The keto diet, it’s what’s on the inside that counts

What is keto?

The ketogenic diet has become very popular over the years and has helped some people lose weight, it involves increasing the amount of fat sources you eat such as meat, oils, oil rich fruits and vegetables such as avocados and olives, dairy and egg products, and significantly reduces a person’s intake of rice, pasta, fruit, grains, bread, beans and starchy vegetables such as peas and potatoes, in order to get in a state of ketosis. Ketosis happens when the body's fuel source, and the brain's main fuel source; glucose, is deficient and the body starts to turn fat into ketones to use in metabolism to generate the energy it needs. To enter ketosis you have to eat less than 50 grams of carbohydrates a day, the same as two slices of bread and banana. This means your fat stores will start to be burned and you will lose weight.

Negative effects can include constipation and bowel changes due to lack of fibre and high intakes of fat, headaches, poor sleep and a change in our gut flora. It should be done with caution as it limits vitamins and minerals vital for health and can cause dehydration due to lack of water from fruits and vegetables. It also makes it harder to reach good intakes of fruits and vegetables. Some benefits include reducing your blood glucose and improving insulin sensitivity by reducing fat in the body, and if done with healthy fats such as those from nuts, seeds, fruits and vegetables that feed good bacteria in our gut, can improve autism, Alzheimers, and is used medically to treat epileptic seizures and some metabolic disorders. But is it healthy long term and can we live without carbohydrates?

What did we eat?

Ketosis is one of the body's survival mechanisms in times of carbohydrate shortages as fat stores are built up as much as possible to get the body through times of starvation. As glucose is the body's main energy source, it makes sense that carbohydrates were a rich part of our diet historically, and studies suggest hunter gatherer tribes ate a diet mostly of 50% or more carbohydrates from tubers, berries and other plants and 50% or less meat. This would obviously vary throughout the year as seasons changed and food availability varied but a lot of daily calories would come from plants as well as other things like honey, which is also glucose based, and these are still the average diets of many tribes still living today such as the Hadza tribe in Africa, studied in the book 'Burn' by Herman Pontzer.

Studies show tribes today do not suffer from the same illnesses as the rest of civilization whose diet consists of mass farmed animals and plants, grown with the help of fertilisers, pesticides, antibiotics, hormones and vaccines. Studies also show when people move from one area to another, picking up the diet of the new area including higher amounts of meat, dairy and high fat, processed foods, they take on the illnesses such as heart disease and cancer, of that area. Animal's products and processed foods today are eaten in such amounts and contain higher amounts of fat than lean wild animals which all contribute to poor health and disease.

What excess fat does in the body?

Consuming large amounts of fat, studies show, build up plaques in our arteries which thicken the blood and cause the heart to beat faster raising blood pressure and putting strain on the heart and artery walls. This can cause the plaques to hit into the artery walls and build up in pockets, narrowing the arteries, increasing blood pressure again and eventually closing the arteries causing strokes and heart attacks. Excess fat in the blood also draws oxygen out of the blood reducing the amount that is taken to the cells for respiration reducing their efficiency. A study looking at the arteries of military men killed in service showed arterial plaque forming in men in their 20’s. Although fit and healthy, too much fat in the diet can cause fat to build up on the inside of the body, in arteries as well as lining the organs. Other studies found babies and embryos with arterial plaques, genetically transferred from the mother and given through the mother's diet during pregnancy.

Of Course, the type of fat matters but more fat than the body needs, regardless of type still negatively affects the body over time. A keto diet full of saturated fat from animals and processed sources have been studied extensively to show negative effects on the body such as heart disease and cancer as they also build up around the lining of the organs such as the heart. When saturated fat builds up in adipose tissue the fat cells become engorged and as they fill and stretch, they can start to leak fat back out and into the bloodstream. When fat builds up around the organs it can start to break down and interact with its environment, causing toxic by-products to form in the tissues causing irritation and inflammation. If this continues ulceration and permanent damage to the tissues can occur, breaking down the functions of that tissue ultimately resulting in disease.

Eating unlimited fat on the keto diet may cause these buildups of fat in the organs and arteries and can go unnoticed for a long time if the person is slim on the outside, until symptoms such as high blood pressure start to arise. The body has evolved to eat whatever it can get in order to survive and so is able to eat a wide range of foods including animal products and fat, however it can only endure short periods of high fat or high animal and processed foods until the negative effects of them start to damage the body.

Eating a diet filled with unsaturated fats has some benefits, many studies have shown eating unsaturated fats can lower cholesterol, lower saturated fats and reduce the risk of disorders like stroke, diabetes and cancers. So a healthy ketogenic diet would be essential although too much of any type of fat puts strain on the liver to produce more acidic bile and puts strain on the blood vessels and other organs that rely on glucose and oxygen such as the brain. It does also restrict the intake of plants which can have a negative effect on the body.

What about plants?

