# RKS: KETO DIET - A Dark Horse To Fight Obesity
# RKS: KETO DIET
- A DARK HORSE TO FIGHT OBESITY
KETO DIET - AN ENIGMA
CELEBRATED 100 YEARS
Dear Reader,
The Keto diet was first conjured in 1825 based on the recommendation of Jean Anthelme Brillat-Savarin (1755-1826), a French lawyer and a politician, who is considered the father of low carbohydrate (carb) diet and who laid foundation of the future Ketogenic Diet (KD) therapy.
Dr. Russell Morse Wilder (1885-1959), a physician, diabetologist, epileptologist and medical researcher at the Mayo Clinic, built on this research and coined the term "Ketogenic Diet" which meant production of ketogenic bodies through an excess of fat and a lack of carbohydrates (carbs). KD is derived from the word ketogenesis, a Greek-based noun dating way back in 1910-1915. In 1994, the Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the Keto diet, created the 'Charlie Foundation for Ketogenic Therapies' to further promote this KD therapy.
So popular is Keto diet today that related foods and supplements available are hot sellers and enjoy a compounded annual growth rate (CAGR) of 5.3% year-on-year. There has never been a better time and era to explore KD therapy for ensuring health and gaining wellness by the obesity afflicted populace.
HEALTHY & EFFECTIVE DIETS
- LOW-CARB DIET: KD therapy is the best effective example of a low carb diet plan.
- MEDITERRANEAN DIET: Based on including fish, veggies and a glass of red wine.
- PALEO DIET: Fish, lean meats, fruit, nonstarchy veggies and nuts are in; starchy veggies, dairy foods, grains and processed foods are out - CAVEMAN (like) Diet.
- VEGAN DIET: Includes a wide variety of whole plant foods such as fruits, vegetables, whole grains, legumes, nuts and seeds.
- GLUTEN-FREE DIET (GFD): Gluten is a protein found in wheat, barley and rye and refraining from consuming such foods especially helps those with celiac disease; weight loss is additionally fostered by GFD by reducing size of adipocytes - cells which are known to store fats.
From the above list, the Mediterranean Diet plan is presently considered as the most popular even in 2022 - after six decades of its existence. The roots of this diet were laid in 1614 by Giacomo Castelvetro who published the book: "The Fruits, Herbs and Vegetables of Italy," (also still in print) which was a forerunner to today's popular "Mediterranean Diet."
LOW-CARB DIETS
The 5 most popular low-carb diets, besides keto, are:
- Atkins diet (six decades) - forerunner of low-carb craze
- Paleo / Caveman diet (five decades) - advocates unprocessed foods based on this being the only available calorie source for paleolithic ancestors (living 2.5 million years ago to 10,000 BC era)
- Dukan diet (two decades) - high protein diet
- South Beach diet (two decades) - 1,500 kcal diet plan with less carb
- Whole30 (over one decade) - meat, seafood, veggies, fruits and fats but omits added sugars
So much popular has been the low-carb diet acceptance that even the most popular Mediterranean diet has now a keto version - 'Low-Carb Mediterranean Diet'.
KETO DIET
A Keto diet is high in fats, low in carbs and causes the body to break down the fats into molecules called ketones. The liver converts fats to ketone bodies, of which acetoacetate (AcAc) and 3-beta-hydroxybutyrate (3HB) are most plentiful, and acetone - a third variety, is least produced.
In a Keto diet the carb consumption is restricted to 50 gms daily, whilst in a low-carb. diet the same is permissible in the 50-150 gms range - 5-10% vs less than 25% respectively.
HOW DOES THE KETO DIET WORK?
The macronutrients in diet provide energy; these include carbohydrates (4 kcal/gm), followed by fats (9 kcal/gm) and last to be utilized, proteins (4 kcal/gm). 1,200 kcal is the minimum level of calories that the average person can survive on without the body going into starvation mode. This entails consumption of 300 gm carbs daily; if 30% of fats are factored as consumed averagely each day - a 1,200 kcal requirement of the body will be serviced by the 40 gm fats taken and balance needs to be available as carbs i.e. 210 gms.
In a Keto diet since the carbs are dramatically reduced, all stored glucose in the form of glycogen is utilized in the first 3 days. Thereafter, the excess fats present in the adipose tissues is broken down to ketones bodies which are utilisable by the cells of body as an alternative fuel source. The liver has a capacity to produce 300 gm of ketone bodies per day which can contribute to 5% to 20% of energy needs in fed - to - fasted - to - starved states.
