The ketogenic diet is a powerful new tool to hit the mainstream recently. This style of eating has substantial data behind it showing that it can boost fat-burning, reduce inflammation, boost cognitive performance, and more. What has not been covered quite enough are common keto side effects and how you can avoid them to make the best of this powerful eating style.
Adherence to a keto diet food list isn’t always great, though. A review published in January 2015 in the Journal of Clinical Neurology found that only 45 percent of participants were able to follow the approach as prescribed. “The poor compliance was attributed to side effects, social isolation, and cravings,” says Yawitz. And some people in the study “reported the diet simply wasn’t helping them lose weight,” she adds. Brissette agrees with this line of thinking. “In my opinion, the keto diet isn't sustainable and takes the joy and fun out of eating,” she says.
If you decide to follow the diet, you’ll want to have an individualized meal plan, stresses Dr. Gonzalez-Campos. “The best possible clinical outcome is for each individual to meet her nutritional needs from well-balanced meals,” he says. “Ideally, we should all have the benefit of medical nutrition therapy and we should all avoid extremes in nutrient restrictions.”
Many people and even some doctors confuse nutritional ketosis with (diabetic) ketoacidosis. Ketoacidosis occurs in uncontrolled diabetes when the pancreas cannot secrete enough insulin to exert its action in cells, so blood glucose levels and blood ketones both skyrocket to dangerously high levels. Ketoacidosis has nothing to do with nutritional ketosis which is when ketones are produced from all the dietary fat you’re relying on and can thus keep your blood sugar levels under control at low and stable levels.
The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up?
However, the complete opposite occurred, practitioners began to lose excess body fat, feel healthier, and in some cases, issues of diabetes even began to subside. Nutritionists began to study the effect of a fat-based diet and its impact on human health, years later; the modified ketogenic diet emerged from the research and had been used with success in modern society.
WY conceived, designed, and coordinated the study; participated in data collection; performed statistical analysis; and drafted the manuscript. MF assisted with study design, performed data collection, and helped to draft the manuscript. AC analyzed the food records. MV assisted with study/intervention design and safety monitoring. EW participated in the conception and design of the study, and assisted with the statistical analysis. All authors read and approved the final manuscript.
Is the keto diet safe for diabetics? Most research shows that yes, it is. However, even though the KD can help reduce insulin resistance while someone adheres to the diet’s principles and strictly limits their carb intake, these positive effects may be short-lasting. Results from some animal studies show that insulin resistence/glucose intolerance may potentially be increased once carbs are reintroduced back into the diet.
This suggests that we should cycle in and out of ketosis by periodically increasing carbs to avoid this hypothyroidism. Incidentally, the more I read of the much-maligned Bob Atkins’ writings the more impressed I become. He clearly was extremely well-read in the scientific literature and modified and expanded his protocols as he got more information. If you read his Age-Defying Diet book, apart from Dr D’s absolute prohibition of grains, it isn’t too different from WB principles. See this quote (page 290)
The biggest issue is that some people consider keto to be a free pass to skip the green stuff. Either that, or they assume “vegetable=carb” and avoid them. Without plants, it’s tough to eat enough fiber, especially the fermentable, prebiotic kind that sustains our gut bacteria. We don’t need bowel-rending quantities of fiber. We shouldn’t take pride in the ability to fill the toilet bowl with perfect coils of crucifer corpses. These are unnecessary at best and downright harmful at worst.
All of our cells need fuel to function. This fuel comes from three sources: fat, carbohydrates and protein, called macronutrients. Too much protein without fat puts us at risk for a handful of complications, so protein can never healthily serve as a primary source of fuel. We are left then with fat and carbohydrates as the main providers of energy – the energy that allow us to do everything from breathing and blinking as we veg out on the couch to swimming the English Channel. Our cells’ preferred fuel comes from carbohydrates, which are easily converted to glucose, which, in turn, is readily converted to energy. This is why athletes “carb load” before they compete. Peak performance occurs when the body has plenty of glucose and glycogen stores available at hand. When glycogen runs out, that’s when the body turns to fat. When there is no more blood sugar for our cells to consume, they seek an alternative form of energy. This energy comes from ketones, which are compounds our body produces from stored fat. So a ketogenic diet is one that is high in fat and very low in carbohydrates, resulting in the production of ketones to be used for fuel instead of glucose.
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The New York Times pieces also points out that studies are disproving this concern and making a case for both children and adults with type 1 diabetes to consider a ketogenic diet. Specifically, a 2018 study published in the journal, Pediatrics, which took a look at glycemic control among children and adults with type 1 diabetes who followed a very low-carbohydrate, high-protein diet. The researchers found that both the adults and children who consumed this diet along with smaller doses of insulin than typically required exhibited “exceptional” blood sugar control without high rates of complications. In addition, the study data did not show an adverse effect of a very low-carbohydrate diet on children’s growth, although more research may still be a good idea, according to researchers.
In either case, think about that for a second: Mancella says a 4% carbohydrate consumption translates to roughly 20-50 grams of carbs per day. And given that a single cup of cooked pasta contains roughly 45-grams of carbs by itself, and a single English muffin has about 30-grams of carbs, a single, poorly-planned meal could undo your efforts to achieve and maintain ketosis in a hurry.
“You can spend two hours in the gym but ruin it with a bad meal,” said Sowers. “Incorporating all the food groups in proportioned sizes throughout the day is the best way to not only lose weight, but to also control appetite. Restaurants are also making it easier to eat healthier with calorie counts on the menu. Now people are able to make mindful choices when they go out to eat.”
The counter-argument is that diabetes is not reversed because it will come back soon after starting to eat lots of sugar and refined carbs. How much time is soon? It is difficult to say how “soon” diabetes will come back, and the time it takes depends on many factors. It is, however, true that the ketogenic diet does not set the body back to zero and allows for another few decades of unhealthy eating. On the other hand: every adult with a high sugar/high carb history has a high risk of becoming diabetic. It is just a matter of time.
While it's not necessarily dangerous, bad breath is a known side effect of entering ketosis. When you’re taking in a lot of fat, your liver metabolizes it and eventually converts it into smaller ketone bodies. These ketones (including acetone — yep, like nail polish remover acetone) will circulate in your body and diffuse into your lungs. Your body wants balance, so you'll exhale ketones to avoid build-up in your bloodstream. Those compounds are what cause keto breath: a metallic-tasting, somewhat stinky side effect.
The ketogenic diet has recently been investigated a great deal for how it may help prevent or even treat certain cancers. One study found that the ketogenic diet may be a suitable complementary treatment to chemotherapy and radiation in people with cancer. This is due to the fact that it would cause more oxidative stress in cancer cells than in normal cells.
Incidentally , there’s a very informative article on the bbc website about one of the last remaining hunter/gather societies left in the world, living in Tanzania. They have amazing gut health and no t2d. Would you like to guess at the type of diet they follow? This would be the caveman diet that the writer mentions, and yes these people might not live as long as us but the cause of death is never a lack of motivation to stay on a keto diet.
If you’re wondering about the difference between ketosis and diabetic ketoacidosis, you’re not alone. “The word ketone is scary for most people with type 1 diabetes because they relate ketones to diabetic ketoacidosis,” says Patti Urbanski, MEd, RD, CDE, a certified diabetes educator with St. Luke’s Hospital in Duluth, Minnesota. “But with the ketogenic diet, we’re talking about a much lower level of ketones.”