A diet high in plant foods is needed to bring a constant influx of antioxidants such as vitamins C and E, which restabilise unstable free radicals or oxygen species with a missing electron that will steal one from our cells, damaging tissues and eventually causing a whole host of deadly diseases. These antioxidants give their electrons stabilising the oxygen, protecting our cells. A constant intake of plants keeps this balance and counteracts the negative effects that animal and processed products, toxins and saturated fats can have on the body.

Plants such as lentils which are high in protein and carbohydrates also have a high importance in the diet as they can rid the body of arterial and organ fat build up. Plants also contain vital vitamins and minerals for e.g. potassium is needed for every cell in the body to function and can reduce the risk of stroke by 21%, the highest sources of which are greens, beans and sweet potatoes. Plants ultimately return the body to health and balance and contain the vital minerals and vitamins, proteins, fats and carbohydrates which maintain all body systems. A high intake of plants is usually missing on a ketogenic diet.

Do we need carbohydrates?

Our bodies have evolved to run mainly off of carbohydrates, some tribes people consuming 60 grams per day. Wholefood sources contain many important minerals, vitamins, water, proteins, are associated with lower mortality rates, and have roles in the body such as maintaining brain health, aiding satiety, improving insulin sensitivity and blood glucose levels and providing fibre. Indigestible fibre is a vital material that acts as a broom sweeping nutrients but also toxins and other material through the digestive tract keeping it free from build up, aiding digestive, allowing proper stool formation and regular defecation and providing a major food source for our microbiome; the internal ecosystem of microbes such as bacteria which are vital for our survival.

Our microbiome provides a physical barrier stopping parasites and pathogens from invading and also helps to digest our food, and produces fatty acids and vitamins. They are part of our immune system defence, and are involved in mood, DNA expression, anxiety and depression. A healthy microbiome runs majorly on indigestible fibre, but also other carbohydrates, proteins and fats. Animal foods, proteins and unhealthy fats and processed foods can feed the unfriendly bacteria in our gut producing toxic by-products and allow them to overgrow which can cause symptoms from gas, constipation and diarrhoea to mental health problems and cancers whereas healthy fats, carbohydrates and proteins increase friendly bacteria.

Studies looking at a ketogenic diet of healthy fats shows reduced pro-inflammatory bacteria, increased growth of beneficial bacterias connected to the reduced risk of Alzheimers, epilepsy, autism and multiple sclerosis. It is thought that a ketogenic diet improves the state of the microbiome, increasing bacteria which produce metabolites involved in many pathways in the body. A previously unhealthy diet and lifestyle and therefore microbiome can be changed with the help of a healthy ketogenic diet. This is also true however of a healthy diet composed of healthy fats and healthy carbohydrates; the mediterranean diet was also found to have similar beneficial effects on Alzheimers, and on a ketogenic diet studies also found an overall decreased richness and diversity of microbes due to the lack of carbohydrates.

Fermentable carbohydrates not present in the gut of a ketogenic dieter are also health promoting and vital as they also produce microbial metabolites, which are involved in the reduced risk of cancers, cardiovascular diseases, diabetes and more. They produce short chain fatty acids such as butyrate which feed the intestinal cells, influence gene expression and modulate the immune system. They also reduce the amount of toxic metabolites produced from protein fermentation in the large intestine which can damage tissues. Studies recommend for this reason a keto diet may need the input of fermented foods to maintain populations of bacteria.

Studies also show eating plant protein sources, which are also rich in carbohydrates and so often cut out of a keto diet, over animal proteins were better for overall gut health and increased the number of friendly bacteria in the gut, the same bacterias that are increased when eating a high unsaturated fat keto diet, showing the effects of improved gut health can be achieved on a healthy keto diet or a diet containing healthy plant protein and carbohydrate sources such as beans and lentils.

Reduced fibre in the gut also means the muscular tissues of the intestines have to work harder to push the materials through and can cause hernias known as diverticulosis. Pouches then form in the wall and unfriendly bacteria can build causing diverticulitis. A diet with a lack of fibre can also cause spasms, strictures or colitis in the bowel, IBS and constipation. This can all cause the colon to retain faeces instead of expelling it which, if left in the bowel for more than 36 hours causes auto-intoxication where toxic products and bacteria in the faeces reabsorbs back into the body harming tissues and causing irritation, inflammation, weakness and illness.

What about grain brain?

Grain brain is known as a condition of sluggishness, fogginess, and a lack of focus in the brain from eating grains such as wheat and rice. Grains are commonly thought to cause inflammation in the body however vast research shows grains actually reduce many inflammation markers in the body. Consuming gluten in wheat, spelt, rye and barley can cause sluggish feelings and digestive problems in people with an intolerance or autoimmune disease where gluten proteins irritate the lining of the digestive tract or trigger an immune response and if so this should be avoided. However, if you do not have a sensitivity, a gluten free diet has shown to negatively affect gut bacteria and immune function, a study found a week on a gluten diet fed beneficial gut bacteria and increased natural killer cells in the body which fight diseases like cancer and viral infections.

