The ketogenic diet is a low carbohydrate, high fat diet that provides substantial amounts of protein. Although it has recently gained a great deal of popularity, the keto diet has been used for treating various illnesses for thousands of years. Ketogenic diets and similar versions have been traced back as far as 500 BC. In 1910, the first studies were performed on fasting as a treatment for epilepsy in France. It was concluded that seizures ceased completely during fasting. Later studies revealed that starvation enhanced mental activity significantly. However, fasting cannot go on indefinitely.In 1924, Dr. Russell Wilder at the Mayo Clinic developed a treatment plan for patients with epilepsy using a ketogenic diet. He had previously used it to prolong ketosis in diabetic patients. Around the same time, physicians at Johns Hopkins Department of Pediatrics, Howland and Gamble, noted that “prayer, a water diet and three to four weeks of fasting” reduced seizures in one pediatric patient. The diet became commonly prescribed treatment for epilepsy by the 1930s. A study performed by Dr. Livingston at Johns Hopkins found that 1000 patients following a ketogenic diet confirmed that their seizures were under control. Treatment using ketogenic diets began to decline with the development of anti-seizure medications.

What is Keto?

Keto is derived from and commonly used to refer to the word ketone. A ketone is an organic compound composed of a carbonyl group bonded to two hydrocarbon groups. There are many different types of ketones including sugars. In the body, ketones are produced when fat is broken down to supply energy. They are essentially small fragments of carbon. Typically, the body gets energy from carbohydrates in the diet. If there is a deficiency in carbohydrates, the body will begin to break down stored fat. Blood tests are often administered to determine ketone levels in the blood of diabetics. Urine tests are also frequently used to monitor ketone levels in those with diabetes, eating disorders or people on a ketogenic diet.

How Does a Ketogenic Diet Work?

The body has three energy sources: carbohydrates, fats, and protein. Carbohydrates are found in sugars, starch and flour. There are two types of fats: saturated fats that primarily come from animal products and unsaturated fats that are found in plants. Protein is mainly provided by meats and fish. A chemical reaction takes place between the oxygen in the body and carbohydrates, fats, and proteins. This produces energy as well as waste products such as carbon dioxide and water. Each of the three is metabolized in the same manner but carbohydrates are burned first, followed by fats, and then protein.

There are two types of carbohydrates: simple and complex. Simple carbohydrates are one to three sugar molecules linked together. There are two types of simple sugars: monosaccharides such as fructose, galactose and glucose and disaccharides which are formed from two monosaccharides. Disaccharides include lactose, maltose and sucrose. Complex carbohydrates consist of three or more sugar molecules linked to form a chain. Simple carbohydrates are metabolized first because they enter the blood stream very quickly. Complex carbohydrates are metabolized much more slowly, providing a sustained yet less dramatic increase in energy. Any carbohydrates that aren’t used are either stored in the liver as glycogen or converted to fat.

Fats are made up of long chains of carbon atoms. The body stores fat naturally. Its primary purpose is energy storage. When insufficient carbohydrates are available, fats are broken down to supply carbon needed for energy production. Fats are metabolized much more slowly than carbohydrates and are not as efficient at providing energy.Proteins are composed of one or more chains of amino acids. They are primarily used to build and replenish the body with vital structural components such membranes, hemoglobin and cardiac muscle. Protein is rarely used for fuel. In the absence of carbohydrates and fats, muscle will be broken down to provide protein for energy production.The average western diet consists of approximately 5 to 15 percent protein, 10 to 20 percent fat and 65 to 85 percent carbohydrates. Any of the three fuels that are not used for energy production will either be excreted or stored as fat. In a ketogenic diet, the percentage of carbohydrates is substantially decreased and fats are increased. The caloric intake is also limited to ensure the body maintains its preference for metabolizing fats. The ketogenic diet simulates starvation similar to fasting by eliminating carbohydrates and forcing the body to burn fats. As the body metabolizes fats, ketones are produced. This state is referred to as ketosis.

What is Ketosis?

Ketosis occurs when the level of ketones in the blood becomes elevated. It may take 3 to 4 days after commencing the ketogenic diet before the body reaches ketosis. When ketone levels are elevated, the body will attempt to lower them by excreting them in the urine or breathing them out. A person in ketosis will often have a sweet, fruity scent to their breath due to the body expelling a ketone called acetone. Individuals experiencing ketosis also tend to feel less hunger. There have been conflicting views concerning the effects of ketosis on the body. Some experts claim that extremely high levels of ketones can be toxic. The blood becomes more acidic and it may damage vital organs such as the liver and kidneys. Others point to studies that provide evidence that ketosis produces no harmful effects even with prolonged use.

