A few months ago, following the death of an Indian actress in her 20s from kidney failure – allegedly brought on by her ketogenic lifestyle – I wrote a story on the divisive keto diet, which prescribes high-fat, medium-protein and low-carb meals.
The piece outlined the risks involved with eliminating entire food groups for weeks on end, as well as the effects of consuming higher-than-usual quantities of protein and fat. As nutritionist Mitun de Sarkar said at the time: "Eating a higher protein diet could add more stress to the kidneys by raising levels of uric acid."
Even more alarming was her first-hand experience with a client who followed a social media influencer’s transformational advice. “Followers were told they are allowed to eat slabs of butter to meet their fat needs, plus free-flowing ghee, fried burger patties without the bread and so on. A stage came when my client had zero energy, suffered severe acidity and started losing her hair,” said de Sarkar.
These extremities aside, the piece concluded that quick-fix diets are not, and perhaps never have been, a solution to lose weight in a safe and sustainable manner.
Not soon after it was published in The National, I was inundated with emails by diehard keto fans, entrepreneurs and even a triathlete; the basic theme of this correspondence was that, when done right, the diet promotes not only weight loss, but also better health.
I was intrigued. Is there such a thing as an unyielding but user-friendly diet, and is keto it?
Its rationale sounds reasonable enough. As Jennifer O'Grady, a nutritionist at Love Food ME, explains: "Essentially the diet works on the premise of switching the body's energy source from carbohydrates to fat. When you restrict your intake of carbohydrates, your body will start to use up stored carbohydrates. Once they're gone, your body will turn to fat as a fuel source – in a process that is known as ketosis."
Of the three main macronutrients used for energy, protein is important for building and maintaining muscle, while fats help the body absorb essential vitamins," explains Francoise Albrando Crosbie, chief executive, Keto Goodies Dubai.
“Carbohydrates transform into sugars, and having too many carbs can have both short-term and long-term negative effects. The keto diet – which advocates removing sugar completely – keeps this in check. Sugar is a major reason for many illnesses that people are currently suffering from. So in terms of gut health, the ketones produced actually help reduce inflammation.”
So the premise sounds effective on paper. How, then, can one do it right to reap the benefits without adverse side effects?
Eat carbs every day
A low-carb diet should not translate to a no-carb diet, with experts recommending up to 50 grams of carbohydrates from healthy sources every day.
“A well-formulated ketogenic diet should include regular amounts of low-carb vegetables, along with quality sources of fats and protein,” says O’Grady. “It is important to make sure the minimal carbohydrates you consume contain the maximum nutritional benefit.”
This boils down to replacing bread, paste, rice and potato (plus crisps, sugar and all things processed) with broccoli, kale, spinach, cauliflower, mushrooms and peppers.
"Keto is a controversial diet because many people believe that removing carbs can cause deficiencies, but what we fail to understand is that, in this day and age, the majority of carbohydrate-dense foods are so highly processed that there is next to no benefit of consuming these," adds Nyma Peracha, co-founder of Be More Keto.
Seek out good fats
Butter-guzzling influencers – and my own friend who ate pizza toppings for dinner every night for a month – are not exactly role models for the keto diet. Sure, it prescribes getting 70 per cent of your daily nutrition from fat, but, O’Grady says: “The type of fat is just as important as the quantity of fat.”
Simply put, monounsaturated fats are your friend – these increase levels of high-density-lipoprotein (HDL), which mops up excess cholesterol and protects heart health – as opposed to saturated fats.
“Adopting a keto diet is not a substitute for common sense,” states Crosbie. “We all know that a healthy diet, in whatever format, doesn’t include highly processed foods. When we talk about the keto diet being high-fat, we are referring to healthy fats – things like salmon and avocado.”
Other “good” fats you can seek out include olive oil, mackerel, cashew nuts and feta cheese, while protein sources include lean meat, seafood and eggs. Other no-nos include honey, maple syrup, agave nectar and, surprisingly, dates.
Keto may work best in tandem with intermittent fasting
Those aiming to shed the kilos often follow the keto diet in conjunction with intermittent fasting. The thought process behind this, says Peracha is that "the fasting increases the opportunity for your body to use its own fat stores for energy".
As nutritionist Lee Sandwith, chief executive of online keto shop Ingfit, explains: "Intermittent eating becomes easier with the keto diet, as when you stop eating carbohydrates that burning sensation of hunger dissipates, and most people find themselves making it to midday without having even thought about food.
“It also works the other way round. A longer fasting period encourages the body to move into ketosis more quickly because our bodies naturally create ketones in the absence of carbs, and will efficiently run on this fuel source without demanding exogenous glucose.”
However, Crosbie cautions some might find following keto and eating intermittently at the same time quite intensive. “We have thousands of customers who get great results from adopting keto alone without fasting. It’s easier for people to sustain a keto diet than one that is heavily restrictive on calorie counting.”
The keto flu is real
Conditioning is a boon and bane when it comes to food habits. On the one hand, if your body achieves ketosis upon eating certain foods, on the other, it takes some getting used to switching up your diet so drastically. This often manifests, in this case, in a condition termed the keto flu.