Diets against carbohydrates such as that from the book The grain brain encourages a ketogenic diet including healthy fats as well as including the need for fibrous fruits and vegetables and recognises the need for a balanced gut microbiome and its roles in disease, the immune system, DNA and the brain. Other studies connect the importance of whole fibrous carbohydrates and their role in brain health as they contain many antioxidant and bioactive compounds that counter oxidative stress and inflammation, helping to prevent damage to brain tissue and maintain optimal cognitive functioning, fibre also helps remove cholesterol and fats from your arteries which can clog the small vessels of the brain as well as reduce the risk of stroke. Most problems with carbohydrates and sugars point to the refined, processed products and do not refer to the whole plant food and its health benefits when unmodified and unadulterated with chemicals.

Another factor that could be affecting our bodies when eating grains and other plants is the change in farming practices. Wheat intolerances as well as soy allergies have increased in the modern world but do not appear in more primitive tribes. Instances have shot up since industrialisation and the use of pesticides and herbicides such as glyphosate used on GMO crops such as corn, wheat and soy. Toxins in the pesticides have also been linked to diseases such as cancers and Parkinson’s disease. An organic, wholefoods diet including 3 portions of grain a day has shown to decrease inflammation, increase life expectancy and reduce the risk of heart disease, type 2 diabetes, stroke and obesity. These health benefits have also been shown on a ketogenic diet of healthy fats.

How to lose weight and stay healthy

There's no question however that people are losing weight on the keto diet but it can be quite restrictive and may not be healthy to do long-term and many people tend to slowly return to their previous weight once they ‘finish’ a diet as they revert back to their old habits.

Carbohydrates have been thought to cause weight gain in the past but when studies look at intake of whole forms of carbohydrates such as potatoes, brown rice, wholewheat and pumpkin they see the opposite. Studies show eating these carbohydrates fills you up, reducing cravings and overeating, keeps you fuller for long and is associated with weight loss and healthy weight management. Carbohydrates like all plants are relatively low in calories and so can be eaten in abundance without fear of weight change if eaten in their whole form without the input of oils, other fats and processed foods. When comparing high fat diets and high carbohydrate diets studies showed little or no difference between them for weight loss.

Studies also show that exercise may not be as effective for weight loss as the body tends to balance its metabolism, upping hunger or reducing cell energy expenditure after exercise to hold onto weight, as this is beneficial for survival in times of shortages, says Herman Pontzer, author of the book Burn. Microbes can also play a role in weight and regulate it according to diet patterns and microbiome of their parents which gets passed down. Exercise, he explains, unless excessive, which carries its own negative effects, may not change our weight much and can leave us feeling unmotivated. A movement filled day and lifestyle is recommended instead and thought to be more effective for a balanced weight. Walking, running or cycling daily as part of our lifestyle, moving around and not sitting down for long periods can all make a more active lifestyle and a more controlled body weight.

The struggle for health and fitness is a constant confusion these days and different things will work for different people. Keto, like any diet, is a short term fix and should only be done short term due to the various negative effects of eating excess fats. Therefore a focus on long term changes veering towards a wholefoods diet mainly consisting of plants in their natural and organic form could provide you with a vibrant healthy diet, increase your lifespan and maintain your weight. Small sustainable changes of cutting out processed foods and animal foods and increasing plant intake and plant sources of proteins such as chickpeas and lentils and whole carbohydrates like potatoes and brown rice may be better long term for a more blanched diet and lifestyle. Cutting out processed oils and eating avocados and olives instead as well as more movement and increased pure structured water may be more beneficial for us.

Other factors affecting a keto diet include the controversial use of sweeteners as they can have negative health effect and the ratio of omega 6 to omega 3 needs to be considered as omega 6 monounsaturated fats have shown to reduce the microbial diversity more than polyunsaturated omega 3 fats; increase omega 3 while decreasing omega 6.

In conclusion the keto diet can be beneficial if done in a healthy way including plant sources of fats and a reduced amount of animal fats and processed products. Fermented foods need to be added to maintain the microbial diversity of the gut and a keto diet should only be done for a short period of time with other periods of whole plant sources to maintain the health of the gut, body and decrease the risk of deficiency of vitamins and minerals. Organic foods should be taken as much as possible to reduce the risks of illness through pesticides and other harmful molecules and herbs and spices contain the most antioxidants and should be added to all food for increased health benefits. A health practitioner should be consulted to ensure a healthy path is taken and just eating any fat and cutting out carbohydrates and therefore many fruits and vegetables is not to be taken lightly.

Resources:

Bernard Jensen, Dr. Jensen's guide to better bowel care, 1999.

Micheal Greger, How not to die, 2015.

Colin Campbell, The China Study, 2016.