The Solution To The Keto Diet Controversy
The Keto Diet controversy exists because nutrition experts disagree and the rest of us are left scratching our heads. Here I discern what the issues are and explain how to thread the needle so that your Keto Diet is as healthy and beneficial as you want it to be.
EVERY DAY a slew of articles appear touting the miraculous benefits of the Ketogenic Diet, and nearly an equal number that attest that Keto is harmful. It appears there’s a pretty strong Keto Diet controversy, and each side is adamant that their perspective it true.
Recently, well-known Keto Diet advocates and critics have been publicly sparing, such as the tussle between veteran NBC weatherman and all-around-good-guy Al Roker and NBC’s “The Biggest Loser” trainer Jillian Michaels. Al Roker lost many pounds of body fat on the Keto Diet, loves it, and seeks to continue with the diet indefinitely. Jillian Michaels says it’s stupid and dangerous long-term.
I do have a nuanced answer to that question, but first let’s address some basics.
What’s the Ketogenic Diet?
Simply put, the Ketogenic Diet involves almost completely eliminating the consumption of carbohydrates, reducing protein and replacing those calories with dietary fat.
Keto dieters are advised to consume about 75% of their calories from fats, 20% from protein and 5% from carbs. On a typical diet, most people about 50- 55% of total calories from carbs, 20 – 25% from protein and 20 – 25% from dietary fat. (1)
Typically, then, a person on the Keto Diet will eat a lot of dairy products, butter, eggs, nuts, seeds and oils; some meat; and little to no grains and carb-heavy fruits and vegetables. This is a wide departure from the U.S. Dietary Guidelines for Americans, which say between 45 and 65% of daily calories should come from carbohydrates.
Usually, our body will preferentially seek to use carbs (glucose) for fuel, but on a Keto Diet, there are an insufficient amount of carbs to do the job; therefore, the body needs to use dietary fat or stored body fat as its fuel source. However, without regular replenishing of carbohydrates, the body begins to break down fat for energy, resulting in the formation of ketones. Ketones can eventually be used by the body for energy.
The idea is to use the Keto Diet to positively affect your biochemistry as would fasting. The thinking here is that when you’re fueled by fat, some favorable potential outcomes include weight loss, lower blood sugar and the prevention or reversal of fatty liver disease.
The move from carb to fat fueling is marked by an adaptation phase, and some people on the Keto Diet complain about the “keto flu“, which is caused by the body adapting to a new diet consisting of very few carbohydrates. This phase can come with some lethargy and other symptoms as your body adjusts, but the body adapts to using fat for fuel instead of carbs in about three to five weeks.
What’s the Keto Diet controversy — Is it unhealthy?
From the many articles I’ve read on the topic, the fast answer to “Is the Keto Diet unhealthy” is that it depends on the kind of dietary fats and carbohydrates you eat on the diet and how long you sustain the diet.
Plenty of research and anecdotal evidence indicates that Keto can lead to short-term weight loss, and potentially help prevent or reverse obesity, type 2 diabetes and fatty liver disease. That said, experts aren’t exactly sure how ketosis affects the body over time, and some doctors caution that such severe restriction are usually unsustainable.
Dr. David Ludwig, endocrinologist, professor of nutrition at the Harvard T.H. Chan School of Public Health, and author of Always Hungry?, underscores the difficulty of adherence when he remarks that:
“Ketogenic and other very-low-carbohydrate diets can be quite challenging to follow over the long term, and the possibility of adverse effects has not been ruled out. Usually, such severe restriction isn’t necessary.” (2)
Dr. Kim Williams, former president of the American College of Cardiology, admonishes that no one should adopt the Ketogenic Diet over the long term—unless weight loss is more important than lifespan — a pretty strong statement!
Williams’ argument is based on a 2013 systematic review of 17 studies that found low-carbohydrate diets to be associated with an increased chance of death, with particularly increased risks to cardiovascular health. Said the authors of the study:
“Given the facts that low-carbohydrate diets are likely unsafe and that calorie restriction has been demonstrated to be effective in weight loss regardless of nutritional composition, it would be prudent not to recommend low-carbohydrate diets for the time being. Further detailed studies to evaluate the effect of protein source are urgently needed.”
