In the world of weight loss and fitness, The KETOGENIC DIET (also known as keto diet) is the rave of the moment, and the reason is not farfetched, it works! And really fast too! Unfortunately, many people have hopped on this train without proper education about possible side effects and long term success rates.
Before I go on, let’s discuss the history and background of the keto diet. The keto diet was originally designed as a therapeutic solution for children with epilepsy. However, as new drugs for epilepsy became available, the diet was used less and less. It started gaining popularity again in children with refractory epilepsy who were not responding to conventional drug treatments.
The KETOGENIC DIET involves consuming very low amounts of carbohydrates and large amounts of fat. Since the body’s primary source of energy, glucose from carbohydrates is now highly restricted, the body is forced to breakdown fat, forming “ketones” as the new source of energy. The name KETOGENIC DIET, comes from this phenomenon, that is, the formation of ketones.
Efficiency in weight loss and the other health benefits
In recent times this method has gained enormous popularity as a weight loss solution, and the results have been amazing! Faster than those on a more balanced diet that includes carbohydrates in the short term, but studies have shown that the amount of weight loss is similar between both methods by the end of a year.
While the results on keto are great, a lot of people trying to transition back to a more balanced diet after losing weight, begin to add the weight back in my own experience. It is therefore important that those on the keto diet, learn how to consume carbs in a way that helps them maintain the results they achieved while on keto.
Side Effects of the Ketogenic Diet
There has been a lot of skepticism about the long term safety of the ketogenic diet, considering the quantity of fat consumed. People generally respond to the diet differently, experiencing varying side effects while their bodies try to adapt to the new diet. The side effects can usually be managed allowing you to continue on the diet, but they are also the reason many have stopped the diet not long after starting.
There are three major causes of the side effects experienced, which occur as a results of the body adapting and transitioning to a ketogenic phase. They include, hypoglycaemia, electrolyte deficiency and Hypothalamic-Pituitary-Adrenal (HPS) dysfunction.
Hypoglycaemia (low blood sugar)
For a period your body will experience low blood sugar, before it fully adapts to using ketones as its source of energy. We can refer to this as the keto adaptive phase. The low blood sugar might cause you to experience the following:
- Keto flu: this one of the most well-known ketogenic side effects. This includes symptoms like fatigue, runny nose, nausea, and headache.
- Sugar cravings
- Dizziness and drowsiness
- Reduced strength and physical performance
How to mitigate symptoms of Hypoglycaemia
- Eat frequently, every 3-4hrs
HPA Axis Dysfunction
The HPA Axis is a series of three glands (Hypothalamus, Pituitary, and Adrenals) that are primarily responsible for regulating our stress response in the body. The hypoglycaemic state of the body causes a cascade of events that disrupts the HPA axis and results in the symptoms below, while also making the symptoms of hypoglycaemia mentioned above even worse.
- Sleep disturbance
- Heart palpitations
How to mitigate symptoms of HPA axis dysfunction
- Balance your blood sugar with the tip stated above
- Use magnesium supplements. Consult your doctor or pharmacist before starting on this.
Electrolytes and minerals are important in regulating how much water your body retains and ensures proper nerve function. During keto adaptive phase, an excess of minerals are excreted through the urine due to HPA axis dysregulation discussed earlier and causes the following symptoms.
- Frequent urination
- Constipation. The consistency of your stool is highly dependent on the water content, so if you are losing too much water, you might end up with hard faeces that’s difficult to pass out.
- Diarrhoea. While most people experience constipation, some will experience the opposite. This might be due to a change in the micro-flora (healthy bacteria) in your intestines, caused by this change in your diet.
- Muscle cramps. As mentioned earlier, minerals are crucial for nerve function, so an imbalance can cause you to have frequent muscle cramps.
Strategies to maintain proper hydration and electrolyte balance
- Drink lots of water
- Use low calorie sweeteners that contain sugar alcohols like sorbitol and xylitol as a mild laxative for constipation.
- Consume salt rich foods. Use salt generously, eat salted versions of nuts. If you are managing hypertension, heart failure or kidney disease, speak to your healthcare professional before doing this.
- Consume Mineral Rich Foods. Increase your intake of mineral-rich foods like leafy greens, celery, cucumber, and seaweeds
- Use a Magnesium Supplement. Unless you are experiencing diarrhea, a magnesium supplement can work great for helping balance electrolytes and hydration levels. As mentioned earlier, speak to a healthcare professional before starting these.
This side effect is not directly due to the three major causes discussed above, and is an unpleasant side effect experienced by many in the early stage. The ketones your body produces come in different forms. The one that is released through the breath is called acetone and is responsible for the keto breath. Luckily this wears off rather quickly, within 1-2 weeks.
Long Term Effects of the Ketogenic Diet
Not surprisingly, there are not many studies analyzing the long term effects of this diet, because most people don’t stay on the diet for long. However studies of the effect when followed up to 6 months, showed some amazing benefits besides weight loss such as:
- Significant decrease in the level of triglycerides, total cholesterol, LDL cholesterol and significant increase in the good cholesterol, HDL.2
- Improved insulin resistance and a significant decrease in blood sugar was also shown, at least in the short term.1,2
- Lower blood pressure1,3
There have been some skepticism concerning the effect of the diet on the kidneys. Studies show no significant changes in kidney function. On the other hand, it is important to note that the studies do not explicitly state the effect on those with existing kidney dysfunction, so if you have impaired kidney function, there is not enough information at this time to tell what effects the ketogenic diet will have on your kidneys.
The information currently available proves the safety of the ketogenic diet when used up to 6 months. For a long time, I have been biased against the keto diet as a weight loss solution, but I am convinced now that most of my reservations were not evidence based. For those looking to follow the diet, ensure you are prepared for the side effects and armed with the strategies to make the adaptive phase tolerable.
On the other hand, the standard low fat diet that includes carbohydrates is equally very healthy, and can help you achieve similar health benefits. So if you absolutely love your carbs, you don’t need to give them up, just learn how to balance the various classes of food.
Whatever diet you decide to follow, do your research! Read from notable websites, buy a book, and seek advice from qualified nutritionists or dieticians. Never jump into any diet because it is trending and seems to be working.
I look forward to more research uncovering other health benefits and long term effects of the ketogenic diet.
- Foster, Gary D., et al. “A randomized trial of a low-carbohydrate diet for obesity.” New England Journal of Medicine348.21 (2003): 2082-2090. Viewed at: http://www.nejm.org/doi/full/10.1056/NEJMoa022207
- Hussein, Dashti M., et al. “Long-term effects of a ketogenic diet in obese patients.” Exp Clin Cardiol. (2004) 9(3): 200–205. Viewed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/
- Meckling, Kelly A., Caitriona O’Sullivan, and Dayna Saari. “Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women.” The Journal of Clinical Endocrinology & Metabolism89.6 (2004): 2717-2723. Viewed at: http://press.endocrine.org/doi/full/10.1210/jc.2003-031606