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To Keto or not to Keto



Of the many things I advise my patients, I most frequently tell them they have to maintain a healthy weight.

If you are overweight or obese, losing 5 percent of more of your current body weight in one year has numerous health benefits and helps with reducing the risk of having high blood pressure, heart disease, kidney disease and diabetes.

The next question my patients ask is usually about what they should or should not eat to lose weight, and my answer is simple: “Just eat less.”

Weight loss is directly related to the difference between an individual’s energy intake and energy expenditure. In other words, if you eat less and burn more calories than you consume, you will lose weight.

The general consensus is that excess intake of calories from any source and a sedentary lifestyle causes weight gain and obesity. And the best way to take the weight off is a combination of diet, exercise and modifying one’s behavior.

A major part of this is reducing caloric intake. If you cut out 500 calories per day for one week you can lose one pound a week.

So what does 500 calories look like? Five hundred calories is 2.5 cups of rice, or 2.5 16-ounce bottles of regular soda (that you really shouldn’t be drinking anyway), or four pieces of pandesal, to give you a few examples.

But what about cutting out certain types of food all together? You hear about diets that are low-fat or low-carbohydrate diets, or high-protein and high-fat diets. South Beach, Atkins, Paleo, Dukan, The Zone… You’ve probably even tried a few of them yourself.

The more “in” diet now is the ketogenic or Keto diet. Some consider anything that is low-carbohydrate and high-protein as a ketogenic diet. But a true ketogenic diet centers on fat, which supplies as much as 90 percent of daily calories.

Instead of relying on glucose that comes primarily from eating carbohydrates, the lack of carbohydrates in a ketogenic diet forces your body to go into a starvation state where it relies on ketone bodies, a type of fuel that the liver produces from the breakdown of stored fat in the body.

The ketogenic diet actually isn’t a new thing. Since the 1920s, ketogenic diet therapies have been used in the treatment of children with epileptic seizures where the ketone bodies act on the brain to help reduce seizures. Then when anti-seizure medications were discovered, the restrictive keto diet was no longer necessary, but still used to augment seizure control in these patients.

With the dawn of the new millennium and the rise of social media, it was easy for the keto diet to regain popularity when bloggers began posting their success stories when they switched to the keto diet.

Restaurants started serving cauliflower rice and shirataki noodles which are low-carbohydrate noodles made from the konjac yam. Burgers were no longer sandwiched in between pieces of bread but lettuce leaves. People were now adding butter and virgin coconut oil to their coffee. They felt fuller longer and best of all, they were all losing weight.

Not for everybody

Another new kid on the block is intermittent fasting. There have been other names and versions before, like the 5:2 Diet, or the After Six Diet.

The latest reiteration is 16/8 where you fast for 16 hours and only eat during an 8 window period.

This uses the same principle of starving your body and forcing it to use your fat as a source of energy instead, and thus lose weight.

But these diets don’t work for everybody, and you only see and hear about the success stories — the ones with posts of before and after pictures because they lost 30 pounds they lost in two months, bikini selfies and people wearing clothes now several sizes too big for them.

No one posts a photo of themselves if they haven’t lost any weight. You don’t hear about the patient whose LDL or “bad” cholesterol went through the roof after three months of being on keto. You don’t tweet about your kidney function being affected. You never see the patient who developed fatty liver disease.

I’ve seen patients with all these issues and more after embarking on a fad diet, or the ones who gained all of the weight back. I once had a patient on intermittent fasting who actually gained weight instead of losing it.

This is an example where a little science in the wrong hands can be a dangerous thing. She followed the 16/8 regimen but ate more than a whole day’s worth of food during the eight hours she was allowed to eat.

We all want magical, instant results when we go on a diet. I remember the three-day diet where it was guaranteed that you would lose 10 pounds in three days. If you only ate three small meals a day which included just a 100-calorie pack of crackers and half a cup of cottage cheese for lunch, you would probably lose weight. But then after the diet was over, you would go back to your regular eating habits and gain the weight back.

With quick weight loss diets which include very low-calorie diets (less than 800 calories per day) or diets where you take only liquids or soup (remember the cabbage-soup diet?), you will definitely gain it back after the diet ends. Fast-off… Fast-on. The recommended safe rate of weight loss is half a pound to 2 pounds a week. When you lose weight slowly, you are more likely to keep it off.

And the problem with “going on a diet” is that it denotes that the period of restricting your food intake will end. If one were to be successful in keeping the weight off, it has to become a change in the way you eat and in your lifestyle — not just for three days or one week or six months, but for always.

The truth is that most patients cannot sustain these fad diets anyway. And when these diets are compared the weight loss results are the same after six months no matter which diet was followed.

What is common though for all these diets is cutting down on the number of calories consumed.

If you want to try one of these new diets, discuss this first with your doctor. There are many groups, sites and bloggers on social media who tout the benefits of these diets and of course their amazing weight loss results, but your doctor is the best person to turn to because you may have some health condition where some diets might not be the right one for you. For instance, high protein diets can place more stress on your kidneys and should not be done by patients with chronic kidney disease. If you have uncontrolled diabetes, having increased ketone bodies can put you at risk for a serious emergency condition called diabetic ketoacidosis. Some diets can also lead to nutritional deficiencies if you do not get enough vegetables, fruits or grains and your doctor can help monitor and correct this.

Consult with your doctor regularly to be safe during your weight loss regimen and to keep an eye on your overall health.

A big portion of weight loss is really eating less. Here are some ways to make it easier:

1. As I’ve said before, cut out the sugary drinks or caloric beverages. They are unwanted calories and don’t keep you full anyway.
2. Portion control. If you eat out, share a dish with a friend or family member. Or have half already set aside for you to take home so you are not tempted to eat it all.
3. Quantity matters. For example, even if you switch from white rice to brown rice but eat a much larger serving of brown rice (meaning more calories), then you won’t lose weight. Or if you decide to eat bread instead of rice, know that 2-3 slices of bread are about the same amount of calories of a cup rice.
4. Pay attention to “calories per serving.” You may look at the package of something low-calorie like rice crackers that says 30 calories and end up eating all the crackers in the package, thinking it was only 30 calories for the whole bag when it actually says 30 calories per serving and there were 10 servings in the bag = 300 calories!
4. Self-monitoring. Weigh yourself regularly so you can keep track of your weight loss, or if your weight might be creeping up. Keep a record of your food intake – it might surprise you once you start writing everything down that you actually eat more than you thought.
5. Turn the TV off and put away the cellphone. Watching TV or using your phone while eating leads to mindless eating where the next thing you know your plate is empty and you do not realize it, leaving you unsatisfied and possibly leading you to eat some more. Take the time to chew and savor your food.

When you start losing weight, you should also realize that everyone is different and your rate of weight loss may be different from your friend or co-worker. Physical activity and exercise are ways to keep the weight off once you’ve lost it. And don’t be disheartened when people tell you that you are starting to look sick or haggard (these people will most likely be heavier than you). If you are feeling well and losing weight at an acceptable rate with healthier food choices being more active, then you are on the right track. If you are overweight or obese, achieving a healthy weight is what is best for you.