The ketogenic or keto diet, as it is also known, is one of the most fashionable regimes today. The reason is that it promises everyone who follows it a great weight loss by drastically reducing the consumption of carbohydrates , increasing that of fats and moderating that of proteins. However, is this diet as effective and good as it is painted?
To start talking about a ketogenic diet, the first thing to do is distinguish what is a ketogenic diet prescribed by an expert from the one that is chosen haphazardly , because it is said by a famous person, an athlete or, more common in these times, the influencer on duty. “Any diet that provides a lower amount of energy than required, uses reserve fats to be used as fuel. That means that to a greater or lesser degree it increases the production of ketones. “Keto-genic” diet means a diet that generates ketone bodies. The approach to the production of ketone bodies is mediated by administering fewer carbohydrates than required, but several aspects must be taken into account. A low carb (or very low) diet can be low or high in fat, low or high in protein, and low or high in calories. We can’t put the possible side effects of a single ketogenic diet in the same bag. It is not the same to guide a ketogenic diet for an epileptic child who has to grow to that of a very obese child who has to decrease ”, explains Dr. Agustí Molins, specialist in Nutrition and Dietetics, director of the Dr. Molins Clinic and member of Top Doctors.
The side effects that Molins refers to are some of those that are collected in a report published last July in Frontiers in Nutrition . It reviewed 123 previous studies and concluded that ketogenic diets very low in carbohydrates can carry significant associated health risks. A drastic increase in LDL (the bad) cholesterol is cited, as well as an increased risk of contracting certain chronic diseases. The reason that is pointed out for the latter is that, by adopting a ketogenic diet, we will be increasing the consumption of red meat, processed meat and saturated fats, foods that are related to an increased risk of chronic kidney disease, cardiovascular diseases, cancer, diabetes and Alzheimer’s. In addition, we will be reducing the intake of “protective” foods, such as fruits, vegetables, legumes and whole grains.
It is possible that after reading the conclusions of the study we will throw our hands to our heads , but we better not get ahead of ourselves. “A keto diet (the one in fashion) is not the same in which we drastically reduce fruits, vegetables, legumes, tubers and maintain a low amount of protein (15% is low in a situation of ketosis) and we raise fats a lot, than ketosis (also keto diet) produced by a decrease in carbohydrates to 50 g of absorbable carbohydrates per day based on about 500 g per day of vegetables with low glycemic load, low in fat (animals and vegetables) and rich in proteins (1 , 2-1.5 g per kilo of ideal weight and day). They are two approaches to generating ketone bodies but very different in unwanted and secondary effects ”, explains Dr. Molins. “The first raises the lipid profile, the second drastically lowers it. The first can generate hepatic steatosis, the second eliminates it in a few weeks. The first has a medium effectiveness in peripheral insulin resistance and in inflammatory diseases, the second improves insulin resistance, in the short, medium and long term, avoiding the medication of the type II diabetic patient, even insulin dependent ”. Again, it is necessary to see the difference between the keto diet proposed by someone without training in nutrition than the one that an expert can recommend.
Regarding the increase in the consumption of red meat and processed meats that can increase the risk of cardiovascular accident, the doctor is very clear and it is that following a ketogenic diet is not synonymous with consuming this type of protein. “The choice of lean meats, chicken, turkey, rabbit, the administration of healthy fats from fatty fish, avocado, nuts, give correct balances if they are used properly,” he explains.
Molins places a vital importance on supplementation in case of following a ketogenic diet. If we lower the level of carbohydrates, mandatory in this regimen, it is possible that we will start consuming less amount of fruits, vegetables and legumes, so it will be mandatory to ingest the nutrients that these foods have in the form of supplements. “It is obvious that, without a mineral supply based on magnesium, calcium and, above all, potassium, we put the lives of people on a keto diet at risk”, explains the doctor. More reasons not to do a keto diet at our own risk.
“ The article refers to problems that do not exist with a correct approach to ketosis. If we know that the diet has magnesium and calcium deficiencies, then the therapist must administer the necessary supplements. If we know that there are alterations in the microbiota in the medium term, we must provide the required pre-probiotics. If the urine becomes acidic, we will have to make it alkaline using another type of protein. If we know that excess protein from beef is harmful, we should encourage the intake of oily fish, to be preferable of small size and to eat eggs, very rich in choline that will help liver function. By ruling out patients with mild kidney failure, you will avoid harming pre-existing kidney disease (it’s a dietary contraindication), and so on. Only the knowledge of the patient and the treatment will give security to the process, but it cannot be a diet for life ”, says Molins.
