Pros and Cons of a Ketogenic Diet

Before I started on my keto journey I did a lot of research.  Mainly because I felt panicked at the thought of increasing fats.  I mean, we’re supposed to avoid them right?  I was having a hard enough time losing weight on my own, the thought of adding fats seemed so wrong!

So if you’re thinking on starting a low carb journey of your own, here are some pros and cons of a ketogenic diet to help in your decision.

Pros

Weight loss

Weight loss results are usually faster, and with better results, than normal dieting methods.  In study after study, when comparing weight loss results of a low carb diet vs a low fat diet, low carb diets have resulted in more weight loss.1

In addition to scientific research, there are many many forums out there with members claiming to lose a lot of weight and keep it off.

As you might have guessed, I frequent Reddit/keto quite often.  I love how active the forum is, and it has a lot of really good information. There are a lot of really knowledgeable people that frequent the forum answering questions, which is wonderful for new people seeking help.  And the Photo Fridays are great for inspiration, where people post their results with before and after pictures.

Visceral fat loss

Keto has been shown to aid in the loss of visceral fat, the fat that sits in the abdominal cavity around your organs.   Visceral fat is very harmful to the body, causing inflammation and insulin resistance, resulting in metabolic dysfunction.2

visceral fat

Studies show that a low carb diet is highly effective at visceral fat loss.  “VAT cells have a two-fold higher glucose uptake rate compared with SCAT cells. It may follow that reducing glucose exposure by reducing glycemic load may reduce the supply of glucose to the VAT depot and possibly impair its accumulation” (E. Freeland, 2004).3

Can Improve Blood Work

It’s been well known, that a high carb diet increases blood sugar and insulin levels.  A ketogenic diet, high in saturated fat and low in carbohydrates, will reduce those levels.4

Triglycerides decrease, HDL (good cholesterol) increases, and LDL improves on a low carb diet.  Triglycerides are fat molecules in your blood and are a strong indicator of heart disease.  HDL and LDL are lipoproteins that carry cholesterol in the blood.  HDL carries cholesterol into the liver where it can be used or excreted, and LDL carries cholesterol from the liver to the rest of the body.5,6

When you cut carbs and increase fats, you will see a dramatic reduction in triglycerides, an increased production of HDL, and lower production of LDL.  “When your physician measures your cholesterol level, he or she is looking at your lipid profile, which comprises low-density lipoprotein cholesterol (LDL-C, or the “bad” cholesterol), triglycerides (blood fats), and high-density lipoprotein cholesterol (HDL-C, or the “good” cholesterol). In a general way, when it comes to measurement of your LDL-C and triglyceride values, a lower value is better because these lipids drive the development and progression of atherosclerosis. In sharp contrast, when it comes to HDL-C, with few exceptions, a higher value is better because HDL-C is beneficial and protects patients from the development and progression of atherosclerotic disease” (P. Toth, MD, 2005).7

Lipid-panel

At my last doctor’s appointment I asked for bloodwork to be done so that I can start tracking my lipid profiles.  I go back in 3 months for additional bloodwork and when I get the results I will post them for comparison.  I don’t usually have too many problems with my bloodwork, but maybe there will be some improvement for us to see.

Can Improve Blood Pressure

Same as with your bloodwork, you should see improvements in blood pressure.  Have you ever wondered why your doctor always squeezes the life out of your arm every single time you see her?  Well, that’s because blood pressure is a good sign of something going wrong in your body.  Namely it’s an indicator of heart disease, stroke, or kidney failure.

blood pressure

So, if you have high blood pressure, but you don’t have kidney disease or an adrenal disorder, then the most likely culprit of high blood pressure is… everything we’ve been talking about above.  Visceral fat, and a harmful lipid profile.  Typically people who are overweight will have high blood pressure, as well as, be at a higher risk for Type 2 Diabetes.

And, as we all know, these issues are usually due to diet!  Raised insulin, caused by a diet high in carbs, “lead to the accumulation of fluid and salt in the body. This increases blood pressure. In addition, high levels of insulin can thicken the tissue around blood vessels (the so-called smooth muscle), which also may contribute to an elevated blood pressure” (dietdoctor.com, 2015).8

Blood-Pressure-Scale1

So, it stands to reason, that if you restrict carbs and increase fats, you improve your lipid profile and reduce visceral fat, resulting in improved blood pressure.  If you want to read more about this from medical professionals, I would start with: Low-Carbohydrate Diet Better Than Weight Loss Drug Orlistat at Lowering Blood Pressure With Weight Loss, and Weight Loss With A Low Carb Diet Reduces Blood Pressure.

