Ketogenic or keto-diet is not new: a hundred years ago, before the appearance of effective anticonvulsant drugs, French pediatricians noticed that certain dietary restrictions reduce the incidence of seizures in children suffering from drug-resistant epilepsy.
Based on metabolic studies, a therapeutic diet was developed – without starch and sugar, which became part of complex therapy for epilepsy in the early 1900s. According to the authorship of the name "ketogenic diet" belongs to the American doctor Russell Wilder (Russel M. Wilder), who used it in the treatment of epilepsy in 20-30 years. last century.
Keto-diet suggests a high fat content in the diet, moderate protein intake and very low carbohydrate. For most people, this ratio of nutrients for a limited period is considered safe and not only helps to lose those extra pounds, but also has therapeutic use.
Indications for appointment
Low carbohydrate keto-diet with epilepsy, which was widely used in foreign clinical practice, helped to reduce the frequency of attacks in children of different ages by 62-75% (after dietary treatment for 12 weeks). At the same time, children who are assigned such a diet should be registered by doctors who monitor their normal growth and increase in body weight, and also make adjustments to nutrition in accordance with the needs of each child.
Diet food with a minimum amount of carbohydrates began to be used in other disorders. Researchers have shown that ketogenic diets are useful in treating patients with De Vivo’s disease — GLUT1 protein deficiency syndrome (which transports glucose through the blood-brain barrier), as well as some other congenital metabolic defects.
It is believed that this nutritional system may slow the progression of amyotrophic lateral sclerosis (Charcot’s disease); Indications for ketogenic diet include such neurodegenerative pathologies as Alzheimer’s and Parkinson’s. Clinical studies of the effect of the ketogenic diet on patients with autism, depression, type 2 diabetes mellitus (insulin-independent) and polycystic ovary syndrome are underway.
The best-known keto-diet for weight loss is in the form of the Atkins diet for the treatment of obesity, modified and popularized by Dr. Robert Atkins (Dr. Atkins Diet Revolution, 1972). Although ketogenic experts consider only the induction phase of this diet. And, in fairness, it should be noted that many American doctors were involved in the principles of the ketogenic diet long before him: Peter Hattenlocher, Alfred Pennington, Richard McCarnes, etc. For example, R. McCarnes wrote the book Eat Fat and Grow Slim in 1958 (“Eat Fat and become slimmer "), and this is essentially the same low-carb diet originally introduced for the treatment of epilepsy.
Since the deposition of excess adipose tissue in the form of triglycerides concentrated in its cells occurs due to excessive consumption of carbohydrate foods (this fact does not cause any doubts), limiting carbohydrates in the diet to a minimum — keto-diet for a month — contributes to a reduction in fat reserves that is losing weight.
In addition, it was found that keto-diet in oncology – by increasing the oxidative stress of cancer cells – significantly reduces the growth rate of malignant neoplasms, localized in the colon, stomach, prostate gland and lungs. In addition, an increase in the sensitivity of some cancer tumors to chemotherapy has already been proven, due to the induced state of ketosis.
Over the past two decades, bodybuilders have begun to use the ketogenic diet – to reduce the fat layer under the skin: on their slang, this is called drying on a keto diet.
The essence of keto diet
With a standard keto-diet, the total amount of daily calories by 70-80% should be provided by fats, 15-20% – by proteins and 5% – by carbohydrates (less than 50 g per day).
As a rule, the ratio of the weight of fat to the weight of protein and carbohydrates is 3: 1 (that is, 3 g of fat per gram of protein + carbohydrates). If the proportion is 4: 1, then 90% of the energy comes from fats, 8% from proteins and only 2% from carbohydrates (about 20 g per day).
Despite the centuries of use, the mechanisms underlying the clinical efficacy of the ketogenic diet in epilepsy are still not fully known. Several versions have been proposed, including modifying the Krebs cycle to increase the synthesis of gamma-aminobutyric acid in the brain and increase the production of energy from ketone bodies, which is consumed by 70% of the brain tissues. A ketogenic diet leads to adaptive changes in the energy metabolism of the brain, which increase energy stores; Ketone bodies are a more effective source of ATP for brain neurons than glucose.
The essence of the diet used to reduce excess weight is the introduction of the body into a state of adaptive ketosis – when the body receives energy (ATP) mainly from blood ketone bodies, and not from glucose from carbohydrate-containing foods.