The Ketogenic Diet can pose long-term health risks because “low-carbohydrate diets tend to result in reduced intake of fiber and fruits, and increased intake of protein from animal sources, cholesterol and saturated fat, all of which are risk factors for mortality” and cardiovascular disease, wrote the authors of the review. (3)
Professor Jim Mann of the University of Otago, in New Zealand agrees. He and his team certainly adds to this Keto Diet controversy when their review of 185 prospective studies and 58 clinical trials over 40 years concluded there was a direct relationship between the highest intake of dietary fiber and a protective benefit against cardiovascular disease, type 2 diabetes, colorectal cancer and breast cancer. The study concluded people should be eating 25 to 30 grams of fiber a day and that their analysis found that those who ate the most fiber had a 15 to 30 percent reduction in deaths from all causes. (4)
In media interviews following the study’s release Professor Mann stressed that carbohydrate quality is important and that sugar and refined grains are “bad carbs” but oats and whole-grain bread, cereal and pasta are “good,” high-fiber carbs.
Health journalist Anne Mullens and cardiologist Dr. Bret Scher take a scalpel to Mann’s conclusions:
“We strongly agree with that first part — sugar and refined grains ARE bad carbs! And, it shouldn’t surprise anyone that cutting out processed foods like white bread, cookies, cakes and sugary beverages and replacing those foods with whole-grain, unsweetened cereal or wheat berry pilaf will lead to health improvements. That says nothing about swapping out whole-food, low-carb staples like vegetables, olive oil, and meat or fish with whole-grain products. We don’t believe that study has been done, especially in a population restricting carbohydrates.” (4)
The Keto Diet controversy is over the type of Fat and Carbs, and the Duration of the diet
To me it’s pretty clear that the Keto Diet controversy distills down to what kind of carbs and dietary fats a person consumes, and for some — depending on their age and overall health — how long the diet is done.
While it’s advisable that you cut refined carbohydrates from your diet, such as white bread, pasta and snack foods, high-fiber carbs are healthy. Foods such as berries, apples, lentils, beans, sweet potatoes and whole grains are crab-dominate, but also nutrient and fiber-rich, and have been linked with health benefits ranging from lower rates of chronic disease to longer lifespans, as is the case with Okinawans.
As with nearly everything in the health field, there is a controversy over the relative merits/demerits of dietary fat. Researchers have condemned fatty foods as the underlying cause of a steady, decades-long increase in developed world’s incidence of weight gain and heart disease, but more recent studies have found that they may not be associated with cardiovascular issues, and may actually keep weight in check by stabilizing hunger and blood sugar.
OK, but let’s be more discerning. The type of carbs you consume matters, and so is it with dietary fats. Just as you want your carbs to be “complex” and fiber-rich (both contributing to slow blood sugar absorption and helping to keep up the much-wanted insulin sensitivity), you also want most your fats to come from mono and polyunsaturated fats, rather than unsaturated fats:
Examples of monounsaturated fats: (5)
- Olive oil (virgin, cold pressed)
- Most nuts
Examples of polyunsaturated fats: (6)
- Sunflower oil
- Sunflower, flax seeds
Focus on consuming omega 3 fatty acids from the mono and polyunsaturated fats: (7)
- Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines)
- Nuts and seeds (such as flaxseed, chia seeds, and walnuts)
- Plant oils (such as flaxseed and hempseed oil)
The bottom line with the Ketogenic Diet is that it could be a good thing if:
- Your current diet is dominated by processed carbs, bread, pasta and the like;
- Your fasting and average glucose (H1Abc) numbers are in the prediabetic or type 2 diabetic range;
- You want to try something new to kick-start a weight loss program and are willing to be selective with the choices of fat you consume; and/or
- You do it for months (or less), not years, unless guided by a doctor well versed in nutrition (most aren’t).
One authoritative resource for all things Keto is the Diet Doctor website. I got the following pics of various low-carb fruits and vegetables from Diet Doctor. They give a quick understanding of which vegetables, fruits and nuts are relatively low in carbohydrates and healthy.
At this point, you have a good sense of what the Keto Diet controversy is all about, and that you can side-step these issues by selecting healthy, fiber-rich low-carb fruits and veggies, as well as dietary fats mainly consisting of mono and polyunsaturated oils.
That said, before you start a Keto Diet, get some learning done:
The solution to the Keto Diet controversy is to eat the healthiest kinds of low-carb foods.
If you’re on the Keto Diet or want to try it, remember to do these three things:
- Choose to eat fibrous carbs, mostly veggies;
- Choose to eat dietary fats consisting mostly of mono and polyunsaturated fats (Keto is not an excuse to fill up on cheese, butter and cream); and
- Give yourself a specific time frame within which to do your Keto Diet experiment, as opposed to making it your dietary lifestyle, unless you get clearance from you doctor.
If you know someone who is on the Keto Diet or is thinking about doing it, please share this article with them.