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The good, bad and ugly of ketogenic diets

The good, bad and ugly of ketogenic diets

Keto diets can help you shed weight quickly, but tread carefully
A spread of avacados, almonds, meat, nuts, butter.
Options are aplenty for someone opting for a keto diet | iStock

Roopa, a homemaker who was looking to lose weight, zeroed in on a ketogenic diet in October 2021. She had read about it as a diet for weight-loss online, with a friend’s testimonial of its benefits sealing the deal for her. 

Within a month-and-a-half, she lost 12 kg, reducing her weight from 89 kg to 77 kg. While this boosted her morale, the gains were only short lived. A month after discontinuing the diet, Roopa put on 7 kg, in turn leading her to develop severe anxiety. 

“I don’t know what is happening to my body. I gained deficiencies and low blood pressure along with weight,” says Roopa, who then consulted nutritionist and dietitian Shalmali Sharma, founder of Re-vive, Bengaluru. 

Obesity is today becoming a problem of epidemic proportions, with over 1.9 billion adults being overweight and a further 650 million being obese—according to the World Health Organization’s 2016 statistics. And there are millions like Roopa who are looking for quick ways to lose weight. 

This has prompted several popular dieting trends to shoot to fame, including ketogenic, vegan, paleo, gluten-free and detox diets. 

“The global crisis of obesity is unchecked and it’s not surprising that the number of diets for weight loss is only proliferating,” says Ishi Khosla, a clinical nutritionist with over 35 years of experience and who is the founder of the Celiac Society of India, Delhi. 

The keto story

Keto diets shot to medical fame in the 1920s as a treatment for children with seizures. Pioneering American physician, diabetologist and epileptologist Dr Russel Wilder figured out that a diet comprising high fat, moderate protein and low carbohydrate content was able to treat seizures in children who did not respond to medications. 

But despite being over 100 years old now, we still do not understand the mechanism by which high-fat and low-carb diets treat seizures. It was not until the 1960s that ketogenic diets became popular among obese people trying to lose weight. Then in the last decade, ketogenic diets took off as a “lose-weight fast” method that took internet forums by storm, with a wave of global tech leaders also speaking about its benefits and further fuelling its adoption.  

“The keto diet is trending due to social media promotions and the Western influence in keeping the weight low,” says Sharma of Re-vive. “When you consume more carbs, they give us fibre and nutrients which are lacking in a predominantly fatty diet.” 

Experts also caution that such weight-loss measures carry several risks. According to Khosla, following a popular diet rarely teaches individuals how to establish and maintain healthy eating habits. These quick weight-loss solutions are not always a sustainable in the long-term, she adds. 

Not a wholesome diet

As humans, we require an uninterrupted supply of energy through the day which we get from carbohydrates. Proteins are needed for muscle mass and fats for insulating the skin and producing hormones. 

The US National Academic Press recommends that for maintaining a healthy mind and body, the distribution range of the three macronutrients or “macros” (based on calorie consumption) should be 45-65 percent from carbohydrates, 20-35 percent from fats and 10-35 percent from proteins. 

In keto diets, carbohydrates make up the smallest percentage of calories – just 10 percent, while 70-80 percent of calories come from fats and 10-15 percent from proteins. This changes the entire architecture of the body, as it is forced to replace its regular energy source – carbohydrates. 

When fat becomes the primary energy source, the body breaks it down into ketones through a process called ketogenesis. In this metabolic state, known as ketosis, your body starts burning down the fat reserves which is why it results in sudden weight loss. 

“Ketones can also be formed when there is crash dieting, fasting, uncontrolled diabetes or in alcoholism,” says Khosla. “The duration of a ketogenic diet may range from a minimum of two-three weeks to induce ketosis and up to a maximum of 6-12 months.” 

Another issue with the keto diet is that the fats in them are mostly saturated fats, something that the UK’s National Health Services (NHS) says should be completely cut out of diets. Keto meals do not even include fats from plants as these usually come along with carbohydrates. 

Ketones: good or bad?

Ketones, in general, do not harm the body so long as they are produced in a small quantity and regulated properly. 

The calorie consumed through a keto diet is also quite impressive – a gram of fat carries nine kilocalories (kcal), while the same amount of carbohydrates and proteins provides 4 kcal each. This is how a keto diet can provide much more energy than a non-keto diet. 

In terms of the rate of energy conversion, carbohydrates get converted into glucose in less than 30 minutes while fat can take up to six hours to produce ketones. This means you end up with instant energy from carbohydrates but not so with fats. 

A fat-rich diet also takes up more space in the stomach and needs quite a few hours to digest. It can increase the level of satiety or fullness; cause loss of hunger and that means you will end up eating less. This causes you to start losing weight and the weight loss effect cascades while ketosis is in action. 

But there is a big downside, says Sharma of Re-vive. “The digestive system needs a lot of attention when you are on a keto diet. That is because you are putting in something which is much tougher to digest than protein and is also in surplus quantity.” 

Experts say that if the gut is not healthy or the body does not have adequate exercise, a high-fat diet can turn out to be a villain rather than the hero as the dieter believed. It can cause constipation, IBS or irritable bowel syndrome and diarrhoea. 

The other negative of going on a keto diet is that the only way to flush out the ketones is through urine, so the kidneys will get strained over time and the chances of kidney damage increase. 

“It will definitely affect your kidneys,” says Dr Randhir Singh Dahiya, Department of Pharmacology, Central University of Punjab, who has over 20 years of research experience. 

“Ketone gets utilised if you are doing continuous and rigorous exercise. Otherwise, it accumulates in the body and starts affecting your kidneys. This is also the case when you take excess amounts of protein.” 

Is it a diet or therapy?

A keto diet works better as a therapeutic diet rather than as a weight-loss one. It needs to be followed only with the guidance of a physician and under the strict supervision of a dietician, experts say. 

Apart from treating seizures, it has been designed to burn the fat accumulated around the liver in fatty liver conditions; it is advised for people fighting cancer as cancer cells survive on glucose; and for maintaining blood sugar levels in Type-2 diabetes. 

While it can be used as a mechanism for weight loss, there are better and easier ways to do so. 

“I only cut down the carbs while preparing a client for a championship that needed one to have a lean and rugged physique,” says Sharaf Ali of Bengaluru, who is a Level-4 certified fitness trainer with over 10 years of experience in the fitness industry. “Otherwise, I suggest taking carbs, which are calculated on the basis of one’s height, weight, and activity level, before a workout session.” 

A balanced, calorie-counted diet can reward you better than a complicated diet plan. With calories being the key if weight loss is the goal, a mix of customised diet, disciplined exercise and quality sleep can catalyse a fast and healthy weight loss, he adds. 

Other risks of going on a keto diet include increasing cholesterol levels and developing nutrient deficiencies. Compared to other diet menus, it is also difficult and expensive to assemble a keto platter which includes items like butter, ghee, meat and eggs every day.

Most experts agree that there is no easy way to lose weight, but that does not mean it is impossible. It just takes more time than one thinks and – as Roopa and many others like her keep finding out – requires a lot of conviction to change one’s lifestyle in a healthy and sustainable manner.

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