Food carbohydrates are transformed into glucose, but when a person consumes very little carbohydrates and a lot of fat, a chain of biochemical reactions is triggered in the body. Schematically, this process looks like this. First, due to a decrease in blood glucose, the pancreas begins to produce more hormone glucagon, which stimulates the catabolism of glycogen stored in the liver to glucose and release it into the blood. Secondly, ketogenesis is activated, that is, the production of ketone bodies by the liver (acetoacetate, which is then transformed into β-hydroxybutyrate and acetone) and the conversion of dietary fat into free carboxylic (fatty) acids. Thirdly, due to an increase in the level of glucagon, the activity of lipase, an enzyme that breaks down triglycerides (fats) accumulated in the cells of fatty tissue, significantly increases.
In addition, in the first two weeks of keto-diets, significant weight loss occurs due to the elimination of water from the body, which is also associated with increased production of glucagon. And therefore, a temporary side effect of a fat-rich diet can be dehydration, which dieticians advise to fight by consuming up to two liters of water daily.
Many believe that an important advantage of keto-diets is the absence of a feeling of hunger, the need to calculate the number of calories and train for hours to burn their excess.
Keto diet for men
Especially effective is the keto-diet for men with abdominal obesity.
If the domestic therapeutic diet for obesity (No. 8 by Pevzner) recommends reducing the caloric intake to 2000 (2300) kcal per day, then the ketogenic diet does not strictly control the calories (but reducing them by at least 10-20% does not hurt). But carbohydrate intake must be reduced five times: instead of 250 g to a maximum of 50 g per day.
Remember that the majority of calories on a keto diet are foods high in natural fats and moderate amounts of protein foods. That is, it is not a “protein load”, as it may seem to some. And if a man is used to eating a lot of meat, then his organism will enter the state of adaptive ketosis much more slowly. So you have to limit the protein: a day to 1-2 grams of protein per kilogram of body weight, which you strive to achieve as a result of losing weight. Example: if the initial weight is 112 kg, and desirable weight is 85 kg, then the amount of proteins for 85-170 g.
The exact ratio of fats, proteins and carbohydrates in the diet (in grams) will depend on the age, goal, level of physical activity and the health status of each individual man. But everyone is recommended short-term fasting with a keto-diet: in the first two days of the transition to this dietary system, you should drink plenty of water and limit yourself to one meal per day (in very small quantities). By the end of the first week, carbohydrates should be eliminated as much as possible (below there will be a list of products for keto-diets), but the portion size decreases very slightly.
Another nuance: claim that keto-diet without sports does not lose its effectiveness, and to lose weight you do not need to go to the gym or just do some additional physical exercise. But, physical exercise, as part of a healthy lifestyle, accelerates the burning of excess fat, so you should not lie on the couch. Especially since you can use the moment and follow the example of bodybuilders to build muscle mass: weight gain on a keto diet is possible only with a muscular load, and then the subcutaneous fat will go away, showing strong muscles.
Keto diet for women
The problem with the keto-diet is that today studies aimed at studying its efficacy and safety apply only to men. There is a logical question: is keto-diet suitable for women, given that female hormones are usually more sensitive to most dietary changes.
Although opinions are divided, most experts argue that the ketogenic diet gives positive results, especially for women in perimenopause or menopause. This food system allows you to get rid of excess weight, control blood glucose levels, improve sleep quality and reduce menopause symptoms, such as hot flashes or night sweats.
However, there are negative reviews, and even complaints of nausea, fatigue and constipation due to diet (for more, see the Possible Complications section). It is also worth mentioning that in case of violations of the monthly cycle, thyroid gland pathologies, it is contraindicated to switch to a keto-diet during pregnancy and lactation.
Women are recommended to combine periodic starvation with a ketogenic diet, that is, just skip lunch and take a break of 10-12 hours between morning and evening meals, which after 50-55 years gives a rejuvenating effect (these are 2016 study data published in the Journal of the American Medical Association). According to Western nutrition experts, this dietary regime allows the body to rest from the digestive functions and direct energy resources to the restoration of tissue cells and the balance of hormones.
If a woman with a body weight of 75 kg and a height of 165-168 cm tends to lose weight to about 68 kg, she should switch from 2300 kcal per day to consumption of no more than 1855 kcal. Protein should be