The Keto Controversy: Helpful or Harmful?
As some of you may know, I just spent a weekend in Austin, TX at the 2018 Paleo f(x) Conference, which was AMAZING!!!
I had so much fun hearing my favorite authors and nutrition/medical experts speak on topics ranging from Brain Health to Where We are Today in Medicine to Gut Health (& a lot more in between).
But one of the topics that I found most interesting were the numerous discussions on the benefits of the ketogenic, or keto diet.
These talks, along with countless companies touting their keto treats, shakes & coffees, had me wondering if I was at the wrong event.
Was this Paleo f(x) or Keto f(x)? (Yes, there is such a thing!)
Make no mistake, I highly favor a lower-carb approach to health in most cases, AND I believe that ketosis is beneficial within certain parameters that are HIGHLY monitored, BUT I'm also someone who questions the legitimacy of diets once they become faddish. And Keto is definitely reached fad levels!
I currently work as a nutrition consultant at a local health food store and have had MANY conversations with people trying to follow the keto diet.
After talking to them, my concerns range from whether 1) they're following the diet correctly, 2) they're being supervised by a physician or nutritionist, 3) they're truly a candidate for ketosis - because not everyone is, or 4) they're taking ketosis to extreme & unnecessary levels.
Most of the research we have on long-term ketosis is within the epileptic & neurological community, and while there has been a lot of success with these patients, there has also been a growing list of adverse & severe reactions.
As Sarah Ballantyne says, you have to consider the good AND the bad that science offers. So, consider the following....
So is Keto Not Healthy?
Did you happen to notice that there are MORE DOCUMENTED ADVERSE REACTIONS (to include death!) than DOCUMENTED BENEFITS?? Is anyone talking about these??? With the exception of Dr. Sarah Ballantyne over at ThePaleoMom.com, I sure haven't heard much about the negative affects of ketosis.
She has respectively stood her ground at the Paleo f(x) conference (including this year's Mastermind Panel), her blog, & her podcast for the last few years regarding her lack of support for the keto diet in most circumstances.
I think there were MANY people listening that thought she was crazy for making such bold statements in an arena that seemed predominantly keto-friendly, if not dogmatic, but I'm so glad she spoke up. Many of us out here needed to hear what she had to say, INCLUDING ME!
As someone who's been playing around with a low-carb diet for almost a year and who has experienced my own positive & negative observations, this gave me room to question the full story of Keto.
Side Note: Several members of the panel have preached & practiced the power of Keto on a short-term basis, and they all agree that it should be followed within reason and with the guidance of a knowledgable practitioner. J.J. Virgin states:
Ketogenic diets are NEVER safe for those who are pregnant or suffer from adrenal or kidney disease.
They should also be avoided if you have thyroid, fertility, or GI issues. And they’re rarely recommended for long-term use because of the excess strain they place on your adrenal system.
Unless you have a neurologist who is following you regularly and recommends a ketogenic diet for seizures, ketogenic diets should be strictly limited to the short-term. Regardless, you should always check with your healthcare provider before starting one.
My Take on Keto
Personally, I have definitely lost weight eating lower-carb, though I lost most of it while following a Paleo dietary pattern in the range of 100-150 grams carbs/day.
I have also experienced appetite suppression in the mornings, especially after having a butter or coconut oil coffee, and have not experienced carb cravings to speak of. However, I haven't had cravings since cutting out sugar, which to me was the real culprit.
However, when I started cutting back my carbs to the 50-75 grams/day range, my sleep became noticeably disregulated, I started burping regularly, my stools became "problematic" (shall we say?) & also started floating (a sign of undigested fats), I had boughts of nausea, AND I felt bloated & started putting ON weight (which could be because I was eating more calories than I had previously).
I had suspicions this was due to lowering my carbs more than usual, so I added back some healthy carbs and guess what?? I slept MUCH better, had more regular "movements", lost the extra weight I gained and the bloating subsided.
When I listened to Dr. Ballantyne after her Paleo f(x) talk this year, she mentioned all of these symptoms as side effects of a keto diet (or too low-carb diet). So, my suspicions were validated.
On top of that, several of the women that stayed afterwards to talk to her personally were experiencing the same problems, in addition to some others. She passionately advised these women to come out of ketosis and EAT SOME DA** CARBS!
It's not like any of these women were overweight AT ALL or dealing with severe neurological trauma. They had just jumped on the Keto Bandwagon in hopes of improving their health or trimming up.
So, after doing some more reading & thinking on the matter, I stick to my original thoughts on ketosis: Use it as a BRIEF tool (~2 weeks) to help your body shift to burning fat, but do not stay at that level of carbohydrate restriction (<50 carbs/day) for very long. And don't go that long if you're feeling horrible for more than a couple days!
I think there may be something to "carb-cycling", a pattern of going in & out of short-term ketosis. Mark Sisson mentioned that he does this about four times a year. But I would only suggest this for those that are wanting to optimize their athletic performance, get out of a weightless plateau, or deal with other disease symptoms UNDER THE SUPERVISION OF A PRACTITIONER.
