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The Ketogenic Diet

The Ketogenic diet has been used therapeutically for the last 100 years. Used since the 1920’s, it was the original form of therapy for reducing and controlling seizures in epileptics. During the 60’s the therapeutic potential of the ketogenic diet was recognised and expanded from a prescriptive treatment to include health conditions such as diabetes, weight-loss, acne, polycystic ovarian syndrome, neurological disorders, and some cancers.

Initially known as very-low-carbohydrate ketogenic diets (VLCKD) these diets surged in popularity and was widely known in the 70’s as the Atkin’s Diet.

Diets like the Atkins diet, VLCKD and “Keto” diets are commonly low in carbohydrates. Usually with less than 50 grams of carbs per day, this pushes the body into mimicking a fasting-like state. The standard Keto diet contains 80% fat, 15% protein and 5% carbohydrates.




What is ketosis

Ketogenesis is a natural process that your body falls into when all available glucose sources (derived from carbohydrates and sugars) have been used up for energy. After about 3-4 days, these stored glucose resources become exhausted and the body is forced to find another source of energy. Once the body runs out of carbs to burn, the next resource to burn is fat. Your body then switches to an alternative metabolic process known as ketosis, whereby fat is broken down and creates ketone bodies as an energy source. This is where the common term “fat burning” is derived from.

If one has a keen sense of smell, you can smell the characteristic “sweet”, or acidic breath which is caused by acetones being eliminated through the breathing. Ketones can also be detected in the urine.


Therapeutic rolls of keto diets

Weight loss

There is strong evidence that supports the keto diet as a form of rapid weight loss. Possible reasons for this include improved insulin markers,an increase in satiating properties due to higher fat intake and changes to the appetite regulation hormones leptin and ghrelin.

Ketone bodies are also known to have appetite suppressing actions. A review published in Obesity Reviews(2015)showed that studies have found that people strictly adhering to the ketogenic diet reported significantly less hunger and desire to eat, compared to the control group, including significant weight loss results.

Some researchers suggested that there is not a metabolic advantage in low carbohydrate diets and that weight loss is due to reduced calories. However, evidence shows that people on a low carbohydrate diet lose more weight within 3-6 months, compared to those following more balanced diets.


Acne

Acne has been linked to nutritional influences and certain food groups like dairy, sugar and high glycaemic foods such as refined carbohydrates. Many studies show that high glycaemic diets strongly influence acne through carbohydrates and glucose ability to affect hormones such as insulin, androgens and insulin-like growth factor-1 (IGF-1). Excluding foods groups that can dramatically fluctuate blood glucose levels and raise inflammation levels, would in theory, negate the negative effects of insulin mediated actions that drive the underlying factors of acne.


Type 2 Diabetes

As mentioned above, restricting the intake of carbs will have a direct impact on glucose levels, especially with individuals who have become insulin resistant. People with insulin resistance have fundamental challenges metabolising dietary carbohydrates and will divert most of the carbs to the liver where the majority will be converted to fat. Therefore, restricting the intake of carbohydrates in these individuals has been shown to improve glycaemic control, haemoglobin A1c, lipid markers and may lead to a reduced need for insulin stabilising medications.


Cardiovascular health

Several lines of scientific discussion have associated the keto diet to improved cardiovascular health. A randomised clinical trail on 53 health obese women following a very low carbohydrate diet and restricted calorie intake over 6 months showed that not only did the women in the VLCD group lose more weight and body fat than the control group, but their blood pressure, lipids, fasting glucose and insulin all remained within a healthy range. The study concluded that, VLCD are not associated with an increased risk for cardiovascular risk factors in health women. Further studies have implied that keto-like diets have a significantly positive effect on total cholesterol reduction and increases in high-density lipoproteins. However, while these diets have shown to be effective short term, ketogenic diets still raise concern with many physicians as long-term safety has not been proven.


What does the Keto diet include and exclude?

Ketogenic diets don’t just eliminate carbohydrates, but all sugars, whole grains, certain pulses, fruit and starchy vegetables. One concern with these diets are that by avoiding these foods, one misses out on all the phytonutrients, antioxidants, vitamins and minerals that these foods offer. It also greatly reduces fibre which not only adds to bowel regularity and tonicity but is the main food source for one’s gut microbiome. The keto diet includes all types of fat including butter, lard, coconut oil, avocado, macadamia nut, flax, olive and hemp oil.


Keto and the Microbiome

Consuming a diet that is restrictive in fibre will in a sense, leave one’s gut bugs deprived of the foods they need to produce butyrate and short chain fatty acids. Both of which reduce inflammation, support immune function and contribute to one’s overall health. We know that gut health is closely linked to our brain health, via a mechanism known as the microbiota-gut-brain axis which works via a bidirectional signal regulation. In lay mans terms, the food that we eat will influence how the bacteria in our gut react and they will send a message to the brain about the “state” of environment they are in. If they are happy, we are happy. But this works both ways-bidirectional. If we are stressed out, our brain will send a message via the vagal nerve straight to the bacteria in our gut and the community structure and the way they function will be altered.


