What is the keto diet?
The ketogenic diet, initially reported by pediatrician Hugh Conklin, is a high-fat, low-carbohydrate diet originally used for the treatment of medically refractory childhood epilepsy since the early 1920s [1]. Despite wide use of the therapy during the 1920s and 1930s, advances in antiepileptic drug treatment resulted in a sharp decline in the use of the diet [1]. However, over the past 15 years, there has been a dramatic increase in the scientific interest and use of the keto diet, particularly as a weight-loss approach [2,3].
How does the keto diet work in the treatment of epilepsy?
The ketogenic diet includes a high ratio of fats to carbohydrates, with moderate protein intake, however, this ratio should be tailored to a patient’s unique needs by an RD-MD team. A typical ratio is about 80% fat, 15% protein, and 5% carbohydrate [1]. There are five main variations of the keto diet differing in terms of macronutrient ratios, that of which includes classic keto, modified keto, and MCT [4]. Tools such as the ketodietclaculator from the Charlie Foundation for Ketogenic Therapies can help dietitians calculate and manage their patient’s ketogenic diets [5]. Meal plans can include heavy cream, bacon, eggs, tuna, shrimp, and other high-fat low-carbohydrate products. Patients are not to consume starchy fruit or vegetables, bread, pasta, or sources of simple sugar [1].
The ketogenic diet is a treatment choice for patients suffering from seizures caused by glucose transport deficiency (i.e. De Vivo disease) and pyruvate dehydrogenase deficiency [1]. The exact reason as to why the ketogenic diet exerts these anti-epileptic effects are still unknown [6], however, several theories have been proposed. Anecdotal reports document the success of fasting or starvation in the treatment of seizures [7]. The ketogenic diet’s intense limitation of carbohydrates maintains a state of ketosis, where the body is forced to use ketone bodies as its predominant fuel source, thus, mimicking the anti-epileptic effects of starvation [7]. Furthermore, this constant state of ketosis has been thought to boost energy production in brain tissue, stabilizing synaptic function and increasing resistance to seizures [1].
How does the keto diet work for weight loss?
While the above mechanism directly correlates with the ability to induce rapid weight loss [2], some research suggests that there are no metabolic advantages in low-carbohydrate diets and that weight loss results simply from reduced caloric intake, possibly due to increased satiety from protein [8]. Other studies, however, have found that individuals who follow a low-carbohydrate diet lose more weight during the first 3-6 months than those who consume balanced diets [8]. As mentioned before, this could be a result of the higher satiety effect of proteins as well as appetite suppression of ketone bodies, and higher calorie requirement to use the energy obtained from the keto diet.
What are other uses of the keto diet, medical advances, and other considerations?
Although the keto diet was originally an exclusive treatment option for childhood epilepsy, the diet can also be beneficial for conditions such as cardiovascular disease and type 2 diabetes [8]. There is also interest in the use of the diet in cancer, PCOS, and neurological diseases [8].
The dramatic increase in interest and use of the ketogenic diet as a weight-loss approach raises some concern, particularly as the keto diet for weight loss is considered a fad diet, which involves eliminating foods that contain necessary nutrients to maintain good health. In the case of the keto diet, a lack of dietary fibre and carbohydrates, as well as certain vitamins, minerals and protective phytochemicals can cause an individual to develop serious health problems over time [9]. Not to mention, misinformation around the keto diet can cause individuals to consume extremely high amounts of saturated fats (i.e. from excessive consumption of bacon, butter etc.) that may also lead to other long term health implications. Furthermore, when such a diet is stopped, weight is usually regained quickly as fad diets are not sustainable and fail to focus on the life-style modifications necessary to keep weight off [9].
A well-balanced diet containing sustainably sourced lean meat can be better for those looking to follow a more keto-style diet. However, individuals considering a full ketogenic diet should consult their MD or RD as a proper ketogenic diet should always be managed under physician or RD care.
References
[1] Rogovik, A. L., & Goldman, R. D. (2010). Ketogenic diet for treatment of epilepsy. Canadian family physician Medecin de famille canadien, 56(6), 540–542.
[2] Giroux, N. F. (2020). "The Keto Diet and Long-Term Weight Loss: Is it a Safe Option?" Inquiries Journal, 12(10). Retrieved from http://www.inquiriesjournal.com/a?id=1807
[3] Wheless, J.W. (2008), History of the ketogenic diet. Epilepsia, 49: 3-5. https://doi.org/10.1111/j.1528-1167.2008.01821.x
[4] Charlie Foundation for Ketogenic Therapies. (n.d.) What is Ketosis? Learn About Ketosis. https://charliefoundation.org/learn-about-ketosis/
[5] Charlie Foundation for Ketogenic Therapies. (n.d.) Resources and Tools. https://charliefoundation.org/resources/
[6] Henkel, J. (2021, January 05). The Ketogenic Diet - Epilepsy. Retrieved January 14, 2021, from https://www.heartsinhealthcare.com/epilepsy/the-ketogenic-diet.html
[7] Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics. 2000 Apr;105(4):E46. doi: 10.1542/peds.105.4.e46. PMID: 10742367.
[8] Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition, 67(8), 789–796. https://doi.org/10.1038/ejcn.2013.116
[9] Fad Diets: Diet, Types, Tips. (n.d.). Retrieved January 14, 2021, from https://my.clevelandclinic.org/health/articles/9476-fad-diets
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