Low-Carb Diets: The Ketogenic Diet (Part 2)

Last week, we published a brief introduction to what low-carbohydrate (low-carb) diets are all about. By limiting many sweet treats and reduced hunger levels reported by some followers of the diet, low-carb diets have been linked to weight loss.

The ketogenic diet is a popular low-carb diet. It touts weight loss benefits and reduced risk of diabetes and cardiovascular disease. Let’s find out more about it.

What is the Ketogenic Diet?
According to the Harvard School of Public Health, the ketogenic diet limits carbohydrates to as low as 5% of your daily calories – while upping your amounts of fat and protein. When our body doesn’t have enough glucose from food, some of the fat stored in our body gets broken down to form ketone bodies. These ketone bodies enter the bloodstream and are used by our body cells and brain for energy – until carbohydrate-rich foods are consumed again.

Some examples of ketogenic-friendly meals are scrambled eggs cooked in butter, salmon with asparagus drizzled with olive oil and beef with spinach cooked in coconut oil. Such meals differ from local dishes which are based on starchy carbohydrates such as noodles or rice. Thus, adapting the ketogenic diet to our local context may be difficult as one may need to forgo many local delicacies like Hokkien mee and chicken rice.

Benefits & Risks of the Ketogenic Diet
A review by the Harvard School of Public Health states that, if done correctly, the ketogenic diet can be linked to weight loss and lower risks of cardiovascular disease and diabetes in the short term. It also has good evidence as a therapy for epilepsy in children.

However, many online followers are led to believe that components of the ketogenic diet including coconut oil, butter, lard, processed meat and red meat are beneficial for one’s health. Unfortunately, their sodium content and high fat – including saturated fat – can instead lead to weight gain, high blood pressure and increased risk of heart attacks and strokes. The World Health Organisation warns of an increased colorectal cancer risk of around 18% for every 50g portion of processed meat or 100g red meat consumed daily.

Sadly, these points aren’t highlighted in most online sources promoting the diet – which can be misleading.

Additionally, the long-term benefits of the ketogenic diet have not been established. This includes sustained weight loss and long-term prevention of chronic diseases. The Harvard School of Public Health review states that adherence to the diet tends to wane over time as well.

Side effects are commonly experienced by followers of the ketogenic diet. These include nausea, vomiting, constipation, headaches, bad breath, mental and physical tiredness. In serious cases, one may need to seek immediate medical attention.

What is the Best Diet to Lose Weight?
Recommendations for weight loss from dietitians (from The Academy of Nutrition and Dietetics) include having nutrient-rich foods from different food groups. Such foods include lean protein, wholegrains, low-fat dairy products, plenty of fruits and vegetables and choosing unsweetened drinks. Singapore’s Health Promotion Board supports these guidelines alongside 150 minutes of moderate-intensity exercise each week.

Check with your doctor before embarking on a significant diet change, especially if you have medical conditions. A diet high in protein and fat (especially saturated and trans fat) may worsen certain kidney and heart conditions respectively. People with diabetes, who are on medications or insulin, should be careful of the potential risk of low blood sugars.

In summary, if you wish to lose weight, do choose a plan which is nutritionally balanced and considers your current medical conditions and lifestyle. Bear in mind that any dietary changes, in order to be effective, need to be sustainable over the long term.

REFERENCES
Campos, M. (2018). Ketogenic diet: Is the ultimate low-carb diet good for you? Harvard Health Publishing. Harvard University. Retrieved from < https://www.health.harvard.edu/blog/ketogenic-diet-is-the-ultimate-low-carb-diet-good-for-you-2017072712089> Accessed 17 July 2019.

Harvard Health Publishing (2018). The smart way to look at carbohydrates. Harvard Men’s Health Watch. Harvard University. Retrieved from < https://www.health.harvard.edu/staying-healthy/the-smart-way-to-look-at-carbohydrates> Accessed 15 July 2019.

Harvard School of Public Health (n.d.) Diet Review: Ketogenic Diet for Weight Loss. Harvard University. Retrieved from < https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/> Accessed 19 July 2019.

Health Promotion Board (2010). Report of the National Nutrition Survey 2010. Research & Strategic Planning Division. Health Promotion board. Retrieved from < https://www.hpb.gov.sg/docs/default-source/pdf/nns-2010-report.pdf?sfvrsn=18e3f172_2> Accessed 17 July 2019.

Klemm, S (2018). Back to Basics for Healthy Weight Loss. Eat Right. Academy of Nutrition and Dietetics. Retrieved from < https://www.eatright.org/health/weight-loss/your-health-and-your-weight/back-to-basics-for-healthy-weight-loss> Accessed 19 July 2019.

Mayo Clinic (2017). Low-carb diet: Can it help you lose weight? Mayo Foundation for Medical Education and Research (MFMER). Retrieved from < https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/low-carb-diet/art-20045831> Accessed 14 July 2019.

Oh R. & Uppaluri K.R. (2019). Low Carbohydrate Diet. [Updated 2019 May 13]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Retrieved from < https://www.ncbi.nlm.nih.gov/books/NBK537084> Accessed 14 July 2019.

Paoli A., Rubini A., Volek J.S. & Grimaldi K.A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition Volume 67, Pages 789–796 (2013). Retrieved from < https://www.nature.com/articles/ejcn2013116> Accessed 13 July 2019.

World Health Organization (2015). Q&A on the carcinogenicity of the consumption of red meat and processed meat. Retrieved from < https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/> Accessed 19 July 2019.

This article is contributed by our dietitians from the Nutrition and Dietitian department of Mount Alvernia Hospital.
To read on Part 1 of this article, click here

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