Are you a keto di­eter?

Daily Mirror (Sri Lanka) - - HEALTH CAPSULE - BY A.L.S. SEWWANDI

Obe­sity has be­come a se­ri­ous prob­lem in both de­vel­op­ing and de­vel­oped coun­tries. This con­di­tion is as­so­ci­ated with a va­ri­ety of chronic dis­eases in our health for ex­am­ples di­a­betes, high blood pres­sure, choles­terol etc. Ac­cord­ing to the re­search stud­ies, fe­male obe­sity preva­lence for Sri Lanka was 7.3% while male obe­sity was 2.9% in 2016. Bad feed­ing habits and un­healthy liv­ing style are the ma­jor rea­sons for this prob­lem. Peo­ple fol­low dif­fer­ent weight re­duc­ing meth­ods us­ing re­duced calo­rie and fat in­take com­bined with ex­er­cise. How­ever, it will take a long time to ob­tain bet­ter re­sults. There­fore, presently Ke­to­genic diet has be­come in­creas­ingly pop­u­lar in our so­ci­ety in or­der to get ef­fec­tive and efficient reduction in the body weight.

What is this Ke­to­genic diet?

Ke­to­genic diet is a reg­i­men that con­sti­tutes a high-fat diet rich in polyun­sat­u­rated fatty acids which is quite ef­fec­tive in re­duc­ing body weight, medium-protein, and low­car­bo­hy­drates. While in this diet, the fat to car­bo­hy­drate ra­tio is 5:1.

Ke­to­sis

Ke­to­sis oc­curs as a re­sult of the change in the body’s fuel from car­bo­hy­drate to fat. When glu­cose re­serves such as glyco­gen stored in liver and skele­tal mus­cle be­come in­suf­fi­cient to pro­vide en­ergy needs for hu­man body, pro­duc­tion of ke­tone bod­ies are oc­curred by the liver, in or­der to pro­duce an al­ter­na­tive en­ergy source no­tably by the cen­tral ner­vous sys­tem. In­com­plete ox­i­da­tion of fatty acids by the liver re­sults in the ac­cu­mu­la­tion of ke­tone bod­ies in the body. A ke­to­genic diet main­tains the body in a state of ke­to­sis, which is char­ac­terised by an elevation of D-bhy­drox­y­bu­tyrate and ace­toac­etate. Mild ke­to­sis is a nat­u­ral phe­nom­e­non that oc­curs in our body dur­ing fast­ing and lac­ta­tion. In ad­di­tion, ke­to­sis has a sig­nif­i­cant in­flu­ence on sup­press­ing hunger. Hence, a ke­to­genic diet is a good reg­u­la­tor of the body’s calo­rie in­take and mim­ics the ef­fect of star­va­tion in the body.

In the hu­man body, ke­tone bod­ies are the sub­sti­tutes for glu­cose which pro­vides en­ergy for the brain. The gen­er­a­tion of ke­tone bod­ies by liver dur­ing fast­ing is es­sen­tial to pro­vide an al­ter­nate fuel to glu­cose. This is nec­es­sary to spare the de­struc­tion of mus­cle from glu­cose syn­the­sis.

Dif­fer­ent types of Ke­to­genic diet

1. Clas­sic Ke­to­genic Diet (KD) There is a fixed ra­tio of fat to com­bined protein and car­bo­hy­drate by weight and it achieves by excluding high-car­bo­hy­drate foods while in­creas­ing the con­sump­tion of foods high in fat.

2.Medium-chain Triglyc­eride Ke­to­genic Diet (MCT)

As less over­all fat is re­quired in this diet, a greater pro­por­tion of car­bo­hy­drate and protein can be con­sumed by al­low­ing a slightly greater va­ri­ety of food choices. Nor­mally, most of di­etary fat is made of long-chain triglyc­erides.

