While the holidays can be an amazing time of year, full of comfort and warmth, sometimes they can be overwhelming in terms of a healthy diet. Lots of baked goods, comfort foods, and snacks can leave even the most disciplined of us feeling as though we overindulged. It’s no wonder that one of the most popular New Year’s resolutions is to begin a new diet!
A popular diet that is gaining more traction and adherents is the ketogenic (often shortened to just “keto”) diet. It is increasingly popular and has brought many people success in both feeling better and achieving their fitness and/or body weight goals. However, it may not be a good fit for others and can even be harmful to people with certain medical conditions.
What is a keto diet?
The keto diet is, at its most basic, a high-fat and low-carb diet that mimics starvation. While there are a few different types of ketogenic diets, the most popular version is 70% fat, 20% protein, and 10% carbs (1).
How does a diet high in fat mimic starvation?
The body generally relies on glycolysis to break down food for energy, which utilizes carbs. This is why most diets consist of 40-60% carbs - it’s easy energy, and the body is naturally in this state (1). However, when the body doesn’t get enough carbohydrates to fuel this process for an extended period of time, it switches its metabolic process to focus on breaking down fats to get energy. This process happens regularly during sleep or other extended periods of fasting. When the body is in this state consistently, the liver becomes more efficient at burning fat and thus supplying ketones (1). Ketones are one form of energy for your body and brain. This is part of the reason why many people also adopt intermittent fasting while on the keto diet. Intermittent fasting also helps the body become more efficient at producing ketones.
How can your brain switch the type of food it needs?
Well, the brain can’t make a direct 1:1 fat: glucose substitution. The brain does need glucose, but if all it has are ketones, the mitochondria of brain cells are able to break down fatty acids and derive glucose. Because this process is so regulated and more complex than glycolysis, fuel for the brain and body comes at a steadier rate, rather than an immediate spike (and subsequent crash) that can occur through the breakdown of carbs.
So, how does this affect your blood sugar?
Since the liver is able to produce ketones even while the body is fasting, and ketones are able to be broken down to produce glucose, blood glucose levels become more stable on the keto diet than on carb-heavy diets. These stabilized energy levels not only mean you more easily avoid post-lunch or sugar highs/crashes, but you actually can improve your brain health. Diets high in sugar result in fluctuating blood sugar levels, which reduce brain-derived neurotrophic factor (BDNF) levels, synaptic plasticity, and cognition- and mood-regulators in the brain (2). Synaptic plasticity, BDNF, and other regulators all contribute to a healthy brain that is able to function, learn, adapt, recall, emote, and build relationships. Fluctuating levels of blood glucose and hyperglycemia (chronically elevated blood sugar levels) can lead to the development of type 2 diabetes, which is a factor in developing Alzheimer’s and other brain diseases (3). (More information on the effects of blood sugar levels on brain health can be found in this article.)
Because diabetes is so often linked to excess weight as well as reduced brain health, it makes sense that studies are beginning to show that ketosis can help manage all three (4). Not only can keto help you lose weight (which itself can help manage diabetes), but some people who adopted a ketogenic diet used less medication to manage their diabetes even two years later (5).
So, limiting sugar - or eliminating it altogether - and maintaining healthy blood sugar levels can affect your health in a positive way. Beyond that, a keto diet paired with intermittent fasting can also create a neuroprotective reaction in your brain, helping fight harmful free radicals and neuronal cell death (also called excitotoxicity) (6). This neuroprotective reaction can help prevent and reduce symptoms of neurodegenerative disorders (6).
Other benefits of adopting a keto diet can include (1):
Weight loss
Lowered blood sugar
Improved insulin sensitivity
Reductions in diastolic blood pressure and triglyceride levels
Improved metabolic health
Decreased risk of heart disease
Slowed tumor growth
In addition to the above benefits, a healthy keto diet can improve (1, 2, 3, 7):
Symptoms and progression of brain diseases such as Alzheimer’s, Parkinson’s, etc.
Diabetes
Epilepsy
Polycystic Ovary Syndrome
Traumatic brain injuries
Is this diet too good to be true? What are some potential less-amazing side effects of keto?
