Clearing Up the Keto Confusion: The Facts

We have talked about the keto diet before, but the fad persists, so I wanted to take some time to dive into this a bit deeper. 

An extremely high fat, low carbohydrate diet, often referred to as the “keto diet” has taken the nation by storm.  Countless people are claiming that its helped them lose weight and feel amazing… But perhaps at a price that is much higher than we want to pay in the long run? 

Let’s talk about how this all works and shed some light on the facts when it comes to a ketogenic diet.

“Keto” is short for ketosis or ketogenic. It’s most often used in reference to the ketogenic diet, which is (depending on the version) about 80% fat, 15% protein and only 5% carbohydrates.  The ketogenic diet is not new; it just has a new name.  You might also know this diet as the Atkins diet, carnivore diet or low carb versions of the South Beach diet. 

What is ketosis and when is it induced?

Ketosis is a metabolic state characterized by elevated levels of ketone bodies in the blood or urine. This is the body’s normal response to a lack of carbohydrates or glucose, which is the body’s preferred fuel source. 

(Yes, carbohydrates are the most efficient and easy to use fuel for the body and especially the brain.) 

This state of ketosis can occur in low-carbohydrate diets, fasting, prolonged starvation and uncontrolled diabetes (type 1).  This can also occur with alcoholism and, in some cases, prolonged intense exercise.

What are ketone bodies and where do they come from?

Ketone bodies are water-soluble molecules that are intermediate in the metabolism of fatty acids.  They are produced by the liver in the absence of carbohydrates and in certain other conditions.

What happens during ketosis?

Ketogenesis (the creation of ketone bodies) occurs in the liver, but in muscles and brain cells is where the ketone bodies are broken down to actually generate energy.  Glucose (carbohydrates) are the first choice of the body for fuel and are usually the most efficient and usable substance from which we can create energy.  However, if glucose is not available, the body must make its own glucose (called gluconeogenesis). 

Your body is amazing and has countless backup systems to help you out so you can stay strong despite imbalances … at least for a time.  When gluconeogensis, or ketogenesis, occurs, insulin secretion slows and the body goes into a catabolic state.¹  Eventually you get to the Kreb cycle (and then the Electron transport chain) which is the way the body creates energy (ATP).  Don’t get bogged down by the terms … Just know it all means that you use the fuel to create the energy for your body to use.  In the case of ketogenesis, ketones are created from fatty acids (called beta oxidation) and used as fuel, specifically for the brain and muscles.

Ketone production is especially important for the brain because it’s difficult for fatty acids to cross the blood-brain barrier but ketone bodies can.²  This is great news when glucose is low.  If the ketones couldn’t cross the blood-brain barrier, your brain would have no fuel and could only survive for a short time.  In instances of low blood sugar, ketones can be a life saver for the brain.³

There are 2 types of ketone bodies:

1. Beta-hydroxy-butyrate
2. Acetoacetate (Acetone is a result of the breakdown of acetoacetate)

Both can be taken into the brain or muscle cells and both are naturally acidic, which can make the blood acidic leading to ketoacidosis (a condition where ketones in the blood are dangerously high and insulin cannot keep up).

If there are too many of these ketones in the blood it can lead to cellular damage and complications for the brain, kidneys and liver.⁴

What is a ketogenic diet (Atkins, keto, etc.)?

The ketogenic diet is a very low-carbohydrate (5%), high-fat diet (80%).  Protein is normally around 15% in most ketogenic diets.  The dramatically reduction of carbohydrates in the keto diet activates the liver to produce ketone bodies, putting your body into a state of ketosis within a few days and then for as long as you continue the diet.

The goal of the ketogenic diet is to eat so few carbs that you trick your body into thinking it’s fasting so your liver will start pumping out ketones and thus burning fat.

What are signs of ketosis?

