The “true” ketogenic diet is a diet that has been around a long time-like almost 90 years. It was started by this guy named Dr. Russell Wilder at the Mayo Clinic. It mitigated epileptic seizures in children.
it kinda fell on deaf ears after the 1940s when new-fangled seizure medication came on the scene. Neurologists flocked to this anti-seizure medication, and the ketogenic diet went on the back burner in treating epileptic seizures.
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Keto has been making a comeback in recent years due to its effectiveness in morbidly obese clients. Of course, this is because... Well, who doesn’t see Mark Bell doing it on YouTube?
OK, so let's describe the ketogenic diet.
It is characterized by a high-fat, low-carb diet (carbs around 20 grams or so). WebMD says this, “Ketogenic” is a term for a low-carb diet (like the Atkins diet). The idea is for you to get more calories from protein and fat and less from carbohydrates. You cut back most on the carbs that are easy to digest, like sugar, soda, pastries, and white bread.”
Calm down, I don’t really get my info from WebMD. We want to be more scientific, right?
First, we have to really define what the ketogenic diet is, so here goes:
Ketosis is a metabolic state that occurs when dietary carbohydrates are in such low quantities that your body must rely almost exclusively on fatty acid oxidation and ketone metabolism to produce ATP.  So basically you “run out” of carbs for a fuel source and you start to use fat as fuel. This can be beneficial for a few reasons.
- Decreasing your carb intake will reduce insulin secretion.
- Since you reduced insulin secretion, you will mobilize fat stores for energy.
- Because of the above, your blood sugar will lower.
For this article, I am not focusing on pathways used and the chemical processes surrounding the ketogenic diet. I am merely asking the question: If it's a “better” diet, why are we not implementing this in weight loss clinics and diabetic education?
Why isn’t everyone on the keto diet? All these type II diabetics, and morbidly obese people could really benefit from this type of diet, right?
Suffice it to say, reading the literature, the keto diet is not better at weight loss. It may be better initially - because carbs hold water, however, in long term studies, it does show no more weight loss than low fat diets.
However, clients don’t experience as much hunger. Think about it - have you ever gone on a starvation diet? Maybe eating 800 cals to lose weight for your High School Reunion so that Billy Bob will say, “Wow, you look amazing now that your not a fat cow!”
Oh, that might be just me. Anyway, during that starvation diet were you hungry?
Probably after three days you really weren’t. That's essentially being in ketosis; your body is using another pathway for energy, basically because it's in starvation mode and needs to keep you alive (so that Billy Bob can tell you how good you look...)
Type II Diabetes and Keto
Diabetic clients who use a higher fat low carb ketogenic diet more than likely will have lowered blood sugar levels. They aren’t eating a bunch of carbs and their body has to use an alternative fuel source.
If this is the case, every diabetic should do this, right?
Calm down, sparky... There is a little sumpin sumpin called patient compliance.
So, you got this diabetic man in your clinic who is used to eating all kinds of crap.
He starts the ketogenic diet with his fats 150 grams. His protein 75 grams and his carbs 20 grams (this is just macros picked out of my head - there is no significance except the fats are high and carbs are low). Then he excitedly starts thinking his blood sugars of 300 will go down.
The first 3 days he feels like crap.
He has headaches, leg cramps, body aches, pees a lot... but pooping is a different story. How likely is he going to power through this period known as the keto flu when he can’t even stop eating Ho Hos for a week?
Compliance is a huge issue, even if this diet was given to him by a physician.
OK, What About Morbid Obesity?
Doing a low-fat, low-calorie diet is just as effective as doing a ketogenic diet - that was in almost all the scientific literature that I have found. Now, add three days of keto flu and tell that morbidly obese client that they will have to only eat 20 grams total (if we are doing a real keto diet) of carbs.
They will likely go for it for a while. Until cake happens. Then, the cycle of depression and failure come back around, and more carbs are consumed.
The thing is, to be in ketosis you have to be consistent. Your carbs have to stay low and you have to maintain that to be in a ketotic state.
- Very little hunger.
- Weight loss.
- Blood sugar levels may stabilize.
- Easy to do once you wrap your head around the concept of higher fat and almost nil carbs.
- Very carb restrictive.
- Keto flu may occur every time you go out of and go back into a ketotic state.
- Mentally the client may feel deprived, making them more apt to go off plan.
In my humble and honest opinion, a ketogenic diet is the way to go for someone who has type II diabetes or is morbidly obese. The compliancy issue is a problem, however. I have done keto for long periods of time, and yes, I felt good, my blood sugar was stellar and I had energy (after the initial difficulty of the keto flu was over).
However, most of America eats carbs, and to cut out a whole food group (limited veggies) made it hard if you are doing a traditional keto diet.