Can Improve Type 2 Diabetes and Insulin Resistance

As we’ve seen in my post on Glycolysis vs Ketosis, eating a low carb diet reduces blood sugar and insulin levels.  For those with insulin resistance, low carb is a great way to remove the need for insulin responses to blood sugar surges… because, well, you are removing the blood sugar surges.  Unsurprisingly, insulin resistance is strongly correlated to metabolic syndrome (that nasty conflagration of issues I’ve discussed above).9

insulin-resistance-syndromeInsulin resistance is something that a surprisingly large number of people suffer from.  It’s “a condition in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells” (NIH, 2014).10  Left untreated, this could lead to prediabetes, and eventually Type 2 Diabetes.11

The simplest solution is to restrict carbohydrate consumption.  By reducing carbs, you eliminate the need for insulin responses in the body.   Here are some great articles that contain a whole lot more information than I feel I am qualified to give to you.  They are a great read if your mind doesn’t slowly start to go hazy over all the medical jargon (like mine does).

Yes, a Low-Carb Diet Greatly Lowers Your Insulin

A low-carbohydrate, ketogenic diet to treat type 2 diabetes

The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus

Comparison of isocaloric very low carbohydrate/high saturated fat and high carbohydrate/low saturated fat diets on body composition and cardiovascular risk.

Having said all that, if you do have insulin resistance, or Type 2 Diabetes, and you are on medications, please consult your doctor before changing your diet!  Your medication may need to be adjusted if you are going to try a low carb diet to avoid hypoglycemia.

Treatment for Epilepsy, Alzheimers, Parkinsons, Bipolar, Depression and other Neurological Issues

Okay, this one is a little tricky for me to write about, as I’m not using Keto to assist with any of these issues, so I haven’t done as extensive research as I did with the other issues above.  But I wanted to at least briefly cover them for this post, as they are important.

Keto has long been used to treat epilepsy.  “Although the mechanisms of action are not clear, the ketogenic diet is now considered an established part of an integrative approach, along with drug therapy, in the major epilepsy centres worldwide, an important benefit being the reduction of drug use and concomitant reductions in severe side effects often associated with antiepileptic agents. The effectiveness of ketogenic diets is strongly supported in a recent Cochrane review where all studies showed a 30–40% reduction in seizures compared with comparative controls, and the review authors reported that in children the effects were ‘comparable to modern antiepileptic drugs’” (EJCN, 2013).12,13

How the Ketogenic Diet Works

Studies are still being conducted, but there is “supportive evidence that a ketogenic diet can also help those suffering from Alzheimer’s and Parkinson’s disease.  It was suggested that this was, at least in part, related to improved mitochondrial function secondary to the reported protective effects of KBs against the toxic consequences of the exposure of cultured neurons to β-amyloid” (EJCN, 2013).14  “Previous work showed that ketone bodies, can correct defects in mitochondrial energy generation. The ability of ketone bodies to protect neurons in culture suggests that defects in mitochondrial energy generation contribute to the pathophysiology of both brain diseases. These findings further suggest that ketone bodies may play a therapeutic role in these most common forms of human neurodegeneration” (PNAS, 2000).15

I highly recommend reading Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets.  It contains a lot more information, including promising data on how ketosis can help with various forms of cancer, acne, polycystic ovary syndrome, and many other issues, including the same issues I’ve covered in this post so far.

Appetite control

I’ve spoken before about how I previously had insane hunger issues prior to keto.  If you haven’t read them, I recommend Can’t Hear You. Thinking About Chocolate, and  When In Doubt, Just Add Bacon.  The thing I like most about Keto is how it curbs my hunger for the most part.  I do still get hungry, but it’s like a normal hunger now.  My stomach now says, “Oh, hey Jess, you haven’t eaten in a while and I think you need some sustenance.”  Instead of, “Feed me now or you’re gonna die!”  The only time I seem to get hungry for no reason anymore, or that it’s sharper than usual, is when Mother Nature is paying me particular attention once a month.  Yay for me!  During those times though, I try to stay within my carb limits, and don’t worry so much about calorie intake.  I may not lose weight as fast, but I try to stay in ketosis.