Neither the ketogenic diet can be for life nor should everyone follow it . “Low calorie and very low calorie diets require a medical examination to rule out contraindications, that is; those clinical situations that prevent this type of diet, such as type I diabetes, liver or kidney failure, the joint administration of certain medications such as corticosteroids, age limits in adolescents and people over 65 years of age, in pregnancy and breastfeeding and some less frequent diseases such as lupus. They are safe under strict medical supervision, with regular control tests and, above all, with the necessary supplementation administered individually ”, explains the nutrition expert.
“In my opinion, following a keto diet for a period of 12 – 14 months, as applied in the very obese, does not pose any risk in expert hands, but I do not consider it to be a diet for a healthy lifestyle maintained to long term”.
To avoid problems, the return to another type of diet should be gradual . “Those of us who manage the diet know that the reincorporation of food must be progressive in terms of glycemic loads, thus avoiding the affectation of insulin sensitivity . If you go from keto to high carb abruptly, it can affect you. If it is done progressively, the recovery of the functionality of the pancreatic beta cells can cure type 2 diabetes ”. And this abrupt change could also be behind another side effect that the report published in Frontiers in Nutrition found , that of gestational diabetes. “I suspect that the increased risk of gestational diabetes in women who were on a keto diet is because they stop keto dieting when they get pregnant. If the reintroduction of carbohydrates is not progressive, it can happen, but if you continue on a keto diet, it is impossible to have gestational diabetes, it does not make sense ”.
Ketogenic diets are not new. They have been prescribed for almost a century to treat obesity and overweight. They are also recommended for epileptic children to reduce seizures. “In the treatment of metabolic syndrome, hypercholesterolemia, hypertension, polycystic ovary syndrome, dysmenorrhea, urinary incontinence and other pathologies associated with obesity and overweight, the effectiveness of a” well-structured “ketogenic diet it is the best option in terms of efficacy in the short, medium and long term ”, says Dr. Molins. It has also been tested in the treatment of cancer, but its strong suit is metabolic syndrome , a group of risk factors for heart disease, diabetes and other health problems. These risk factors are: abdominal obesity, high triglycerides, low HDL (the good) cholesterol, high blood pressure, and high blood sugar while fasting.
“ On a low-fat ketogenic diet, LDL (bad cholesterol) levels are drastically lowered, and remain low even many months after the diet is ended, even with weight regain . On the contrary, it happens with HDL cholesterol (the good one) that rises and remains high many months after the diet. The figures for C-reactive protein, an indicator of low-grade chronic inflammation, decrease rapidly in my dietary approach, while it is observed that it increases if the protein used is animal protein ”, says the doctor.
The doctor is very blunt about the results obtained in the report. “Each and every one of the adverse effects mentioned in the article are the result of poor diet control .”
Ketogenic diet and cancer
The Warburg effect is a phenomenon described by Otto Warburg in 1920 that broadly consists of cancer cells consuming glucose and converting it to lactate, even in the presence of oxygen . These malignant cells produce large amounts of lactate to multiply. If we almost completely reduce the available glucose through a ketogenic diet, could we slow down the advance of malignant cells? “The studies carried out so far are few and inconclusive for most neoplasms. Although it is true that in some neuronal cancers the efficacy of the ketogenic diet is suspected, the studies are not conclusive. However, it seems obvious that reducing the carbohydrate dose using low glycemic load vegetables, even without causing ketosis, can be a beneficial option for the cancer patient. In the same way, one of the main problems of the cancer patient subjected to chemotherapy treatments, biological therapies and others, is the loss of muscle mass. This weakens him in the battle against his disease, so an approach that includes a varied diet, rich in antioxidants, nutraceuticals and rich in proteins of high biological value and low in fat, could be effective for a better therapeutic approach to the patient. from the holistic point of view of the disease ”, Dr. Molins tells us. As Molins points out, not all cancers behave in the same way and not all patients are the same, so generalizing would be wrong.
More research is needed to know if the keto diet could be helpful in fighting cancer. Meanwhile, what is useful is to turn to a professional in case we want to follow it.
