Why You Should Kick Keto To The Curb

The keto diet is the #1 most searched diet on Google, but also, one of the worst ranked diets by health professionals. Over the past few years, plenty of people have been sold on this carb-phobic, fat-loving way of eating because of the quick weight loss it’s well known for, but health advocates are getting concerned.  Tune in to find out why.

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Credit to MonoSheep for the theme music.

Transcript

Welcome to Nutrition Bites. The no nonsense podcast where you get the truth about food so you can eat what you want, and be healthy. I’m your host Maggie and welcome to Episode 23 of this series! Today’s topic is extra trendy and controversial. We’re focusing on the most searched diet on Google, that’s also ranked as one of the worst ways to eat. On the menu today, the keto diet.

As a reluctant member of the lactose-intolerant club I mostly avoid dairy, but on occasion, you can find me sneaking low-lactose cheese into my shopping cart. A few days ago when I was picking up my cheeky rind of parmigiano, a neighbouring item caught my eye: cheese wraps. Let me be more specific here. Thin, tortilla-like circles made entirely out of cheese! I first thought that this must have been made for quesadilla connoisseurs who want a perfectly circular, giant, cheese slice. But on closer inspection I realized it had a different purpose. This cheese wrap was for the keto crowd. It heavily advertised that it only contained 1 gram of carbohydrates, and recipes on the back of the package promoted this as a keto-friendly tortilla replacement. Grocery stores are slowly stocking their shelves with “keto-friendly” pizza crusts, sugar-free jams, and pseudo-granola bars - and it’s all to meet the demand of this booming carb-phobic diet. Over the past few years, plenty of people have been sold on keto because of the quick weight loss it’s well known for, but health advocates are getting concerned. So, let’s dig in.

Health Canada, the CDC, and many other health agencies around the world have a pretty similar recommendation when it comes to the breakdown of macronutrients in a healthy diet. It goes like this. Obtain a little over half of your calories from carbohydrates, about 20% from protein and around 25% from fat. There are ranges of course, but in general, it’s a carb-forward way of eating. The keto, or ketogenic, diet, essentially throws this guidance in the trash. Instead the focus is on getting energy from fat, and restricting carb intake in the process. Guidelines for a keto diet instruct followers to obtain at least 70% of calories from fat, no more than 20% from protein, and no more than 10% from carbohydrates. A big switch from the standard recommendation. In practice, keto followers are instructed to avoid almost all fruits, along with most vegetables, and essentially all grains, beans and legumes. The recommended daily allowance for carbs on a keto diet looks like eating 1 cup of rice, or two pieces of fruit max. Essentially, a nightmare for a pro-carb enthusiast like myself. But for some people this is manageable, and seemingly worth it. So if most carbs are off the table, what’s left to eat?

Well, the staples on a keto diet revolve around animal products, plant fats, and low-carb veggies. This includes foods like meat, seafood, cheese, milk, plain yogurt, plant oils, nuts, seeds, avocados, and leafy greens like kale, spinach, and swiss chard. Because of the meat-heavy, low-grain guidelines of keto, it tends to get confused with the paleo diet, but there are some key differences. Paleo, which has been described as the “caveman” diet, is based on the principle that we should only eat foods available to early humans. Its focus is on food groups rather than a specific macronutrient composition. So while both discourage eating grains, legumes, and anything with added sugar, it’s for different reasons. Another big difference is that paleo discourages dairy intake while keto allows it, so while the cavemen cosplayers miss out on the wonders of cheese, the keto dieters can make entire quesadillas out of them. 