So why does this happen with Keto?  Well, mainly because carbs tend to digest faster in your body than fat and protein (which are the main dietary sources of food on Keto).  The faster your food digests and leaves the stomach, the faster you get hungry.  So if you mainly eat fat and protein, which take longer to digest, then you feel satiated longer and can go longer between meals without the need for snacking.16,17

In addition, as previously discussed, eating low carb reduces blood sugar fluctuations which lead to hunger.  Nix the fluctuations, and you nix the hunger spikes.18

blood sugar cycle

Interested in Fasting?  Keto makes it easier.

Fasting is when you abstain from eating for a long number of hours and then only eat within a short window of time.  There is no hard and fast rule for the number of hours, but typical periods are 16/8, 18/6, and 20/4.  So if you wanted to try the 18/6 period, you would fast for eighteen hours (say, 8pm the night before to 2pm the next day) and then eat within a six hour timeframe (2pm to 8pm).  Please remember, fasting refers to 10 calories or less of sustenance.  You still must make sure you get adequate liquids, preferably water, so you stay hydrated.  Coffee, tea, and water flavorings are also okay as long as you stay within 10 calories.  Diet, calorie free, soda is also okay, but I don’t recommend drinking it daily for other reasons that I’ll explore in a different post.

Fasting is good for people who just aren’t hungry often, who find it easier for meal prep/cost reasons, who are trying to break a plateau, or who want to get more out of their workouts.  It’s important to note, that though you can eat fewer calories using intermittent fasting (IF), it is not recommend to go below your daily caloric needs.  It’s more of a means of redistributing your calories in your schedule so that you are relying on fat reserves for a longer period of time.  In the example above, if you are only eating in a six hour timeframe, and your daily caloric needs are 1200 calories, then you would want to aim for eating all 1200 calories within that six hour time frame.  Don’t eat just 800 and call it a day.  Or least, it’s not recommended.

I personally have only fasted twice, and both times were on this current round of Keto.  I was never able to do it the first time I tried Keto, but I wasn’t really trying to fast either (my history with hunger makes me think it’s just not for me personally).  Then again, the two times I did fast recently, I wasn’t purposely trying to do it.  I just listen to my body more.  If I’m hungry, I eat.  If I’m not, I don’t.  That’s one of the things I really love about this way of eating; I can finally tell the difference between actual hunger pangs, and the times when I just want to eat for other, usually mental, reasons that have to do with true hunger.

If you want to learn more about fasting and how to do it, you can check out The Complete Guide to Intermittent Fasting by The Keto Diet Blog.  There are many other resources out there too (say it with me, google is your friend), but the Keto Diet Blog’s is pretty informative.

keto fasting

 

You get to eat bacon wrapped everything.

There’s nothing you can’t add bacon to!  Need I say more?

bacon many ways

Vegetarians can join in the fun too!

By the way, if you are vegetarian or vegan, there is a way you can try low carb and still participate in Keto.  I don’t follow it, obviously my love of bacon prevents that, but you can always check out these helpful sites for more information: Reddit/VegetarianKeto, 2 Week Vegetarian Keto Diet Plan, Keto for Vegetarians, and Low Carb Dieting for Vegetarians/Vegans.

 

And now, that brings us to… dun, dun duuuuuuuuun…

Cons

As with any diet, there are cons to this one too.  As I mentioned above, if you have any known health issues and are on medications, I strongly recommend asking your doctor before starting this diet.  You never know how a reduction in almost all carbs could affect your meds.

Keto Flu

Keto flu can hit you if you’re not making sure you get enough electrolytes, which are vastly different than what you would need on a regular carby diet.  Keto flu symptoms can vary, but usually consist of: headaches, brain fog, fatigue, muscle spasms, difficulty sleeping, and heart palpitations.  Experiencing these can, of course, make you want to rethink the whole keto thing.  However, if you make sure to get the right electrolytes, and stay on top of them, you should be able to avoid them.  And if you do experience them, make sure to replenish your electrolytes, you are probably low.

electrolytes

There are three biggies that are recommended: sodium, potassium, and magnesium.  This may sound a little scary, as the requirements will seem kind of high, but there are reasons for the amounts.  The minimum daily requirements are:

3000 – 5000 mg of sodium
3000 – 5000 mg of potassium
300 – 400 mg of magnesium

Again, I know ingesting 5000 mg of sodium can seem frightening, but when you eat low carb, your sodium is released rapidly through your kidneys and gets flushed out of your body.19  It’s important to make sure you get enough sodium to compensate for this flushing.  Don’t be afraid to salt your food, and if you like, heavily salt it.  You can also drink bone broth and make your own electrolyte drinks (recipes coming soon, but google is your friend).  And, um, I recommend spreading the salt out throughout the day.  Ingesting too much at once can have a diuretic affect.

