Authors: Dr Ayesha & Dr Dean Sherzai
In a day and age where fad diets and food misinformation runs rampant, it seems there is always a new, revolutionary and often restrictive dietary regiment on the market that promises weight loss, boundless energy and optimal health. In recent years, the ketogenic (keto) diet has taken the cake – no pun intended – as a dietary lifestyle that offers all of the benefits listed above and more. It is a trend that has taken over like wildfire, in large part because, while restrictive, it allows its followers to eat meat and fat-based foods. By significantly lowering carbohydrate levels and drastically increasing fat intake, followers of the ketogenic diet reduce insulin resistance and report a host of benefits such as feeling focused and full of energy while experiencing reduced appetite and rapid weight loss.
The purpose of the ketogenic diet is to achieve ketosis, a state in which the ketone levels in your blood actually rise. When you are consuming a fat-based diet, your energy source becomes fat. This means, after you have reduced carbohydrates from your diet and your muscles have run out of them, your body has to resort to metabolizing fat. Under ideal conditions where your body is burning whole-food carbohydrates with lots of fiber as its primary energy source, similar to the Whole-Foods Plant Based diet, glucose metabolism breaks down into carbon dioxide, water and a fuel molecule called adenosine triphosphate (ATP). This breakdown is very clean and efficient. However, when fat metabolism takes place, it inefficiently breaks down into small ketone molecules that access cells and the brain very differently.
Origin of The Keto Diet
In fact, this difference is why the ketogenic diet was developed in the first place. The keto diet was created in order to help a subset of pediatric epilepsy patients who experienced uncontrollable seizures that were not relieved by the aid of traditional antiepileptic medications. The ketogenic diet was used under the strict direction of physicians to change the entire metabolic mechanism of energy utilization in the brain. In this regard, the diet was a success due to the fact that the brains of these pediatric patients were so damaged that by shocking their brains, they seized less. These results did not mean that the patients’ seizures went away, that they were cured from epilepsy or that there were any medical benefits; the results of the ketogenic diet simply meant that the children seized less because their brain cellular metabolism and PH was changed so significantly.
It is with this point that the crux of our concerns over the long-term viability of the keto diet are rooted: why do we think that something that is used in a sub-sub-category of pathology should be used in the general population? Especially when the sustainability and long-term effects of the ketogenic diet remain unknown (there are currently no long-term studies that have been done of people who follow the keto diet. There have also been no studies conducted of population bases that have survived on the keto diet exclusively).
This leap is like suggesting that because chemotherapy works against certain cancers, it should be widely available to the general public with no oversite or long-term consideration. It just doesn’t make sense.
The Problem with Ketones
Let’s think of the ketogenic diet in a framework we can all understand: the world of dating. In this context, the breakdown of glucose molecules represents a lengthy courtship. Gazes across the room, tentative first dates, meeting of parents, merging of families and finally, a trip to the altar and ultimate wedded bliss. Cute right?
Let’s break it down: in order for a glucose molecule to get to a neuron or any cell (in a healthy diet of whole food carbohydrates with lots of fiber), it goes through a lot. It has to be broken down in the mouth and stomach and then at the cellular level and absorbed into the blood. It is then passed through the blood-brain barrier through receptors, then from there through finicky cells that require just the right amount of glucose molecule to stimulate the right amount of insulin. Only then is a gate opened up in the cell, allowing the molecule to bind first through tyrosine pathways and from there multiple other metabolic pathways, until it makes its way to the mitochondria where it does even more processing! Just like the work involved in a successful long-term relationship, a lot of work has to happen in order for a glucose molecule to get into the cell. However, when processed properly, there is no inflammation, no waste by-product and the cell functions properly.
The breakdown of ketones on the other hand are more akin to a one-night stand. Ketones are different – they are small molecules that waltz right through the blood-brain barrier without receptors, right through the cell wall without having to rely on insulin and then right into the mitochondria. Just like a new connection with a charming suitor, this quick pathway to the mitochondria feels great and is why people who start keto report high energy and fast weight loss results. However, it is also damaging, causing inflammation in cells and creating waste by-product. While there has been no long-term study specific to the keto diet, we do know for a fact that the brain is the most energy-hungry and sensitive organ of all and any imbalance creates significant inflammation and long-term pathologic processes.
There is a proven link between waste disposal and Alzheimer’s disease, therefore the question must be asked: if we are following a diet that creates a profound amount of waste, inflammation and energy disproportionality, is it not our responsibility to understand the long-term consequences of such a diet?
Should you be Worried about the Keto Diet?
It is our belief that the ketogenic fad has a short-term benefit, but potential for significant long-term harm. Fat-based diets have been studied extensively and have been proven to damage vasculature. Even for those people who believe that the brain needs fat (which it actually doesn’t, it only needs omega 3’s) the brain has 400 miles of micro-vasculature – aka arteries – that are incredibly sensitive to fat and the damaging inflammation it causes. This we know.
While we know that a fat predominant diet has potential for significant damage for any system in the body, and especially the most metabolically active and most vascular organ in the body, we still believe that there is room for research into a plant based ketogenic diet to at least better understand the role of ketosis in brain function.