Many people have reported the “keto flu” in their first few weeks adopting keto, with side effects such as increased thirst, diarrhea, constipation, nausea, vomiting, poor mental function, low energy, disturbed sleep, digestive discomfort, and decreased exercise performance (1). Other risks include low protein levels in the blood, extra fat in the liver, kidney stones, and micronutrient deficiencies (1). It may be recommended to adopt a low-carb lifestyle at first, and slowly switch to a full ketogenic diet in order to minimize these effects. Another option is to add some extra salt to your meals or take mineral supplements in order to balance electrolyte levels, as well as to eat more high fiber veggies to help with digestive issues (1). Other supplements, such as MCT oil, minerals, caffeine, exogenous ketones, creatine, and whey are all great options to help reduce some of these symptoms and increase mental and physical performance overall (1).
While keto is a great option for some people, it may not be a good option for others. If you take SGLT-2 inhibitor medications (Invokana, Jardiance, Farxiga, and others) for type 2 diabetes, you should avoid keto (7). Those who are prone to kidney stones, or have pancreatitis, liver failure, disorders of fat metabolism, carnitine deficiencies, or porphyria should also generally avoid low-carb and ketogenic diets (7).
Keto seems like it may be right for me. How do I start?
A common saying in the ketogenic community is that there is a “clean” way to eat keto and a “dirty” way to get all your macros in. “Dirty keto” allows for any type of food as long as you hit the macros of 70% fat, 20% protein, and 10% carbs, and often evokes images of fast-food bacon cheeseburgers sans bun. While convenient, and still offering the potential to lose weight, dirty keto excludes a variety of important vitamins, minerals, fiber, and nutrients that are vital to long-term health - and also for mitigating some of the more unpleasant side effects and health risks that can be associated with keto (8).
“Clean” keto, on the other hand, focuses on consuming healthy foods in order to maintain a well-rounded diet, even with such an emphasis on eating fat. Foods like high-quality meats, fatty fish, and dairy products, as well as low-carb veggies (especially greens), berries, avocados, eggs, and nuts and seeds are all great options to keep the body in ketosis, but still give it the wide range of nutrients that it needs (1).
If you’re interested in adopting a ketogenic diet, please reach out to us! We would love to help you discover if keto overall is right for you or if your individual needs are better suited to another plan. If it is, we can then help you determine the best type of keto diet, supply resources on the day-to-day eating patterns of successful keto-ers, and address any other concerns you may have. It would be our pleasure to help you achieve greater brain and body health!
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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Mawer, R. (2020, October 22). The Ketogenic Diet: A Detailed Beginner's Guide to Keto. Retrieved December 13, 2020, from https://www.healthline.com/nutrition/ketogenic-diet-101
Molteni, R., Barnard, R. J., Ying, Z., Roberts, C. K., & Gómez-Pinilla, F. (2002, June 21). A high-fat, refined sugar diet reduces hippocampal brain-derived neurotrophic factor, neuronal plasticity, and learning. Neuroscience. https://www.sciencedirect.com/science/article/abs/pii/S0306452202001239?via=ihub.
Henderson, S. T., Vogel, J. L., Barr, L. J., Garvin, F., Jones, J. J., & Costantini, L. C. (2009). Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial. Nutrition & metabolism, 6, 31. https://doi.org/10.1186/1743-7075-6-31
Al-Goblan, A. S., Al-Alfi, M. A., & Khan, M. Z. (2014). Mechanism linking diabetes mellitus and obesity. Diabetes, metabolic syndrome and obesity : targets and therapy, 7, 587–591. https://doi.org/10.2147/DMSO.S67400
Athinarayanan, S. J., Adams, R. N., Hallberg, S. J., McKenzie, A. L., Bhanpuri, N. H., Campbell, W. W., Volek, J. S., Phinney, S. D., & McCarter, J. P. (2019). Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Frontiers in endocrinology, 10, 348. https://doi.org/10.3389/fendo.2019.00348
Lee, J., Bruce-Keller, A. J., Kruman, Y., Chan, S. L., & Mattson, M. P. (1999). 2-Deoxy-D-glucose protects hippocampal neurons against excitotoxic and oxidative injury: evidence for the involvement of stress proteins. Journal of neuroscience research, 57(1), 48–61. https://doi.org/10.1002/(SICI)1097-4547(19990701)57:1<48::AID-JNR6>3.0.CO;2-L
Masood, W. (2020, June 22). Ketogenic Diet. Retrieved December 14, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK499830/
Horton, B., & Horton, B. (2018, December 14). What Is 'Dirty Keto' and Should You Try It? Retrieved December 17, 2020, from https://www.health.com/weight-loss/dirty-keto