Is Losing Weight With A Keto Diet Worth It?

You may have heard it referred to as the low-carb diet, ketogenic diet or keto diet, but what exactly is this way of eating? The ketogenic diet is a very low-carbohydrate, high-fat diet. It has become very popular, but is it safe? Experts at Franciscan Health explain the pros and cons of a keto diet.

What Is The Keto Diet?

The keto diet involves reducing carbohydrate intake and replacing it with fat, which this is usually a drastic change for people. Some of the carbohydrate sources that you must cut out include:

• Sugar
• Soda
• Pastries
• White bread

“For most people, this is a major change from what they were previously eating,” said Kristal Twardy, registered dietitian and health coach at Franciscan WELLCARE. Twardy said that the keto diet differs from general healthful eating recommendations.

How Does The Ketogenic Diet Work?

Simply put, the ketogenic diet is essentially backing off on carbs and eating more fat, cholesterol and protein.

On the keto diet, the goal is eating so few carbohydrates that your body can't rely on glucose for energy. And since keto meals are loaded with fat, your body switches over to using fat for energy instead of carbohydrates. Once you begin reducing the carbs that you put into your body, you can enter a metabolic state called ketosis.

“When you're eating more fat or less carbohydrates, we start breaking down fat in your fat cells,” said James Carlson, DO, a family medicine doctor with Franciscan Physician Network Cedar Lake Health Center. “When we're breaking down fat to create energy, these molecules called ketones are formed. The term keto comes from ketones, which are the byproducts of fat, digestion, and utilization to create energy.”

Is The Keto Diet Plan Different Than Other Low-Carb Diets?

The premise of many popular diets is eating a lower amount of carbohydrates, but most of these diets, including Atkins and Paleo, are also very high in protein. The keto diet plan is different because you only eat a moderate amount of protein. Otherwise, your body would convert protein into glucose and wouldn’t achieve a state of ketosis, where it only uses fat for energy.

“A true 'keto diet’ means you are in ketosis,” said Amanda Crosby, registered dietitian and certified diabetes educator with the Franciscan Healthy Living Center in Lafayette.

How Does Ketosis Work?

Normally the body's cells use glucose as their primary form of energy. Glucose comes from dietary carbohydrates, and when you are on keto, you are not consuming enough carbs to meet your body’s energy demands.

“Ketosis comes about from breaking down fat to create energy,” Dr. Carlson said. “That's where the ketones come from. These are benign dietary ketones. So, the chemistry is the body does not prefer carbohydrates for fuel. That's a common misconception. It actually prefers free fatty acids for fuel. But when you stop eating carbohydrates, what's left to break down to create energy is fat. And then the byproduct of that are the ketone bodies.”

To achieve ketosis, people generally need to eat fewer than 50 grams of carbs per day and sometimes as little as 20 grams per day. The process to go into ketosis typically takes 3 to 4 days.

Symptoms of ketosis 

• Bad breath
• Weight loss
• Increased ketones in the blood
• Increased ketones in the breath or urine
• Decreased hunger
• Increased focus and energy
• Short-term fatigue
• Digestive issues
• Insomnia

Can The Keto Diet Help My Medical Condition?

The keto diet is used often by people who are trying to lose weight, but it has been proven to help people with certain medical conditions.

Epilepsy

Epilepsy is a common neurological disorder that affects people of all ages. Anti-seizure medications can help control the seizures many, but around 30% of patients continue to have seizures despite using these medications. According to the Epilepsy Foundation, doctors usually recommend the keto diet for those who have not responded to several different seizure medicines. Higher ketone levels is often the reason of improved seizure control.

Other health conditions

Other medical conditions that the keto diet may help benefit include:

• Heart disease: Reducing carbs to achieve ketosis may improve heart disease risk factors like blood triglycerides, total cholesterol and HDL cholesterol.
• Metabolic syndrome: Ketogenic diets can improve all major symptoms of metabolic syndrome, including high triglycerides, excess belly fat and elevated blood pressure.
• Alzheimer's disease: A ketogenic diet may have benefits for patients with Alzheimer's disease.
• Cancer: Some studies suggest that ketogenic diets may aid in cancer therapy, possibly by helping to “starve” cancer cells of glucose.
• Parkinson's disease: A small study found that symptoms of Parkinson's disease improved after 28 days on a ketogenic diet.
• Acne: There is some evidence that this diet may reduce the severity and progression of acne.

Talk to your doctor if you have any medical conditions before attempting a keto diet.

Are There Negative Side Effects Of Keto?

Like any diet, there are negative side effects to the keto diet. Some of the side effects are common and will most likely happen while on the keto diet, but other effects will only occur if keto is not done properly. Partnering with a registered dietitian and your healthcare provider can help you make the best dietary choices for your health.

• Constipation: Cutting out common sources of fiber from your daily diet can cause constipation.
• Muscle loss: The keto diet can lead to loss of lead body mass, which includes muscle protein.
• Kidney stones: On the diet, people may eat too much meat and not drink enough water and this can cause an increase of uric acid and this acid is known to cause kidney stones.

