Indian actress Mishti Mukherjee, 27, died on October 2, with the cause of death cited by her publicist and family members as kidney failure brought on by the keto diet. While it's not known whether Mukherjee had any underlying health issues, that is still a disturbing claim, given that the ketogenic diet has experienced the largest growth among most-searched dietary requirements in the UAE over the past three years, with a 1,028.21 per cent rise, according to digital marketing platform SEMrush.
We ask Dubai nutritionist Mitun de Sarkar and Ruba El Hourani, head dietician at RAK Hospital, for their expert opinions on the diet.
How would you describe the ketogenic diet?
Mitun de Sarkar: In its simplest form, it is eliminating food groups that contain any glucose (mainly carbohydrates), and eating a dominantly high fat, medium protein and very low or almost negligible carbohydrate diet.
Ruba El Hourani: The keto diet prescribes a minimum 70 per cent of energy from fat and a severe restriction of carbohydrates to mimic a fasting state and induce ketosis. This is a process that happens when your body doesn't have enough carbohydrates to burn for energy, and it burns fat instead.
What are the foods the keto diet prescribes and avoids?
MDS: The keto diet requires followers to avoid sweet and carbohydrate-rich foods such as wheat flour, lentils, beans and rice, as well as sweet fruits. They can base their diets on natural fats, for example, avocados, coconut oil, coconut butter and ghee; proteins that come mainly from animal sources, such as beef, lamb, poultry, fish and eggs; low-starch vegetables, such as asparagus, broccoli, lettuce and mushrooms; and some fruits, including coconuts, limes, lemons and some berries.
REH: Followers of the diet can also eat cheese, which is rich in fat and high in protein, but they must avoid most refined carbohydrates, such as grains and flour, sugar, sweetened yoghurt, crisps, crackers and processed food.
Can the keto diet cause kidney failure or other issues in a person with no pre-existing health conditions?
MDS: All elimination diets, barring the ones required due to medical conditions or food allergies, carry a certain amount of risk. As the human gut is used to different food sources, eliminating entire food groups can put one at risk of certain gut issues and this may also disturb the homeostasis, or balance, of the body. Eating a higher protein diet could add more stress to the kidneys by raising levels of uric acid and it may disturb the calcium balance.
The authentic ketogenic diet is very difficult to follow socially, and requires the elimination of many fibre-rich, plant-based foods, so one may experience ill effects such as gut discomfort and constipation.
Research is ongoing to establish a definitive guide to navigate the ketogenic diet and some of the data is still nascent. It is advisable for anyone attempting the diet to do so under supervision and get regular tests done, to minimise the unpleasant side effects that may occur.
REH: Since more protein and fewer carbohydrates are the most common modifications of the keto diet, it can result in health complications over time. Changes in the macronutrient composition affect hormones, 14 metabolic pathways, gene expression, and the composition and function of the gut microbiome, which might affect fat storage. This can burden the organs and lead to conditions including kidney diseases and, eventually death if not treated or monitored.
Are there any conditions for which the diet is beneficial?
REH: Early research suggests that a keto diet that is closely monitored and based on individual needs, for a shorter period of time, may benefit several health conditions, including epilepsy, metabolic syndrome, glycogen storage disease and type 2 diabetes.
If a person is following the keto diet for weight-loss reasons, for how long can they do so safely?
REH: To minimise the adverse effects of ketosis on the body, I suggest that the ketogenic diet not exceed a 28-day cycle. This should be sufficient to initiate weight loss if other prescribed diets have failed, depending on each individual's needs and condition. Every cycle of the diet could be initiated again when the rate of weight loss has decreased, but for no longer than three cycles. It is important to keep in mind that old lifestyle habits will affect weight regain and health status, so any weight-loss plan should not be initiated without the supervision of a healthcare provider and dietician.
MDS: Get the required tests done, establish your core markers of health and the recommended ranges before going on any extreme diet.
What is a suitable substitute to the keto diet?
MDS: That's an easy one – a wholesome, plant-dominant diet with plenty of fresh fruits and vegetables. Also, engage in mindful eating – eat to nourish your body, avoid TV and mobile screens while eating, avoid grazing and processed foods, and follow professional advice if needed.
In general, is it time we got over quick-fix diets?
MDS: Weight loss is sustainable only if done over a period of time. Quick-fix diets are not permanent; we see many examples of people regaining the lost weight and more. The ketogenic diet may be beneficial to a few, but its long-term sustainability is one of its main caveats.
Take the case study of one of my clients, a lady in her late forties, who went on a keto diet based on the advice of a social media influencer, who cited the example of how she transformed herself. Followers were told they are allowed to eat slabs of butter every day to meet their fat needs, plus free-flowing ghee, coconut oil, fried burger patties without the bread and so on.
As enjoyable and tasty as it was initially, a stage came when my client had zero energy, suffered severe acidity and started losing her hair. A check at the clinic showed that her ferritin levels had hit rock bottom, her cholesterol and triglycerides had skyrocketed, her gut microbiome had suffered due to a lack of prebiotics and probiotics, and a few other blood markers were out of whack.
On top of this, her fear of the weight coming back caused her mental trauma. We are now helping her transition to a healthier eating plan, replenishing the deficiencies and treating her gut, yet without weight gain.
My question is, why do anything that's not sustainable? How is it logical to eat a whole slab of butter a day and consider it healthy? How and why would you want to be so adventurous with your health and believe everything you see on social media? Celebrities with personal chefs and high budgets cannot be the markers for determining our own trajectory to better health.