The high fat / low carb ketogenic diet is one of the hottest trends in nutrition. Due to it’s therapeutic potential, I have been using it in my naturopathic practice for over 2 years – often with dramatic results. So when I came across a US World & News Report article ranking the world’s best diets I started looking down the list for the ketogenic diet. The allegedly heart-healthy DASH diet and Mediterranean diets were at the top. But the ketogenic diet? Second-to-last place! Should I be surprised?
I’m not sure why the keto diet received such a low ranking. The study team expressed concern about the high fat intake of the ketogenic diet and the potential impact for heart health. I don’t know that much about the politics of dietetics in the US, ut I read Nina Teicholz’s book The Big Fat Surprise. In this book, Teicholz presents a compelling case to disassociate heart disease from saturated fat intake. She conducted 9 years of extensive research revealing generations of industry-bias and bad science. Teicholz and others believe fats have been unnecessarily vilified and that the current low-fat dietary guidelines are simply wrong. I raved about the book here.
So maybe the ketogenic diet deserves it’s embarrassing placement; or perhaps this is yet another example of industry bias against fat. In an attempt to find the answer, I decided to explore some of the research for myself. What I found was quite compelling. But first …
KETOGENIC DIET – THE BASICS
The ketogenic diet is a high fat, very low carb, moderate protein diet. Without dietary carbs (like breads, grains, fruit, etc.), we starve the body of its usual energy source. This forces a metabolic switch to use fats in the form of ketones for energy. Ketones are made in the liver from our fat stores and the fats we eat.
This system actually mimics the body’s starvation state. Ketones are a fuel source for the brain when we go for longer periods of time without food – a situation that we, in North America, don’t usually find ourselves in.
For what to eat on a ketogenic diet, check out dietdoctor.com. They walk you through it with easy to understand text and great visuals.
THE EVIDENCE
Truth be told, the research behind the ketogenic diet has its limitations. Most of the research is new and short-term (less than 6 months). But recently, research interest has been plentiful and in a few years I think we’ll know more. As it is, there are some promising results.
Weight Loss
Low carb diets (including keto) fare better than low fat diets for weight loss. In a 2017 review of 23 studies, low-carb groups often lost 2-3 times as much as weight as the low-fat groups. Just reducing carbs in your diet can curb your appetite and cause you to eat less. When you restrict the carbs to induce ketosis, the results are even more significant.
The study results reflect in my clinical experience. When some of my patients have been unable to lose weight any other way, the ketogenic diet has been able to kickstart fat burning in a dramatic manner.
Blood Sugar Balance
Type 2 diabetes is a metabolic disease caused by resistance to insulin. Functionally, it’s like an intolerance to carbohydrates. Type 2 diabetics have started using the ketogenic diet to reduce their need for medication and reduce the complications associated with diabetes such as heart disease, kidney problems, eye and nerve damage. There are studies emerging with excellent results. In one study, 95% of Type 2 diabetics were able to get off or reduce their medications. In a review published in the European Journal of Clinical Nutrition, the study team reports the results “nothing short of remarkable”. Studies consistently show a reduction of plasma glucose, “dramatic” improvements in insulin sensitivity, and reduced use or withdrawal of insulin use and other medications.
Cancer
Most cancers express insulin receptors and some cancer cells are inefficient in processing ketones for energy. Research into cancer as a metabolic disease dates back to the 1980s. Currently, there is emerging evidence that the ketogenic diet can be an adjunct to conventional treatment. Eugene Fine has published some recent studies, and there is a list of clinical trials on cancer and keto here.
Epilepsy and other Neurological Diseases
The ketogenic diet has been recognized as a tool for treating epileptic seizures since the 1920s. The most recent metastudy shows a reduction of on average 50% in adults and children.
It has been proposed that ketones are a more efficient fuel for the brain than glucose. And that there are other neurological benefits to the ketogenic diet. There are a handful of promising studies that show a reduction of frequency and duration of migraines for people on the ketogenic diet. Elena Gross had debilitating migraines and significantly reduced them using the ketogenic diet and is now doing academic research on the subject.
Children with autism frequently use special diets as a treatment approach. Autism studies on the ketogenic diet like this one show improvements in symptoms on the Autism Ratings Scale, even when compared to the more frequently recommended gluten-free, casein-free option.
Parkinson’s Disease and Alzheimer’s researchers and medical professionals are starting to consider the ketogenic diet as a valuable therapeutic tool. Studies are emerging, clinical evidence is piling up, and the mechanism of action is becoming clearer.
CONCLUSION
More research is needed. Got it. But there are promising results, particularly with diabetes and weight loss. And that’s not all. Many people are improving blood pressure, cholesterol, energy, endurance, mental clarity using the ketogenic diet. Sure, the diet is strict. And it sometimes feels weird to eat that much fat. But based on the evidence, I think it’s time for the US World & News Report study team (and other experts) to reconsider their opinion of the ketogenic diet.
