“I am doing keto.”
This is a familiar phrase I hear at social gatherings and, invariably, the reason for ‘doing keto’ is to lose weight. Once people figure out that I am a nutritionist, I get asked more and more questions on the keto diet. Here are some basics on what a keto diet is, and whether it does, in fact, work.
History of keto
Essentially, a ketogenic diet is a way of eating where you limit your carb intake, eat moderate protein and add more fats. Instead of the traditional diet of using carbs as an energy source, the keto way of eating uses fats as a primary source of energy.
It all actually began way back in 1924, when Dr Russell Wilder, a medical practitioner at the Mayo Clinic USA, developed this diet as a means to treat epilepsy in children. He rationalised that the brain would use ketones as a primary source of energy. Interestingly, this diet proved to be effective in some cases of epilepsy in children.
What is even more interesting is that, nowhere in its development did Dr Wilder see this as becoming a ‘weight-loss’ diet.
How does keto work?
A quick recap of human metabolism tells us how ‘keto’ works. Essentially, our body is primed to use glucose as the primary source of energy, which is why we crave yummy potatoes when hungry! But the body can also use fat as fuel if it has to, and it does this by breaking fats into ketones. Ketones are produced when we intentionally fast or eat less carbs. The state of ketone production is called ketosis. Now, ketosis is incredibly challenging to maintain: any small increase in carbs will switch the energy source to carbs and not fats leading to non-compliance. If small amounts of carbs can throw you off ketosis, how does ‘keto’ cause weight loss? The initial loss you see on the scales is water loss, however motivating it might be to see!
Our muscles store glycogen which is bound to water – in fact, loads of water – something like a ratio of 1-part muscle to 4-parts water, so what you lose is that water! The trick to succeed is to persist with this way of eating, which is eating loads of fat. In fact, within 72 hours your body goes into ketosis and maintaining that may see a significant loss of weight.
What is the keto way of eating?
Maintaining ketosis is the main goal and the level of carbs needed to do that differs from person to person. A meal of 85% fat, 15% protein and 5% carbs is a typical example. What does that then translate to in a day? Think a breakfast of egg bhurji with some spinach, a lunch of chicken tikkas and an avocado and a dinner of shahi paneer, tomato soup and maybe some cauliflower.
This, of course, also means no accompanying naans, or garam rotis! Snacks tend to be nuts such as cashews, almonds and pistas. Low carb vegetables such as asparagus, eggplants, spinach and cauliflower are allowed. Some dairy is ok mainly in the form of cheese, butter and cream, but sadly, no pindi chhole, rajma or dal makhani. While this type of eating is possible with extensive planning, it is not sustainable. It can be socially isolating, and cannot be adapted to celebrations where typically the tables are loaded with mithais, pakodas, samosas and chaat. Your own birthday cake is not permitted. A bit harsh, eh?!
Are there any benefits of keto?
Of course, there are studies that show an improvement in blood cholesterol levels. Again, this depends on the individual and more importantly on the ethnicity. Most do lose weight as eating high-fat foods at every meal keeps you full for longer, so you don’t snack as much. I have heard people say they feel energetic and motivated, an excellent outcome. Eating whole, minimally processed foods is way better than eating ultra-processed foods and it is whole foods that are allowed on ‘keto’.
What should you be aware of then?
This way of eating is low in fibre and carbs but high in fats. This does not help the healthy gut bacteria to thrive. Recent research published in the journal Gut has also shown that moving to a high fat diet decreases the number and variety of good gut bacteria. Now, that is a worry because we need high numbers and a variety of good gut bacteria to stay healthy. In fact, what is more concerning is that high-fat diets allow inflammatory proteins associated with diabetes and obesity to enter the bloodstream, and these diseases have been linked to poor gut health. What we also know is that carbs and fibre from legumes such as rajma, lobia and chana when broken down in the gut produce short chain fatty acids; these fatty acids feed good bacteria and they thrive. Traditional Indian food is heavily plant-based and loaded with fibre and carbs. Is that a good thing then? Absolutely!
A study called DIETFITS, done in early 2018, compared a low-fat high-carb diet to a high-fat low-carb one and found that there was no significant difference in weight loss from following either. What they also recommended is that the best diet is one that you can stick to. Wow, isn’t that incredible!
In conclusion, a keto is not for everyone. See a qualified nutritionist for a personalised plan rather than relying on online advice. Enjoy your food, eat a variety and keep those critters in the gut happy.
Dr Jyothsna R Rao is a university-qualified nutritionist with a background and expertise in human physiology, who has studied and lived in Australia for 19 years.