The downlow on keto

What is it

and is it right for you?

Keto - you may have heard of it, you may have tried it or you may know someone who swears by it. So what is this miraculous diet? Can you really lose as many kilos as some people claim? And will it impact your blood glucose levels? Dietitian Susie

Burrell is here to tell you what you need to know.

THE KETO DIET

The keto diet is designed to shift the body into a state of fat burning by keeping carbohydrate intake exceptionally low (less than 10-20% of total energy, or as little as 20g of total carbohydrates per day). When the body is in ketosis, fat is metabolised at a much faster rate than is usually seen when carbohydrates are the primary energy source. As a result, weight losses of more than 2kg a week can be observed.

NEED TO KNOW

While this may sound amazing, there are some important specifics to know about the keto diet. Firstly, as ketosis is not the body’s default metabolic process, when carbohydrate intake is dramatically reduced it takes a number of days to actually achieve ketosis. It is not just a matter of cutting your carbs for a couple of meals. Rather, once you eliminate carbs from your diet it takes some time for glycogen stores in the muscles to be depleted and for ketosis to be induced, 2-3 days at least. As the body shifts from glucose or carbohydrate metabolism into ketosis, a number of symptoms can be experienced including headaches, cravings, fluctuating blood glucose levels and fatigue. It is generally not a pleasant process.

It is actually not very easy to achieve ketosis. The specific requirement for ketosis is that the majority of calories are coming from fats (at least 70% of total calories). As the foods that are mostly fat are limited to oils, seeds, nuts and avocado, the number of foods you can eat on a keto diet is extremely limited - think oils, avocado, oily fish, salad greens, nuts, cheese, cream and a couple of other high-fat, low-carb foods. This also means no pasta, bread, rice, cereal, grains, fruits or non-leafy green vegies, ever.

THE GOOD THINGS

If you can follow a keto diet, the results can be dramatic, especially if you have a lot of weight to lose. Some people have achieved weight loss of 5-7 kilos a week! For those who like to eat fatty foods, including cream, cheese, nuts and oily fish, they can find this diet relatively easy to follow. Adherents may also find that the keto diet aids hunger management, with higherfat foods helping to keep them full and less vulnerable to fluctuating blood glucose levels. Over time though, there is evidence to show that there may be significant improvements in both glucose and insulin levels, secondary to significant weight loss in some individuals.

THE NOT-SOGOOD THINGS

While the results of keto can be dramatic, it is hard to follow, especially when you are eating away from home, as the food options are exceptionally limited. The low intake of grains, fruits and vegies can result in a low intake of dietary fibre which in turn can impact gut comfort and cause constipation. There are also a few side effects including bad breath and lightheadedness.

WHO IS KETO BEST FOR?

Any diet will work if you can follow it but without doubt the greatest issue with keto is that it is difficult to follow, especially long term. Remember keto means very, very little carbohydrate long term - this means literally no fruit, bread, cereal, rice, pasta or vegies. Very few people, in general, are happy to eat this way for an extended period of time.

WHERE DO PEOPLE GO WRONG?

Many people confuse keto with low carb and simply replace their carbs with extra protein and vegies. This is not keto, keto is a high-fat diet not just a low-carb one. The most common reason that keto does not work is because fat intake is too low, and protein intake from dairy, meat, chicken and fish is too high. Keto may also not work if overall calorie intake is too high. This is common in small women who need to strike a balance between a high-fat diet and also a diet that is calorie controlled. This can be a tricky balance if you do not have a lot of weight to lose and have a small frame.

In my clinical practice I get the best results with keto for larger males who are happy

to eat loads of fat.

GETTING STARTED

If you have diabetes, it is vital that you get advice from your dietitian or endocrinologist before you attempt keto, as medication doses often need to be adjusted and monitored to account for the dramatic reduction in carb intake. In general, most people will benefit from seeing a dietitian to develop a version of keto that is specific to them. The next best option is to monitor your own diet using a program such as ‘myfitnesspal’ to ensure that your diet is reaching the targets of just 20-50g of carbs in total and 70% of energy from fat overall. In my experience those with diabetes benefit just as much from diets that have slightly higher carbohydrate intakes as they do from an extreme keto approach.

THE DIETITIAN’S VERDICT

Keto diets have been used medically for many years but in my experience they are difficult to follow. In my clinical practice I get the best results with keto for larger males who are happy to eat loads of fat. For women, and most people, I think there are better diets out there, that focus on eating a lot more fresh foods, to utilise for sustainable weight loss.