What is that
The ketogenic diet (“keto diet”) is a food scheme based on the reduction of carbohydrates that pushes the body to produce ketonesresult of the metabolic breakdown of fats in the liver, to be used as energy. “Because we descend from our ancestors who survived famines, we have very efficient defense systems, including ketogenesis,” he explains. Stefano Erzegovesinutritionist and psychiatrist, scientific communicator in the field of preventive nutrition and eating disorders (as well as author of the thematic forum of Health Courier) —, but this does not mean that it is advisable to forcefully stimulate them for long periods. The prerogative of the ketogenic diet is the high consumption of animal proteins, but if everyone in the world followed it we would face a certain extinction due to environmental consumption: a diet cannot be good for humans and toxic for the environment».
When it’s useful
«The ketogenic diet can be useful in specific pathologies, such as for example drug resistant epilepsy, but only and exclusively if included in a treatment path prescribed by a doctor – continues Erzegovesi -: therefore no ketogenic drugs suggested by the personal trainer or do-it-yourself and never for a generic weight loss, but exclusively for certain pathologies. And then let’s stop demonizing carbohydrates as a single category, but rather learn to distinguish the good ones rich in fiber (such as whole grains and legumes) from the refined ones with a high glycemic index».
Epilepsy and the keto diet
There is evidence that the ketogenic diet — followed under the supervision of an epileptologist and a dietitian — can improve seizure control in patients with drug-resistant (i.e., unresponsive to medication) epilepsy. Various formulations can be used in epileptic patients, all with a high percentage of fat and low in protein and carbohydrates: classic ketogenic diet, medium-chain triglyceride-based diet and modified Atkins diet. The classic keto diet aims to induce a state of chronic ketosis which simulates the effects of fasting on the metabolic level. With this diet the body is forced to use fat instead of glucose as a source of energy, keeping the development of ketone bodies deliberately high. In the case of epilepsy, a patient who continues to have seizures despite having tried at least two specific drugs, administered at the maximum tolerated dose and for an adequate period of time, in monotherapy or in combination with other drugs, is considered “drug resistant”. There is also false drug resistance (or pseudo-drug resistance), i.e. due to an erroneous diagnosis of epilepsy, inadequate choice of the drug and/or its doses, or poor regularity in the patient’s taking of the therapy. Real drug resistance affects about 30% of people with epilepsy, but this condition is not necessarily definitive and irreversible. It is estimated that at least 15-20% of drug-resistant patients could benefit from specifically targeted neurosurgical intervention. For those drug resistant patients who cannot benefit from surgery, there are some alternative therapies, such as vagal stimulation, neurostimulation techniques such as deep brain stimulation (DBS) and, indeed, the ketogenic diet.
Do you eat fat at will?
Everything has been written about the keto diet and not always about it: the first incorrect indication concerns the quality of the fats that can be consumed. If it is true that in this diet plan 75% of calories should come from fat sources, this does not mean that saturated fats can be consumed at will: unsaturated fats always remain the best option. “Given that there are more or less healthy fats, it must be stated that it makes no sense to follow an unbalanced diet with lots of fat and few carbohydrates unless, as mentioned, for health reasons and under the supervision of a doctor”, Erzegovesi further underlines .
In itself, the ketogenic diet is not dangerous, but it certainly presents risks that should not be underestimated, such as kidney stones, vitamin and mineral deficiencies, decreased bone mineral density, gastrointestinal disorders and an increased risk of cholesterol and heart disease. «Keto is dangerous if it is followed without medical supervision – Erzegovesi reiterates -, but above all it makes no sense as a long-term lifestyle to stay slim, because we are programmed for efficient ketogenesis for defined and limited periods, not forever. Not enough, the ketogenic diet can increase the risk of binge eatingwhich I was able to verify on some of my patients with obesity problems ».
Should we say goodbye to alcohol?
In general, alcohol is not completely forbidden in the keto diet, but you need to know what to choose (wine and beer generally contain carbohydrates) and pay more attention to how much you drink, because when you follow this type of diet, alcohol tolerance is lower. «Following the keto while drinking alcohol adds damage to damage – objects Erzegovesi – and I would add “poor liver!”. All the more reason to avoid do-it-yourself and follow the instructions of a doctor».
Are ketosis and ketoacidosis synonymous?
In reality they are two very different things. “Ketosis” is the metabolic process of using fat as the primary source of energy instead of carbohydrates, while “ketoacidosis” is a potentially fatal complication, which occurs in the presence of dangerously high levels of ketones and blood sugar. “We can all have ketosis as a temporary compensation mechanism, for example if we fast – confirms Erzegovesi -, while ketoacidosis is a serious situation, to be treated urgently”.
Is fasting mandatory?
It is not true that to follow this food plan it is necessary to skip meals: if you decide to do so, it is advisable to wait until the whole process has been “metabolized”. «Our organism perceives the lack of carbohydrates as a “famine” – notes Erzegovesi -: hence the risk of subsequent overeating and, consequently, of a yo-yo effect on weight».
Is it a high protein diet?
In the keto diet, the daily calories should be approx 75% fat, 5% carbohydrates and 20% protein, therefore it cannot be defined as a high protein diet in the strict sense. “This diet is unbalanced due to the excessive use of animal products, given that vegetable proteins, such as legumes, are not contemplated due to the presence of carbohydrates and proteins together”.
Should I stop exercising?
There is no need to be so drastic, but possibly it is good to change the type of workouts, avoiding those that are too demanding and tiring until the body has got used to keto. «Ketone bodies are a reserve fuel with less efficiency than glucose – notes Erzegovesi -, consequently it is good never to do too intense exercises during ketosis, because the risk is pass out from a collapse».