The ketogenic diet is only one of the most recent options in the rotation of the notorious fad diets. The American Academy of Nutrition and Dietetics holds the position that the use of the keto diet may be used to treat epilepsy in children.
The ketogenic diet has no established benefit for other populations and may be detrimental, over time, for anyone adhering to its strict protocol. This diet poses a variety of health threats, despite its popularity within the diet culture.
Dangers of Cutting Carbohydrates
Carbohydrates are the body’s preferred source of energy, and in its absence, the body breaks down dietary fat and protein to provide glucose and ketones. If dietary intake is inadequate to meet the body’s needs, the body then breaks down its own fat and protein stores (this includes muscle and organ tissue).
The body is amazing in its ability to adapt to the stress of a semi-starvation state. This is typically a short term state for the body, and the prolonged use of this diet can lead to serious health consequences.
The body is designed to operate at its best with a carbohydrate intake of approximately 50-55% of caloric intake. The lowest carbohydrate diets are associated with an increased risk of mortality, including an increased risk of cardiovascular events, cerebrovascular events, and cancer (Banach, M. 2018).
In addition to these issues, there are concerns over the loss of muscle mass (Kossoff, E. 2014). There are also cautions regarding the increased risk of fatty liver disease and insulin resistance.
Despite the touted advantages of the diet on weight, triglycerides, blood pressure, and blood sugar levels, research indicates complete reversal of any physiological “improvements” after 18 weeks (Kosinski, C. & Jornayvaz, F. R. 2017).
The Brain on the Keto Diet
The brain is a major consumer of energy in the biological system, consuming approximately 20-50% of the resting energy expenditure (Westman, E. C. 2003). The brain has a unique preference for glucose as its most efficient fuel source.
Brain fog is a commonly reported complaint of those on the keto diet. While the brain can use ketones, in dire situations such as starvation, it is not ideal and can result in impaired cognitive function (Seidelmann et al., 2018).
Serotonin is a neurochemical that is important for mood regulation and the prevention of depression. The brain requires glucose in order to produce Serotonin. Decreased carbohydrate intake can compromise the production of this crucial chemical and lead to severe mood dysregulation.
The Body on the Keto Diet
As noted above, when the body does not receive adequate carbohydrates, a symphony of events occur. The body breaks down dietary and endogenous fats and proteins to create glucose and ketones.
This increases the amount of free fatty acids in the bloodstream, as well as the waste products from converting protein into glucose. This creates stress on the arteries, liver, and kidneys (McGettigan, B. et al. 2019).
Multiple studies have found a decrease in lean muscle mass during the course of a ketogenic diet (Tinsley, G. M. & Willoughby, D. S. 2016). The body’s loss of lean muscle mass includes organ tissues, such as the heart.
This damage to the heart, along with increased arterial stiffness, may be contributing factors in the increased risk of cardiovascular events (Kossoff, E. 2014).
Neuropeptide-Y is a neurotransmitter produced in the brain. It increases with the lack of adequate carbohydrate intake, and increased NPY produces increased hunger and a heightened drive to eat carbohydrates.
It can be countered by Leptin, which is released from fat cells. If fat tissue is lost, Leptin decreases, and hunger increases. Leptin also decreases when insulin levels are low, which is typical of the ketogenic diet. Neuropeptide-Y is stimulated with any caloric restriction and may drive binge behaviors.
A Case Against Diets
Many people seek out the keto diet and weight loss in the name of improving their overall health. A review of the research on diets and weight loss outcomes actually indicates an increased risk of premature death with weight loss and weight cycling.
In addition to weight loss proving detrimental, all restrictive (either via calories or macronutrient profile) diets are shown to be ineffective over time in maintaining weight loss. Further, evidence indicates that most diets ultimately lead to weight gain beyond baseline (Bacon, L., & Aphramor, L. 2011).
It is easy to argue that it is unethical for physicians or other health care providers to encourage the use of the ketogenic diet or other restrictive diets. In addition to being ineffective, they are potentially harmful and regularly contribute to food and body preoccupation.
The rise of the Health at Every Size movement provides a sound model based on the emerging science. Many dietitians are advocating for Intuitive Eating or other body-centered approaches to eating. The use of such evidence-based approaches allows for more inclusive and effective care and feeding of self and others (Bacon, L., & Aphramor, L. 2011).
Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10 (9). doi: 10.1186/1475-2891-10-9
Banach, M. (2018). Caution against cutting down on carbohydrates
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Kosinski, C. & Jornayvaz, F. R. (2017). Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies. Nutrients, 9 (5), 517. doi: 10.2290/nu9050517
Kossoff, E. (2014) Danger in the pipeline for the ketogenic diet? Epilepsy Current. 14(6), 343–344. doi: 10.5698/1535-7597-14.6.343
McGettigan, B., McMahan, R., Orlicky, D. et al. (2019). Dietary Lipids Differentially Shape Nonalcoholic Steatohepatitis Progression and the Transcriptome of Kupffer Cells and Infiltrating Macrophages. Hepatology, 70 (1).
Seidelmann, S., Claggett, B., Cheng, S. et al. (2018). Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet, 3 (9). doi:10.1016/S2468-2667(18)30135-X
Tinsley, G. M. & Willoughby, D. S. (2016). Fat-Free Mass Changes During Ketogenic Diets and the Potential Role of Resistance Training. International Journal of Sports Nutrition and Exercise Metabolism, 26 (1), 78-92.
Westman, E.C., Mavropoulos, J., Yancy, W.S. et al. (2003). A review of low-carbohydrate ketogenic diets. Current Atherosclerosis Reports, 5: 476. doi: 10.1007/s11883-003-0038-6
About the Author:
Jennifer Pereira, LPC, RD, LD, is a Licensed Professional Counselor and a Registered Dietitian in private practice in Austin, TX. She has been working in the eating disorder field since 2005 in a variety of settings and levels of care. She is trained in EMDR and uses ACT and IFS approaches in therapy. She works from a Health at Every Size model and utilizes Intuitive Eating as her ultimate nutrition goal with clients.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on November 13, 2019, on EatingDisorderHope.com
Reviewed & Approved on November 13, 2019, by Jacquelyn Ekern MS, LPC