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How safe is the ketogenic diet?

Is the Ketogenic Diet (KD) safe? That’s the question WebMD recently posed to its readers.

The simplistic answer, according to the website, is “people use a ketogenic diet most often to lose weight, but it can help manage certain medical conditions, like epilepsy, too. It also may help people with heart disease, certain brain diseases and even acne, but there needs to be more research in those areas.”

Let’s add to the list certain forms of cancer and polycystic ovarian syndrome (PCOS).

Type 1 diabetics need, in my opinion, to be under medical supervision, if they elect to try the KD — due to the potential for excessive build up ketones and the associated lower pH (acidity).

According to Mignonne Mary, an internal medicine physician and medical director of the Remedy Room in New Orleans, “a ketogenic diet is not advised for children, who are still growing or for people, who are significantly below normal body weight or who are nutritionally compromised.”

Korean researchers — writing in the December 2018 online journal Nutrients — Two-Week Exclusive Supplementation of Modified Ketogenic Nutrition Drink Reserves Lean Body Mass and Improves Blood Lipid Profiles in Obese Adults: A Randomized Clinical Trial — commented that “although there is no standardized ketogenic diet therapy, it can be classified as a diet with a carbohydrate intake of less than 10 percent or a total daily carbohydrate intake of less than 30 grams.”

When a person goes on the KD, glycogen (sugar) stored in the liver is depleted, resulting in losses of water and body fat. One gram of body fat has an associated 1.12 grams of bound water, with protein and carbohydrate both at the 4-gram level.

As the liver and muscle glycogen is depleted due to a restricted carbohydrate intake, the body turns to lipolysis (breakdown of fat), which in turn generates ketone bodies for energy, replacing glycogen, as an energy source while causing a diuretic effect of sodium and water.

A possible downside of the KD has been the potential for protein (muscle) loss, by the process of gluconeogenesis — how the body makes glucose from non-carbohydrate sources. However, newer research tends to disprove this potential loss of metabolically active muscle tissue for energy.

It appears “low-carbohydrate diet therapy has been reported to reduce body fat and maintain fat-free mass, which is partially a response to the decrease in plasma insulin,” according to 2012 research — Therapeutic Potential of Ketogenic Diets.

As to potential side effects of the KD, Mary commented that “as people adapt to burning fat for fuel rather than burning sugar, they might feel a series of symptoms known as the ‘keto flu.’

“This includes fatigue, headaches, irritability or even flu like symptoms but most people feel better after two or three days. In addition, the kidneys become more efficient at releasing excess fluid, leading to dehydration, so it’s important to stay well hydrated.”

One side benefit of the KD is hunger control “by reducing the appetite-regulating hormones ghrelin and leptin.”

Ketogenic food choices include meat, fatty fish, eggs, butter and cream, cheese, nuts, seeds, healthy oils, avocados, low carbohydrate veggies, herbs and spices. Foods to avoid include sugar, grains/starches, fruit (expect small portions of berries), beans/legumes, root veggies, low fat diet foods and sugar-free foods.

The obvious question is how long can a person stay on the diet?

“While the ketogenic diet is an excellent tool to reduce inflammation, lose weight, increase energy and stimulate cellular healing, the key to long lasting success is diet variation,” Mary said. “This is when we vary our diet in order to take advantage of the body’s innate ability to adapt. A ketogenic diet for prolonged periods of time without any variation can lead to increased production of sugars from the liver, which will lead to poor results.”

It’s best to check with your physician first.

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