For the treatment of severe obesity, type 2 diabetes mellitus and other chronic non-communicable conditions, low-carbohydrate diets (or “ketogenic diets”) have been a mainstay of recommendations by weight-loss experts.
There is no doubt that such diets allow for weight loss. Short-term weight loss happens efficiently and predictably if the patient is compliant with such a diet.
However, for a few reasons, I do not recommend this diet for my weight loss patients. Here is a summary of my reasoning:
The Harm Of Low-Carb Diets:
Low carbohydrate diets usually allow for 20-120g of carbohydrates per day. These diets produce good short-term and medium-term results. There are a number of low carbohydrate diets (LCDs). These include the following:
- Very Low-Calori Ketogenic Diet (Keto)
- Protein-sparing Modified Fasting diet
- Hypocaloric LCD
- Hyperproteic LCD
- Hyperlipidic LCD (Atkin, Paleo…)
- Normocaloric Hyperproteic diets
Generally speaking, if you’re taking in 20-120g of carbohydrates in a LCD, the total caloric intake is about 1000 to 1200 per day. For the morbidly obese, this will reduce insulin and increase glucagon; this will increase fat oxidation for energy. Thus, these diets will assist with losing weight.
However, studies have shown that fat loss and energy expenditures is higher with low-fat-diets than with isocaloric LCDs. Also, the weight loss of LCD is similar to low fat but iso-proteic diets. Fat loss is usually higher when lipids and not carbohydrates are restricted.
How The Keto Diet Works
For low-calorie keto diets specifically, the carbohydrate intake should be below 30-50g a day; this induces ketosis by mimicking the physiologic state of fasting. A low-calorie Keto diet will have carbohydrates at less than 30g a day. This diet has 13% of intake as carbohydrates, 44% as fats and 43% as protein.
The total caloric intake is usually 800-1200 calories per day. The Very Low calorie Keto diet has the caloric intake capped at less than 800 per day.
By vastly reducing normal carbohydrate intake, such a diet will stimulate lipolysis for energy and this reduces storage fat. A physiological ketosis ensues.
The ketonemia (ketones in serum) never exceeds 3mMol per liter. Such a diet should be under medical supervision and it is not recommended to follow it for more than 12 weeks.
The Keto Diet: An Unsustainable Option For Weight Loss
Such a diet usually requires the purchase of industrial meal replacements for safety with regard to components of the food and to hopefully provide nutrition balance. This diet is considered a transitional diet and is not a lifetime diet or a lifestyle that is sustainable. Eventually, users of this method must transition back to a more correct food style.
Keto diets are problematic in my opinion for these reasons. Although one will lose weight, it is not a sustainable or healthy way to eat. The levels of protein are too high, especially if these are animal proteins and that source of calories induces chronic inflammation and oxidative stress itself.
These diets are expensive and usually require the purchase of a plan or an industrial food package or kit. There is a lack of micronutrients and phytochemicals in this diet.
And finally: this is not a social diet and is the antithesis of what foot means to humans in terms of culture.
Health Goes Beyond Weight
There is more to health than just your weight. What is really important is your level of inflammation and oxidative stress. High energy levels (obesity) with increased storage of energy in the form of fat leads to more inflammation.
High protein and high fat diets contribute to overall inflammatory status. This is not a good thing in my opinion. There is a study that looked a relatively high protein diet v the American Heart Association diet (15% protein). This study found that the AHA diet reduced inflammatory markers in the blood, but the high protein diet did not. Most studies comparing diets find that higher protein intake is associated with poor inflammation status.
If you are obese and a physician has recommended this diet, there may be very good reasons behind those recommendations. I usually recommend exercise, the Mediterranean Lifestyle way of eating and additional micronutrient supplementation.
There are a variety of additional methods to lose weight such as lipotropic injections, infrared spa treatments and such. The best and most effective way to lose weight is to take in less energy than you expend each day.
