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Ketogenic Diet: Is Going Low Carb Healthy?

March 21, 2017 by Joanna Drake, Registered Dietitian

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Ketogenic Diet: Is Going Low Carb Healthy?

When it comes to nutrition, it is wise to be cautious of advice that seems too good to be true. An example of this is the hype surrounding the use of very low carbohydrate diets, like the ketogenic diet.

Historically used to treat severe epilepsy, the ketogenic diet is promoted as a way to lose weight; improve brain function; control blood sugar, cholesterol, triglycerides, and blood pressure; reduce inflammation; and the list goes on.

However, research on the impact of these diets is limited and based on very short term studies (weeks, months, or at best, a couple of years). And while some may seem promising, if you hope to follow a healthy living pattern for another three, four or five decades, it’s good to get the full picture on what the evidence is (or, in this case, isn’t) before making any huge dietary changes.

What is a ketogenic diet?

Carbohydrates are your body’s preferred energy source, and they will be used first. If you are mainly eating fat, your body will burn (metabolize) it, pushing you into a state of ketosis. A ketogenic diet restricts carbohydrates to the point that your body goes into this state.

Are there side effects to burning fat for energy (ketosis)?

It appears that most people on the ketogenic diet lose weight at the outset, mainly due to its rigid restrictions. And at least in the short-term, this has been shown to lead to positive outcomes such as improved blood cholesterol and blood sugar. But there are negative side effects too. Even in healthy people, constipation, nausea, fatigue, and headaches are common. The bigger problem is that research is lacking on what the long-term effects are on the body. Not only do we not know what the cardiovascular risks are, people following a ketogenic diet may be at increased risk of the following:

  • elevated uric acid (which may worsen kidney disease and cause inflammation in joints) 
  • vitamin and mineral deficiencies
  • bone mineral loss
  • kidney stones

And there may be other effects we aren’t even aware of yet.

How low is “low carb” when following a ketogenic diet?

Health Canada currently recommends that 45-65 per cent of calories come from carbohydrates. For a person eating 2000 calories per day, this is 225 to 325 grams of carbohydrate per day. To develop ketosis, most people need to restrict carbohydrate intake to about 50 grams per day. To put this amount into perspective, there are 40 to 50 grams of carbohydrate in the following foods:

  • 1 cup of cooked spaghetti or quinoa
  • 3 cups of cooked carrots
  • 1 ½ large apples
  • 4 cups of milk
  • 1 can of pop

Now, before you get excited and think that doesn’t sound too bad, you can pick only one of those items, not all of them when following a ketogenic diet. And this doesn’t factor in all the other sources of carbohydrate in your diet, like cucumber. Yes, cucumber has almost 5 grams of carbohydrate per cup.

If people aren’t eating foods with carbohydrates, what’s left? People on a ketogenic diet focus on low-carbohydrate vegetables, high-fat milk products, meat, fish, poultry, eggs, and nuts and nut butters. Additionally, it may be recommended to eat something called “fat bombs.” (I’ll leave you to look that up.) While it’s commonly thought that these popular ketogenic diets are high in protein, they are not. About 20% of calories come from protein, which is similar to a typical diet.

Following a ketogenic diet is likely not a nutritionally balanced pattern of eating. It requires planning, some solid math skills, and being okay with how this diet may impact the social aspects of eating with your friends and family.

The bottom line: Restrictive diets don’t work over the long haul, and a single nutrient, like carbohydrate, is not our enemy any more than fat was the enemy in the 1980s. Instead, think about choosing moderate amounts of carbohydrate-containing foods as part of a healthy pattern of eating. And if you are thinking of trying a ketogenic diet, make sure you get the support you need. Your doctor can monitor your blood work. A pharmacist can manage any needed changes to your medications. And a dietitian can help you assess your nutrition goals and determine an individualized plan to minimize any potential risks to you and your health. To speak with a registered dietitian for free, call HealthLink BC at 8-1-1 (or email). 