Since more ketone bodies are produced in starved states, the 1,200 kcal Keto diet must be supplemented with exercise to avail of this benefit. The extra 15% capacity of liver to provide energy as ketones must be exercising-facilitated so as to result in adipose tissue breakdown and reduced obesity.
CALCULATING WEIGHT LOSS WITH KETO DIET + EXERCISE
The most popular, and feasible for all age groups, is walking 10,000 steps. Since 20 steps burn 1 kcal, the universally cherished 5,000 steps achieving per day will burn 250 kcal additional.
The daily equation is:
- 1,200 kcal Keto diet: 93-107 gms fats (70-80%); 30-60 gms proteins (10-20%); 15-30 gms carbs (5-10%)
- 5,000 steps per day: energy burnt is 1,200 + 250 = 1,450 kcal daily
- Keto diet food contributes: 60-120 kcal from carbs + 837-963 kcal from fats = 900-1100 kcal approximately
- Adipose tissue fats to be utilized: Balance 350-550 kcal required, to prevent starvation, needs to be derived from burning body fats (in adipose tissue)
Average 450 kcal of adipose tissue burning is equivalent to losing 0.06 kg weight daily - or approx. 0.4 kg per week (or 1.6 kgs per month). Also, 1,450 kcal is roughly 15% excess required if 5,000 steps are walked everyday, and the liver has the capacity to cater to this additional energy needs of the body by its capacity for extra ketone bodies production by mobilizing and utilizing the body fats lying stored in adipose tissue.
WHY KETO DIET CAUSES WEIGHT LOSS?
Keto diet not only reduces insulin secretion from pancreas but also improves its efficiency in reducing glucose levels in blood (increased insulin sensitivity). Less carbs intake with KD therapy will require the pancreas to produce lesser amounts of insulin. Additionally, the levels of insulin required in blood are also reduced since Keto diet increases this hormone's efficiency of transporting glucose in blood to within inside of the cells for conversion to energy (insulin resistance diminished). [Nutr Diab 2020; 10: Article 38; https://doi.org/10.1038/s41387-020-00142-z]
Reducing insulin levels:
- Minimizes storage of glucose as glycogen.
- Allows unhindered breakdown of fat cells in adipose tissues - releasing free the fatty acids for travelling to liver for their conversion into ketone bodies.
- Normalises the high leptin levels in obesity [51 ng/mL (normal range: 2.5-21.8 ng/mL)]. The high leptin levels (in those overweight) is because of increased leptin resistance (due to hindrance in its function of causing satiety) which is induced by insulin resistance - the latter is tackled and reduced by Keto diet. [Cureus 2020; doi: 10.7759/cureus.12178]
Leptin secretion from adipose tissues - accompanied by reduced leptin resistance, is facilitated by KD therapy leads to stimulating the satiety centre (present in the hypothalamus region of brain) and thereby reducing appetite and resultant restriction in food and calorie consumption. Insulin can increases concentrations of leptin by 80%! [Endocrinol 1997; 138(10): 4463-4472]
IS KETOSIS A CONCERN?
Ketosis occurs when the liver breaks down fats into ketone bodies for use as energy instead of glucose during KD therapy. A very nominal presence of ketone bodies in blood is the hallmark of a Keto diet, and even healthy individuals experience slight ketosis whilst sleeping and during periods of strenuous exercising.
In ketosis the blood ketone levels range is 0.5-3.0 millimoles per liter (mmol/L). However if the concentrations increase beyond 3 mmol/L, the condition is labelled as ketoacidosis.
'Ketoacidosis' occurs when the body thinks that it is starving and starts breaking down fats and proteins too quickly. Ketoacidosis refers to the dangerous toxic levels of ketoacids (AcAc & 3HB) in blood and is a grave concern. During ketoacidosis, the kidneys begin to excrete ketone bodies along with body water in the urine, causing some fluid-related weight loss. Ketoacidosis most often occurs in individuals with type 1 diabetes mellitus (T1DM) - because they do not produce insulin, but can even occur in nondiabetic individuals following a prolonged very low-carb diet.
In an otherwise healthy individual, ketone bodies do not excessively accumulate in the blood since the pancreas produce insulin hormone which blocks their excessive production.
