Keto diet or a ketogenic diet is arguably the most popular dietary trend in today’s times. Especially for someone looking for quick weight loss or for someone trying to control their diabetes. It’s quite possible that you’ve been tempted to follow the Ketogenic diet to lose weight fast, reduce HbA1C and lower your blood glucose levels. Given the benefits you’ve heard of of, it might seem really tempting to enter a metabolic state of ketosis. I’d like you to avoid the mistake I made, as in the past, I was lured into following this diet too. It’s important you know the limitations of this diet so that you are aware of the risk of developing long term complications from following this diet. To do this, I am going to take you through the 7 most common statements that the ketosis community throws around about biology and physiology of ketogenic diets and we’ll cross examine each of these statements to see if they have any biological validity or not. You’ll discover the truth underlying ketosis and I’ll refute statements based on misleading science, incorrect biology and a fundamental lack of understanding of human biology.
But first, what is ketosis?
A ketogenic diet is a very low carbohydrate diet by design. You are allowed to eat a maximum of 30 grams of dietary carbs per day. The keto food pyramid has eggs, dairy, meat, oil and fish at its base. All delicious starchy vegetables like potatoes and sweet potatoes are avoided. Thankfully, green leafy vegetables are included (this is the only redeeming factor). A small quantity of fruits are allowed. You aren’t allowed to have any whole grains or legumes. When you go this low carb, muscles and liver switch from oxidizing glucose as primary fuel to using fatty acids as primary fuel source. To withstand this, your liver manufactures Ketones as a emergency back up fuel for your brain. Being in this state is called as ketosis.
It seems like a great idea because now your pancreas is provided with an opportunity to reduce insulin production due to the low amount of dietary carbohydrates. A lot of people on keto diets flat-line their blood glucose (aka don’t have elevated blood glucose levels) and have reduced their need for medication while on the diet. If you’ve tried keto, you might have experienced this and you might think ‘great, eating keto is keeping my diabetes in check!’ You might have experienced other short term benefits too like rapid weight loss. reduced glucose levels, reduced postprandial blood glucose, reduced A1C, low fasting insulin. low total cholesterol low LDL etc. The problem though, these are all short term benefits and I can guarantee eating a ketogenic diet increases your risk of chronic disease and early death in the long term.
After researching advice from top ketosis gurus, I have identified seven common dangerous misconceptions about the ketogenic diet.
Myth 1: Insulin is your fat storage hormone
And by adopting a low carb diet you can prevent insulin from causing spikes blood glucose levels after a meal. Now, any biology textbook will tell you the primary function of insulin is to help glucose exit your blood and enter tissues. Sure, insulin also helps fatty and amino acids enter blood and tissues. However, the primary function of insulin is to help transport glucose from blood to tissues and secondary function is to help transfer fatty acids and amino acids to tissues. Simply because insulin has ability to transfer fat to tissues it is incorrect to label insulin as fat storage hormone. It is a scare tactic and is used to make people believe that any amount of insulin in your blood stream is bad. See, insulin triggers macro-nutrient absorption as follows:
- Priority function No 1 is to transport glucose to tissues to be used a fuel for energy or to be stored as glycogen for later use.
- Then it is to transport fatty acids to tissues be burnt for energy or to be stored as triglycerides for later use.
- Followed by transport of amino acids to be synthesized into new protein or to be burnt for energy or to be converted into other compounds.
It is important to understand this order of priority because it reinforces the concept that primary role of insulin is to handle all things related to glucose metabolism before it does anything with fatty acid or amino acid metabolism. Insulin is the most anabolic hormones in the body which means it provides more cell growth and more fuel storage than any other hormone. Ketogenic dieters exaggerate this fact condemning insulin saying that insulin will make you fat. The truth is that all mammals secrete insulin because insulin is required for life- your dog secretes insulin, your neighbors cat secretes insulin, your non diabetic colleague secretes insulin, your thin cousin secretes insulin. Insulin is so important that if you stop manufacturing insulin, you’d die.
In truth, a physiologically normal amount of insulin is required to stay alive. However, injecting excess insulin is what increases risk of cardiovascular disease, atherosclerosis and coronary artery disease. Also, excess insulin due to insulin resistance can lead to weight gain. That’s the only way insulin can be harmful.
Myth 2: Eating carbs spikes blood glucose levels and leads to weight gain
Fans of the keto diet argue that eating any food containing carbs will spike blood glucose and the only way to avoid blood glucose spikes is to avoid carbohydrate rich foods. Purely technically speaking, when you eat carbohydrates, your blood glucose will spike and technically reducing carbohydrates will keep blood glucose stable- for this useless ‘technical’ reason keto diets keep total carb intake to below 30 gm. Those in ketosis don’t understand that the amount of glucose in your blood is not only determined by amount of carbohydrate intake but is a reflection of both, your dietary carbohydrate AND your dietary fat intake. Keto dieters are unaware of the detrimental role that excess dietary fat plays in development of insulin resistance leading to high blood glucose, beta cell death, high cholesterol and increased risk of many chronic diseases.
