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What to carefully consider before starting the keto diet

The ketogenic diet can come with serious side effects and needs to be carefully considered, says Tairāwhiti-based dietician Kate Rhodes. She talks to Akula Sharma . . .

At her practice Kate Rhodes supports clients with a range of different conditions to help improve their eating habits, usually through one-on-one sessions.

She said the most trending diet at the moment in the community was the ketogenic or “keto” diet.

“Diets have been around for centuries and there's always a new one gaining popularity.

“Among the most popular at the moment are the ketogenic diet, fasting, plant-based and vegan diets.

“These diets have been around for many years, for example the keto is almost an adapted version of the Atkins diet which came out in 1972.”

Ms Rhodes said a keto diet is when the main fuel used for energy in one's body is switched from glucose to ketones.

“In this diet an individual drastically limits their intake of carbohydrate foods such as bread, cereals, and starchy veges (kumara and potatoes) and replaces it with fats such as avocados, nuts, seeds, butter and oils. It has a moderate amount of protein as well, but overall, it's a very low carbohydrate and a high fat diet.

“If someone's following it correctly, that is, they are reducing their carbohydrate intake to the extent requires, the body switches from using glucose as its main fuel source to using ketones (which comes from fat stored in our body). This state is called ketosis, which is where the name ‘keto' comes from.”

Ms Rhodes said the keto diet was originally developed in the 1920s as a medical treatment to reduce seizures for children with epilepsy who were resistant to epilepsy drugs.

“This medical treatment is still used today, and can reduce seizures in children by about 60 percent.

“However, it requires a very strict version of the diet (parents must weigh food by the gram) and medical supervision by a team of health professionals — neurologist, GP and an experienced dietician.”

Ms Rhodes said accessing appropriate medical and dietetic support for the use of the keto diet in children with refractory epilepsy can be expensive as “funding through Hauora Tairawhiti DHB is not available”.

“DHB-funded paediatric ketogenic diet programmes are currently only available in some Auckland, Wellington and Christchurch regions. It needs huge resources to set up a local service, which our region wouldn't be able to afford or sustain.”

Ms Rhodes said that in the short-term, the keto diet could help people with weight loss, reducing appetite and people with type 2 diabetes to control their blood glucose levels.

“The key is ‘short term'. The research has shown us the longest period people have benefited from this diet is 12 months, usually even shorter than that. We don't currently have long-term evidence of the effects of this diet, either positive or negative.”

Ms Rhodes said people with long-term conditions like diabetes and heart disease needed to be mindful and consult their doctor or dietician before pursuing a ketogenic diet.

“Bear in mind, it can be extremely hard to sustain a ketogenic diet in the long term. If you start it, it may not be sustainable.

“Other negative effects of the diet are increases in LDL cholesterol, or our ‘bad cholesterol', and an increased risk of heart disease. Ketosis can also increase the risk of kidney stones and therefore adequate fluid and monitoring is required.

“It is also important to know some side-effects/difficulties people have following it. Because it is a high fat diet, the lack of carbs can make it unpalatable — a lot of people won't enjoy eating in this way. And it is quite strict. If you go out for brunch with your friends, it can be quite challenging to eat socially.

“The other thing is, because carbohydrate intake has to be so low, people have to take out a lot of healthy foods from their diets — most fruits, grains, legumes, and even some veges are off limits.

“Because of this people might miss out essential vitamins, minerals, and fibre, with constipation being a common side effect which can impact on gut health.”

Ms Rhodes said there were a lot of claims about the ketogenic diet, and it was important for people to understand the full picture before making a dietary shift.

“It's really important to understand the long-term effects, safety and side effects of the diet.

“The ketogenic diet has received a lot of hype over the years, and with all the claims out there you would think to yourself why wouldn't I do it? But it can come with serious side effects and therefore needs to be carefully considered.

“I recommend discussing this with your GP or a New Zealand registered dietician just to weigh up pros and cons, also to do the diet safely i.e. getting all your nutrients.”

Ms Rhodes said the best eating pattern consisted of veges, lots of plants, less meat, healthy fats and whole grains.

“Most successful diets are those which contain a variety of these foods.”

Ms Rhodes said she focused on addition rather than subtraction in her practice.

“It's a great approach to have and seems to be the most successful for my clients.”

She said everyone was looking for an optimal way of eating, a silver bullet, when actually, “healthy looks different on everyone”.

“I think a lot of us are caught up in labelling what works for us when it should be about eating what feels good and nutritious; energises your mind and body.

“I think we are getting this pressure to jump on these trends. We all need to take a step back, look at what we are eating at the moment and focus on what we can eat more of (what can you add in) and if you don't know where to start — add veges.”

Ms Rhodes said anyone considering going on a ketogenic diet or exploring this option for their child should seek individual advice from their doctor or a NZ registered dietitian first.

Find a NZ Registered Dietitian at https://dietitians.org.nz/

Cons

• The diet can be high in saturated fat, the type of fat that increases our LDL ‘i.e. our bad cholesterol' and risk of heart disease. These fats include meat fat (e.g. from steak, bacon, chicken, pork), butter, and coconut oil

• Ketosis can increase risk of kidney stones and therefore adequate fluid intake and close monitoring is essential.

• Some experience headaches, lack of sleep, agitation, low mood, constipation, muscle cramping, and difficulty exercising whilst following the diet.

• Ketogenic diets are not nutritionally complete for children. Growth, development and overall health, can be compromised if the diet is not undertaken with strict supervision by an experienced medical team.

• The ketogenic diet is not superior to other diets: a recent review of the current evidence suggests that a ketogenic diet shows no greater benefits on cholesterol levels and body mass index than any other balanced diet. And like all diets, sustaining the restriction and weight loss in the long-term is extremely difficult.

Pros

• In the short term, keto has helped people lose weight, control their appetite, and help manage blood sugar levels in diabetes. However in the literature, these benefits are not typically carried on past 12 months.

• It's a well established and effective medical treatment for drug resistant epilepsy in children.

• In mice and rat studies, ketogenic diets have been shown to prolong survival time and slow down tumour growth and progression in certain cancers. However, it's important to note these effects are seen in animals, and thus we cannot apply the same conclusions for humans.

CARE ADVISED: Dietician Kate Rhodes says the keto diet is no better than other eating regimes, but is a well established and effective medical treatment for drug-resistant epilepsy in children. Picture by Paul Rickard