KETOSIS vs KETOACIDOSIS
The complaints when ketosis occurs include the following:
- fatigue
- weakness
- poor concentration or memory problems
- changes in mood
- anemia
- feeling cold
- getting ill more frequently
It is indeed interesting to know that the fatigue and weakness is not on account of ketosis since ketone bodies, also referred to as "super fuel", produce more adenosine triphosphate (ATP), the chemical energy form into which the food calories are all converted. One hundred grams of AcAc generates 9400 gms of ATP, and 100 g of 3HB yields 10,500 gms of ATP; whereas, 100 gms of glucose produces only 8,700 gms of ATP. [Masood W, Annamaraju P & Uppaluri KR. Ketogenic Diet. (Updated 2022 Jun 11). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2022 Jan-] This allows the body to maintain efficient fuel production even with a low-caloric / low-carb diet.
In ketoacidosis, the initial manifestations could be:
- high blood glucose levels
- rising levels of ketones in the urine
- thirst and frequent urination
- exhaustion
- dry or flushed skin
Ketoacidosis is never a concern of KD therapy in obese non-diabetics, or even in those with type 2 diabetes mellitus (T2DM) - the adult form of disease. Unlike, ketosis which has been desirably induced, or cold be a temporary nutritionally precipitated event, ketoacidosis is an emergency - but highly treatable. Triggers that can precipitate ketoacidosis in either nutritional ketosis or during a Keto diet include:
- Stress
- Heart attack
- Alcohol abuse
- Dehydration
- Skipping meals
- Severe sepsis
The estimated 0.6% risk of ketoacidosis in T1DM is based on over 200 thousand patients followed up and analysed in 2017. Besides T1DM, KD therapy is also not advisable for those who have kidney damage, individuals at risk for heart disease, pregnant or nursing women, presence of pre-existing liver or pancreatic condition, and anyone who has undergone gallbladder removal.
HOW LONG A DURATION CAN ONE STICK TO 'KETO'?
Keto diet - induced ketosis facilitated weight loss is recommendable for upto 3 months; one study suggests a maximum Keto diet phase of 12 months but with close monitoring of kidney functions. The standard Keto diet comprises of 70% fats + 20% proteins + 10% carbs. There is a variant called Keto-2.0 which makes more room for plant-based foods and comprises of 50% fats + 20% proteins + 30% carbs. [https://www.health.com/nutrition/keto-2-0]
Alternatively cyclical Keto dieting - meaning 3 months on and one month off, is also safe enough for longer periods. Cyclical keto recommendations are 70-75% fat, 15-20% protein, 5-10% carbohydrates on "keto days;" 15% fat, 15% protein and 70% carbohydrates on "off days". [https://www.health.com/weight-loss/keto-diet-types]
With any diet, including Keto, there can be prompt gaining back 2.6-5.2 kgs (5-10 lbs) of weight immediately on discontinuing KD therapy. However, the immediately regained weight following discontinuing Keto diet is largely on account of fluid retention.
SUMMARIZING
If one opts for a Keto diet the following are the equations that need to be adhered to whilst opting for a diet plan. For 1,200 kcal, 1,500 kcal and a 2,000 kcal per day Keto diet the daily intake of macronutrients have been specified in the table below. [Masood W, Annamaraju P & Uppaluri KR. Ketogenic Diet. (Updated 2022 Jun 11). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2022 Jan-]
CONCLUSION
The Keto diet was created almost 100 years ago as a treatment for epilepsy, but most are now familiar with it for weight loss. There are solid evidences establishing the effectiveness of the Keto diet for weight loss in the short-term and nil yet reported serious health implications, including the much feared occurrence of ketoacidosis. For the belly fat reduction especially, Keto diet is the most promising.
Amongst 40 diets scored by an expert panel, Keto diet emerged as:
- 4th Best Fast Weight-Loss Diet
- 9th Best Weight-Loss Diet
In 2020, “keto” was the most Googled food-related topic in the world with 25.4 million searches. Keto has overtaken previously popular diets such as the Atkins Diet and intermittent fasting. There has been a waning for googling popularity for 'Keto' in 2022 maybe because many have realised that adhering to KD therapy requires strong will-power - Keto diet being 35th ranked amongst 40 diets evaluated with respect to 'Easiest Diet To Follow'.
However, the bottom line is: Keto is backed by science and the diet simply puts that science into action.
DR R K SANGHAVI
Prophesied Enabler
Experience & Expertise: Clinician & Healthcare Industry Adviser
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