To Keto or Not to Keto?? — DMP Fitness

We’ve addressed the mechanisms of KD weight loss, other health benefits, and its sustainability long term. So the only question remains is: its safety for use as a weight loss strategy. 

Does KD Possess Any Risk Factors? 

Questions most often raised by colleagues when discussing KDs concern blood lipids.

In common opinion a low carbohydrate, high protein and fat diet is potentially unhealthy as it may cause a rise in LDL cholesterol and TGs and this issue is of special importance in obese individuals.

There are nevertheless several lines of evidence that point to beneficial effects of KDs on these cardiovascular risk factors.

The majority of recent studies seem to amply demonstrate that the reduction of carbohydrates can actually lead to significant benefits in total cholesterol reduction, increases in HDL and reduction of blood triglycerides.

Furthermore KDs have been reported to increase the size and volume of LDL-C particles which is considered to reduce cardiovascular disease risk since smaller LDL particles have a higher atherogenicity.

Another concern regards potential negative renal effects.

It is suggested that high levels of nitrogen excretion during protein metabolism can cause an increase in stress on the kidney and how they function.

In individuals with normal kidney function, higher dietary protein levels have caused some  adaptations but without negative effects.

It is important though to take into account the renal related effects on blood pressure.

During ketogenesis, the amino acids involved in gluconeogenesis and/or production of urea have, in general, blood pressure lowering effects in healthy individuals. 

On the other hand, Individuals with pre-existing kidney conditions, and even more so, those that are obese, will be more susceptible to the hypertensive effect of amino acids. 

Noto and colleagues suggested a possible harmful effect of low carbohydrate/high protein diet (LC/HP) on health: i.e., an increase of all-cause mortality risk whilst there was no effect on CVD mortality.

On the other hand, for example, a large European study demonstrated that an increase in protein content and a reduction in the glycemic index led to better maintenance of weight loss without differences regarding adverse effects.

The existing contradictory evidences on this matter lies in the complex interactions between low-carbohydrate diets and long-term outcomes.

Moreover it is important to underline again that a ketogenic diet is not, strictly speaking, a LC/HP; KD is mainly a very low carbohydrate diet with a normal amount of protein that produce a peculiar metabolic state that should not be assimilated to a LC/HP.

It is reasonable to suppose that after a period of very low carbohydrate diet there would be an increased glucose sensitively and for this reason is advisable to have a transition phase from ketogenic diet to a normal diet.

In human subjects the effects of a very prolonged ketogenic diet are, as yet, not well investigated, for this reason, KD may be used safely for a limited period (from 3 weeks to some months) to stimulate fat loss, improve metabolism and help the transition to a well supported Mediterranean diet style eating strategy. 

In Closing

A period of low carbohydrate ketogenic diet may help to control hunger and may improve fat oxidative metabolism and therefore reduce body weight.