Common signs of ketosis include:

1. Bad breath due to the acetone, a specific type of ketone.⁵
2. Weight loss.⁶
3. Ketones in the blood⁷ and urine (ketones in the urine are easier to test but a bit less reliable).
4. Decreased appetite.⁸
5. Several others that can vary depending on how long the person has been in ketosis (digestive issues, increased focus, challenges with sleep and fatigue, etc.)

Why are people so excited about the keto diet?

It does indeed cause rapid weight loss.¹  From a medical perspective this can be especially seen as helpful in obese populations where fast weight loss is needed.  And sadly, most people are so frustrated with their weight loss battle that they are willing to do just about anything to get the scale to move in the right direction.  Unfortunately, in this state, they are less concerned about fat loss or optimal wellness but only concerned with reducing weight.

However, it’s important to consider why this weight loss occurs.  I propose that there are essentially 3 reasons:

1. Nearly any diet that eliminates processed junk food is likely to improve a person’s weight, at least initially due to the fact that processed foods, among other things, tend to lead to overeating.⁹
2. As with nearly any diet there is a great deal of water weight loss initially as inflammation is reduced.  Excess weight nearly always brings inflammation¹⁰ along with it so therefore there will be more inflammation (and thus more water) that needs to be reduced.  Most diets help a person lose more weight at first due to water weight that comes off quickly; however, the keto diet appears to help a person lose more water initially as compared to other diets.¹¹
3. Due to the fact that being in ketosis reduces the appetite⁸ coupled with the fact that processed foods are eliminated, it is likely that a person on this diet will simply be eating fewer calories.

What are the potential challenges of the keto diet?  What does the research really show? 

1. Although you can lose more weight, you’re actually losing less fat weight because you’re losing muscle.¹²  You do indeed lose some fat but a great deal of muscle as well.  Muscle mass keeps you strong and increases your metabolism so a loss of muscle is counterproductive in a weight loss program.
2. Processing the amount of fat and protein in this diet is extremely hard on the kidneys.  So much so that it is recommended to have your kidney’s checked regularly if you’re on a ketogenic diet for more than a year.¹
3. Most people doing the keto diet are getting most of their fat from animal products such as meat, cheese and eggs as opposed to plant sources such as nuts, seeds and avocados.  The high levels of animal fats and proteins are associated with a multitude of health challenges but specifically, numerous nutrient deficiencies.  Of the 27 micronutrients tested, the keto diet only supplied 12 of them.¹³  The implications of even one nutrient deficiency can be detrimental, let alone 15 of them!
4. The keto diet creates digestive distress due to the trouble it causes in the microbiome.  This diet is associated with gastro-intestinal disorders.¹⁴  It reduced beneficial bacteria in the gut as well as feces output (likely due to the lack of fiber).¹⁴
5. The ketogenic diet reduces power and exercise performance.¹⁵
6. An overly acid pH is associated with many health conditions.  Those on the keto diet tend to have a lower urine pH.¹⁵
7. The keto diet is associated with an increase in both total cholesterol and inflammatory markers (C-Reactive Protein).¹⁶

A safer way to weight loss

If you’re looking for a safe way to reduce weight by reducing fat mass, without muscle loss or other detrimental health effects, a better option could be time-restricted eating (a form of intermittent fasting)¹⁷ coupled with a whole food, plant-based diet.¹⁸

The conclusion:  It is not prudent to look at weight loss alone as the primary factor in using a keto diet.  Overall health and longevity must be considered.  Although the keto diet may produce weight loss, it is also associated with morbidity and mortality and is not sustainable as a long-term food plan.¹⁹

My goal for my own health as well as yours is not to help one area at the expense of another.  I want you to have radiant health: Lots of energy during the day to fulfill your mission and to sleep like a baby at night … Glowing skin … Clear thinking.…

It’s way more than just avoiding illness.  You deserve the best health!  If you need help, call the clinic today.  Don’t wait for it to get worse!

Resource List:

1. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. StatPearls. 2020.