Keto flu

“You can go through what they call a keto flu, where you're going through withdrawal from carbohydrates,” Dr. Carlson said. “This is a transition state, because our bodies biochemically are used to using the enzymes for carbohydrate energy creation, and I call this the transition period where our cells start to use the enzymes needed to break down the fat to utilize for fuel, which is the preferred fuel source. Free fatty acids are the preferred fuel source, right? So, maybe some diarrhea, maybe some nausea.”

Weight loss

Yes, you can lose weight on the keto diet because you're consuming fewer calories. The weight-loss equation remains the same: You lose weight when you consume fewer calories than you use each day. On the keto diet, you eat high-fat meals with protein, which keeps you feeling full for longer and cuts down on your overall eating throughout the day.

Impacts on cholesterol

Research indicates that diets that are high in fat, like the keto diet, do not have a negative impact on cholesterol and triglycerides as long as the carbohydrate intake remains very low. In fact, your cholesterol and triglycerides might actually improve, if you're focusing on eating healthy fats like avocado, olive oil and nuts, not loading up on bacon and burgers.

Types Of Ketogenic Diets

The traditional ketogenic diet puts your body into ketosis, but there are modified keto diets. On a modified keto diet, your body will go in and out of ketosis and still shed weight and body fat.

Targeted keto diet

The targeted keto diet is popular among athletes and active individuals who want to live a keto lifestyle but need more carbs. It allots an additional 20 to 30 grams of carbs immediately before and after workouts to allow for higher-intensity exercise and enhanced recovery. (The total carb count comes to 70 to 80 grams per day.)

The best options include fruit, dairy or grain-based foods, or sports nutrition products. Because the additional carbs are readily burned off, they don't get stored as body fat.

Cyclical keto diet 

Keto cycling is a way to cycle in and out of ketosis while enjoying a more balanced diet on your “days off.” One keto cycling approach includes five days of traditional keto diet and two non-keto days per week. For best results, eat wholesome carbohydrate-rich foods on your off days, including fruits, starchy veggies, dairy products, and whole grains (rather than added sugars or highly-processed fare).

High-protein keto diet

This plan entails eating about 120 grams of protein per day and around 130 grams of fat per day. Carbs are still restricted to less than 10% of daily calories.

Many people find this modified keto diet easier to follow, because it allows you to eat more protein and less fat than the standard keto diet. This approach may not result in ketosis, because like carbs, protein can be converted into glucose for fuel. But the high-protein keto diet will generally result in weight loss.

Diabetes And Keto

In diabetic patients, ketosis can occur due to the body not having enough insulin to process the glucose in the body.

According to Crosby, ketones produced when you have diabetes is usually seen with patients who have type 1 diabetes, as the pancreas no longer produces any insulin.

“If you are sick, not taking insulin and need to be, or have, increased carbohydrate intake, then it can lead to the body’s inability to get glucose to cells. The body is then forced to use fat as an energy source,” said Crosby. Some dietitians may recommend a ketogenic diet for individuals with type 2 diabetes. With type 2 diabetes, the body still produces some insulin but is unable to properly use the insulin to transport glucose into cells for use as fuel.

“If a patient has type 2 diabetes and follows a keto diet, then they need to look for good glucose control and test positive for ketones,” said Crosby.

People with type 2 diabetes are recommended to reduce carbohydrate intake as carbohydrates are converted to glucose and increase blood sugar levels. Work with your healthcare provider and dietitian to help avoid developing diabetic ketoacidosis, a separate, serious, life-threatening, condition that can lead to diabetic coma or even death.

Who Is A Good Candidate For The Keto Diet?

Before you start the keto diet, talk to your doctor to make sure you're a candidate. For example, those who are pregnant, nursing or have diabetes, need a doctor's approval before moving forward.

Then, you need to ask yourself, is this something I want to do long term, or is there a better way to do this? If you're serious about starting a keto diet, talk to your physician and get nutritional counseling. It's not easy to get the nutrients your body needs while keeping your carbohydrates so low.

If you're only allowed 20 to 30 grams of carbohydrates a day, you'll need to scrutinize everything. Even foods you don't traditionally think of as carbs – like broccoli and nuts – contain them. A dietician can work with you to create healthy, ketogenic meal plans.

How Can You Avoid Regaining Weight After A Keto Diet?

The keto diet is so restrictive, it can be difficult to sustain over time. Only people who are truly devoted can maintain that level of diligence when it comes to meal planning, nutrient tracking and eating out. So after losing the weight, most people go back to their old eating habits. Unfortunately, the vast majority of people who try fad diets end up gaining the weight back because they haven't really found a new way to live.

Is There A Better Way To Lose Weight Than Keto?

Determining the diet that best suits you is a very individual choice and can be impacted by other health conditions you have, so it's hard to make a general recommendation for one type of diet. You can lose weight through a variety of eating styles, whether you choose a low-carb, low-fat, keto or Mediterranean diet, or another one. But in general, eating lots of fruits and vegetables, lean proteins and whole grains is going to help you lose weight and achieve a healthy lifestyle.