Despite only becoming culturally popular in the past 5 years, the keto diet has actually been prescribed in the medical community since the 1920s. In particular, doctors have been using this diet to reduce the frequency of seizures in eplipetic children. While the exact mechanism of how this works is not fully understood, the leading hypothesis is that using fat as an energy source over glucose, changes the neural activity of the brain. As I’ve discussed in many episodes of the podcast, our body’s preferred source of energy is glucose, which is released when carbohydrates are broken down. Our bodies keep a steady amount of glucose circulating in our blood, ready to be used whenever a cell requires it. And as that blood supply becomes depleted, our body works to restore it by breaking down glycogen found in our liver and muscle. Once all that glycogen is used up, and there are no more carbs coming in through our diet, we turn to metabolising fat. One of the main purposes of having fat is to store energy - that’s why bears get all chunky before they hibernate. Although fat can be used as a source of fuel for our cells, it doesn’t follow the same metabolic pathway as carbs. Instead of creating glucose when it’s broken down, it produces a type of energy-containing molecule called a ketone body. This process is called ketosis. Healthy individuals naturally experience a mild form of ketosis during periods of fasting - like when we’re sleeping, participating in a religious ceremony, or competing in endurance exercise. However, we often consume carbs shortly after these events, providing the body with it’s preferred fuel source. You can think of ketosis like using a back-up generator during a power outage. It’s available when necessary, but not something our bodies are used to relying on for a long period of time. The purpose of a ketogenic diet, however, is to maintain a permanent state of ketosis. But why?

Well, one reason is that ketones, or ketone bodies, are thought to be a more efficient fuel source compared to glucose - you get more bang for your buck per molecule. But a more popular reason why ketosis is an enticing strategy, is that relying on fat for fuel means that your body fat will be used up as an energy source. Not only does this result in weight loss, but the fact that this is achieved while eating cheese, bacon, and chicken nuggets really helps sell this diet. But, like with all nicely packaged internet promises, keto, is a little too good to be true. 

If you want to see how hype people get about keto just ask Vincent Guadagnino (gwada-nino), aka Vinny from Jersey Shore. Loveable, Staten Island Vinny, also known as ketoguide on Instagram, swears by a keto diet for weight loss, and encourages otherwise to follow suit. And, you know what? A lot of people find success on this diet! Many studies have shown that a keto, or similar carb-restrictive diet can help promote more weight loss, and faster, than following other eating plans. But, and it’s a big one here, the effect is short-lived. After following a keto diet for 12 months or more, any difference in weight loss compared to another diet strategy is gone. So keto is not necessarily better at helping someone drop weight, it’s just a bit faster. However, one benefit that seems to differentiate keto from other diets, is how it affects our hunger hormones. Most notably the fact that it seems to suppress the release of ghrelin - the hormone that makes us feel hungry. Anecdotally, people following the keto lifestyle have often shared that they feel full on the diet, which is in contrast to a lot of other experiences.

The potential for weight loss, while not feeling hungry, is a big advantage when it comes to investigating this diet as a strategy for managing Type 2 Diabetes. This metabolic disorder is characterized by high blood sugar levels, and is often associated with being overweight. Some research has shown that placing obese Type 2 Diabetics on a keto diet helps promote more weight loss and lower blood sugar levels, compared to being on a standard low-calorie diet. However, a familiar caveat makes an appearance. Any advantages keto has in managing Type 2 Diabetes, disappears in the long-term. Just like with The Bachelor and Bachelorette hopefuls - it really seems like keto is only good for a short time, not a long time. 

When talking about diabetes and the keto diet, one extremely important flag needs to be raised: ketoacidosis. Ketoacidosis is a state where the level of ketones in the blood becomes so high that it increases blood acidity and can lead to coma or even death. For a healthy individual, this will never happen, but for Type 1 Diabetics, it’s a pretty common risk. That’s why it is so important that Type 1 Diabetics avoid a keto diet at all costs. And because this way of eating so drastically messes with our glucose metabolism and insulin levels, anyone at risk of, or living with Diabetes, should be wary of trying this out without guidance from their doctor. 

