All We Have To Know About Ketogenic Diet In 2020

The ketogenic diet is an eating pattern that is characterized by extremely high fat intake and a high carbohydrate restriction on the menu. The first ketogenic diet options were developed in 1920 by Dr. R. Wilder (Mayo Clinic, USA) for the treatment of type I diabetes and difficult-to-control epilepsy in children.

A century ago, diet therapy in these patients was the only treatment because of the lack of effective drugs. During the period 1950-1990, ketogenic diets gradually came to the fore due to the development of new drugs. At present, the interest in the ketogenic diet for the treatment of epilepsy in children is renewed. In addition, ketogenic diets have the potential to complement treatment in some nervous system disorders, rare genetic disorders, and more.

The ketogenic diet is an alternative diet with an excess of fat as an energy source.

According to current recommendations on healthy eating, carbohydrates should provide 45-60% of all calories, protein - 10-20%, and fat - up to 30% (16). In the ketogenic diet this ratio is quite different: carbohydrates - 5 (up to 20%), proteins - 10%, fats - 70-85%.

Example:If the recommended daily intake of one person is about 2000 kcal, then in a ketogenic diet, his portion should ingest about 165 g of fat, 75 g of protein and only 20 g of carbohydrates.

In ketogenic diets, the abundance of fat is provided by the allowed foods.

Allowed foods:

• Vegetable sources - olive oil, avocado, coconut, palm oil, linseed oil and more.

• Animal products - fatty meat, offal, sausages, bacon, bacon, cow butter, bird fat, fish and more.

Banned foods:

• Fruits (only some members of the forest fruit group are allowed, in very small quantities)

• Starchy vegetables (carrots, turnips, potatoes, etc.)

• Bean foods

• Cereals and pasta of all kinds

• Milk (source of milk sugar (lactose)

• Desserts (incl. With sweeteners)

• Alcohol

• Nuts and a variety of vegetables (tomato, onion, garlic, etc.) are restricted.

In the course of its long evolution, the human body has adapted to use glucose as a major energy source.

Many of our tissues can function by using fatty acids (eg muscle), but there are also glucose-dependent organs. This is especially true of the brain and kidneys. The human brain needs an average of 120 grams of glucose per day. With the ultimate restriction on carbohydrates, the brain relies on glycogen stores. However, they run out quickly - within 1-3 days. To ensure the normal function of the brain, which controls all other organs, the body involves a process called gluconeogenesis (ie, synthesis of glucose in the body from non-carbohydrate sources - fatty acids or amino acids, ie proteins).

For the first few days (3-5 days) after carbohydrate fasting, the blood sugar level (respectively, providing the brain with glucose) is maintained at the expense of protein degradation, ie. of muscle mass. However, it is very disadvantageous for the human body to synthesize glucose from a protein and to lose valuable muscle tissue. Metabolic adaptation for muscle mass storage is fat ketogenesis. This process allows a large part of the body's energy expenditure to be covered by the ketone (ketones) obtained from the breakdown of fat stores (adipose tissue).

Ketotelles are water-soluble molecules produced in the liver by fatty acids. In carbohydrate starvation, they cover part of the brain's energy needs. When the blood keto bodies reach a concentration> 2 mmol / l. a condition is known as ketosis occurs.

In ketosis, the body relies primarily on fat as an energy source.

Ketogenesis arose during evolution in connection with episodic starvation in the nomadic period of human history. A healthy person often falls into ketosis spontaneously - e.g. after prolonged sleep (because he did not eat), after heavy training or exercise without nutritional support, after prolonged fasting on various occasions, etc. 

How Do Ketones Work?

Because they are relatively small and water-soluble molecules, ketones cross the blood-brain barrier seamlessly and reach two very important centers in the cerebral cortex: the center of appetite and the center of euphoria. In this way, ketotelles affect the levels of the hormones ghrelin and leptin (regulators of appetite and satiety). They suppress appetite, improve hunger control and reduce cravings for sugary foods. As a result, it reduces energy intake and body weight without significantly affecting muscle mass.

Currently, ketogenic diets are universally administered for overweight and obesity without considering the health risks posed by carbohydrate starvation.

There is no evidence yet that long-term ketogenic diets are easier to follow and more successful than other alternative eating patterns in overweight people.

Ketogenic diets may be an option for some people who have had difficulty losing weight with other methods. However, the exact ratio of fats, proteins, and carbohydrates that are needed to achieve the goals are different for individuals because of their unique genome and body composition.

A meta-analysis of 13 randomized controlled trials (duration> 12 months) compares two diets with the same calorific value - CD (very low carbohydrate diet) and a low-fat diet. The results of the two regimens are similar - the average weight loss at CD is only 2 pounds (less than 1 kg) greater over a 12-month period. In the second year, the results are leveled (1). An analysis of 26 short-term studies (4-12 weeks) compared the appetite for CD and a low-fat diet (with the same calorie content). The results are similar in both appetite and weight loss.