3. Mod­i­fied Atkins Diet (MAD) This diet al­lows 10- 20g/day of car­bo­hy­drate in­take and strongly en­cour­ages fat in­take while there is no calo­rie re­stric­tion.

4. Low Glycemic In­dex Treat­ment (LGIT) This diet al­lows a low-car­bo­hy­drate diet by lim­it­ing car­bo­hy­drate in­take to 40-60g/day and foods with low glycemic in­dex (< 50).

Ben­e­fits of Ke­to­genic diet

Be­sides efficient ef­fect of ke­to­genic diet on weight loss, re­search stud­ies have dis­cov­ered that low-car­bo­hy­drate ke­to­genic di­ets also re­duce serum triglyc­erides dra­mat­i­cally and also reduction in to­tal choles­terol and in­crease in high-den­sity lipopro­tein choles­terol have also been ev­i­dent. More­over, low-car­bo­hy­drate ke­to­genic di­ets have been shown to have im­mense ben­e­fits in blood sugar con­trol. Fur­ther­more, there are some re­ported ben­e­fi­cial ef­fects on can­cer and neu­ro­log­i­cal dis­or­ders such as Alzheimer’s dis­ease and epilepsy.

Ad­verse ef­fects of Ke­to­genic Diet

There are few side ef­fects that come across when peo­ple fol­low ke­to­genic diet and fre­quently the most com­mon is­sues are de­hy­dra­tion or lack of mi­cronu­tri­ents (vi­ta­mins) in the body since ke­to­genic diet is lim­ited to car­bo­hy­drates. De­creas­ing the amount of car­bo­hy­drates con­sumed leads de­ple­tion of glyco­gen stores in the liver. Wa­ter is stored along­side glyco­gen for ex­am­ple, 03 grams of wa­ter are stored in ev­ery gram of de­posited glyco­gen. There­fore, when glyco­gen stores are de­pleted, the body loses wa­ter.

1. Cramps

Es­pe­cially leg cramps are pretty com­mon at the be­gin­ning of a ke­to­genic diet. It’s usu­ally oc­cur­ring in the morn­ing or at night due to lack of min­er­als, specif­i­cally mag­ne­sium, in the body. Be­cause, in ke­to­genic diet, peo­ple are not pay­ing at­ten­tion to fruits which are good source of mi­cronu­tri­ents such as vi­ta­mins and min­er­als.

2. Con­sti­pa­tion

The most com­mon cause of con­sti­pa­tion on low car­bo­hy­drate is de­hy­dra­tion and lack of fi­brous food con­sump­tion. Nor­mally, get­ting of veg­eta­bles and fruits are lim­ited in ke­to­genic diet since most of them are starchy and this will be the cause for oc­cur­rence of con­sti­pa­tion in peo­ple who fol­low ke­to­genic diet.

3. Heart pal­pi­ta­tions

When tran­si­tion­ing to keto, our heart is beat­ing faster and harder. This can hap­pen dur­ing the first few weeks of ke­to­genic diet. A reduction in the amount of fluid in the blood stream leads pump­ing of blood by heart slightly harder and faster in or­der to main­tain blood pres­sure. There­fore, this prob­lem can be re­cov­ered by drink­ing plenty of wa­ter, juices and eat­ing enough salt.

4. Bad breath

Some peo­ple can ex­pe­ri­ence char­ac­ter­is­tic smell from their breath on strict low car­bo­hy­drate diet. Be­cause, the smell is from ace­tone which is a ke­tone body pro­duced due to our body is burn­ing lots of fat and even con­vert­ing lots of fat to ke­tones in or­der to gen­er­ate en­ergy for our brain. This smell can sur­face as a body odour through ex­ces­sive sweat­ing. How­ever, with the time our body adapts and ter­mi­nates the leak­ing of ke­tones through breath and sweat. 5. Re­duced Phys­i­cal

