You’ve seen them in the grocery store—keto entrees, keto snacks, keto candy, keto ice-cream, keto toothpaste... Okay, that last one was thrown in there for effect, but I think you get the picture. The ketogenic—or keto—food industry is growing rapidly in response to consumers desiring to shed pounds, keep pounds off, or just prevent serious health issues in the future. Naturally, the question arises—is this our best choice? And how does the keto diet impact mental health?
But first, here are a few interesting facts about the keto diet[i]:
- About 13 million Americans follow the keto diet each year
- Ketogenic diet products are flourishing
- Globally, ketogenic diet products are valued at $10.2 billion
- Weight loss is the most common reason for following the diet
- People earning more than $100,000 a year are three times more likely to follow ketogenic diet
The ketogenic diet is typically composed of a much higher percentage of fat (70-90%), adequate protein (6-12%), and drastically reduced carbohydrates (2-10%). [ii] It is suggested that carbohydrates be kept below 50 grams per day to maintain ketosis. Ketosis can be thought of as an altered state of energy usage. Carbohydrates aren’t around to burn so the body turns to its fat stores to supply energy needs. At least that is how most people hope it works. There is some concern that maintaining a state of ketosis will allow the body to also turn to nonfat energy sources.[ii]
Regardless of the source of energy accessed during ketosis, weight loss does occur for those practicing the ketogenic diet. Given the state of obesity around the world, this is actually a pretty good thing.
Another strong point for ketosis is an elevated level of GABA. GABA is an important neurotransmitter that helps keep things on an even keel by inhibiting overactivity in the nervous system thus limiting anxiety.
Popularity of the ketogenic diet spiked by about 25% from 2019 to 2020, but the COVID-19 years even impacted usage of the ketogenic diet as the number of people engaged in it dropped by about 38% through 2021.[i] The number one reason for taking up keto is weight loss, followed closely by long-term health and disease prevention. These are two good reasons here for choosing to go keto, however, is the diet capable of delivering the intended results?
Why Not Ketogenic?
Some, like Dr. Caroline Apovian of Harvard Medical School, suggest that initially the ketogenic diet was not a “diet” at all, but was designed to be a treatment. In other words, it was not meant to be used for a lifetime, but rather to be used to reduce seizure frequency, which it effectively does in 30-50% of those with drug-resistant seizures or quickly reduce weight so an obese person could be eligible for knee surgery.[iii]
“We would never recommend that anybody be on a ketogenic diet chronically for the rest of their life.” –Dr. Apovian
The problem is that this is not how some people are using the diet. Keto has become a fixture of many people’s lifestyle. In the previous section we looked at the rational people use for adopting the diet. Second on the list is a desire for long-term health and prevention of future health conditions. This suggests that people are not using this as a therapy, but rather as a sustained dietary practice. However, to accomplish long-term health, other dietary patterns are a much safer choice.
Implementation of a ketogenic diet robs us of the vast array of beneficial components that come from plant foods. Dangerous micronutrient deficiencies are possible even for people on a ketogenic diet who emphasize nutrient-dense foods. With this dietary pattern there are just not enough calories allocated to carbohydrate foods like fruits, vegetables, whole grains, and legumes to supply the body with what it needs in the long run.[iii]
One of the most concerning potential problems with the ketogenic diet is adverse gut health. Fiber content in the ketogenic diet may be woefully low. Thus, the microbes in the gut are skewed toward a less healthy population. This may lead to reduced production of short-chain fatty acids which accomplish all kinds of great things for gut health including better nutrient absorption, release of satiety hormones, immune function, anti-inflammatory effects, and even deterrence of cancer.[iv-vi]
Proponents of the ketogenic diet may suggest that it be used for a time and then switch to a more conventional dietary pattern. Can people who are used to eating so many animal products effectively make this change and will they feel the need to? Messages broadcast over the media are sending mixed signals regarding discontinuation of the ketogenic diet. In fact, it is at times being touted as a pattern to be used long-term to sustain health.
When examining the ability of the ketogenic diet to sustain weight loss, there is no clear advantage to going keto, especially for periods of at least two years.[ii] Other dietary strategies such as a low-fat, plant-based diet perform similarly without the inherent dangers of keto mentioned in this article.
A two-week head-to-head match-up of the ketogenic diet to a low-fat, plant-based diet produced interesting results.[ii] The ketogenic diet did produce faster weight loss, but most of the weight lost on the ketogenic side was not from fat as opposed to the plant-based diet which was almost entirely fat loss.
Slow and Steady Wins the Race
Remember the story of the tortoise and the hare? The hare ran out early and unwisely used up all his energy. Then when he was all tired out, the tortoise plodded right on past and won the race. There were some serious side effects for the hare in using the “get it now” approach.
When it comes to weight loss a nice, steady long-term approach is the safest way to proceed. It could be that by using the ketogenic diet significant weight will be shed, but at what cost? At one time the Atkins diet was very popular. It also produced quick weight loss but was not sustainable in the long run.[vii]
Low carbohydrate diets have been associated with approximately double the risk of falling victim to the top two killers in the United States—vascular disease and cancer. In fact, dying prematurely from any cause appears to be up to 32% higher for those who consume the fewest carbohydrates.[viii]
Plod ahead day after day with a highly varied, satisfying, plant-based diet and you will cross the finish line lighter and happier.
A look ahead…Earlier we mentioned better GABA production and better mental health as a possible highlight of the ketogenic diet. In our next blog entry addressing the ketogenic diet, we will look at the vital role that carbohydrates play in improving mood.
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[i] Reed, A. (2022). Keto diet statistics in 2022 (U.S. data). Bodyketosis. Retrieved October 23, 2022, from https://bodyketosis.com/keto-diet-statistics/
[ii] Crosby, L., Davis, B., Joshi, S., Jardine, et al. (2021). Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks. Frontiers in nutrition, 8, 702802.
[iii] Martin-McGill, K. J., Bresnahan, R., et al. (2020). Ketogenic diets for drug-resistant epilepsy. The Cochrane database of systematic reviews, 6(6), CD001903.
[iv]Holscher H. D. (2017). Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut microbes, 8(2), 172–184.
[v] Paoli, A., Mancin, L., Bianco, A., et al. (2019). Ketogenic Diet and Microbiota: Friends or Enemies?. Genes, 10(7), 534.
[vi] Jeffery, I. B., & O'Toole, P. W. (2013). Diet-microbiota interactions and their implications for healthy living. Nutrients, 5(1), 234–252.
[vii] Mahdi G. (2006). The Atkin’s diet controversy. Ann Saudi Med. 26(3):244-245.
[viii] Mazidi M, Katsiki N, Mikhailidis D, Sattar N, Banach M. (2019). Lower carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling of prospective studies. Eur Heart J.