Potassium level needs seem to vary person by person even on a regular diet, and sadly it seems most people are low on it.20   It can be even more difficult for someone on a low carb diet.  After all, bananas are out, right?  They’re too high in carbs.  Well, there are actually many foods you can eat to increase potassium: all meats, avocados, nuts, salmon, mushrooms, dark leaf greens, broccoli are all potassium rich foods.  If you find you’re having trouble getting enough potassium though, you can also take a potassium supplement.  In addition, you can use Lite Salt in place of regular table salt (available next to regular salt in the spice aisles).  A quarter teaspoon of Morton’s Lite Salt contains 360 mg of potassium and 290 mg of sodium.  I exclusively use Lite Salt in place of table salt now.

Magnesium is also commonly deficient in most people.  Symptoms of poor magnesium intake can include muscle cramps, facial tics, poor sleep, and chronic pain.21 Magnesium can be found in fish, artichokes, nuts, cacao powder, dark chocolate, and dark leaf greens.  If you find you’re having trouble getting enough magnesium, you can also take a magnesium supplement.  I actually do recommend this since it is believed that most people don’t reach minimum requirements through food.  Most ketoers recommend magnesium citrate as it’s easier to absorb than other variations.  It is also recommended that you take magnesium before bed as it can help improve your sleep.

Along similar lines, drink water.  Lots and lots of water.  Low carb diets dispel fluid from your body rapidly, so it’s necessary to make sure you’re replenishing your water often.  Basically always have a glass of water in hand… and yes, you will be peeing a lot, plan accordingly for long trips.

If you’re wondering how you’re going to know if you’re getting enough electrolytes, you can track most nutritional data at myfitnesspal.  They also have apps for your phone and tablets that connect to their website so you can access your info from any device.  The only thing I’ve found that they don’t track is magnesium so you’ll want to either plan ahead so you know you’ve taken enough for the day, write it down in a journal or binder, or just try to mentally calculate as you go throughout the day.  There might be other apps out there, but I mainly use myfitnesspal for tracking needs as that’s the only issue I’ve found with it so far.

Confusion with ketoacidosis

Something that people tend to become confused on is that ketosis is the same as ketoacidosis.  It’s NOT!

ketosis ketoacidosis

As previously discussed, Ketosis is a metabolic process that occurs when the body does not have enough glucose, and stored fats are broken down for energy.

Ketoacidosis happens when ketones are present in addition to a complete lack of insulin in the body, mainly this happens in someone with Type 1 Diabetes (for this reason, many have tried to stress the importance of calling it diabetic ketoacidosis (DKA), to help differentiate it from ketosis).  Without insulin, blood sugar continues to rise, but the body thinks it’s starving because there is no insulin to transport the glucose to their cells.  So the body, not recognizing there is glucose present, also creates ketones and it can’t stop.  The rising combination of ketones and high blood sugar create a very toxic acidic state in the blood that can be fatal if not treated in time.22

Hopefully I haven’t caused anyone any concern.  Diabetic Ketoacidosis is not actually possible in a person that can produce insulin, even if it’s only in small amounts.  In ketosis, “the brain shifts from being primarily dependent on glucose, to being primarily dependent on beta-hydroxybutyrate.  This has nothing to do with what a diabetic patient is experiencing in DKA, but does illustrate how poorly informed and quick to react the medical community is.   DKA and nutritional ketosis (or keto-adaptation) have as much in common as a house fire and a fireplace” (P. Attia, MD, 2012).23

Sugar/Carb detox.  The struggle is real.

So, this is totally going to be a case of do as I say, not as I do.  I cheat, kind of often.  And I really really don’t recommend it.  But I’m not going to lie, it’s really really hard stay away from sugars and carbs if it’s right in front of you.  Hell, it’s hard even if it’s not.