Per­for­mance Nor­mally, our body uses en­ergy which is gen­er­ated by breaking down of car­bo­hy­drates. The body has built up an arse­nal of en­zymes ready for this process and only has a few en­zymes to deal with fats mostly to store them. How­ever, when our body has sud­denly dealt with the lack of glu­cose and in­crease in fats, which means build­ing up a new sup­ply of en­zymes, our body be­comes in­duced into a ke­to­genic state. Then our body will nat­u­rally use what’s left of your glu­cose. Even­tu­ally, our body will be de­pleted of glyco­gen in mus­cles which can cause a lack of en­ergy and gen­eral lethargy which leads to the reduction of phys­i­cal per­for­mance.

6. Nu­tri­ent de­fi­cien­cies

Ma­jor con­cern of keto diet is los­ing of es­sen­tial mi­cronu­tri­ents. Con­sum­ing of fat and pro­teins based on an­i­mal sources will lose es­sen­tial mi­cronu­tri­ents which are highly found in starchy grains, legumes, fruits and veg­eta­bles. More­over, low car­bo­hy­drate diet con­tains only lit­tle fiber per­cent­age.

7. Keto flu

Keto flu is caused by tran­si­tion of burn­ing sugar to burn­ing fat in or­der to meet out body’s en­ergy need. When we switch our di­etary plan from high car­bo­hy­drate diet to very low car­bo­hy­drate diet, it low­ers the in­sulin level in our body. When in­sulin level is very low, our liver be­gins con­ver­sion of fat into ke­tones, which is sub­sti­tutes for glu­cose. More­over, when in­sulin level is dropped, our body re­sponds by ex­cret­ing more sodium in the urine, along with wa­ter. Los­ing lots of wa­ter and sodium is re­spon­si­ble for many of the symp­toms of Keto flu such as fa­tigue, headache, ir­ri­tabil­ity, lack of mo­ti­va­tion, dizzi­ness and vom­it­ing.

8. Keto Rash

Keto rash is a prurigo pig­men­tosa, rare in­flam­ma­tory skin con­di­tion hap­pen more fre­quently in peo­ple with in­creased ke­tone lev­els like those with di­a­betes or peo­ple on a keto diet. 9. Ke­toaci­do­sis Ke­toaci­do­sis is a con­di­tion seen in type one di­a­bet­ics. The main fac­tor for devel­op­ment of ke­toaci­do­sis is lack of in­sulin. The cell can­not shut­tle in glu­cose from the blood­stream for en­ergy use and the body has no sig­nal to stop re­leas­ing fats which are con­verted into ke­tones. When ke­tone level gets too high, the blood be­comes too acidic and which may potentiall­y be­come life- threat­en­ing. Al­co­holism, over­ac­tive thy­roid and in­fec­tions such as pneu­mo­nia are other med­i­cal prob­lems which are as­so­ci­ated with ke­toaci­do­sis.

In con­clu­sion, Ke­to­genic diet is a more ben­e­fi­cial and as­so­ci­ated with some im­prove­ments in some car­dio­vas­cu­lar risk fac­tors, such as obe­sity, type 02 di­a­betes and HDL choles­terol lev­els. How­ever, there are ad­verse ef­fects which can be clas­si­fied as mild, mod­er­ate and se­vere short term and long term ef­fects. There­fore, if you need to re­duce your body weight through a di­etary plan, get­ting ad­vices from a di­eti­tian or other per­son who has bet­ter knowl­edge on hu­man nu­tri­tion and di­et­ing, is a bet­ter op­tion to stay away from these kind of health prob­lems. The writer is a med­i­cal lab­o­ra­tory tech­nol­o­gist at a pri­vate hospi­tal and holds a MSC. De­gree in In­dus­trial and En­vi­ron­men­tal Chem­istry from the Univer­sity of Ke­laniya and BSC. Food Pro­duc­tion and Tech­nol­ogy Man­age­ment de­gree from the Wayamba Univer­sity of Sri Lanka.

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