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A few years ago, a diet consisting mainly of high-fat foods such as butter, cream and bacon would have seemed a recipe for a health disaster. But fat, it seems, is no longer the public enemy No. 1. The ketogenic diet very low in carbohydrates and high in fat ("keto") makes waves like the latest craze for celebrity weight loss. But it works? Is it safe? Are there any additional benefits to keto for those who also eat gluten-free?
The genesis of ketogenic
Despite its recent popularity, the ketogenic diet is not new. Nearly a hundred years ago, it has become a popular treatment in children with epilepsy, a seizure disorder. Before the 1920s, drugs for epilepsy were limited and not always effective. The researchers noted that after two to three days of fasting, convulsive activity had decreased. It was thought that this resulted from a metabolic shift in the brain, ranging from the burning of carbohydrates to the use of ketone bodies from fat as the main fuel.
Since long-term fasting was not an option, researchers discovered that depriving the brain of carbohydrates produced many of the same benefits. The first documented ketogenic diet plans were similar to those used today for seizure control, with up to 90% of calories in the diet derived from fat. At the end of the 1930s, the diet fell as a result of the discovery of more effective drugs for the control of seizures, although it has experienced a recrudescence in recent years for children with epilepsy who do not respond good to drugs.
Ketosis is a normal body process that occurs when the body lacks glucose to produce energy and goes on to burn fat. This process produces ketones. This can be a byproduct of starvation and can also occur in people with poorly controlled type 1 diabetes. Ketosis can also result from severe limitation of carbohydrates (usually less than 30 to 50 grams per day).
When the body turns into ketosis, a person may experience some side effects. The first, known as "keto flu," causes a few days of nausea, fatigue, brain fog, decreased ability to exercise and increased hunger. Fortunately, these symptoms are temporary because the body goes from burning carbohydrates to burning fat. Bad breath can also occur with increasing blood levels of acetone, but usually disappears after a few weeks. People with ketosis may also experience leg cramps, constipation, and a high heart rate.
Weight, cholesterol and blood sugar
Low carb diets are not new: studies have shown that it works – at least in the short term – and is generally safe. The ketogenic diet is only the latest version to make the headlines. Although studies show that reducing carbohydrates leads to weight loss, the mechanism of action remains controversial. One theory is that the higher protein content of the diet gives a feeling of greater satisfaction and therefore less hunger. This leads to taking fewer calories in general, which leads to weight loss. Other research shows that ketosis produces beneficial effects on hormones that trigger hunger and that ketosis can reduce appetite.
Some dieticians even use it in their personal and professional practice. Franziska Spritzler, RD, CDE, author of the Low Diet Dietian blog (lowcarbdietitian.com), started the keto diet a few years ago when her blood sugar level began to rise after meals. "I was thin and I had no evidence of insulin resistance, but my blood sugar after meals was well above what it should have been, even though I ate a lot fiber, "she says. Spritzler began to wonder if this way of eating would benefit people with blood sugar problems. "I started researching the carbohydrate restriction for diabetes and I was surprised to find many studies that supported this way of eating to control weight and blood sugar," she says.
Spritzler sees many benefits for his patients. "The appetite is removed and it is possible to stay several hours without eating. This is obviously a major advantage for those who have weight and who are always hungry, "she noted. "It's also great for busy people who do not have time to nibble and who may need to delay or skip meals."
Research shows that for diabetics, banishing carbohydrates leads to weight loss and decreased need for diabetes medications. "For people with prediabetes, metabolic syndrome and polycystic ovarian syndrome (PCOS), a ketogenic diet can help keep their insulin levels under control," Spritzler advises. "Plus, I notice that there is an increase in energy when I eat little carbohydrates – a benefit for everyone!"
A high-fat diet may be reminiscent of heart disease, but research on low-carb diets and cholesterol levels is generally favorable. Some studies of children on a ketogenic epilepsy diet show increased levels of bad cholesterol (LDL) and triglycerides, at least during the first few months after the onset of the plan. However, research in adults has shown that "good" cholesterol levels (HDL) increase and that triglycerides decrease when reducing carbohydrates. It is important to note that the majority of studies involving the ketogenic diet are short-lived, so long-term effects are not necessarily known.