Apart from Diabetes, keto has also been explored in other areas of health research, from Alzheimers to cancer. But the science is still too early to discuss in detail. One interesting area keto has been applied to is athletics. This one’s a bit odd because carbs are usually treated as the most important fuel source for athletes. I mean, even Michael Scott carb-loaded before the Dunder Mifflin Scranton Meredith Palmer Memorial Celebrity Rabies Awareness Pro-Am Fun Run Race For the Cure. But despite this, the idea that ketones are a more efficient fuel source has made some athletes curious. Small studies have shown that professional athletes on a keto diet improve their lean body mass, because they usually lose fat.  But, when it comes to improving performance, there doesn’t seem to be any difference. Also, keep in mind that the keto diet caps protein intake at 20% of calories. So depending on the physical activity of choice, muscle growth may be impaired. The reason keto maxes out protein consumption is because eating too much protein can interfere with ketosis. Unlike with fat, when protein is used for fuel, it’s broken down into amino acids which are then converted into glucose. And because glucose is a no-no for keto, protein intake has to be restricted.

As a nutritionist, I’m always interested to see research on how diets can be used to treat disease and improve athletic performance. It’s like my boy Hippocrates said “Let food be thy medicine and medicine be thy food”. But we all know that the reason keto is so popular today is not because of its potential in health research, it’s because we’re vain. We are a culture obsessed with losing weight and having as little fat mass as possible. I mean, I’m already bracing myself for the “get bikini ready” ads from local gyms come the New Year. Despite the fact that keto followers do lose weight, and often quite quickly, it’s well known among health professionals to be one of the least sustainable diets you can try. There’s just so few people who can commit to such a restrictive diet for a long period of time. I don’t even mean a decade, I mean like more than a year. Research and anecdotal evidence, show that many keto followers end up dropping the diet shortly after they begin. And take a wild guess what happens when they transition off? Any weight lost is gained right back. Like I covered in last week’s episode, any type of diet that forces your body weight to yo-yo can have lasting damage on your metabolism.

Another strike against the keto diet is that it essentially eliminates two important food groups - grains, and fruits and veggies. Not only is it difficult to find a menu item you can eat while following keto, but even your at-home meals can become super limiting and repetitive. This can drastically interfere with social plans as well as your own enjoyment of eating. And if you can’t enjoy food, why are we even here people?! Also, because keto relies on tracking macronutrients, it’s a diet ripe for developing disordered eating. This focus on numbers and percentages, rather than thinking about the entire context of a food, can also lead individuals to eat in a pretty unhealthy way, like bacon wrapped cheese chased with a Coke Zero for lunch.

Since meat and dairy products are such staples in the keto diet, there’s also a concern from health professionals about long term heart health, due to the high levels of saturated fats in these foods. And depending on how strict a keto follower is about including low-carb veggies, it can be really easy to miss out on key vitamins and minerals, and a lot of fibre, by eating this way. Not only does that put keto dieters at risk of nutrient deficiencies, but gut health can be compromised, because fibre intake is key to a happy gut bacteria. And trust me, you do not want to piss those guys off. 

In terms of side effects from the keto diet, there are some well known inconveniences from eating this way. Complications include bad smelling breath, brain fog, poor sleep, and the elegant sounding “keto crotch” - a change in genital odour due vaginal pH disruption.  But these side effects aside, the biggest problem with the keto diet is that it's just really unsustainable - both for the environment and for our bodies. 

Choosing an approach to eating is a very individual journey, and same goes with weight loss. But long-term sustainability needs to be the cornerstone of whatever eating pattern you chose, otherwise, what’s the point? While the keto diet does help people lose weight, the extremely restrictive nature of this diet makes it nearly impossible to maintain for the long term. And come on folks! The first and biggest, Taylor’s Version, RED flag of this diet is the fact that it forces you to cut out most fruits and vegetables, literally the ONLY food group scientists undeniably agree is vital for our health. And personally, I’m fed up with the anti-carb narrative at the centre of the keto diet. Do we all need to cut down on the amount of refined carbohydrates, and processed foods, we eat? Absolutely! But should we demonize the macronutrient as a whole? Hell no! So please, for the love of focaccia, refrain from the keto temptation and enjoy your carbs in peace.

That’s been the bite for today. Stay hungry.