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Comments (8)

sharonfast

Posted on Sunday March 26, 2017 a 1:34pm

Please post links to evidence based research that support the negative effects of a ketogenic diet. To provide a fair summary if low carb is healthy, also provide the evidence of how ketogenic diets are being used to control seizures in epilepsy, reverse type 2 diabetes, improve cholesterol markers, improve dementia and how they are being used as a adjuvant treatment for cancer. There is good evidence to support decreasing the amount of carbohydrate in our diet and replacing it with healthy fats is beneficial to our health. We should be focusing on eating meals balanced in protein, fat, and high fiber carbohydrates. Consuming whole foods, which provide the nutrients our bodies need to function at their best.

cpetelski's picture

HealthyFamilies BC

Posted on Thursday March 30, 2017 a 8:38am

Thank you for your comment. We agree; there is a large body of evidence that eating a balance of protein, fat and higher fibre carbohydrates supports good health. And reducing carbohydrates can be helpful when they are coming from sugary drinks, other high sugar foods and refined carbohydrates. Many studies—their findings, limitations, and further prompts for research—form the context for the current opinions and recommendations stated in the blog post. However, here are some studies you might find helpful: Ulamek-Koziol, M., Pluta, R., Bogucka-Kocka, A., and Czuczwar, SJ. To treat or not to treat drug-refractory epilepsy by the ketogenic diet? That is the question. Annals of Agricultural and Environmental Medicine. 2016, Vol 23, No 4. (https://www.ncbi.nlm.nih.gov/pubmed/28030918) Martin, K., Jackson, CF., Levy, RG, and Cooper PN. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2016 Feb 9; 2. (https://www.ncbi.nlm.nih.gov/pubmed/26859528) Tay J., Luscombe-Marsh ND., Thompson CH., Noakes M., Buckley JD., Wittert GA., Yancy Jr. WS., and Brinkworth GD. A Very Low-Carbohydrate, Low-Saturated Fat Diet for Type 2 Diabetes Management: A Randomized Trial. Diabetes Care. 2014 Nov; 37(11): 2909-2918. (http://care.diabetesjournals.org/content/37/11/2909) Ajala O., English P., and Pinkney, J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013 Mar; 97(3): 505-516. (http://ajcn.nutrition.org/content/97/3/505.long) Cicero, AFG., Benelli, M., Brancaleoni, M., Dainelli, G., Merlini, D., and Negri R. Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study. High Blood Press Cardiovasc Prev. 2015 Dec; 22(4):389-94. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666896/) Bueno, N., De Melo, I., De Oliveira, S., and 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. British Journal of Nutrition. 2013. 100(7), 1178-1187. (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0056190/) Mengmeng, LV., Xingya Z., Wang, H., Wang, F., and Guan, W. Roles of Caloric Restriction, Ketogenic Diet and Intermittent Fasting during Initiation, Progression and Metastasis of Cancer in Animal Models: A Systematic Review and Meta-Analysis. PLoS One. 2014 Dec 11; 9(12). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263749/) Hertz, L., Chen, Y., and Waagepetersen, HS. Effects of ketone bodies in Alzheimer’s disease in relation to neural hypometabolism, beta-amyloid toxicity, and astrocyte function. J Neurochem. 2015 Jul; 134(1): 7-20. (http://onlinelibrary.wiley.com/doi/10.1111/jnc.13107/abstract) To continue your research, a combination of any of the following search terms in PubMed will give you lots of additional reading: ketogenic or very low carbohydrate and epilepsy, seizures, diabetes, cardiovascular, cholesterol, cancer, dementia, or Alzheimer’s. I hope you find this information helpful. Thanks for reading.

juau

Posted on Thursday July 13, 2017 a 2:49pm

Rather than post a bunch of links to studies that people have to weed through - you should be referencing your specific claims that low carb diets are unhealthy - AND, there is a growing body of research and much anecdotal evidence that clearly contradicts your claims above. You need to cite these too. Your article is biased and incorrect. You are clearly misleading the public - which is not acceptable for a site with your name and purpose. One example - I suggest you do your research before writing on this topic again - and correct your claims above. You might check out the work of Dr. Dominic D'Agostino, Dr. Thomas Seyfried and Dr. Toronto based kidney specialist, Dr. Jason Fung for starters.