Ketogenic Foods

Ketogenic foods are low in carbohydrates, high in fats and low in protein. The amount of protein consumed is important. Over time, the body can become more efficient at converting protein to glucose. This can prevent the body from maintaining ketosis. Most keto foods are in their natural state since processed foods are often high in sugar and starch. Acceptable foods include whole meats, poultry, seafood and eggs. It is preferable to select meats from grass fed or wild animals with high fat content. The diet also includes natural fats such as butter, cream and coconut oil. A limited amount of mayonnaise, vegetable oils and olive oil may be consumed. Green leafy vegetables including lettuce, spinach, kale, collards and cucumbers good keto food as are high fiber vegetables such as broccoli, cauliflower and cabbage. Some sweeter vegetables such as tomatoes, peppers and summer squash are allowed but must be limited due to sugar content.

Weight Loss

Although controversial, ketogenic diets are frequently used for weight loss. A study performed in 2006 compared ketogenic diets with nonketogenic diets used for weight loss. It was concluded that nonketogenic diets were as effective as ketogenic diets and that the risks associated with ketogenic diets were not warranted. Other studies have found that ketogenic diets were not only effective for weight loss but included additional health benefits. Low carbohydrate diets lower the amount of triglcerides in the blood and may help reduce the risk of heart disease. Keto diets also increase the level of high density lipoprotein (HDL). HDL is responsible for the removal of cholesterol from the body. Higher HDL levels can help reduce the risk of heart disease as well. The diets are an effective means of lowering blood pressure and can decrease the probability of stroke, kidney failure and other diseases.

One of the key factors in the success of keto diets for weight loss is the suppression of appetite. The main reason most people fail to stay on a diet is hunger. Those who follow a ketogenic diet feel hungry less often. As a result, they not only consume fewer calories but find it easier stay on the diet. In addition, keto diets have been found to reduce the amount of fat in the abdominal cavity more effectively than other diets. This can substantially reduce the risk of metabolic disorders.

Athletic Performance

Athletes who desire improved performance over prolonged periods have found that keto diets can improve aerobic efficiency and increase the anaerobic threshold. The diets provide metabolic flexibility that can enhance endurance in an aerobic environment. This has helped many triathletes, marathon runners achieve peak performance. Bodybuilders have found the keto diet especially useful for cutting. It allows them to eliminate fat from the abdominal region without sacrificing muscle.

Cancer Treatment

Ketogenic diets have begun to be used for treatment of cancer. Cancer cells rely on glucose to sustain their metabolism. In the absence of carbohydrates, the body will adapt to burn ketones that are produced in the breakdown of fats. Cancer cells are unable to use ketones for energy. Therefore, a diet that eliminates carbohydrates and sugars will essentially starve the cancer cells. One case was reported in 1995 where a ketogenic diet was used to treat two girls with brain cancer. The blood glucose levels and glucose uptake at the cancer site was decreased by 21.8 percent after 7 days of commencing the diet. One showed substantial relief of symptoms, and progression of the disease was halted for 12 months. Research of ketogenic diets for cancer therapy is ongoing.

Controlling Diabetes

Ketogenic diets are used to treat patients with type 2 diabetes. Carbohydrates are broken down into simple sugars, primarily glucose. As sugars enter the bloodstream and levels become elevated, insulin is released. This prompts cells to begin either burning or storing excess glucose. In healthy people, this quickly minimizes a blood sugar levels that would otherwise become toxic. In people with type 2 diabetes, the cells don’t recognize insulin, making it difficult to control blood sugar levels. This is referred to as insulin resistance. Keto diets reduce blood sugar levels and lower insulin levels.

Precautions

People should be made aware of the side effects of ketogenic diets. Constipation is a common problem. Most have found it treatable and it has not been a cause to discontinue the diet. Hypoglycemia may require some adjustments to diet. Hypercholesterolemia may occur in people who are unable to metabolize fat efficiently. Mineral supplements are often helpful in correcting this problem. In the event the condition persists, the diet should be discontinued. Hyperacidosis may occur if ketone levels rise too high. This usually occurs from dehydration and treatment typically involves re-hydration. The diet has been known to contribute to osteoporosis. Vitamin and calcium supplements should be a part of the nutrition plan to lower the risks. Kidney stones may develop in ketogenic diets that restrict fluids. This condition should be treated by a physician. Pancreatitis may occur in individuals who cannot process large amounts of fats in their diet. Pancreatitis is fatal, and the diet should be stopped immediately.