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Safety Concerns about the Ketogenic Diet and Ketones
I loved my keto diet. And, no, love is not too strong a word. Like iodine and organics, kombucha and tabatas, it served me well. I was on the ketogenic diet for just over 2 years: my energy improved, focus was better than it had been in years, sleep much improved, and I lost 19 pounds and 2 inches from each of the 3 major circumferences.
I did stop the diet because I found a lifestyle diet that was better for me and easier to maintain. Getting and staying in ketosis is the challenge and it is a constant challenge. There are other considerations, too, and it's very individual!!! Some people do GREAT on keto forever. As a short term "reset" diet, I think it can be awesome. I just found a better way for ME!
Definitions (so we are speaking the same language)
keto: short for ketogenic
ketosis: when your body is burning fat for fuel
sugar stored: your body stores sugar as glycogen in the liver
sugar being burned: glucose (when your liver releases it into your bloodstream to be used for fuel, it's now glucose)
sugar as food: ALL carbs turn to sugar in your body. Even broccoli. A vegan diet is basically a high-sugar diet.
The ketogenic diet looks a lot like Atkins, only keto is a huge improvement. Here's the shortcut version: to go keto, you eat high fat (approx 40%+ of your calories), high protein (40%+), low carb (5-10%).
Used to be that keto was high fat, like 75% high fat. But no more: it's now high fat/high protein. For one thing, if you eat too much fat, your body will burn the fat in your stomach before it burns stored fat. Oh no you don't!!!
The critical factor is the carb count: it's gotta be LOW. You can actually do higher fat or higher protein as long as carbs are under 30 grams a day!
Once your carb intake is low enough, your body switches your fuel supply from glucose to fat.
This is because your body runs out of glucose and needs more fuel so it turns to the stored fat.
Your body metabolizes your adipose tissue (a polite way of saying FAT) via your liver, producing "ketones" in the process which are then released into your bloodstream. When there are ketones in your bloodstream, we call this "being in ketosis."
Your muscles and brain use these ketones for fuel.
Essentially, you are in ketosis every time your body runs out of glucose... So if you don't eat for 10-12 hours (think Intermittent Fasting), your body is going to run out of glucose and turn to fat. Basically we all wake up in ketosis!
Ketones are a much longer burning, higher quality fuel than glucose. Sugar burns out fast, like kindling. When it's gone, you crave more fuel, usually in the form of carbs which turn to sugar in your body... which burns out fast. it is truly a vicious cycle!
Interestingly, we humans are born in ketosis, born fat-burners. Somewhere along the way, we become sugar burners!
Here's a correlation for you. I don't know if you've noticed, but Americans are FAT. As a woman who's battled her weight all her life (shopping in the Chubbettes at 6yo, ya'll), I know that misery. The only reason I'm not huge today is because I had a "come to Jesus" health crisis. It scared the crap outta me and my family. When I got well enough, I started learning about health, fell in with the Weston A Price Foundation, then started implementing everything I learned.
Today, as a functional health practitioner and health blogger, I'm committed to doing and sharing what works. Like...
High fat diets are healthy.
Sugar is poison.
Low carb diets works and, for most people it seems, are a healthier option than following the carb-heavy food pyramid. And I'm not the only one saying so.
As you read the links below, you'll find there are many, many, MANY other advantages to being in ketosis than just weight loss. That's like the minor miracle.
Before I started the keto diet, I spent hours researching it. I bought books, watched videos, followed bloggers and youtubers... I'm a little OCD when it comes to research. I like to know what I'm getting into.
I looked for all the warnings re. the keto diet, ketosis and ketones. There are almost none.
On the flip side, I found -- and continue to find -- more and more people singing its praises, specifically of the therapeutic benefits of having ketones in your bloodstream.
I'm thinking we're on to something.
Safety Concerns for All Things Keto
I can find no evidence of inherent dangers to the ketogenic diet, ketosis or ketones.
Here’s a PubMed study on the long-term effects of a ketogenic diet on obese patients. The conclusion states:
“The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated.”
The three topics of concern I did find are:
Most people confuse ketosis with ketoacidosis;
The myth that ketones are bad for kidneys;
Whether or not a person can eat too low carb.
Ketosis vs. Ketoacidosis
A LOT of people (including doctors) confuse ketosis with ketoacidosis. Ketoacidosis IS dangerous. However, it would be darn near impossible to get from ketosis to ketoacidosis if your pancreas is still producing insulin. Any insulin at all!