cpetelski's picture

HealthyFamilies BC

Posted on Wednesday July 26, 2017 a 9:46am

Thank you for contributing your thoughts, Juau. It’s great to get a variety of perspectives on emerging issues in nutrition. To be clear, this blog post was about very-low carb ketogenic diets, not low carb diets, and the two are profoundly different. We do not believe that “low carb diets are unhealthy.” Rather, we said that “following a ketogenic diet is likely not a nutritionally balanced pattern of eating” and may have “negative [health] side effects.” We continue to stand by these points. When it comes to discussing ketogenic diets, we agree that there is a growing body of research. In fact, we said that short-term research “has been shown to lead to positive outcomes…” Our concern is that we don’t know the long-term outcomes (i.e. 5, 10, 25 years) of following a ketogenic diet. That is the crux of the issue, and we stand by this point too. For these reasons, we don’t recommend the ketogenic diet, but we realize that some people may still wish to try it. That is why we encouraged those individuals to get the support they need to do it safely. We hope this helps clarify our intent. Thank you for reading.

cpetelski's picture

HealthyFamilies BC

Posted on Wednesday July 26, 2017 a 9:46am

Thank you for contributing your thoughts, Juau. It’s great to get a variety of perspectives on emerging issues in nutrition. To be clear, this blog post was about very-low carb ketogenic diets, not low carb diets, and the two are profoundly different. We do not believe that “low carb diets are unhealthy.” Rather, we said that “following a ketogenic diet is likely not a nutritionally balanced pattern of eating” and may have “negative [health] side effects.” We continue to stand by these points. When it comes to discussing ketogenic diets, we agree that there is a growing body of research. In fact, we said that short-term research “has been shown to lead to positive outcomes…” Our concern is that we don’t know the long-term outcomes (i.e. 5, 10, 25 years) of following a ketogenic diet. That is the crux of the issue, and we stand by this point too. For these reasons, we don’t recommend the ketogenic diet, but we realize that some people may still wish to try it. That is why we encouraged those individuals to get the support they need to do it safely. We hope this helps clarify our intent. Thank you for reading.

juau

Posted on Wednesday July 26, 2017 a 9:59am

My mistake - I meant Ketogenic when I said "low carb".
You didn't address my point - your article is biased. You said, "following a ketogenic diet is likely not a nutritionally balanced pattern of eating” and "may have health side effects" but you do not cite research to support this claim. Yes, there is not a lot of research, but you could have just as easily said "following a ketogenic diet MAY BE nutritionally balanced pattern of eating” and "may have POSITIVE health side effects". See how different that sounds to readers, especially to those uninformed. This shows your bias and that you are not informed and you are misleading the public with your slant. AND, how about posting a bunch of links that show support for the ketogenic diet like you did that support your bias?

Tom ketos

Posted on Wednesday August 2, 2017 a 5:51pm

one thing we do know from over 25 years of experience is following the current food nutrition chart it leads to obesity, high blood pressure, depression, diabetes and the list goes on. I think I prefer what the ketogenic diet offers over that one

Tom ketos

Posted on Wednesday August 2, 2017 a 5:40pm

This article is very misleading, not until you addressed another comment did you mention you were talking about a very low carb diet which is not what a ketogenic diet is. First of all it is net carbs so fiber is subtracted from your carb count. Also you wrote While it’s commonly thought that these popular ketogenic diets are high in protein, they are not" this is wrong information it is not commonly thought the diet is high in protein, it is high fat, a moderate amount of proteins and low carbs as too many proteins will make your body convert back to glucose for its energy source. And your list of the benefits "Historically used to treat severe epilepsy, the ketogenic diet is promoted as a way to lose weight; improve brain function; control blood sugar, cholesterol, triglycerides, and blood pressure; reduce inflammation; and the list goes on." definitely outweighs your side effect list "constipation, nausea, fatigue, and headaches " which again is not totally accurate as some people experience the ketos flu but it doesn't last more than a few days. This type of misinformation upsets me to read

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