Only paying attention to how much carbohydrate you are eating misleads you into thinking that this single macro-nutrient affects your entire blood glucose profile when it is in fact primarily determined by how much fat you eat and secondarily by how much glucose you eat.
Why does your blood glucose remain flat on a keto diet? It’s simply because of a near absence of any carbohydrate rich foods and in this way eating a high fat diet is every good at flat-lining you blood glucose levels. As long as you avoid carb rich foods like fruits, potatoes, whole grains, legumes your blood glucose is likely to stay very stable but the minute you eat a delicious carbohydrate rich food like bananas or potatoes or quinoa or brown rice, your blood glucose is going to rise immediately due a fatty acid induced state of insulin resistance.
The Standard American and Indian diet is perfect example of a diet that is high in both carbohydrates AND fat which increases your risk of high blood glucose, insulin resistance and diabetes. In these diets, because both the nutrients are present in large quantities controlling your blood glucose becomes increasingly difficult over time. However, because a low-fat plant based whole food diet is low in dietary fat, your carbohydrate tolerance or your ability to eat carb rich food increases substantially resulting in maximum insulin sensitivity and provides the opportunity to completely reverse insulin resistance all together.
It is quite easy to maintain a flat-line blood glucose on a plant based whole food diet as long as total fat remains controlled below 30 grams per day and your carbohydrate intake comes from whole foods like fruits, vegetables and legumes and not from products containing refined sugar. In my own case, my post prandial insulin on a high fat diet, low carb was 144 and after I switched to a plant based, high carbohydrate diet my post prandial insulin is 19. It’s not just me, I’ve seen the same pattern consistently repeat with all our patients at Thrive.
Myth No. 3: Diabetes is carbohydrate toxicity and insulin resistance a state of carbohydrate intolerance.
Diabetes is often labelled as a problem of carbohydrate toxicity suggesting that dietary carbohydrates are the primary cause of disease. In addition keto dieters believe insulin resistance is caused by insulin itself, triggered by excess consumption of dietary carbohydrates. In order to find out if these statements are factually correct it is necessary to go back to basic biology principles that have shown that vast majority of people who develop insulin resistance develop it due to eating a high quantity of dietary fat. The research world has know this for 85 years. This was first established in 1930 by Dr. Hemsworth and by Dr. Walter Kemper in 1950 and by Dr. JW Anderson in 1970. Despite this, the cause of insulin resistance remains the most debated subject in the world of diabetes even today. I’d like you to think of insulin resistance as a series of metabolic of dominoes and the dominoes are arranged this way:
- You eat a diet containing dietary fat greater than 15% of total calories,
- You eat a banana, potato or rice and check your blood glucose after 2 hrs and you find your blood glucose reads 200 or higher. You then say bad banana, bad potato, bad rice, saying that these foods increased my blood glucose.
- Now, the reason that this happened is not because bananas and potatoes are bad foods, but because the insulin receptors in your muscles and in liver have become dysfunctional due to too much dietary fat. Under normal circumstances the glucose from these carbohydrate rich foods is accompanied by insulin into your cells. Insulin says knock knock, would you like to take this energy up and normally the receptor cells in your liver and muscle would say yeah sure, but when you go into insulin resistance the receptors say you got to be kidding me.. do you see how much energy I’ve already have inside? First I have to burn this only then I can allow glucose. Now, when glucose becomes trapped in your blood due to dysfunctional insulin receptors, you have two choices- either you avoid carbohydrates like the plague and continue to remain in ketosis or drop your fat intake and gain the ability to eat carbohydrate rich food.
Diabetes is not a problem of carbohydrate toxicity but a problem of fat toxicity. Insulin resistance and the weight gain that accompanies it is a state of carbohydrate intolerance first created by excess dietary fat.
Myth No. 4: Carbohydrate is not an essential nutrient
Keto followers often say there are no essential carbohydrates while there are essential amino acids and essential fatty acids. Technically this sounds correct, however, let’s return to basic human physiology for a moment. Liver, muscles and other tissues are capable of oxidizing either glucose, amino acids and fatty acids for energy. Your beautiful brain however, can’t oxidize amino acids or fatty acids. Your brain can only run on glucose for energy plus the brain can’t store glucose. As a result, the brain must oxidize glucose on demand. Carbohydrate rich foods are your brain’s primary fuel source. When you consume a low carb diet you force your liver to make an emergency back up food called ketone bodies to prevent brain from starving. You go into ketosis and and ketones become the brain’s primary food.