Here’s an article from one of my favorite keto bloggers, Dr. Peter Attia, on the topic of keto vs ketoacidosis.
Heck, ask the Diabetes Warrior about high fat/protein, low carb diets. He's been helping people effectively cure their diabetes for years with that diet. He's so good, the state of NC tried to shut him up. That's my standard: if the authorities want to shut you up, you must be doing something right. Authorities lost, by the way.
Ketones 'n Kidneys
Kidney stones, to be exact. No laughing matter! Here are the facts, then you can decide if ketones are right for you.
For decades, the ketogenic diet has been used successfully with epileptic children. Over 50% of kids on the diet experience relief. Some kids experience complete relief, meaning no more epilepsy!
However, between 5-8% of kids developed kidney stones. Most of these were easily resolved with potassium citrate, either prescribed or with lemonade. It's important to note that there has been no attempt to correlate the kids' kidney stones with any other health concerns or diet. It was just noted that a very small percentage of the kids in the study developed kidney stones. This is one of those "uncontrolled variables," the bane of a researcher's life. But there it is.
Now, while no studies have been done with adults, it might be prudent for anyone with the risk factors for kidney stones to proceed with an eye open.
Interestingly, the #1 risk factor for kidney stones is not drinking enough water!!! The ketogenic diet is diuretic in nature so any good direction on going keto will tell you to drink lots of water, more than normal.
Here’s Robb Wolf on the topic of ketones and kidneys.
Low Carb vs. No Carb
You can find so much discussion on the pros and cons of going very low carb (VLC). Oy vey, no room to even begin with it here. The bottom line with carbs is that there is no human physical requirement for them. We just really like them!
In fact, this was a big factor in my decision to move away from the keto diet to one a bit higher in carbs. I feel better with carbs in my diet. I started to feel a little "starved" on the keto diet and I don't do well feeling starved. This is not an indictment of the keto diet, just my personal experience!!!
As far as diets go, the weight-loss sweet spot for carbs is below 30 net grams per day. To maintain weight, you can eat 70-100 net grams of carbs a day. (To figure net carbs for a food, take total carb grams minus fiber grams. That's your net carb grams.)
Ketones for Health!
Just today, I listened to Dr. Mercola and Dr. Thomas Seyfried discuss mitochondrial dysfunction as possibly being the root of all disease, and the role of ketones in healing it! (If you follow me on Facebook or Twitter, you'll see what I'm learning.)
Research has consistently proven that ketones have benefits for fitness, fat loss (not just weight loss, but fat loss), focus, improved energy, muscle retention, treating epilepsy, cancer, diabetes, MS, auto-immune disease -- too many dysfunctions to list. In fact, do an online search for "[any malady] keto" and see what you get.
Taking Exogenous Ketones
Exogenous means created outside. Exogenous ketones are created in a lab and you drink them (most of the exogenous ketone products on the market are powders that you add to water).
Endogenous means created inside. When you are eating a keto diet, your body CREATES endogenous ketones as the result of fat-burning.
The critical distinction between exogenous and endogenous ketones is in the area of fat-burning.
Exogenous ketones have NOTHING to do with fat-burning. They don't promote fat-burning in your body (despite what promoters may lead you to believe).
Whereas endogenous ketones are the RESULT of fat-burning! See the distinction?
Now, there are lots of benefits to having ketones in your bloodstream, whether you add them or create them. For instance, increased energy, focus, appetite suppression, good for brain health (all of which I get with my current eating plan.)
But, again, exogenous ketones DO NOT promote fat-burning.
If fat loss is your goal, drinking ketones won't work alone.
I drank Keto OS for almost two years. I loved the nice caffeine rush, lol. And the appetite suppression factor was helpful when starting on my weight loss journey.
But there are too many things I don't like. The big one is that it does NOT contain healthy ingredients. And it's basically a one-trick pony and the trick got old.
Not wild about the marketing either. It's very slick and leads one to believe that ingesting ketones helps you burn fat. Not true. It does suppress appetite which is helpful to a point when it comes to weight loss. But it does not promote fat loss.
I still have friends who drink it. But, like I said above, I've found something that works much better for me. All told, I've lost 35 pounds and I'm so much healthier because of it.
Questions, suggestions, comments?
Please ask -- I'd love to help if I can!