Misconceptions About the Keto Diet

Alarming social media posts cry out dire warnings about the supposed “dangers” of the ‘keto diet’ but are they founded? What is “the keto diet”?

The Keto Diet

There is no one “keto diet”, but many variations of ketogenic diets that are used for different therapeutic purposes.

Some therapeutic ketogenic diets are used in the treatment of epilepsy and seizure disorder and are extremely high in fat. Other types of therapeutic ketogenic diets are used in the treatment of various forms of cancer (those that feed on glucose), such as brain cancer. There are ketogenic diets that are used in the treatment of Polycystic Ovarian Syndrome (PCOS), as well as for weight loss and for increasing insulin sensitivity in those with Type 2 Diabetes and insulin resistance. Even among those using a nutritional ketogenic diet for weight loss and to increase insulin sensitivity, there is no one “keto diet”.  There are ketogenic diets with a higher percentage of fat than protein, with a higher percentage of protein than fat and mixed approaches which may have different ratios of protein to fat – depending on whether the individual is in a weight loss phase or a weight maintenance phase. There are as many permutations and combinations as there are people following a keto diet for these reasons.

What makes a diet ketogenic (or keto) is that the amount of carbohydrate relative to the amount of protein and fat results in the utilization of fat as a primary fuel source rather than carbohydrate. 

Macronutrient Percentages of Keto Diets

Another assumption is that a keto diet used for weight loss (as if there were only one?) is 20% protein, 70% fat and 10% carbohydrate (and such posts are often accompanied by photos of large plates piled high with bacon and eggs), however therapeutic ketogenic diets used for weight loss ranges from those with a higher percentage of fat than protein (which may focus on mono-unsaturated fats and omega 3 fats), a higher percentage of protein than fat (thus no piles of bacon!), and a mixed approach with different ratios of protein to fat depending on whether the individual is in a weight loss phase or a weight maintenance phase.

This idea that a “keto diet” has a specific percentage of fat to protein to carbs in itself is very  confusing, because the percentage of calories of any of these macronutrients will depend on how many calories a person is eating in a day. For example, two different people may be eating ~30% of their calories as protein but one person is eating just over 55 gm of protein on an 800 calorie a day diet, while another person is eating 160 gm of protein on a 2000 calories diet. When discussing macronutrients, we have to specify grams of protein, grams of fat and grams of carbohydrate, otherwise the figures are meaningless.

What makes a diet ketogenic is that the amount of carbohydrate in the diet results in people’s body utilizing fat as its primary fuel and depending on the individual, how insulin resistant (IR) they are, how long they have been IR or had Type 2 Diabetes and whether they are male or female will affect the degree of carbohydrate restriction. Some may do very well with 100 gms of carbohydrate, while others may need to consume less.

Not everyone with lactose intolerance for example, needs to restrict milk to the same degree; some can tolerate 1 or 2 cups whereas other can only tolerate a few ounces. It is the same case with those that have become intolerant to carbohydrate. Different individuals depending on their metabolic state and clinical conditions,  have varying ability to process carbohydrate. That is why there is no “one size fits all” ketogenic diet.

The “Dangers” of Keto Diets

Some articles warn that “ketosis is actually a mild form of ketoacidosis” which is simply not true.

Ketones are naturally produced in our bodies during periods of low carb intake, in periods of fasting for religious or medical tests, and during periods of prolonged intense exercise. This state is called ketosis. It is normal and natural and something everyone’s body does when using glucose as its main fuel source.

Once our glycogen levels are used up, fat is broken down for energy and ketone bodies are a byproduct of that. These ketones enter into the mitochondria of the cell and are used to generate energy (as ATP) to fuel our cells.

Ketosis is a normal, physiological state and we may produce ketones after sleeping all night, if we haven’t gotten up and eating something in the middle of the night.

Ketoacidosis on the other hand is a serious medical state that can occur inuntreated or inadequately treated Type 1 Diabetics, where the beta cells of the pancreas don’t produce insulin. It may also occur in those with Type 2 Diabetes who decrease their insulin too quickly or who are taking other kinds of medication to control their blood sugars.

In inadequate management of Type 1 Diabetes or in insulin-dependent Type 2 Diabetes, ketones production will be the first stage in ketoacidosis. This is not the case when the above medical issues are not present.

Final Thoughts…

There is no one “keto diet” but rather  many variations of ketogenic diets that are used for different therapeutic purposes. Depending on the condition for which a person is using a therapeutic ketogenic diet, the number of grams of fat, protein and carbohydrate will vary. Even in those utilizing a ketogenic diet for weight loss or lowing insulin resistance, the number of grams of carbohydrate will vary considerably person to person.

People following a ketogenic diet need to work closely with their doctor. For those on blood sugar- or blood pressure lowering medication this is very important, because clinical studies have demonstrated that the dosage of medication needs to be adjusted downwards as glycemic control is restored.

As with anything we read in magazines or on the internet, a healthy dose of discernment is needed. The person writing the article may not be current with the research in this field and be sincerely operating on an older paradigm. I encourage you to ask questions, read reviews of current studies using ketogenic diet for the condition of relevance (whether on this site or others) and to speak with your doctor. Let your decision will be an informed one, not fueled by dramatic headline with dire warnings and misinformation.

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