why the diet has been used to treat people with severe epilepsy.

What does the keto diet look like?

A ketogenic diet primarily consists of high fats, moderate proteins, and low carbohydrates. The dietary macronutrients in an actual keto diet are divided into approximately 55% to 60% fat, 30% to 35% protein, and 5% to 10% carbohydrates. A typical ketogenic diet might look like following

Sample Vegetarian Keto diet

Breakfast: 

• Bullet coffee (i.e., Coffee with coconut oil or ghee) / Curd
• 1 tbsp ghee

Lunch: 

• Paneer Bhurji (100 gms) 
• Buttermilk

Dinner: 

• Panner (100 gms) sabji with coconut oil/Butter
• Salad

Sample Non-Vegetarian Keto diet

Breakfast: 

• Bullet coffee (i.e., Coffee with coconut oil or ghee) 
• Scrambled eggs with cheese

Lunch: 

• Roasted Chicken breast 
• Salad

Dinner: 

• Tandoori chicken

Which foods are allowed in the keto diet?

Allowed foods in the keto diet are as follows

• meat: red meat, steak, ham, sausage, bacon, chicken, and turkey
• fatty fish: salmon, trout, tuna, and mackerel
• eggs: pastured or omega-3 whole eggs
• butter and cream: grass-fed butter and heavy cream
• cheese and paneer 
• nuts and seeds: almonds, walnuts, flaxseeds, pumpkin seeds, chia seeds, etc.
• healthy oils: extra virgin olive oil and avocado oil
• avocados: whole avocados or freshly made guacamole
• low carb veggies: green veggies, tomatoes, onions, peppers, etc.
• condiments: salt, pepper, herbs, and spices

Foods that need to be avoided while on the keto diet

• sugary foods: soda, fruit juice, smoothies, cake, ice cream, candy, etc.
• Grains or starches: wheat-based products, rice, pasta, cereal, etc.
• fruit: all fruit, except avocado, small portions of berries like strawberries
• beans or legumes: peas, kidney beans, lentils, chickpeas, etc.
• Root vegetables and tubers: potatoes, sweet potatoes, carrots, parsnips, etc.
• low-fat products: low-fat mayonnaise, salad dressings, and condiments
• unhealthy fats: processed vegetable oils, mayonnaise, etc.
• alcohol: beer, wine, liquor, mixed drinks
• sugar-free diet foods: sugar-free candies, syrups, puddings, sweeteners, desserts, etc.

Now, Lets talk about Benefits, Risk and Potential Issues and Side effects of Keto Diet

Benefits of Keto Diet

• Keto Diet helps you to lose weight: A ketogenic diet is an effective way to lose weight and lower risk factors for disease. The diet is so filling that you can lose weight without counting calories or tracking your food intake. Ketogenic diets appear to have an advantage for weight loss in the short term, but there are no long-term studies

• Keto diets for diabetes and prediabetes: Diabetes is characterized by changes in metabolism, high blood sugar, and insulin sensitivity. The Keto diet helps lose excess fat, which is closely linked to prediabetes and metabolic syndrome. Short-term research does show benefits for improving insulin sensitivity—making it easier for insulin to clear glucose out of the bloodstream—and managing blood sugar levels.

• Keto diets reduce seizures: The Epilepsy Foundation suggests that ketosis can reduce seizures in people with epilepsy — especially those who have not responded to other treatment methods. It seems to have the most effect on children who have focal seizures.

Studies have now shown that the diet can have benefits for a wide variety of different health conditions:

• • Heart disease: Studies have also found that while “bad” LDL cholesterol tends to go up for some people, triglycerides tend to go down, and protective HDL cholesterol is likely to rise.
  • Alzheimer’s and Parkinson’s disease – Diet helps improve symptoms and slow their progression.
  • PCOS: Improves symptoms
  • Cancer: Latest research indicates; that it can be used in the treatment of some forms of cancer  

Potential Issues with Keto Diet

• Reduces Intake of Essential Vitamins and Fiber: Although ketogenic diets eliminate sugar and refined carbohydrates (a good thing), they also curtail consumption of nutritious foods like pulses, whole grains, fruit, and starchy vegetables—all of which are essential sources of vitamins, minerals, antioxidants, phytochemicals, and fiber.
• High Muscles loss: A certain degree of muscle loss is expected with calorie-restricted diets. Some studies have found that muscle loss with ketogenic diets is more significant if they are not followed correctly, possibly because the body attempts to break down protein to create glucose.
• Requires long term commitment without breaks: Cycling on and off the ketogenic diet makes it harder to get back into ketosis, especially for people with insulin resistance, and could actually be harmful if they eat high-carbohydrate meals while off the ketogenic diet.
• Not Affordable and Practical: This diet is challenging to eat out or participate in a social activity involving food. It also may be too expensive for someone. 
• Difficult to follow: It strictly limits what you can eat. You need to prepare meals with specific ingredients. As a result, it is challenging to follow. If you add carbs to your diet, you may regain lost weight. 
• Not Rich in Taste: In the Indian context, the keto diet may not suit your taste, especially for vegetarians, making eating food a struggle rather than an enjoyable experience. 
• Needs Professional Guidance to avoid side effects

Side Effects of Keto Diet

Although the ketogenic diet is usually safe for healthy people, some initial side effects may occur while your body adapts. Some of the Potential Side effects are

• Keto Flu is observed in many people from mild to moderate intensity. Keto flu includes Diarrhea, constipation, and vomiting. 
• Nausea
• Sleep Issues
• Fatigue/Weakness
• Digestive discomfort

Multivitamin tablets and adding extra salt and lemon to meals are recommended to avoid potential side effects.

Risks of Keto Diet

A keto diet, if not appropriately followed under professional guidance and monitoring, may lead to 

• low protein in the blood
• extra fat in the liver
• kidney stones
• micronutrient deficiencies

Also, once the keto diet is stopped, the transition to regular food should be slow and monitored. A sudden influx of carbs and sugar can wreak havoc on your body. If you don’t transition properly off the ketogenic diet, there could be some unwanted symptoms such as

• Weight gain
• Bloating and other bathroom issues
• Blood sugar spikes
• Fatigue and Irritability
• Increased hunger and sugar addiction

References:

Paoli A. Ketogenic diet for obesity: friend or foe? Int J Environ Res Public Health. 2014 Feb 19;11(2):2092-107. doi: 10.3390/ijerph110202092. PMID: 24557522; PMCID: PMC3945587.

Gomez-Arbelaez D, Crujeiras AB, Castro AI, Martinez-Olmos MA, Canton A, Ordoñez-Mayan L, Sajoux I, Galban C, Bellido D, Casanueva FF. Resting metabolic rate of obese patients under very low calorie ketogenic diet. Nutr Metab (Lond). 2018 Feb 17;15:18. doi: 10.1186/s12986-018-0249-z. PMID: 29467800; PMCID: PMC5816424.

Freeman JM, Kossoff EH, Hartman AL. The ketogenic diet: one decade later. Pediatrics. 2007 Mar;119(3):535–43. doi:10.1542/peds.2006-2447. PMID 17332207

Husari KS, Cervenka MC. The ketogenic diet all grown up-Ketogenic diet therapies for adults. Epilepsy Res. 2020 May;162:106319. doi:10.1016/j.eplepsyres.2020.106319. PMID 32199222.

Lowery R, Wilson J. The Ketogenic Bible: The Authoritative Guide to Ketosis. 1st ed. Victory Belt Publishing; 2017. ISBN 9781628601046.

https://www.medicalnewstoday.com/articles/319196

https://www.healthline.com/nutrition/ketogenic-diet-101#diet-types