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  • Deb Orosz

Can a ketogenic diet be done in moderation?


It seems like everyone is talking about adopting a ketogenic diet. What is all the hype about? Interestingly enough, US News and World Report in December 2018 did not rank the ketogenic well in its list of best diets for 2019. I am sure this is surprising to many of you as the ketogenic diet seems hailed as a panacea for weight loss. It is true that the ketogenic diet can literally be a lifesaver under certain circumstances. For many children with treatment resistant epilepsy the diet has changed their lives by ending their seizures. The general population is interested in the diet due to its reported success with quick fat loss. The question I ask is whether it is effective for long term sustained weight loss and overall health.


On a ketogenic diet, you eat a high amount of fats, adequate protein, and extremely small amounts of carbohydrates. Our body normally converts carbohydrates to glucose for fuel for our brain, muscles, and organs. This is called glycolysis. With the ketogenic diet, you don’t eat carbohydrates, so the body has to find another fuel source. Fats are broken down into ketones, which are used for fuel. This is called ketosis.


Does this mean you only break down fats when you eat a ketogenic diet? No. When you eat a regular diet, first your body uses up glucose from your diet and then begins to break down body fat into ketones to use for fuel. When you eat a ketogenic diet, your primary fuel is ketones from both the fat you eat and then body fat. With both a standard diet and the ketogenic diet, stored body fat is broken down and used for fuel after food sources are depleted. The difference with the ketogenic diet is that the food sources are primarily fat so the body has to shift to using almost exclusively ketones for fuel and no glucose. In the most extreme versions of the diet, you confirm ketosis daily by testing your urine for ketones.


Carbohydrates and glucose are important for our health. Carbohydrates contain fiber which keeps our digestive tract and heart healthy. Glucose is the main fuel for the body and this is what our body is designed to work on. When the body is adjusting to using ketones for fuel, you may get the “keto flu”. You may feel a lack of energy, increased urination, and flu like symptoms for the first week. Ketones are meant to sustain us in times of starvation and are not the intended source of fuel for the body.


One benefit of ketosis is that the body is not using glucose for fuel. For some people glucose has become problematic over time due to eating too many refined carbohydrates. This has caused weight gain and high blood sugar. Your insulin many no longer be working well to transport glucose into your cells. In these cases, it makes sense to adjust the macronutrient range closer to a ketogenic diet which can help stabilize blood sugar.


A major drawback of the ketogenic diet is that many foods must be eliminated. For instance, beans, starchy vegetables, fruit, and grains, are essentially eliminated on a ketogenic diet. It is a good idea to eliminate white bread and other refined carbohydrates, but the ketogenic diet requires such a drastic reduction in carbohydrates that even an apple or orange is not permitted. The eliminated foods are high in carbohydrates but also have important vitamins, minerals, and anti-oxidants, which are essential for health. The ketogenic diet is typically low in potassium, calcium, magnesium, folate, and vitamin C. These nutrients are important for bone health, energy, and immunity. There hasn’t been enough long-term research on the ketogenic diet to understand how the lack of nutrients will affect health over time.


You may be able to benefit from the ketogenic principles and avoid the downfalls by using a more moderate approach. Both ketosis and glycolysis are normal body processes. You can think of ketosis and glycolysis as a sliding scale and adopt a diet midway between the extremes. By staying away from the ends of the scale, you can support both long term wellness and short-term fat loss.


In a ketogenic diet, your nutrition percentages might be something like 20% protein/75% fat/5% carbohydrates. A standard percentage is closer to 25% protein/30% fat/45% carbohydrates. Thinking of the sliding scale analogy, we can adjust our ranges between these extremes to get the benefits of both glycolysis and ketosis. The Institute for Functional Medicine recommends adopting a modified ketogenic diet with percentages of 30% protein/45% fat/25% carbohydrates, which slides the percentages towards a mild ketosis. The Institute for Functional Medicine also recommends using this mild ketogenic diet as a short-term solution and transitioning to a diet with less restrictions long term.

You can take advantage of the ketogenic diet benefits of short term fat loss, and blood sugar stabilization, and minimize the risks of nutrient deficiencies by using a modified version. The Institute for Functional Medicine’s Renew Food Plan is a short-term diet with macronutrient percentages approaching a mild ketosis. This moderate approach to ketosis can help you develop more insulin sensitivity, lose weight, and still ensure you are getting enough vitamins and minerals and have adequate energy. A licensed nutritionist can work with you to develop a customized plan that optimizes the risks and benefits for your situation.

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