Ketogenic diet
And what to do with it if you are a biohacker
Being a nutritionist is not very convenient if you go to parties. With an unfortunate combination of circumstances, they tell you all evening about how to actually eat right (I'm not talking about compromising photos with beer). Recently, the views of my interlocutors have been hopefully turned to the ketogenic diet, but the information about it is confusing and contradictory. Let's figure out what ketosis is and what use ketogenic diets find in medicine.
Alternative fuel
The main nutrition for our cells is supplied by glucose as part of carbohydrates. It is also stored in the liver and muscles in the form of a complex carbohydrate glycogen to ensure stable blood sugar levels and provide energy for muscle contraction. Glycogen reserves are limited, so when fasting or insufficient intake of carbohydrates with food, cells begin to use other sources of energy – proteins and fats. New glucose molecules are also synthesized from their structural components in the process of gluconeogenesis.
In addition, when fatty acids are oxidized, ketone bodies are formed – acetoacetic acid, beta-hydroxybutyric acid and acetone. They serve as an alternative source of energy for our cells when glucose is unavailable for some reason. If the body is "powered" mainly from fats, then the concentration of ketone bodies in the blood increases significantly. They penetrate the blood-brain barrier and provide energy to the brain, providing about two-thirds of its needs. Under normal conditions, the brain is powered by glucose, that is, ketosis is an adaptation mechanism that allows a person to survive. Ketones are used by muscles and other tissues and even appear in urine.
Therapeutic ketones
Ketogenic dietary therapy is used to treat children with drug-resistant epilepsy. Research has been conducted since the 30s of the last century. It was noticed that fasting reduces the number of seizures, so the state of ketosis during fasting was imitated using a diet high in fat and low in carbohydrates. In the classic ketogenic diet, the ratio of fat to protein and carbohydrates is 4:1 (by weight). Lower ratios can also be used (for example, 3:1 or 2:1), depending on individual tolerance and ketosis levels. Such a diet is not an easy thing, because we usually get about half of our calories from carbohydrates. In addition, it is important to adequately supply the growing body with protein and other essential nutrients.
When appropriate medications were used to treat epilepsy, the enthusiasm for the ketogenic diet subsided. However, in the 2000s, options with a large amount of carbohydrates were proposed - for example, a modified ketogenic diet, in which there were 30-50 grams of carbohydrates per day. Such a diet reduced the likelihood of seizures by at least two times in 40-50% of children, as it was shown in several randomized clinical trials (for example, this and this). However, a systematic review of the Cochrane Collaboration reminds us of the need for more extensive work. There are even fewer studies in adults, so the issue continues to be actively studied.
50 grams of carbohydrates per day is quite a bit. About as much in two slices of rye bread or in one medium-sized potato. The ketogenic diet is not balanced because it excludes a number of food groups and the nutrients they provide. Like many restrictive diets, it requires mandatory supervision of a nutritionist and prescribing the necessary vitamins and minerals.
Ketogenic diets are in many ways the last resort if antiepileptic drugs have proved powerless. Although there are clinical situations when they are more effective, parents should not put their child on such a diet on their own. Side effects – constipation, growth disorders, nausea and vomiting, kidney stones, changes in blood lipids. Before this, a preliminary examination is strictly necessary, and then the observation of a neurologist and a nutritionist. The level of ketosis is monitored both in the laboratory and at home.
A ketogenic diet requires motivation, organization, and commitment. You need to regularly weigh and calculate everything, you have to give up your favorite dishes. Not only nutrition is changing, but also social life. The diet usually lasts at least a couple of years (with good results and tolerability), and it is canceled gradually.
What about weight loss and biohacking?
Now let's say a few words, so as not to ignore the amazing trend of modernity – the desire of some healthy people without any excess weight to follow curative restrictive diets. (Apparently, the greater the deprivation, the greater the expected benefit?)
With a ketogenic diet, short-term weight loss can indeed be greater than with other approaches. This is caused by depletion of glycogen reserves and associated water, lower calorie intake, as well as a decrease in appetite. One of the effects of eating foods rich in fat and protein is a longer feeling of satiety. And the monotonous diet itself reduces appetite: we are terribly bored to eat the same thing. And appetite suppression, apparently, is associated with the metabolism of ketones. There is also a mechanism for increasing energy expenditure – for example, the loss of ketones in the urine.
But if the observation of losing weight continues for a year or more, the benefits of low-carb diets for weight loss compared to a more balanced diet are lost. There are very few studies of ketogenic diets, they note the difficulty of complying with prescribed restrictions and a high dropout rate of volunteers. If the restriction of carbohydrates corresponds to the lower limit of the current dietary recommendations (45% of the daily calorie content), then this may be quite acceptable and more sustainable approach for people with diabetes and other metabolic disorders (see: one, two). Only this has nothing to do with the ketogenic diet.
Even if we take a diet not as harsh as ketogenic, but still low-carb and high-fat (less than 130 g of carbohydrates per day), it is based on significant dietary restrictions. You can eat meat, fish, poultry, eggs, fatty dairy products and fats in general, nuts, a limited set of vegetables, a few berries. Any grain products and cereals, legumes, root vegetables and starchy vegetables, most fruits are excluded from the diet. Such a diet does not comply with dietary recommendations for healthy people. It lacks some B vitamins and phytochemicals. Such a diet is low in fiber, which is necessary for the nutrition of the intestinal microbiome, and the International Cancer Research Foundation recommends eating at least 25 grams of fiber from plant products daily.
Although the ketogenic diet can offer great weight loss in the short term, that is, for several months, the consequences of following this diet for healthy people are poorly understood. This means that their long-term effectiveness, safety and benefits are still unknown (hello to you, biohacking lovers!). The key to maintaining a healthy weight in the long run is a diet and eating behavior that you can adhere to throughout your life. With this in mind, dietary recommendations should always be tailored to a specific person. It is necessary to form eating behavior that will allow you to maintain a balance between incoming food and consumed energy.
It's not as entertaining as a startup drink with ketones at $99 per bottle. But it is not given to everyone to enjoy the liquid with the smell of nail polish.
About the author:
Elena Motova is a nutritionist, author of the book "My best friend is the stomach. Food for smart people."
Portal "Eternal youth" http://vechnayamolodost.ru