In addition to diabetes and weight control, new research suggests that the ketogenic diet may play a role in the treatment of certain cancers and neurological disorders such as Alzheimer's disease and Parkinson's disease.
Spritzler notes that some people should not attempt a ketogenic diet. "There are certain conditions in which the ketogenic diet is contraindicated," she advises. "Most of them are genetic abnormalities involving enzyme deficiency that would have been identified very early in life (see box below)." Spritzler advises those who are suffering from an existing illness or condition to discuss a ketogenic diet with their doctor before starting one: "Especially patients with a history of pancreatitis , kidney failure, active gall bladder disease, impaired liver function, impaired fat digestion, gastric bypass or a person who is pregnant or breastfeeding.
Eat gluten and keto
The ketogenic diet limits all cereals and can therefore be a natural transition for those who eat gluten free. Spritzler sees only advantages. "I think it's a great way to eat for people with celiac disease and gluten intolerance, because a strict low carb / fat or ketone diet does not allow bread, cereals or additives made from cereals. "
Elana Amsterdam, New York TimesThe author and founder of Elana's Pantry, a website dedicated to gluten-free and cereal-free recipes, also sees the link. "If you're already following a healthy gluten-free and processed food diet, the next step is to eliminate grains, corn, potatoes and fruit." Amsterdam has found personal benefits by following the ketogenic diet. "It helped my gut and my brain work better."
Amsterdam recommends almond flour for gluten-free and ketogenic people. "It's an independent flour that does not need a combination of other flours to" value "it. It has an incredible taste in baked goods and is rich in fats and carbohydrates, making it the optimal flour for those on a keto diet. "
The abandonment of all grains and all fruits can lead to other problems, including constipation, which already preoccupies many people who need to eat gluten-free. Spritzler recommends fruits less rich in carbohydrates such as blackberries and raspberries, as well as avocado seeds, flax and chia, cruciferous vegetables such as broccoli and cauliflower and almonds. "To avoid constipation, I recommend taking a portion of any of these high fiber foods with every meal," she advises.
Restaurants, which are already a challenge for those who do not have gluten, may require additional planning to stay on the keto diet. "We need to plan trips, restaurants and celebrations in advance," says Spritzler. "Always have low carb foods on hand in case you find yourself surrounded by high carbohydrate foods. For example, the low carbohydrate side dishes that you can try include cauliflower rice or cauliflower mashed potatoes. "
Stick to the plan
Research shows that while many people lose weight when trying to diagnose, very few people manage to maintain it. The keto diet is no different in this respect, and moving away from the very strict diet usually means taking back lost pounds. Although research supports a low-carb diet in the short term, most studies in children and adults show that long-term therapeutic compliance is lacking. Spritzler admits to having mixed results with his clients. "Some people are doing very well (ketogenic diet) and never find comfort foods, especially after seeing many positive health effects," she says. "But some people can not resist the temptation, especially when they live with family members who do not follow the diet. Other bored with low carb options or reach a plateau of weight loss that occurs with all diets. "
Spritzler urges his patients to stay positive, focusing on what they can have instead of what they can not. "I encourage my patients to make a list of reasons that they care to stay keto and review it frequently." Amsterdam agrees, "If you try it for a month and find that you're feeling better, stay on the diet. It's not as difficult because the earnings are so high. Everything in life is a compromise. "
Genetic conditions where the ketogenic diet would be contraindicated
- Carnitine deficiency (primary)
- Palmitoyltransferase (CPT) deficiency I or II
- Carnitine translocase deficiency
- Beta-oxidation defects
- Mitochondrial deficiency of 3-hydroxy-3-methylglutaryl-CoA synthase (mHMGS)
- Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)
- Long-chain acyl dehydrogenase (LCAD) deficiency
- Short-chain acyl-CoA dehydrogenase (SCAD) deficiency
- Long-chain 3-hydroxyacyl-CoA deficiency
- Medium chain 3-hydroxyacyl-CoA deficiency
- Pyruvate carboxylase deficiency
Source: Franziska Sprtizler, RD, CDE