The rapidly growing menace of overweight and obesity arising from the westernisation of our meals and sedentary lifestyles has brought with it the increased incidence of diabetes, high blood cholesterol levels, hypertension, kidney disease and fatty liver disease.
This has also brought into sharp focus the need for lifestyle modification, including dietary modification and exercise in order to stay healthy.
The desperation in losing weight to change health outcomes leads many to try many diets. The desire to lose weight rapidly with very little effort has led many attempting any new diet that comes up - from the Paleo diet to the Mediterranean diet, the Dr diet to the blood group diet and now to Atkin’s Ketogenic diet.
Many of these dieting regimes have come and gone only to resurface at a later date in different countries.
In Ghana now, the blood group diet, with its attendant challenges, is gradually giving the stage to the latest diet in town: The Ketogenic diet or keto-diet. This diet, like many others, originated from the United States of America in the 1970s when the obesity epidemic was at its peak and attention had been brought to it as a potential public health problem. It seems as though Ghana is gradually getting to that level, especially in its urban and peri-urban areas. Hardly a day goes by without a dietician being asked if it is okay to go on a ketogenic diet and requesting to be put on such a dieting regime.
This is why I have painstakingly done extensive research on peer–reviewed articles, as well as meta-analysed articles, to help our countrymen and women with an objective position on what the advantages and disadvantages of the ketogenic diet are.
A ketogenic diet in simple terms is a low carbohydrate, high fat and normal protein diet that reduces the reliance of the body on glucose and turns more to fat for the supply of energy. When carbohydrates are eaten, they are digested into smaller molecules known as glucose which are stored as fat in the liver when in excess of what the body needs. This leads to fat accumulation in the liver and results in a non-alcoholic fatty liver, as well as a fat build-up on other parts of the body.
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In a person on a keto-diet, due to the drastic reduction in carbohydrate (about just 50g carb) intake a day, the body does not store up fat in the liver. It rather breaks down all glycogen (stored glucose) and fat in the liver for the body to use. After this, it then relies on and metabolises the high fat taken in rapidly to provide energy for the body. This leads to the accumulation of ketones.
In the short term, a ketogenic diet is known to lead to rapid weight loss, improvement in insulin function leading to the control of blood “sugar” levels, correction of non–alcoholic fatty liver disease, reduction in triglyceride and total cholesterol levels and the reduction in size of LDL (bad cholesterol) levels but not quantities.
The resultant weight loss is theorised to be due to the suppression of appetite, easy satiety from proteins and fats, as well as the high-energy expenditure involved in the metabolism of fat for energy production. Weight loss as with keto diets is thought of as being very effective between eight and 12 weeks. Some studies even pushed it up to 18 weeks, after which there it difficulty in compliance and a possible rebound in weight gain. It is also known to be good at preventing seizures in epileptics and improvements in many neurological conditions such as Alzheimer’s disease, Parkinson’s disease, myasthenia gravis and multiple sclerosis. This is what currently in Ghana we mainly use the Keto diets for.
The concerns for many have been with the long-term effects of headaches, kidney stones, dehydration, osteoporosis, dizziness and dyslipidemia (out-of-control blood fat levels) due to the intake of a bit more protein. This is associated with high uric acid levels, depletion of calcium and increased need for water.
A Ketogenic diets is, therefore, thought of to be problematic and not sustainable in the long term. The benefits, however, in the short term are real. The question arises as to if we want a weight loss which is a quick fix that may not be sustainable or one that is gradual but possible to inculcate into a lifestyle change that can be continued for the long haul without looking back on any possible side effects over time.
Another question is whether it is more about low calories or low carbs? If we arbitrarily take high fat and protein way beyond what our body needs, the rebound weight gain is also real. High carbohydrates, especially refined carbohydrates, as are in pastries, polished cereals and grains, roots and tubers etc. are definitely not good. Reducing them to an appreciably low level and ensuring that we have complex (with fibre) forms of those is in no doubt beneficial.
Which fat is better to take? The scientific world is inconclusive in their support to the proponents of high saturated fats consumption as being safe. It is, however, conclusive that polyunsaturated fats such as in nuts, seeds and oily fishes are safe. It should, therefore, make sense that even if you would want to increase your fats intake, they should be on these generally accepted to be safer ones.
So a proposition of a modified ketogenic diet, which is also the well-balanced diet, with reduced carbohydrates (whole grains and cereals), adequate “good” fats, moderate saturated fats, adequate proteins and high fibre (vegetables, fruits), is the most plausible way, in my view, to maintaining a good balanced health that reduces the risk on disease onset and can lead to the loss of appreciable weight over time. You do not want to, in the long term, create another problem while solving one.
Why sit aloof and allow weight gain to get to an uncontrollable level where you will have to do something as drastic as a keto-diet to lose weight? Taking just adequate complex carbs, coupled with the right quantity of good fats (poly unsaturated fats) and adequate proteins puts one at no risk of cancers, diabetes, high cholesterol, fatty liver etc. Definitely, refined carbohydrates or any nutrient for that matter taken in excess of what the body needs is not healthy to do. A perpetual or back and forth ketotic state can in no way be a healthy thing as is in the ketogenic diet.
Some still believe that it is possible to have your cake and eat it by doing a short-term keto-diet for about a month or two and maintaining weight with a reduced calorie balanced diet without rebounding. To them, I can only wish well and ask that this should be done with supervision of your dietician.
Balance and moderation with exercise will continue to be the time tested, unchanging words of healthy eating while every new diet craze will come and pass.
Life is precious, so eat to live.
The writer is a Dietician / Lecturer (UHAS)
For Ghana Dietietics Association (Media and Apologetics Committee)