The bottom-line

Just because Keto is the current trending diet, doesn’t mean that it is the right diet for you. While some bodies thrive on this diet, others may gain weight or have unwanted health outcomes. There are many alternative dietary patterns such as the Mediterranean or whole food diet, that can be modified to suit your individual bodies make up. We are a diverse nation with diverse needs and there is never a one-size-fits-all approach to health and wellness.

As with any diet or nutritional modification, please check in with your naturopath, nutritionist or GP before altering your diet or starting new supplements. There is never a one size fits all approach, you are unique and so the needs of your body will be unique.


Keto Must Haves

1. MTC oil: Medium chain triglycerides are types of fatty acids that are quickly digested and absorbed and used for energy. MCT have been proven to be useful in reducing waist circumference and weight.

2. Non starchy vegetables: Eat these veggies in abundance; Kale, broccoli, cauliflower, spinach, zucchini, leeks, cabbage, okra, mushrooms, tomato’s, beans, lettuce greens, peppers, onions, eggplants

3. Nuts, seeds and sprout mix: Roar mix

4. Avocado’s: This nutritious food is high monounsaturated fatty acids, vitamins and nutrients and makes the perfect snack on keto bread

5. Keto bread (venerid): Low carb made with hemp and linseeds and resistant starches like konjac, psyllium and banana flower that will nourish your microbiome.

6. Coconut oil (Commonsense): A good source of MCT’s. MCT are used readily by the body to burn fat when in a “fat burning” state.

7. Collagen (Nutraorganics or Great Lakes): Add to your “bullet proof coffee”. Add in these amino acids to elasticise skin and increase muscle recovery.

8. Kelp noodles: Sea Tangle Kelp Noodles are raw, ready-to-eat noodles made of kelp, sodium extracted from a brown seaweed, and water. They are fat-free, gluten-free, and low in carbohydrates. Their neutral taste means you can use them as a pasta alternative in many dishes including salads, stir fries and soups.

9. Konjac noodles, fettuccini, rice and lasagne: They're made from glucomannan, a type of fibre that comes from the root of the konjac plant. They are zero carbs and zero calories.

10. Biltong: Canterbury. These high protein snacks make a great on-the-go snack. They are also one of the only preservative free meet snacks in New Zealand.



References:

American Diabetes Association. (n.d.). Non-starchy vegetables . Retrieved March 9, 2020, from https://www.diabetes.org/nutrition/healthy-food-choices-made-easy/non-starchy-vegetables

Batta, A. (2016). Ketogenic diet and its role in eliminating medicinal treatment in various disease. Medico Research Chronicles, 4(3), 309–322.

Brehm, B. J., Seeley, R. J., Daniels, S. R., & D’Alessio, D. A. (2003). A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. Journal of Clinical Endocrinology and Metabolism, 88(4), 1617–1623. https://doi.org/10.1210/jc.2002-021480

Dennett, C. (2019). The Ketogenic Diet for Weight Loss . Today’s Dietitian, 21(1), 26. Retrieved from https://www.todaysdietitian.com/newarchives/0119p26.shtml

Martin, C. R., Osadchiy, V., Kalani, A., & Mayer, E. A. (2018). The Brain-Gut-Microbiome Axis. Cellular and Molecular Gastroenterology and Hepatology, 6(2), 133–148. https://doi.org/10.1016/j.jcmgh.2018.04.003

Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789–796. https://doi.org/10.1038/ejcn.2013.116

Paoli, Antonio. (2014, February 19). Ketogenic diet for obesity: Friend or foe? International Journal of Environmental Research and Public Health. Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/ijerph110202092

Paoli, Antonio, Cenci, L., & Grimaldi, K. A. (2011). Effect of ketogenic mediterranean diet with phytoextracts and low carbohydrates/high-protein meals on weight, cardiovascular risk factors, body composition and diet compliance in Italian council employees. Nutrition Journal, 10(1), 112. https://doi.org/10.1186/1475-2891-10-112

Reddel, S., Putignani, L., & Del Chierico, F. (2019). The impact of Low-FODMAP’s, gluten-freem and ketogenic diets on gut microbiota modulation in pathological conditions. Nutrients, 11(373), 1–16. https://doi.org/10.3390/nu11020373

Rial, S. A., Karelis, A. D., Bergeron, K. F., & Mounier, C. (2016, May 12). Gut microbiota and metabolic health: The potential beneficial effects of a medium chain triglyceride diet in obese individuals. Nutrients. MDPI AG. https://doi.org/10.3390/nu8050281

Zhang, Y., Zhou, S., Zhou, Y., Yu, L., Zhang, L., & Wang, Y. (2018). Altered gut microbiome composition in children with refractory epilepsy after ketogenic diet. Epilepsy Research, 145, 163–168. https://doi.org/10.1016/j.eplepsyres.2018.06.01

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