“In the modern world we have been conditioned to think we should be constantly eating or snacking – the six small meals a day mentality – whereas our ancestors would never have had this luxury. This is why at the beginning, people experience the keto flu while their bodies adapt to running on ketones instead of glucose,” explains Sandwith.
"When starting the diet, we recommend everyone have a good magnesium supplement and some pink salt at the ready, as well as potassium-rich foods such as avocados. When the body stops retaining the water it does when carbs are present, electrolytes are lost with it, which causes the sensations of keto flu.
“However once you are over that hump, you have access to a life with less bloating, less gut discomfort, fewer digestive issues, no acid reflux, the disappearance of IBS, the list goes on,” he claims.
The keto x diabetes connection
The keto diet came into being to help people with diabetes and epilepsy, and its applications still remain relevant. This is particularly significant given the increase in lifestyle-related Type-2 diabetes, as a low-carb approach can help to regulate blood sugar and insulin levels.
Sandwith sheds some light. “The Virta Study in the US has been using keto to reverse Type-2 diabetes for three years. The results are nothing short of miraculous. Not only do the clear majority of patients normalise their HBA1C [blood markers], but 94 per cent of the nearly 200 patients who were prescribed insulin reduced or stopped its use, and sulfonylureas were eliminated in all patients.
“Keto can even be used for the effective management of Type 1. Dr Ali Al Lawati – who practises in Oman and trained with Dr Eric Westman in the US, both of whom sit on Ingfit’s board of directors – has been managing his own Type 1 diabetes through keto since he was 15.
“In the UAE, Dr Feruza Gafarova has been reversing Type 2 diabetes in her patients through the keto diet. This becomes evermore relevant during a pandemic where we see people with metabolic health and diabetes having a far more difficult time fighting the virus,” says Sandwith.
Peracha adds: “The keto diet is fantastic for people who suffer from not only diabetes, but also for women who suffer from a hormonal imbalance. We also have clients who are ex-cancer patients and have seen some fantastic changes in their energy levels.”
Always, always consult an expert
Given the number of young people developing diabetes and other lifestyle diseases, Crosbie advocates getting regular check-ups whether or not you’re embarking on the keto diet. “Monitoring nutrition is important to ensure healthy development and physical and mental well-being,” she says. “Whenever you change diet or lifestyle, we recommend consulting a doctor or nutritionist because everybody is different. A consultation will help you understand the best individual approach for you, while also identifying if you have any underlying conditions that may need a specific diet.”
For those on the diet, Sandwith says: “Test your blood glucose and ketones if possible on a regular basis, as this gives you a window into what is happening in your body and allows you to learn how you feel when your blood glucose and ketones are at particular levels.”
How long to do the keto diet
Even its advocates admit that keto is not a sustainable lifelong diet plan; in fact, most agree that it should be followed for no longer than 12 weeks or a maximum of 90 days at a stretch. The tricky bit is when you’re making a dietary transition. How you approach this weaning period is crucial, especially if you don’t want to pile on more kilos than you’ve lost or, worse, suffer from gut or other health issues.
“To support your body, reintroduce carbohydrates gradually,” says O’Grady. “Start with whole grains, beans, legumes, fruits, and non-starchy vegetables. Also be aware that for every 1 gram of carb consumed, your body stores 2-3 grams of water. Do not confuse this with gaining fat. I would also recommend a probiotic to help digestion as your body adjusts to increased fibre.”
Sandwith adds: “You can slowly increase your carbs from clean, natural sources. However, we recommend staying away from refined carbs and sugar, and vegetable and seed oils permanently. These foods have been unquestionably shown in peer-reviewed science to feed disease in the body.”
The ultimate goal, he says, is “be able to switch easily between being a glucose burner or a ketone burner, and for the body to become fat-adapted to be able to move in and out of ketosis easily”.
All this sounds peachy, but one massive disadvantage is just how difficult it is to maintain a state of ketosis, even whilst on the diet. As O’Grady puts it: “Even one banana – which contains roughly 24 grams of carbohydrate – can throw you out of ketosis. It’s not as simple as just eating fat and protein, rather it needs to be carefully measured. When attempting to do keto by yourself, it is very easy to go off-plan.”
For example, one cup of cooked cauliflower florets, contain 5 grams of total carbohydrates, two of which are insoluble fibre (that won’t trigger an insulin response or disrupt ketosis), so 3 grams of net carbs. A cup of dairy milk, meanwhile, contains 13 grams of carbohydrate, which is better replaced with almond milk, which has a single gram.
Following a highly specific diet or meal plan to a tee, then, is key to ketosis and its assurance of weight loss.
So am I convinced? Marginally. I see the sense in cutting out processed foods and sugar, and incorporating “good fats” as a lifestyle choice. However, to me, eating well-rounded wholesome meals and exercising my pasta away still seems more sustainable in the long run, especially given the complex math involved in keeping the body in a state of ketosis. A real fear of gaining more weight than I’ve lost if I fall off the keto wagon lingers on.
Plus, any diet that disallows dates is a no-no in my book.