The ketogenic diet is all the rage, but what is ketosis and why do people want to be in it? Fad diets come and go like the seasons with few proving to be worth a second glance in terms of proven health benefits or healthy, sustained weight loss. There is no magic or fast path to either and all professionals agree a healthy and balanced diet (plainly and simply -proper food, no junk) is the best approach. That said the Ketogenic diet is possibly the most heavily researched dietary approach that has ever landed. With a whopping 113 scientific studies and counting to back up the ketogenic claims. Despite all this hype, the diet is nothing new and medics have been using it for many years to treat drug resistant epilepsy, such are its radical and deep effects.

Many people (including a growing number of physicians) are avid supporters of the ketogenic approach to eating, finding it gives more energy and helps to maintain a healthy weight. Whilst other Doctors state the lack of longer-term studies insufficient to support its safety and effectiveness.


What is a ketogenic diet?

The Ketogenic diet goes further in its reduction of carbohydrates than other “low carb” diets you may have stumbled upon, (amongst them the “Atkins” diet). It’s based on the understanding that carbohydrates are the main macronutrient responsible for raising our blood sugar or glucose levels, which the diet primarily aims to reduce. Additionally, it promotes a larger consumption of beneficial fats that are needed for satiety as well as the other huge health benefits they provide (nuts, avocadoes, oily fish etc).

By avoiding most carbohydrates and consuming only a small amount (30g or less per day) strictly from vegetable sources (veggies contain carbs too which is news to many) upping the intake of green vegetables in particular (as well as other veg too) and fats, and not overly increasing proteins as with the Atkins diet) the body eventually (and it can take up to 6 weeks) switches its fuel source from glycogen – produced by glucose that’s obtained from carbs and sugars, to ketones – produced by the burning of fat as fuel.


Macronutrient: proteins, fats, carbohydrates

Micronutrient: minerals and vitamins

The notable difference between macronutrients and micronutrients, is the quantity in which we need to consume them to reach optimum health.

That said it may be misleading to think that we only require a “micro” amount of minerals and vitamins. In truth we should seek to eat plenty of “nutrient rich” foods for good health (foods that are the densest with vitamins and minerals such as vegetables, nuts and fruits rather than the “empty calories” attributed to some carbohydrates such as white bread and pasta).

How does a ketogenic diet work?

The theory is that this diet keeps blood sugar levels low and regulated (avoiding sugar highs, and subsequent energy slumps, decreasing the body’s need to produce insulin, and so avoiding the development of insulin resistance). It encourages the body to break down fat for fuel, but the amount of fat consumed must be monitored to result in weight loss by burning of body fat rather than dietary fat.

The process of burning fat for fuel is known as “ketosis”. It can be measured by the ketones present in urine and is different from the dangerous condition of “diabetic ketoacidosis” (that occurs mainly in Type 1 diabetes patients, although some insulin dependent Type 2s experience it as well). Confusingly, both conditions are related to ketones.

What is Type 2 diabetes?

Diabetes mellitus or “type 2 diabetes” (formerly known as “adult onset diabetes”, due to it historically afflicting the over 40s) is an increasingly common, sometimes long-term illness and has sadly become more and more prevalent. It now effects all age groups accounting for up to 90% of all diabetes cases worldwide.

Type 2 diabetes is a metabolic disorder resulting in overly high blood glucose levels (hyperglycaemia), over time the body becomes unable to metabolise (cope) with the heavy load by using its inbuilt regulation system – insulin, this results in a state known as insulin resistance. Given enough time, high blood sugar levels will damage the organs and as with any ongoing disease, will stress the body and begin to have a knock-on effect on many other systems and functions. This is why people with diabetes are advised to avoid dietary sources of sugar, although many are not told or aware of the fact that complex carbohydrates (starchy foods) such as bread, pasta, rice, oats and other grains such as rye, barley and kamut are broken down by the body into glucose/ sugar in the same way that “simple carbohydrates” (which include refined sugars) are.

The good news is, because it’s considered a dietary disease you can regulate it by maintaining a healthy lifestyle and weight and eating a healthy diet.

Understanding carbs

When choosing which carbohydrates to eat (and how much to include in our diets) it’s best to choose wholegrain varieties such as whole barley, brown rice, skin on potatoes etc. They contain more fibre and in the U.K we eat well below the recommended 30g of fibre per day, wholegrain varieties also contain more nutrients.

Remember there are carbohydrates in vegetables and pulses such as lentils and beans as well. The government’s Eatwell Guide recommends that potatoes, bread, rice, pasta and other starchy carbohydrates should not make up more than a third of a “normal” Western diet (if this is the approach you wish to take).

It’s worth considering your level of exercise/ activity as well. If you are trying to lose weight (maintaining a healthy weight is key to diabetes prevention), there must be a caloric deficit in order to do so (you must consume less calories than you burn off). In order to lose weight sustainably whilst maintaining a balanced diet we recommend speaking to your GP, certified nutritionist or dietician to establish the best approach for you.

Diabetes and the ketogenic diet

Dr Fung, kidney specialist from the University of Toronto is not alone in referring to the disease as a “predominantly dietary disease”. He states that the disease is reversible because it is entirely related to the amount of sugar in the body. At his clinic he focuses on ridding the patients’ bodies of excess sugar, this treats the root cause and regulates the condition. But stresses that any change in the diet of a diabetic should be discussed with and monitored by a health care professional, as one size never fits all.

It’s no leap to see why the ketogenic diet is so controversial. Whilst in theory it makes sense as an approach to tackling the type 2 diabetes epidemic, in terms of its extreme avoidance of sugars (we’re talking no sugars from fruit or complex carbs, let alone the obvious “free sugars” in sweetened foods), it is a huge change from the diets we have become accustomed to in the Western world and requires a total rethink of the foods we stock our shelves with, cook and eat… good old British sarnies are certainly not on the menu!

Try to embrace sustainable changes to your diet, that you can maintain over time. A colourful, balanced diet that avoids processed foods, and includes a rich variety of fruits, vegetables, herbs, spices, whole grains, good quality meat and fish and lots of healthy fats from nuts, seeds and unheated olive oil has the best evidence to support a vibrant and healthy body.

Originally written 25th September 2018