Your body is basically going to throw one hell of a tantrum and demand sugary carby goodness stuff, now.  And I mean NOW!

cake baby

I wish I could be more help with this, as I fail miserably at times.  All I can say is power through it if you can.  The longer you go, the easier it gets.  But if you do cave, don’t beat yourself up about it.  Just keto on, as they say.

Also, it helps if you can remove all temptations from your home before you start keto.  You may think you got this and you won’t have any problems; but I promise you, there will come a moment where you will be looking in every nook and cranny of your cupboards and fridge for something, ANYTHING, sweet (or potato chippy)!

empty out the pantry meme

You’ll also have to deal with everyone around you still eating carbs, and insisting one meal isn’t going to hurt you.  It won’t, but cheating brings on more cravings which can spiral into more cheating, and before you know it you’ve been out of ketosis for a damn week.

Planning and prep

Unfortunately, Keto is not the easiest to just think about one day and decide to start the next.  It really does require a lot of planning and prep.  For one you’ll want to make sure you have a lot of keto friendly foods on hand, and ideally, you’ll want to write out a week’s worth of meal plans ahead of time.  See this post on some keto friendly foods I try to keep in stock.  I take about two hours every Saturday to plan my meals for the week.  Once you get into the flow of things, you will probably be faster though (I’m really slow).  Look online for keto/low carb friendly recipes to help in your planning.

In addition to planning, food preparation will probably increase, especially if you used mainly already prepared/packaged foods prior to starting.  I can spend anywhere from 30 mins (not bad) to 2 hours (yikes!) making a meal.  I purposely plan only one or two time consuming dishes a week, and the other days I try to keep it simple with chicken and broccoli (with cheese!) or pork chops and caulimash, both around the 30 min mark.

To make your first few weeks easy, I am working on a few weeks of plans and recipes to post.  But if you want to get started sooner, there are several sites that can get you going with really good weekly plans.  I highly recommend Keto Diet Blog, Ruled MeI Breathe I’m Hungry, and Caveman Keto, but there are many others that a google search will pull up.

keto diet blog meal plan

Take Away

Ultimately the decision to start any diet plan (or not) is up to you.  However, I hope that this post adequately explained the major pros and cons of a ketogenic diet, and was able to answer some questions you might have had.  If anyone has any questions I didn’t answer, or maybe I created more, please feel free to comment below.  I will do my best to answer your questions or at least point you in the right direction.

Now if you’ll excuse me, I hear some bacon calling my name.

Please don’t mind the mess.

Jessica Signature2

 

 

 

If you enjoyed this post, I’d be grateful if you’d help me by emailing it to a friend, or sharing it on Twitter or Facebook.  Thank you!

 

 

References

  1. http://www.ncbi.nlm.nih.gov/pubmed/23651522
  2. http://onlinelibrary.wiley.com/doi/10.1038/oby.2006.277/abstract
  3. http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-1-12
  4. http://www.ncbi.nlm.nih.gov/pubmed/18046594
  5. http://jn.nutrition.org/content/136/2/384.short
  6. http://jama.jamanetwork.com/article.aspx?articleid=207954
  7. http://circ.ahajournals.org/content/111/5/e89.full
  8. http://www.dietdoctor.com/blood-pressure
  9. http://www.utsouthwestern.edu/education/medical-school/departments/center-human-nutrition/research/projects/insulin-resistance.html
  10. http://www.niddk.nih.gov/health-information/health-topics/Diabetes/insulin-resistance-prediabetes/Pages/index.aspx
  11. http://link.springer.com/article/10.1007/s00125-002-1009-0
  12. http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html
  13. http://epilepsycurrents.org/doi/pdf/10.5698/1535-7511-11.3.88
  14. http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html
  15. http://www.pnas.org/content/97/10/5440
  16. http://www.ncbi.nlm.nih.gov/pubmed/18469287
  17. http://www.andjrnl.org/article/S0002-8223(05)01151-X/abstract?cc=y
  18. http://www.ncbi.nlm.nih.gov/pubmed/17228046
  19. http://www.ketogenic-diet-resource.com/low-carb-dieting.html
  20. http://www.webmd.boots.com/a-to-z-guides/low-potassium-hypokalaemia
  21. http://www.ancient-minerals.com/magnesium-deficiency/need-more/
  22. http://eatingacademy.com/nutrition/is-ketosis-dangerous
  23. http://eatingacademy.com/nutrition/is-ketosis-dangerous
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