Keto diets were invented for people with epilepsy and can reduce seizures but they come with a laundry list of unwanted side effects including diarrhea, nausea, constipation, vomiting, acid re-flux, stunted growth in children, hair-loss, kidney stones, muscle cramps, muscle weakness, hypoglycemia, impaired cognition, impaired concentration, mood swings, ,disordered mineral metabolism, increased risk of bone fractures, acute pancreatitis, high cholesterol, high cortisol, menstrual irregularities, amenorrhea and premature death. In short, people on low carbohydrate diets die sooner and suffer from more diseases. Therefore, labeling carbs as non essential is not just factually inaccurate, it results in a wide variety of chronic health conditions and can decrease quality of life.
Myth No. 5: Low fasting insulin means high insulin sensitivity.
People in the keto community often measure their fasting insulin levels as indicator of their insulin sensitivity and fasting tests measure the amount of insulin your pancreas have to secrete to control your blood glucose level. The lower the number the higher your insulin sensitivity. Low numbers are a good thing. Keto dieters report very low fasting insulin numbers and then draw the conclusion their insulin sensitivity has increased. This is untrue. The only way to actually measure your insulin sensitivity is to utilize a glucose challenge which is done either by drinking a glucose solution or by eating a food containing carbohydrate energy. You measure insulin sensitivity is with the oral tolerance test by drinking 75-100 gm glucose dissolved in water. You then measure your serum insulin and glucose levels at 60, 120 and 180 mins. The higher your glucose and insulin, the worse you perform on the test and conversely the lower the numbers, the better your insulin sensitivity. The reason why this test is so good is because it measures the ability of your liver and your muscles to uptake glucose from the blood when challenged by a food or drink containing glucose. Simply measuring fasting insulin or glucose independent of glucose challenge is insufficient information.
However many keto dieters fail to understand this concept entirely. If you never challenge your glucose metabolism with carbohydrate rich foods or glucose solution, it is impossible to measure insulin resistance. Despite this those in ketosis often claim their insulin sensitivity has increased even though they avoid eating carbs completely.
Myth No . 6- Low carbohydrate diets are not high protein diet
The question to ask here is what proportion of total calories constitutes a high protein diet according to this scientific evidence? According to the evidence.. diets containing more than 10-15 % calories from total protein increase risk for cardiovascular and diabetes mortality. Especially if majority of protein comes from animal foods. Many studies have shown that a diet that’s got protein calories more than 15-20% of total calories can lead to heart diseases, diabetes, cancer, atherosclerosis. Any diet containing excess of 10-15% of total calories from protein is a high protein diet. It is practically impossible for a keto diet to be low in protein.
Why? Because cheese, eggs, meat, poultry, fish, seeds, avocados, vegetables and coconut oil make up bulk of calories and with exception of vegetables and coconut oil every food listed here is high in fat and also higher in protein. So, low carb diets are in fact high protein diets too.
Myth No. 7- Evidence based research shows low carb diets are effective
Low carb dieters are great at documenting effectiveness of their diet using studies with small population sizes as is conducted over short time periods (often over weeks or months). While these studies are useful in documenting short term benefits of ketosis they fail to document long term effects of the same. A classic example is a paper that was published in 2017 documenting results of 10 weeks of ketogenic diet in 262 patients following a diet containing less than 30 grams of carbohydrates per day and an average of 175 grams of protein per day.
Researchers document how 10 week of ketosis resulted in drop of average A1C by 1%, an average weight loss of 7.2% and how more than 56% of participants reduced their need for all medication. These are all great outcomes. The problem is the study was conducted in a small cohort of over a relatively short period of time.
In order to determine the true effectiveness of any diet you have to do two things. First, study your diet in large number of people which is atleast tens or hundreds thousand of people and study the outcome of following your diet over a long period of time which should be greater than approximately 5 years. Studies conducted in thousands of people over twenty years indicate that low carbohydrate diets promote the following disastrous outcomes
1. increased risk for Cardiovascular Disease
2. increased risk for hemorrhagic stroke
3. increased risk for hypertension
4. increased risk for atherosclerosis
5. increased risk for diabetes mortality
6. increased risk for obesity
7. increased risk for cancer
8. increased risk for all cause mortality (premature death from any cause)
Low carbohydrate diets trick patients and doctors into believing that ketosis is an excellent long term dietary strategy. In reality the long term consequences are worse than the initial disaster the diet was trying to avert.
If you are a keto dieter or are planning to go on one, ask yourself a simple question. Are the long term consequences worth the short term benefits? If your are answer is no, and you need to talk to someone regarding your health goals, book your free consultation with Thrive. We can help you uncover the root causes of your health problems and solve them permanently.