The Ketogenic Diet

What is the Ketogenic Diet?

The ketogenic diet (or keto diet) is considered to be a very low-carb diet, where you consume around 30g of carbohydrate per day or less. It encourages the body to get its energy from burning body fat which produces an energy known as ketones. This helps to lower the body’s demand for insulin, which can benefit people with type 1 diabetes and type 2 diabetes. The main outcomes of the keto diet are to control diabetes and assist weight loss.

This diet is based on understanding that carbohydrate is a macronutrient that raises blood glucose. The primary goal is to reduce consumption so that it is lower than that of a traditional low-carb diet with moderate protein and very high fat content. This also determines the nutrient density of the keto diet as well as how to follow it. Different foods will have varied effects on insulin and blood glucose levels.

There are several types of keto diet which differ in the level of carbohydrates and protein that are allowed, as well as the length of time someone is looking to spend in ketosis. Some types of keto have been specifically designed for people who are athletes or regularly do intense levels of working out.

How the Ketogenic Diet Works

Blood glucose levels are kept at a low but healthy level, which encourages the body to breakdown fat into a fuel source called ketones. Ketosis is the process where body fat is broken down. This is of great advantage for people who are looking to lose weight. People with pre-diabetes or those who are at risk at developing type 2 diabetes could stand to benefit.

Additionally, people require smaller doses of insulin whilst undertaking the keto diet. As a result, this leads to a reduced risk of dosing errors.

Benefits of the Ketogenic Diet

The Ketogenic diet has the following benefits:

  • Ketones produced from burning fat for fuel have been shown to have significant weight loss effects.

  • Blood glucose levels can be reduced.

  • Reliance on diabetes medications are reduced.

  • Triglyceride levels are reduced.

  • HDL cholesterol levels are raised, which is a sign of good heart health.

  • Improved mental performance.

  • There is an interest in therapeutic ketosis that could potentially benefit other long-term conditions, including: cancer, epilepsy, Alzheimer’s disease and dementia.

Side Effects

Every diet comes with an adaptation period, especially when you are altering your usual eating habits. With the keto diet, the body has to change its fuel source from glucose to fat, therefore it isn’t uncommon for there to be the following side effects:

  • Loss of salts – For the first couple of weeks of the keto diet, there are some changes with fluid balance. The body uses up stored glucose (glycogen) which releases water into the blood that gets passed out of the body as a waste product (urine).

You will experience a loss of fluids as you move into and maintain ketosis. As fluid leaves the body, salts become depleted. You will need to stay hydrated throughout the day to make up for the loss of fluid. Additionally, ensure that you have enough salt in order to prevent headaches and wooziness.

  • Keto-flu – The body may be used to relying on glucose as its energy source, therefore it will need to use ketones for fuel. This is known as keto-adaption which may result in initial brain fog, but it will disappear once the body has fully adapted. This is estimated to take an average time of four weeks.

Symptoms occur that are much like flu. You may experience slow thinking, dizziness, fatigue, a racing heart rate when you lie down, insomnia and cravings. Allowing the body to ease into ketosis helps to lessen the effect of keto-flu. You can gradually lower your carbohydrate intake over a few weeks.

  • Changes in bowel habits – Constipation is rather common when changing to the keto diet. It is often the case with any major change in diet, because the body’s own gut bacteria will need to adapt to handle different foods in different amounts. Your bowel habits will usually improve within a coupe of weeks. However, if they don’t you aren’t getting enough fibre.

To ease the period of bowel discomfort, drink plenty of water and increase your consumption of non-starchy, fibrous vegetables, pulses, nuts and seeds. These are all good low-carbohydrate sources of fibre.

  • Leg cramps – Muscle cramps during this adaptation to the keto diet are typically harmless but are still annoying. It is known as hyponatremia, which occurs when the level of salt (sodium) in the blood is too low. This is alleviated by keeping hydrated and having enough salt.

  • Bad breath – Bad breath is a common side effect and is often referred to as “keto breath”. This usually occurs once you enter the fat-burning stage of ketosis. Ketones can be released in the breath, as well as urine and sweat. Acetone is a form of ketone and when it’s released on the breath, it may lead to a metallic taste in the mouth or bad breath.

Keto breath is usually temporary and will likely disappear after a few weeks, without having to come out of ketosis by reintroducing carbs. Minty, sugar-free gum, mouth wash or breath freshener can help ease the smell. Being more rigorous with oral hygiene can also help. Brush your teeth and use mouthwash more frequently throughout the day.

  • Loss of energy – A common misconception of the keto diet is that the lack of glucose causes a loss of energy. In reality, it is rather challenging to maintain steady energy levels on a keto diet compared to a standard diet. Eating less carbohydrates doesn’t prevent the fluctuation in glucose levels.

Once in ketosis, the body can use energy from its own fat stores. As a result, the liver is able to create as much glucose as the body needs.

You may notice a dip in energy during the adaptation phases, but this should pass in a few weeks.

Safety on a Ketogenic Diet

Diabetic ketoacidosis (DKA) is when someone with type 1 diabetes, or late-stage, insulin-dependent, type 2 diabetes, can’t produce any insulin and make large amounts of ketones without stopping to prevent an effective state of starvation, which can lead to that person becoming seriously ill.

When undertaking a keto diet, your body will go into a state of keto-adaptation where the body changes from relying on glucose as its main source of energy to relying on ketones from fat burning, after the significant reduction of carbohydrate.

Ketosis should only be a concern or danger to someone on insulin if they have missed a dose of insulin or they are rationing their food and insulin too severely.

It is important to always speak to your doctor before starting the ketogenic diet. Generally, there is a lack of long-term studies into the safety and effectiveness of ketogenic diets. There are a few groups that the keto diet wouldn’t be suitable for or at least would require supervision. These include:

  • Pregnant women;

  • Children;

  • People at risk of hypoglycaemia;

  • People with a very low BMI; and

  • Those with conditions that a ketogenic diet may aggravate.