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Go Ahead and Eat the Carbs

The Ketogenic Diet is the Most Dangerous Fad Diet of the Twenty-First Century

By Gabriella Salazar

 It’s safe to say that you know someone who has gone through the incessant cycle: “to carb or not to carb.” Designed to mimic the metabolism of fasting, the ketogenic diet became widely used for the treatment of epilepsy in the early 1920s. This is how the restrictive low-carbohydrate diet was used for decades. Today, nearly 12.9 million Americans follow the ketogenic diet each year. 

How on Earth did a diet once used to treat epileptic patients become one of the hottest fat-loss regimes in the United States? In the 1990s the effects of a ketogenic diet on weight loss in individuals with type 2 diabetes were widely studied. With that wave of research, the newly termed “keto” diet became popularized by best-selling books, social media promotions, and food production marketing campaigns. The keto diet quickly became the new paradigm of fat loss and nutritional idealism.” In 2018, holistic nutrition expert Dr. Gemma Newman called the public’s blind leap into a low-to-no-carb diet “the most dangerous lifestyle fad of the twenty-first century.”

Nutritional misinformation is not in short supply. In fact, there is still an abyss of the unknown in terms of what the perfect diet may look like. However, individuals are quick to glamorize the discipline and commitment that is displayed when they give up carbs. Many make this judgment not knowing that a ketogenic diet is unsustainable and dangerous because carbohydrates are our bodies’ indispensable source of energy.

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Modern society did not pause to question what this lack of carbohydrates would inflict on our bodies. The idealized basal metabolic state that people think they are achieving on keto is simply misguided and not evidence based. You may in fact be seeing the scale drop on a keto diet. You may very well see your waistline shrink. But, it is time we publicize what type of tissue you are actually losing on a keto diet, how your basal metabolic state and energy reserve progressively slow, and how a ketogenic diet disrupts your body’s overall homeosis. 

How ketosis works

First, we will investigate the bodily systems of ketosis in order to investigate and better understand potential dangers associated with applying the keto diet. The original keto diet was a 4:1 ratio of carbohydrates to fats and proteins. Glucose, a simple, deconstructed carbohydrate molecule, is our body’s preferred source of energy. Depriving your body of carbs depletes the glycogen stores in your body, forcing your body to undergo metabolic changes to create energy from alternate sources in the body. This forces your cells into a state of gluconeogenesis and ketogenesis, the synthesis of glucose from noncarbohydrate sources, which forces your system to use more energy than otherwise necessary. These processes can be sustained for up to three days before additional sources of energy are required to meet the metabolic needs of the body and the brain. After that, the body must use fats and proteins or break down existing adipose tissue.

“Sure, we can turn fat and protein into energy sources, but those things have other jobs. But, you know, carbs are the most efficient way to get energy into our cells”, says Brittany Verras, a registered dietician and disordered eating researcher.

In 2019 Anna Valenzano of the University of Foggia published a study investigating the ketogenic diet’s effect on visceral adipose tissue, the vital protective layer around the organs and what constitutes lean body mass. The study also examined how keto affects liver function. Valenzano and her colleagues found that caloric restriction partnered with a ketogenic state often leads to the rapid loss of visceral adipose tissues and lean muscle mass. 

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This is often described as sarcopenia, the rapid and involuntary loss of skeletal muscle mass and strength. Sarcopenia is a serious condition and is difficult to reverse. This may not be enough to scare you out of your low-carb ways, but it is important to remember that muscles are not just the tissues that aid our everyday motor functions. Our heart, kidneys, liver and other vital organs are all major muscles in our bodies that are damaged in the presence of sarcopenia. 

In contrast to the keto diet, a gradual and healthy loss of fat would result in a decrease in subcutaneous adipose tissue: the fat found underneath your skin, or say the stubborn fat underneath one’s arms or love handles. However, because a ketogenic diet depletes the reserve of carbohydrates in your body, you are forced to use proteins and fats for energy, and proteins are the only molecules capable of catalyzing cell growth and cell division, both necessary processes to support energy and metabolism, immunity and defense, transport and storage, and structure and regulation within the body. Valenzano and her colleagues conclude by saying that individuals may very well be losing weight as a result of following a keto diet; however, it is not optimal to maintain their health in the long-term. 

The keto diet’s effect on major organs

We now know that a ketogenic diet has adverse effects on muscle mass. We also know that the heart is a major muscle in the body, as is the liver, and nearly every other organ. So how are these organs and vital bodily functions responding to keto? You can go out on a whim and assume that the impacts are definitely not positive. 

In a 2020 review article, Dr. Jennifer T. Batch and co-authors drew attention to the advantages and disadvantages of keto, on both body weight and internal bodily functions. The review found that weight was definitely lost during short-term keto interventions. However, a significant increase in dyslipidemia, hypertension, and fatty-liver disease biomarkers were also found. Dyslipidemia is a disease characterized by abnormally elevated cholesterol levels or lipids found in the bloodstream. Specifically, the review found that a keto diet, even when only used in the short-term, leads to elevated levels of low-density lipoprotein (LDL) or “bad cholesterol.” LDL is the cholesterol that transports fat molecules in the body back to the liver to be reabsorbed. Your body can only metabolize a certain amount of fat at a time, as fats are about 44% more calorically dense than carbohydrates per gram. Thus, elevated levels of LDL have been directly linked to fatty-liver disease, and eating too many fats to make up for a caloric deficit in carbohydrates will only make the condition worse. 

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Similarly, a meta-analysis of 11 randomized controlled trials tested the effects of a low-carbohydrate diet against increased risk factors of cardiovascular disease (CVD). The conclusion found that a keto diet led to an increased prevalence of CVD risk factors such as clogged arteries, stroke, and death when compared to baseline and lower-fat diets. In addition to this, the study found that as patients remained in a ketogenic state, their basal metabolic rates steadily declined. This means that in order to maintain or lose any amount of body weight, you would have to progressively eat less and less in order to keep the weight off. 

Is there a place for low-carb diets?

I have no underlying intentions or biases for writing this piece besides giving the general public all the information and potential dangers linked with a ketogenic diet in healthy, adult populations. With that, I will be sure to acknowledge the benefits of implementing a ketogenic diet. A low-carbohydrate diet is a wonderful tool when used in the short term for individuals with overweight or obesity, for epileptic patients, and when prescribed by a Registered Dietician (RD). However, it is important to understand that the keto diet is a good short-term clinical tool. 

The evidence against the ketogenic diet for the general population is astounding. Healthy individuals should not be engaging in fad diets such as the keto diet that pose a threat to their overall health and well-being unless explicitly under the guidance of an RD. The keto diet has been proven to disrupt the body’s natural state of homeostasis, and it can have lasting effects on body composition, motor functionality, and metabolic rate. 

“I just want to advise caution about not grouping all carbs together, because we know that there’s benefit to some, and not benefits to others like sugar,” says Dr. Jean Welsh, a child nutrition expert and associate professor of pediatrics at Emory University School of Medicine. “You just have to be cognizant of the decisions you make surrounding them. But we simply cannot cut out such a vital food group entirely.”