As a food activist, Samara Sonmor thinks a lot about what she eats.
She had followed plans that cut out sugar and flour, while looking for ways to stay healthy as she entered menopause. She had “added a few pounds.”
Sonmor, executive director of the Food Action Society of the North Okanagan, started to look at all carbohydrates differently and that led her to the ketogenic diet.
“I became interested in keto because of the way people spoke about it being a Way of Eating rather than a diet. It is a lifestyle change, not a fad,” she said. “Strict keto is for weight loss. Lazy keto and other variations are more my style, as the focus is on health as opposed to weight loss.”
The first three weeks were a “horrible experience” with intense carbohydrate cravings. For all her troubles, it didn’t seem to be working.
“Then one day my pants fell off at work,” she said. Over six months she lost 40 pounds and six pant sizes.
“I didn’t really ease in,” said Vancouver writer Katherine Brodsky. “I went ‘full keto’ because I didn’t know if it would work otherwise.”
While her friends experienced weight loss and improved energy, she didn’t feel much difference and eventually took her foot off the gas.
“I realized that even if I see the benefits, I wouldn’t last with it because I value a lot of the foods you have to cut as part of what makes my life enjoyable,” she said. “A good diet is one that doesn’t involve you falling off the wagon quickly.
“That said, I have been trying to avoid eating as much of the foods forbidden on keto and I view oils differently. For example, avocado and grass-fed butter are really valuable nutrients.”
What are we talking about?
Interest in low-carb diets caught fire in the 1990s with the Atkins diet, continued at the turn of the century as the South Beach diet before morphing into the romantic notion of eating like a paleolithic caveman around 2012. The ketogenic diet is the newest and most extreme of the lot, but that isn’t stunting its popularity one bit. To better explain things, we have enlisted the help of registered dietitian Alex Inman of Vancouver Dietitians and UBC Okanagan Prof. Jonathan Little, who studies human metabolism and diabetes as it relates to diet.
Where did the ketogenic diet come from?
Coined in the 1920s as a way to treat children with seizure disorders, the ketogenic diet is intended to change the fuel your body burns from glucose to ketones, which are derived from fat. That fat-burning phase is called ketosis and results from limiting protein and carbohydrates to as little as 10 per cent of your calories and eating about 90 per cent fat, said Little. It reduces the frequency of seizures in some people with epilepsy, because brain cells function differently when they burn ketones.
What is the modern ketogenic diet?
The fat-protein-carb ratios vary depending on who you talk to. Some dietitians recommend up to 80 per cent of calories from fat and as little as five per cent carbs, 25 grams a day, max. Little believes most modern keto dieters eat about 60 to 70 per cent fat and more like 50 grams of carbs, what he calls a “nutritional” or “whole-foods” ketogenic diet. They typically see elevated ketone levels, but don’t really spend much time in ketosis, if ever.
“You may be producing some ketones and your muscles, heart and brain can use those, but for the most part it helps people by maintaining low levels of insulin and a higher rate of fat oxidation,” said Little. Keeping insulin down prevents the body from storing energy as fat.
“Most people benefit from simply cutting out added sugars, refined grains and pretty much all packaged junk food, so it’s probably not the ketogenic part of the diet that drives the benefits,” he said.
Hear Alex Inman: How hard is the Keto Diet?
Registered dietitian Alex Inman talks about the challenges of the Ketogenic Diet.
What is allowed?
It sounds a bit sexy at first. You get meat, fats, eggs, seeds, berries, full-fat dairy and cheese, fish, chicken, butter and salad with full-fat dressing. You can also eat tofu, if you care to. Learn to like avocados, as you will need the fibre to avoid constipation.
“It’s a lot of fat and then you need to add fat. You aren’t just drinking milk, you have to have heavy cream, add extra oil to your food, the high-fat meat, oily fish, eggs, those types of things,” said Inman. “It’s very little carbohydrate and you have to really control the amount of protein you eat, because too much will kick you out of ketosis as well.”
What is not allowed?
This list is less sexy. You will not be eating bread, pasta, grains and tree fruits. Forget about potatoes — fries and chips, too — and even the yummy yams your paleo friends get to feast on. No more sugar, honey or agave, so cookies, cake and candy are all out.
There is no evidence that alcohol is incompatible with the ketogenic diet, but beer and drinks mixed with pop or juice should probably be avoided.
Who can benefit?
People with seizure disorders, obviously, but also people with certain kinds of cancer and Type 2 diabetes. People who take insulin for diabetes can probably benefit from a low-carb or ketogenic diet.
“You need to do this with the help of a medical professional, because you will need to change those medications, usually reduce or eliminate them,” said Little.
Are there other benefits?
Certain ketones may have a beneficial hormone-like effect in the body, according to Little.
“The main ketone that circulates is beta hydroxybutyrate, which has been shown to have potential anti-inflammatory and antioxidant signalling roles,” he said. “So it might act like a hormone that tells immune cells and other cells in our body to calm down, be less inflamed and produce less reactive oxygen species.
“Pretty much every disease you look at involves inflammation and heightened oxidation,” he said.
Is keto a long-term solution?
Almost everyone will experience weight loss in the short term, which may be why otherwise healthy people are trying it. Inman notes that people also credit the ketogenic diet with appetite suppression, improving mental focus and energy, reducing anxiety, lowering high blood pressure, curing acne, cholesterol control and “everything under the sun.” It’s a suspiciously long list of miracles.
“The research really isn’t there to support keto for doing all these things, except improved blood sugar control and weight loss,” Inman said. “But when you follow up a year later, they don’t stay improved. It could be that the diet is so restrictive that people can’t stay on it for that long.”
Who should avoid the keto diet?
Children on keto show poor growth and stunting, low bone density and increased risk of fractures. Women who are pregnant or planning to become pregnant should be discouraged from trying keto as well, said Inman.
If you really want to try the keto diet, do it under the supervision of a dietitian and get your doctor to sign off on it as well. It takes planning and deep food knowledge to achieve and maintain ketosis. Without a well-considered plan, you may experience calcium and Vitamin D deficiencies and electrolyte imbalances in potassium, sodium and magnesium. Constipation and diarrhea are common and you may experience a loss of muscle mass and increase your risk of kidney stones.
“A lot of people don’t have a lot of food knowledge or know where the carbohydrates are in their food, so it’s really hard for them to follow keto,” said Inman.
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What about my brain?
“Children who don’t respond to seizure medication are often switched to a ketogenic diet and often that will help them,” said Inman. “There’s no blanket notion that everyone will have more clarity or have better focus or mood on keto, but for some people, maybe.” Changing the brain’s fuel, for some people “might not be a good thing and for others it won’t make any difference at all.”
If you do enter ketosis, all your cells will notice the change in fuel and many people experience the “keto flu” during that process, which can mean headaches, fatigue, nausea and confusion.
The last word is acetone
If you achieve ketosis, your friends and family may suffer from the byproducts of ketone burning, one of which is acetone, often used as a solvent and paint thinner. It smells bad and you might, too. A warning from the mate of a keto enthusiast: “Keto is the only diet you don’t have to tell people you’re on. You can smell it. The ketones being exhaled are not pleasant in a work environment or your home. The worst is point blank, of course — in bed. I’ve accompanied a serial dieter for 26 years of fads. Keto is hands down my least favourite to be around.”
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