And I suggest "warming up" to ketosis by steadily reducing carbs and increasing healthy fats over a few weeks so as to not SHOCK your body when you do make the transition. Mark Sisson does a good job of presenting this pattern in his Keto Reset Diet.
If you don't want to buy the book, look me up! I'd be glad to walk you through the process.
Overall, I think it's really important for the average person considering "a true ketogenic diet" (generally less than 50 grams of carbs/day) to talk to their doctor or a knowledgeable nutritionist about their personal potential for harm, AND to be monitored if they decide to try it out.
I never experienced keto flu because I slowly worked myself down the carb ladder over a matter of months. Once I noticed uncomfortable side effects, I stopped.
And there was really no reason for me to go below 100 grams of carbs a day because I didn't need to lose weight or train my body to burn fat. I feel good, I'm sleeping well, and I'm not putting on weight (nor do I need to lose any).
BUT, if you're still considering KETO FOR WEIGHT LOSS, here's what you need to know:
Keto For Weight Loss
Weight Loss is the #1 reason I hear for people "going Keto". This is not inherently bad, as it has been shown to "alleviate" obesity & diabetes, BUT most of these results were seen in a clinical setting where people were highly monitored and guided through the process.
One reason keto has been successful for weight loss is because most people experience significant APPETITE SUPPRESSION due to the higher amounts of fats they consume. Therefore, they eat less.
This may be helpful for those who have a tendency to overeat or who may be sugar-addicted. However, this type of "intermittent fasting" may be problematic if it causes you to consume less essential nutrients AND you are not overweight.
You must be careful to maintain a diet full of nutrient-rich foods that your body needs versus eating a crazy amount of bacon, butter, coconut & coffee (which many people do), which has little to no phyto- & micro-nutrients (mostly found in plant foods).
It is true that once your body adapts to minimal carbohydrate (i.e. glucose) consumption, it will turn to fat stores for fuel (i.e. ketones). I write more about that HERE.
For those who are overweight to obese, this state may be helpful to get the body in a fat-burning versus a fat-storing mode, as is common with higher carbohydrate consumption.
But for most people, this extreme of a "starvation" method isn't necessary for more than a couple of weeks, AND it could be dangerous. Your body literally thinks it is starving when the external glucose supply (i.e. carbohydrate foods) is shut off.
This can significantly raise cortisol levels (fight-or-flight response) as your body seeks to find homeostasis again (adapts to burning ketone bodies) and can result in the "keto flu" that many people experience.
Calories Still Matter
You might be surprised to know that several "low-carb trials" have shown that when it comes to weight loss, calories still matter!
For example, one study comparing low-carb (LC) vs. high-carb (HC) diets show that even though the LC group lost their initial weight faster, they lost virtually the same amount of weight as the HC group in the end.
Both groups focused on consuming real, unprocessed foods and went from consuming around 2300+ calories BEFORE the trail to around 1750 calories at the end of the trial (see Figure 1).
This goes to show that eating nutrient-dense, highly-satiating foods can significantly affect your calorie intake, regardless if you eat a LC or HC diet!
Consider the following graphs from the trial. Notice that both groups followed the same curve in Total Energy Intake, albeit different macronutrient ratios, and lost virtually the same amount of weight:
Eat Nutrient-Dense Foods!
Generally speaking, those who have a tendency to overeat are eating foods that are HIGHLY-PROCESSED and NUTRIENT-POOR. These foods also happen to be high in refined carbohydrates and processed fats.
Though emotional eating is definitely a cause of overeating, oftentimes your body is simply not getting the micronutrients (vitamins & minerals) it needs to be fully satisfied. Therefore, your body (and taste buds) keep telling you to eat more in order to fill whatever nutrient void you may have.
People eating a REAL FOOD diet (i.e. an ancestral or paleo diet) high in NUTRIENT-DENSE FOOD find it difficult to overeat. This type of dietary pattern encourages LOTS of vegetables (fiber!), a good amount of healthy fats, some fruit and moderate protein, which are all HIGHLY SATIATING & naturally lower in carbohydrates.
The study linked above clearly shows that genetics, insulin secretion, & amount of carbohydrates do not determine one's weight loss success - but the amount of food they're eating (and the quality) does matter!
I still prescribe to the belief that everyone is unique, and finding a tailored, individualized nutritional approach is the best route to optimal health!
Ketosis has its advantages, but I would NOT recommend it unless under supervision of a knowledgable doctor and/or nutritionist.
In the end, eating real, wholesome, nutrient dense foods is ALWAYS YOUR BEST OPTION!
You'll find that an Ancestral- or Paleo-type approach to nutrition, which I advocate, will have you consuming less carbohydrates than you would in the Standard American Diet (SAD); and whatever carbohydrates you DO consume, will be full of nutrients that will actually help your body perform optimally!