How did this diet, which was first developed in the 1920s as a treatment for children with epilepsy (and has been shown to reduce seizures in patients whose epilepsy symptoms aren’t responding to other medications), become the diet du jour, and why such a discrepancy between its fandom and expert opinion? Let’s take a closer look at what “going keto” entails.
Yes your are totally right, I meant to take off 500 calories a day to lose 1 pound a week (7 days/week x 500 calories/day = 3500 calories/week = 1 pound of fat/week) or take off 1000 calories to lose 2 pounds a week (7 days/week x 1000 calories/day = 7000 calories/week = 2 pounds of fat/week). Thanks to you, I fixed this little typo 🙂 Thanks a lot!
The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more calories than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein and carbohydrate is then evenly divided across the meals.
Wondering what fits into a keto diet — and what doesn’t? “It’s so important to know what foods you’ll be eating before you start, and how to incorporate more fats into your diet,” says Kristen Mancinelli, RD, author of The Ketogenic Diet: A Scientifically Proven Approach to Fast, Healthy Weight Loss, who is based in New York City. We asked her for some guidelines.
On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through fatty-acid oxidation in the cell's mitochondria (the energy-producing parts of the cell). Humans can convert some amino acids into glucose by a process called gluconeogenesis, but cannot do this by using fatty acids. Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and most fatty acids do not cross the blood–brain barrier. However, the liver can use long-chain fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone. These ketone bodies enter the brain and partially substitute for blood glucose as a source of energy.
Other kinesiologists think the keto diet could have dangerous effects on athletic performance, and it's tough to know what potential side effects a long-term high-fat diet might have for a healthy person, since we don't have any solid study results yet. Low-carb diets like keto can make it easy to neglect key nutrients like magnesium, calcium, and potassium found in fresh, high-carb foods like beans, bananas, and oats.
As far as keto's track record with longer term weight loss, a systematic review and meta-analysis that looked at 13 randomized trials that lasted at least a year showed that people who followed the ketogenic diet recommendations lost, on average, 2 more pounds compared to those who followed lowfat ones. But some experts say that weight loss from a keto diet probably isn't from any specifics about the diet itself. If the ketogenic diet aids weight loss, says Brian St. Pierre, R.D., director of performance nutrition at Precision Nutrition, it’s because it might enable some people to maintain a caloric deficit.
This can be tough for folks who need a "cheat" day, but it can also take a mental toll on the dieter. In a usual diet plan when you go off of it for a day or two, you just get right back in the saddle and start again. With keto it's more than that: You need to start from scratch to get yourself back into ketosis, which can take a few days or weeks. This can really make you feel bad about yourself and take a psychological toll on your well-being and self-worth. (Related: Why You Should Give Up Restrictive Dieting Once and for All)
“When you’re on a restrictive diet, deprivation builds and builds, and when you finally give in and have something that’s not on your plan, you can overeat,” Notte says. This can lead to shame and guilt, she warns. “You think, well, I already blew it, so I might as well just eat it all,” she says. Occasional binge eating can, in turn, develop into a full-blown disorder called binge eating disorder for those who are predisposed to it, according to the National Eating Disorders Association. Check out the 10 surprising health benefits of keto.
Probably, and there are a few reasons why, Keatley says. For starters, people usually reduce their daily caloric intake to about 1,500 calories a day because healthy fats and lean proteins make you feel fuller sooner—and for a longer period of time. And then there’s the fact that it takes more energy to process and burn fat and protein than carbs, so you're burning slightly more calories than you did before. Over time, this can lead to weight loss.
This was a great read. I aim to restrict carbs always because I believe most are why the American population is obese. I would very much like to hear more about carb restriction excluding the discussion on processed meats and processed high salt content foods because I consume neither. I also don’t consume dairy or eggs. So can you provide some substance.
In the 1960s, it was discovered that medium-chain triglycerides (MCTs) produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides). MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system. The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on twelve children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.
The popular low-carb diets (such as Atkins or Paleo) modify a true keto diet. But they come with the same risks if you overdo it on fats and proteins and lay off the carbs. So why do people follow the diets? "They're everywhere, and people hear anecdotally that they work," McManus says. Theories about short-term low-carb diet success include lower appetite because fat burns slower than carbs. "But again, we don't know about the long term," she says. "And eating a restrictive diet, no matter what the plan, is difficult to sustain. Once you resume a normal diet, the weight will likely return."
About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether. Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.
The keto diet is taking the fad diet arena by storm. Folks are turning to the diet as a means of weight loss, and some believe that it can also help with a slew of health conditions. But even though you may know someone who swears by it, as a dietitian focused on healthy, delicious food, I've never been able to condone such an extreme diet (whether used as a way of life or as a timebound diet to "reset"). (Related: Is the Keto Diet Bad for You?)
One downside to a ketogenic diet for weight loss is the difficulty maintaining it. “Studies show that weight loss results from being on a low-carb diet for more than 12 months tend to be the same as being on a normal, healthy diet,” says Mattinson. While you may be eating more satiating fats (like peanut butter, regular butter, or avocado), you’re also way more limited in what’s allowed on the diet, which can make everyday situations, like eating dinner with family or going out with friends, far more difficult. Because people often find it tough to sustain, it’s easy to rely on it as a short-term diet rather than a long-term lifestyle.