The Keto-Fad | Fact or Fiction?
From corsets to camisoles, diet fads have been used through the ages. In 1820, Lord Byron commercialized the vinegar and water diet, which involves drinking water mixed with apple cider vinegar. One of today’s latest diet trends is the ketogenic diet (KD). In actual fact, the KD was already developed in the 1920s and was used worldwide for the non-pharmacological management of drug-resistant epilepsy1. In modern times, however, the applications of the KD, as well as other low-carbohydrate and high-fat (LCHF) diets are evolving. These applications may vary from weight-loss, Type 2 Diabetes Mellitus (T2DM), Polycystic Ovary Syndrome (PCOS), Inflammatory Disorders (ID) to cancer (as combination therapy) and so much more. Many individuals who follow an LCHF or KD states that they experience long-term benefits and tempts to make this a lifestyle and not a ‘quick fix’. Many of the ‘diets’ or lifestyles that are applied in the modern world were developed centuries ago. Another example is Banting, this low-carbohydrate diet was already described by William Banting in the 1800s, while in 2018 plenty of South Africans are Banting.
As a registered dietitian, who has seen the benefits of the KD in individuals with drug-resistant epilepsy and cancer, I do believe there is surely benefits for certain individuals when following some form of an LCHF lifestyle. When I talk about benefits, my very first epilepsy patient was a 2-year-old female who was suffering from GLUT-1 Deficiency Syndrome (GLUT-1 DS) and had 10 seizures on average per day and is now completely seizure free for the past 3 years. But what is the difference in applying a classical KD (in which 90% of the total energy comes from fat) or just following an LCHF lifestyle? Thinking about it, an LCHF diet or lifestyle consists of a lot of foods that are readily available in nature, which therefore means that the diet does not (or is not supposed to) consist of unnatural foods. While on the other hand a classical KD, which is applied for medical purposes, is very strict, all foods should be weighed, and there is only just enough protein provided within the diet to ensure growth, while almost all of the remaining energy intake comes from fat. A strict KD then causes an individual’s body to use fat, in the form of ketones as the primary energy source (known as ketosis) and no longer carbohydrates in the form of glucose, hence the name, ketogenic. An LCHF lifestyle can cause ketosis as well, but usually not to such a severe extent. Keep in mind, that the human’s brain is 60% fat and the brain’s capabilities may improve when fat is supplied as the energy source, for example in individuals suffering from Parkinson’s Disease, Alzheimer’s and even Attention Deficit Disorder (ADD) etc.
A narrative review written by Professor Tim Noakes and Johann Windt, which was published in 2016, aims to provide clinicians with a broad overview of the effects of LCHF diets on body weight, glycaemic control, and cardiovascular risk factors while addressing some common concerns and misconceptions. The conclusion as made from this study states that although LCHF diets may not be suitable for everyone, available evidence shows this eating plan to be a safe and efficacious dietary option to be considered. The Dietary Guidelines for Americans (DGA) recommend a total carbohydrate intake of 45-65% of total energy per day. Any carbohydrate intake less than 45% of the total energy, is considered to be a reduced carbohydrate diet/lifestyle. But why do individuals follow LCHF or Keto-diets? One of the main understandings is due to the leptin and ghrelin hormone balances. Leptin hormone contributes to the feeling of satiety while ghrelin contributes to the feeling of hunger. Leptin levels may be improved by an increased intake of omega-3 fatty acids, which is often something that naturally occurs in an LCHF lifestyle or KD. Therefore, some individuals suffer from fewer cravings, making it easier to control their calorie intake when wanting to shed some weight. With all the diet trends, I have experienced that individuals will often try something for a short period of time, but it is important to plan for the long hall and find something that is appropriate for the entire family.
There is concrete evidence that supports the application of ketogenic diets in individuals with drug-resistant epilepsy. However, in practice, the applications of LCHF and KD remains patient specific. Beneficial responses to any diet are entirely reliant on the degree of patients’ adherence, thus an LCHF diet is only appropriate for those patients motivated to comply and completely grasp the aspects thereof.
1. Kossof, EH, Zupec-Kania, BA, Amark, PE, Ballaban-Gil, KR, Bergqvist, AGC, et al. Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group. Epilepsia: 1-14, 2008.
2. Noakes, TD, Windt, J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. British Journal of Sports Medicine: 51; 133-139, 2016.