Does the Keto Diet Work for Weight Loss?

I’m sure by now you must have heard about the ketogenic diet – from someone in your office, a family member or a friend perhaps? I mean it’s one of the more popular “weight loss” diets out there. But that sounds too good to be true. That’s because it is.

A Refresher

The ketogenic diet is a low-carbohydrate, high-fat diet that was developed in the 1920s as a potential treatment for epilepsy^[1]Wheless, J. W. (2008). History of the ketogenic diet. Epilepsia, 49 (SUPPL. 8), 3–5. https://doi.org/10.1111/j.1528-1167.2008.01821.x^[2]Paoli, A., Mancin, L., Bianco, A., Thomas, E., Mota, J. F., & Piccini, F. (2019). Ketogenic diet and microbiota: friends or enemies? In Genes (Vol. 10, Issue 7). MDPI AG. … Continue reading. Today, it’s popularly known as a rapid weight loss diet with promising health benefits. The diet is also used in the treatment of a few other conditions, such as polycystic kidney disease^[3]Wheless, J. W. (2008). History of the ketogenic diet. Epilepsia, 49 (SUPPL. 8), 3–5. https://doi.org/10.1111/j.1528-1167.2008.01821.x.

Nutrition of the Ketogenic Diet

The keto diet varies drastically from the healthy eating recommendations outlined by Health Canada. The keto diet promotes 80-90% of our caloric intake to come from fats and the remaining 10-20% to come from carbohydrates and proteins. To put this in perspective for you, it’s recommended that 45-65% of our caloric intake should come from carbohydrates and only 20-35% should come from fats.

Additionally, this change in the proportion of carbohydrates to fats in the diet means there’s a change in the number of vitamins and minerals consumed. The keto diet has been associated with deficiencies of several vitamins and minerals. Some vitamins and minerals that are commonly lacking in the keto diet include,

• Folate
• Vitamin B6, A and E,
• Calcium
• Magnesium
• Selenium

In the short term, insufficient consumption of vitamins and minerals may not be a problem. But, prolonged deficiency can result in micronutrient-deficiency diseases.

The Keto Diet and Rapid Weight Loss

In the first 2 weeks of the keto diet, many people experience a period of rapid weight loss. But, contrary to popular belief, this isn’t “fat” loss, it’s water loss.

During the first few days of the keto diet, your body uses up all of the remaining glycogen stores it has, before becoming reliant on beta-oxidation (ß-oxidation) to make energy. During this time, the body loses 3 grams of water for every 1 gram of glycogen used, leading to that quick drop in weight.

Once your body has entirely depleted its glycogen stores, it then begins to rely on fatty acids as a source of energy. At this point, you have reached a state of ketosis.

Effects on Health

In addition to the decrease of epileptic seizures in some individuals, the ketogenic diet is associated with improved glycemic control due to its severe carbohydrate restriction^[4]Walton, C. M., Perry, K., Hart, R. H., Berry, S. L., & Bikman, B. T. (2019). Improvement in glycemic and lipid profiles in type 2 diabetics with a 90-day ketogenic diet. Journal of Diabetes … Continue reading. But, this primarily benefits individuals with diabetes, rather than non-diabetic individuals. Unfortunately, there are more negative health effects than good^[5]Wheless, J. W. (2008). History of the ketogenic diet. Epilepsia, 49 (SUPPL. 8), 3–5. https://doi.org/10.1111/j.1528-1167.2008.01821.x^[6]Bilsborough, S. A., & Crowe, T. C. (2003). Low-carbohydrate diets: what are the potential short- and long-term health implications? Asia Pacific J Clin Nutr, 12(4), 396–404..

The restriction of carbohydrates and vitamin and mineral deficiencies associated with the keto diet can lead to many adverse effects^[7]Sirikonda, N. S., Patten, W. D., Phillips, J. R., & Mullett, C. J. (2012). Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation. Pediatric Cardiology, 33(5), 834– … Continue reading. Most adverse effects are minor, such as nausea, vomiting and diarrhea, electrolyte disturbances, hypercholesterolemia, and hypertriglyceridemia. However, severe side effects have been associated with the diet including,

• Kidney stones
• Iron-deficiency anemia
• Osteopenia
• Cardiomyopathy^[8]Sirikonda, N. S., Patten, W. D., Phillips, J. R., & Mullett, C. J. (2012). Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation. Pediatric Cardiology, 33(5), 834– … Continue reading

On top of all of this, micronutrient deficiencies from the diet may exacerbate underlying conditions that you didn’t even know you had.

It’s safe to say, you should really check with your registered dietitian (or doctor) and make sure you’re all good before committing to the keto diet.

Sustainability

For many people, the keto diet isn’t used as a long-term diet for a variety of reasons. Two main reasons that many people struggle to stick with the diet are,

1. Severe carbohydrate restriction.
   • The keto diet severely limits the amount of carbohydrates someone can eat on a day. This means saying “no” to a lot of meals because they contain “too many” carbohydrates. For most people, this means they return to a more regular diet once they hit their goal weight.
2. Adverse effects.
   • Side effects can be quite prevalent with the keto diet and result in many people stopping the keto diet, particularly if they have underlying conditions or experience some of the more severe side effects

Is Keto Right for You?

If your ultimate goal is sustainable weight loss, then this diet probably is not right for you. There are many healthy, and more successful options for weight loss than the ketogenic diet. Working with a Registered Dietitian can help you achieve your weight goals while ensuring you are still supporting your health.

On the other hand, if you are someone who is good with sticking to the rules, it might be an option. There is no argument that the keto diet does result in rapid weight loss. However, the weight is quickly regained after the diet ends which can easily deteriorate into yo-yo dieting to achieve a weight goal.

It’s also important to take into consideration your health history and the medications you are taking when deciding whether to try the ketogenic diet.

Before starting the keto diet (or any other diet), you should chat with your doctor or healthcare team to make sure the diet is right for you.