A number of common side effects of extreme carbohydrate restriction have been described:

• fatigue (mental and muscular)

• muscle aches and cramps (nausea)

• nausea

• dizziness

• mood disorders (apathy, depression, aggression)

• irritability

• headaches

• impairments in mental capacity (memory impairment, concentration, clear thinking)

• constipation

• and others.

A number of studies have looked at the link between carbohydrate intake and overall mortality.

One of the most extensive studies in this area is ARIC (Atherosclerosis Risk in Communities). It looks for the link between average carbohydrate consumption and the risk of death tracked over a 25-year period. Eating habits of 15 428 people aged 45-64 years, all without extremes in daily energy intake, have been studied. The results show a statistically significant, non-linear correlation between the risk of death and carbohydrate intake. The lowest risk is observed when consuming carbohydrates, providing 50-55% of daily energy intake. Mortality is highest when carbohydrate intake is below 30% and increases steadily when carbohydrate exceeds 60%.

A relatively higher risk of death is found when carbohydrates on the menu are replaced with animal fats and proteins and lower when replaced with vegetable fats. There are significant differences in the average predicted upcoming life based on carbohydrate intake. A meta-analysis of 12 publications covering studies conducted in North America, Europe, Asia, as well as international cohorts in recent years confirms ARIC results.

The most significant health risks when strictly following a ketogenic diet are:

• gastrointestinal problems: bad breath (due to ketones), gastric reflux, biliary dyskinesia, constipation, pancreatitis, etc.

• in some of the human population, there is a decreased tolerance for high fat intake with the consequence of greatly elevated triglycerides and cholesterol (dyslipidemia) and increased cardiovascular risk

• worsening and exacerbation of kidney diseases (renal failure, gout, etc.), liver, bones (including fracture healing and osteoporosis)

• a tendency to hypoglycemia

• electrolyte imbalance affecting potassium, calcium, magnesium, manifested by painful cramps, nausea, dizziness

• hypersensitivity to cold, dry skin, hair loss

• in children: slow growth, frequent acidosis, increased incidence of acute infectious diseases
  
  

It is absolutely contraindicated that a ketogenic diet should be followed by:

• children and adolescents;

• women during pregnancy and lactation, women with menstrual disorders and reproductive problems;

• overweight people (BMI <18.5);

• people with eating disorders (anorexia, bulimia, etc.), alcoholism, etc. Dependencies;

• mental illness (psychosis);

• porphyria and some congenital enzyme deficits;

• renal or hepatic insufficiency (including active chronic hepatitis), gout;

• some endocrine disorders: type 1 diabetes, hyperthyroidism, Cushing's syndrome;

• hematological diseases;

• fresh myocardial infarction (6 months ago), unstable angina, heart failure, vascular incident;

• progressive inflammatory and malignant diseases.

Relative contraindications to the ketogenic diet are kidney stones and gall bladder and diuretics (risk of developing hypokalemia and heart rhythm disorders).
There are several issues with increased difficulty in following a ketogenic diet.

First and foremost is the long-term health risk and safety (over 1 year). Another serious question is whether the side effects do not outweigh the potential benefits for people with more than one illness. Do not forget that it is obese individuals who have a number of accompanying diseases, some of them could be undiagnosed, which worsen and worsen in conditions of ketosis. There is a serious risk of following ketogenic diets in diseases occurring with disorders of protein and fat metabolism (kidney, bile, liver, pancreatic) and the introduction into ketosis in these patients can be life-threatening.

Last but not least is the selection of fat in ketogenic diets. It is of great importance whether 70-80% of the calories in the daily menu will come from mostly solid, saturated fat or at the expense of liquid monounsaturated and polyunsaturated fat.

Instead of a recommendation

When switching to a ketogenic diet, it is advisable to choose, as a matter of priority, foods containing mostly unsaturated fats: fish, nuts, seeds, olive oil, avocado, poultry. It is desirable to avoid sources of saturated fatty acids, especially unconventional geographic areas such as coconut and palm malt. It is absolutely inappropriate and risky for health to include hydrogenated oils rich in trans-isomers of fatty acids, so-called trans-fats, in a ketogenic diet.

A healthier alternative to the classic ketogenic diet as a weight-loss approach could be to replace carbohydrates with mostly vegetable fats and proteins.

A ketogenic diet may be an alternative for some people who have had difficulty achieving their health or weight goals by other methods. However, the exact ratio of fats, carbohydrates, and proteins will vary from person to person due to the specific set of genes and characteristics of the body composition.

Therefore, if you decide to start a ketogenic diet, it is recommended that you consult a nutritionist to monitor any biochemical changes after starting the diet. The doctor will create a nutrition plan that is tailored to the health status and physiological characteristics and will give adequate instructions for reintroducing the carbohydrates (in the appropriate quantitative and qualitative composition) after reaching the goals. This will minimize the health risks of prolonged ketosis.