To Keto or Not to Keto

One of the trends in weight loss has centered on a ketogenic or keto diet. For some, this is the most dramatic way to lose weight and shift your metabolism. For others, it’s too extreme and unsustainable. As with almost all lifestyle modifications, the use of a ketogenic diet should be based on individual factors and preferably after more research is done.

Last week, I saw Jack, a fifty-year-old male in for a three-month follow-up visit to check on his progress after following a ketogenic program for about two months. His medical problems included high cholesterol, hypertension, fatty liver disease and obstructive sleep apnea. He had been overweight for many years, but to look at him, and by American standards, he’s not what anyone would consider flagrantly obese.

His metabolic status improved more in two months than any other single intervention I could imagine. He had lost 18 pounds with significant improvement in his cholesterol numbers and liver enzyme levels. His blood pressure was down enough that we stopped his hypertensive medication. With continued weight loss, I anticipated he will probably be able to discontinue the use of his CPAP machine for sleep apnea relatively soon.

The ketogenic program involves an extremely low intake of carbohydrates in all forms with an emphasis on high intake of quality protein and healthy forms of fat. He not only avoided sugar, starchy carbs and alcohol, but also fruit and most vegetables. The vegetables allowed were those with a relatively low glycemic index like broccoli, cauliflower, kale, onions and peppers. He said it took about a week for his sugar/carb cravings to subside.

 So is this a cure-all? There is a documentary on Netflix called The Magic Pill that includes stories of people with a variety of chronic health conditions including seizures, cancer and autism that improve dramatically by following a ketogenic diet.

This is countered by many in the nutrition world who have concerns about the safety and long-term viability of a ketogenic program. Many who make these changes experience constipation related to a lack of fiber in the diet. It would make sense to worry about nutrient deficiencies also for those on a keto diet since supplements only approximate the nutrient value of organic fruits and vegetables grown in good soil. There is a long list of potential health problems one can experience from a ketogenic diet including kidney stones, hypoglycemia, cardiac rhythm disturbances and others.

In the end, the most important principles the best diets all share are avoidance of processed sugar and packaged foods with good intake of high quality nutrient-dense real foods. Beyond that, there are pros and cons of vegetarian, vegan, Mediterranean, Paleo, ketogenic and other diets. It is always better to individualize as much as possible as each person is unique relative to their genetics, ethnicity, microbiome, biochemistry, toxic load, environmental exposures and lifestyle.

Debate will continue and we would prefer to focus on solid, unbiased research if available to make the best decisions. Is dairy good or bad? Legumes? How about wheat-based carbs and other grains? Low fat vs. low carb? Intermittent fasting or many small meals? So many important questions when it comes to diet, nutrition and health. It helps to avoid a dogmatic position that cherry picks those anecdotes and studies that support our opinion while selectively ignoring counterarguments.

Either way, Jack has had a dramatic improvement in all of his most important chronic health conditions. We discussed gradually transitioning to a low carb diet that incorporates more fruits and vegetables so we maintain his fiber and nutrient intake. If you decide to try a ketogenic diet, I would recommend extensive research, working with someone who understands the complex physiology of ketosis and seeing a medical provider regularly for close monitoring.

 My wife, Mary, has useful information on her website. For individual coaching and support, you could contact Marnie Lawler through email or Maria Lappin.

To make your transition to a low carb diet even simpler, you could also go the Whole Made Kitchen in Beverly. The owner Helen Allard is an expert on low carb diets. Farmers to You is another great resource where you know you’re getting high quality local food from farmers around New England.

p.s. My patient Jack in the blog is also controlling his chronic allergies with an herb called Boswellia (another term for Frankincense) and told me that the brand of Boswellia can make a difference in terms of effectiveness.  He is off all of his allergy medications using BosMed5 500 Extra Strength.

Andrew Lendhartd, MD

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