As a naturopathic doctor, I’m frequently asked about the effectiveness and health benefits of various diets. One that frequently comes up is the ketogenic diet (a.k.a. the ‘keto diet’). Known for its high-fat, low-carb composition, it results in fat being broken down into ketones within our bodies to be used as an energy source in place of carbohydrates, since the body is not being provided with enough carbohydrates to run on. Some people may feel best consuming a low-carb, ketogenic diet, but I do have concerns with the way many people are going about consuming a keto diet.
While the benefits of eating a plant-based diet rich in whole-food carbohydrate sources, versus a diet high in full-fat dairy and red and processed meats are plentiful (e.g., healthier blood sugar levels, lower cholesterol, weight loss, and ultimately a lower risk of numerous chronic diseases), that doesn’t mean it’s the only way we can achieve good health. With that said, most people are doing keto wrong. In this article, I’m going to outline what the research suggests to help my die-hard keto friends get the MOST health benefits out of their keto diet – while limiting the possible health risks. Let’s dive right in…
History of the keto diet.
Initially, the keto diet was developed to treat some forms of epilepsy but has since gained popularity as a weight loss method. With roots in the 1920s, the diet was shown to reduce glutamate levels and inflammation in the brain, while enhancing the synthesis of GABA (gamma-aminobutyric acid) – a neurotransmitter in the brain responsible for inhibiting the firing of nerve cells, which is speculated to be one reason ketogenic diets may prevent seizures in patients with epilepsy, particularly in cases where medications are ineffective.
However, following a keto diet can be incredibly limiting and tough to maintain. Why? Because high-carb foods like grains (eg. rice, bread, pasta, etc.), many legumes, and most fruits are generally avoided, and even minor slip-ups can kick your body out of a state of ketosis (more on that later).
What is the keto diet?
A ketogenic diet is characterized by a very low intake of carbohydrates. The central idea is to ensure the body remains in a state of ketosis and thus the diet generally consists of approximately 70-75% fats, 20% proteins, and 5-10% carbohydrates. For the medical ketogenic diet used to treat epilepsy, doctors aim for a ratio of up to 4 grams of fat for every 1 gram of protein and carbs combined.
The types of fat-rich foods that are consumed are key for influencing the healthfulness of a particular keto diet. Foods rich in unsaturated fats, such as avocados, fatty fish like salmon and mackerel, and nuts and seeds, oils, particularly those rich in monounsaturated and polyunsaturated fats like olive oil, canola oil, and flaxseed oil can also be a very healthy addition to the diet.
While protein is important, it should not dominate the diet, unlike some other low-carb diets because consuming too much protein can also hinder the body’s ability to enter ketosis, as protein can be converted into carbohydrates and used as energy, rather than needing to break down fats into ketones. Protein sources could include tofu, tempeh, seitan, low-saturated fat plant-based meat alternatives, fish, protein powder, and moderate amounts of lean meats, and eggs.
Is keto good for you?
The typical keto diet is rich in saturated animal fats sourced from meat and high-fat dairy products, including butter. This iteration of the keto diet has been shown to raise LDL-C levels – which can increase one’s risk of developing cardiovascular disease (CVD). Therefore, this has raised concerns about the potential negative effects of a keto diet on CVD risk, but what if there’s a safer way to do it?
The right way to keto…
SAT vs. PUFA
This trial compared a saturated fat-rich keto (SAT) diet to a polyunsaturated fat-rich keto (PUFA) diet. 20 healthy participants were randomized to one of two diet groups. Both diets were 70% fat, 15% protein, and 15% carbs, and were designed to be weight-maintaining. The SAT diet derived 60% of its fat from saturated fat, 15% from polyunsaturated fat, and 25% from monounsaturated fat, while the PUFA diet was 60% polyunsaturated fat, 15% saturated fat, and 25% monounsaturated fat. The polyunsaturated fats in the PUFA diet were largely from nuts and oils.
They measured several markers, including the participants’ ketone levels, after 5 days on their respective diets. Unsurprisingly, ketone levels rose in both groups demonstrating that they did enter ketosis. But interestingly enough, the PUFA diet led to greater ketone levels. This suggests that a polyunsaturated fat-rich keto diet might be even better at putting someone into ketosis than the typical saturated fat-rich keto diet. However, more research is needed to confirm these findings.
The PUFA diet also resulted in lower blood glucose, greater insulin sensitivity, and lower LDL-cholesterol levels compared to the SFA diet. In fact, the LDL-C levels didn’t significantly change from baseline in the PUFA group. However, they shot up in the SFA group, which could worsen CVD risk.
So, if one were to adopt a keto diet, a high-PUFA, low-SFA version appears to be the safer – and possibly more effective – option for inducing ketosis in the first place.
Additionally, while not specifically evaluating very low carbohydrate diets (ie. keto diets), this new meta-analysis of observational studies found that low-carb diets that are higher in plant protein and plant-based fats may lower one’s risk of premature death, while low-carb diets rich in animal protein and animal fat may increase one’s risk of dying due to cancer. This further supports the idea that a larger focus on plant-based sources of fat and protein is ideal.
Find a plant-based doctor in Vancouver.
While the keto diet can offer potential benefits, it may not be suitable for everyone, particularly for those with certain pre-existing conditions involving their pancreas, liver, gallbladder or thyroid, nor those who are pregnant or breastfeeding. Remember, diet is not a one-size-fits-all approach. What works well for one person may not work as well for another. The goal should always be a balanced, nutrient-rich diet that supports your overall health and wellness needs. Therefore, whether you’re embarking on a keto or plant-based diet, it’s important to consult with a healthcare provider before making any significant dietary change.
In my practice, I’ve seen how individualized, whole-food-based nutrition can promote well-being. Whether the ketogenic diet is a part of that will depend on your unique health circumstances and goals. As a naturopathic doctor, I’m here to guide you in exploring these possibilities. Together, we can determine the best nutritional path for your health journey.
Matthew Nagra is a Naturopathic Doctor and is a passionate advocate for evidence-based nutrition as medicine. I have a particular passion for plant-based/vegan nutrition, physical medicine, and chronic disease. With additional training in nutrition, I hold a Plant-Based Nutrition Certification from Cornell University and the T. Colin Campbell Center for Nutrition Studies where I’ve authored multiple articles on the subject.