2. Hasselbalch SG, Knudsen GM, Jakobsen J, Hageman LP, Holm S, Paulson OB. Blood-brain barrier permeability of glucose and ketone bodies during short-term starvation in humans. Am J Physiol – Endocrinol Metab. 1995. doi:10.1152/ajpendo.1995.268.6.e1161

3. Lamanna JC, Salem N, Puchowicz M, et al. Ketones suppress brain glucose consumption. In: Advances in Experimental Medicine and Biology. ; 2009. doi:10.1007/978-0-387-85998-9_45

4. Kanikarla-Marie P, Jain SK. Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes. Free Radic Biol Med. 2016. doi:10.1016/j.freeradbiomed.2016.03.020

5. Musa-Veloso K, Likhodii SS, Cunnane SC. Breath acetone is a reliable indicator of ketosis in adults consuming ketogenic meals. Am J Clin Nutr. 2002. doi:10.1093/ajcn/76.1.65

6. Bueno NB, De Melo ISV, De Oliveira SL, Da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: A meta-analysis of Randomised controlled trials. Br J Nutr. 2013. doi:10.1017/S0007114513000548

7. Wallace TM, Meston NM, Gardner SG, Matthews DR. The hospital and home use of a 30-second hand-held blood ketone meter: Guidelines for clinical practice. Diabet Med. 2001. doi:10.1046/j.1464-5491.2001.00550.x

8. Gibson AA, Seimon R V., Lee CMY, et al. Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obes Rev. 2015. doi:10.1111/obr.12230

9. Hall KD, Ayuketah A, Brychta R, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial of Ad Libitum Food Intake. Cell Metab. 2019. doi:10.1016/j.cmet.2019.05.008

10. Ellulu MS, Patimah I, Khaza’ai H, Rahmat A, Abed Y. Obesity & inflammation: The linking mechanism & the complications. Arch Med Sci. 2017. doi:10.5114/aoms.2016.58928

11. Yang MU, Van Itallie TB. Composition of weight lost during short term weight reduction. Metabolic responses of obese subjects to starvation and low calorie ketogenic and nonketogenic diets. J Clin Invest. 1976. doi:10.1172/JCI108519

12. Kephart W, Pledge C, Roberson P, et al. The Three-Month Effects of a Ketogenic Diet on Body Composition, Blood Parameters, and Performance Metrics in CrossFit Trainees: A Pilot Study. Sports. 2018. doi:10.3390/sports6010001

13. Calton JB. Prevalence of micronutrient deficiency in popular diet plans. J Int Soc Sports Nutr. 2010. doi:10.1186/1550-2783-7-24

14. Brinkworth GD, Noakes M, Clifton PM, Bird AR. Comparative effects of very low-carbohydrate, high-fat and high-carbohydrate, low-fat weight-loss diets on bowel habit and faecal short-chain fatty acids and bacterial populations. Br J Nutr. 2009. doi:10.1017/S0007114508094658

15. Wroble KA, Trott MN, Schweitzer GG, Rahman RS, Kelly P V., Weiss EP. Low-carbohydrate, ketogenic diet impairs anaerobic exercise performance in exercise-trained women and men: A randomized-sequence crossover trial. J Sports Med Phys Fitness. 2019. doi:10.23736/S0022-4707.18.08318-4

16. Rosenbaum M, Hall KD, Guo J, et al. Glucose and Lipid Homeostasis and Inflammation in Humans Following an Isocaloric Ketogenic Diet. Obesity. 2019. doi:10.1002/oby.22468

17. Moro T, Tinsley G, Bianco A, Marcolin G. Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males. J Transl Med. 2016;14(Article 290).

18. Najjar RS, Feresin RG. Plant-based diets in the reduction of body fat: Physiological effects and biochemical insights. Nutrients. 2019. doi:10.3390/nu11112712

19. Shilpa J, Mohan V. Ketogenic diets: Boon or bane? Indian J Med Res. 2018. doi:10.4103/ijmr.IJMR_1666_18

Nothing said or implied in this post is intended to treat, cure, diagnose or prevent any disease.  It does not take the place of a qualified health care practitioner and is intended for educational purposes only.