What are the advantages and disadvantages of the Ketogenic diet

What is the ketogenic diet? Who is the ketogenic diet recommended for? What are its advantages and disadvantages? And what is my take on it?

What is the ketogenic diet?

The ketogenic diet is a way of eating where, by greatly reducing carbohydrate intake and increasing fat intake, you enter a state of 'ketosis'.

If you have less than 50 grams carbohydrates per day, this can lead to mild ketosis and below 30 grams even to severe ketosis.

Ketosis is a strategy of the body to fuel the brain when glucose stores become insufficient. Through altered fat burning, fatty acids are then converted into 'ketones' or 'ketone bodies'. The brain can function on both glucose and ketones, so you can think of ketones as a kind of alternative fuel for the brain.

Ketones can be measured in urine with a test strip and so you can measure whether you are in ketosis. In addition, ketones also have a smell that you can smell on someone's breath, which is the smell of acetone (acetone smell).

Recently, I have been getting more and more questions about the ketogenic diet. In fact, this is nothing new under the sun. The ketogenic diet has both advantages and disadvantages and can be used for certain symptoms and diseases such as epilepsy, Parkinson's and diabetes (especially type 2), but is also used as a weight-loss strategy as with the time-honoured Atkins diet.

Who is the ketogenic diet recommended for?

• In medical terms, the ketogenic diet has become best known as a complementary treatment for epilepsy and Parkinson's disease. In both cases, there seem to be positive effects of ketones at the brain level. In epilepsy, for instance, there is a theory that there is a deficiency of certain fatty acids, namely butyric acids. These butyric acids are also released when you are in ketosis. However, that this explains the effect has not yet been proven (1), (2).
• Recently, the ketogenic diet has also been used in type 2 diabetes in the Netherlands as a start-up of the 'turn around diabetes' programme. This aims to give rest and restore efficacy to the insulin receptors that are highly insensitive in type 2 diabetes. Thus, insulin resistance is quickly reduced. After this start-up, a milder approach is taken. Again, it is important that this is done under the supervision of a doctor who adjusts the medication accordingly. This is because otherwise there is a high risk of hypos or hypoglycaemia (severe blood sugar dips).
• The ketogenic diet is also being investigated in the complementary treatment of cancer. However, the anti-tumour effect has not yet been conclusively established (3).
• It is also more widely used as a weight loss diet, with Atkins gaining worldwide fame. That a ketogenic diet is more successful in reducing fat percentage in the long term than other calorie-restricted diets has not been proven. It could, however, suppress the feeling of hunger in the short term (4). What is true, of course, is that the body retains less fluid with a low carbohydrate intake so it seems more effective, but that is mainly fluid loss that you see on the scale. This means that when you start eating more carbs again you immediately start retaining extra fluid again. So you can gain a few kilos in a day. This sometimes makes people unduly fear carbs.

What are the possible benefits of the ketogenic diet?

• Suppression of hunger pangs through ketosis (5)
• No rapid blood sugar spikes that come with insulin resistance, pre-diabetes and diabetes are often unwanted.
• Reducing body weight through fluid loss
• By reducing carbohydrates, the intake of gluten is less, so glutensensives experience additional benefits
• Sometimes symptom reduction in epilepsy and Parkinson's disease
• Improving mood. (6)

What are the possible disadvantages of the ketogenic diet (areas of concern)?

• When cutting out high-fibre carbohydrate sources, it is important that you get enough fibre from other sources. Otherwise, this can cause constipation and other gastrointestinal problems (7).
• Ketogenic diet may unbalance gut flora (8).
• You can let the number on the scales fool you too much, because fluid levels in the body can fluctuate a lot at very low carbohydrate intakes. With a very low carbohydrate intake, you lose several kilos of fluid that can quickly add up if you are a little less strict in terms of carbohydrate intake for a while. Dehydration can also be a risk, so it is extra important to drink enough.
• Ketogenic diet may reduce thyroid function (9), (10)
• It requires a considerable adjustment in eating patterns and if the person does not have strong motivation, the chances of relapse are high.

What is my take on the ketogenic diet?

First of all, I think it's important to say that everyone is different and you ultimately have to experience what suits you. In a general sense, I have an opinion on the different applications of the ketogenic diet:

1. I personally find the ketogenic diet an interesting intervention in epilepsy, Parkinson's and other brain-level problems. For me, though, it is still questionable whether severely reducing carbohydrate intake to the level at which ketones arise is addressing the real cause (causally). Cutting out so many carbohydrate sources is also likely to make you almost gluten-free. Indeed, there are also studies that show a link between hypersensitivity to gluten and epilepsy (11), (12), (13). So perhaps a lot of results can also be achieved with a gluten and dairy-free intervention such as The Hormone Factor instead of ketogenic diet (14).
2. Using the ketogenic diet as a temporary start-up at the reversing type 2 diabetes I find quite interesting if the main goal is to get off the medication as soon as possible. The downside here is that before starting the switch to a ketogenic diet, the doctor has to adjust the medication properly, otherwise there is a risk of hypo (dangerously low blood sugar). I therefore hope that no one with diabetes 2 will do this on their own, now that the success stories are being trumpeted in the media. By the way, it is also perfectly possible to reverse diabetes 2 without a ketogenic diet, but by a more moderate broad lifestyle approach (diet, training, stress, mental) that will make you lose weight, get better fitness and muscle strength and have less low-grade inflammation. It is even possible by still consuming quite a lot of carbohydrates, but surrounded by large amounts of fibre, so blood sugar rises only slowly and insulin can work in peace (15). I personally think this is easier to maintain for many people.
3. Using a ketogenic diet to lose weight is of little interest to me personally, as there are many other paths to Rome that I find safer and require less adaptation. For instance, I am concerned that thyroid function and gut flora balance can be undermined if this diet is strictly maintained for more than a few months.