Every now and again I get a flurry of requests about a topic that is either in the news; gaining popularity; or causing confusion for bariatric patients. This has been the case just recently with the keto diet. Some WLS patients have been enjoying success with this low-carb regime; others are tempted to try it but want to know more; and some want the advice of a bariatric professional as to whether it’s safe, a good idea or best avoided.
We asked Dr Sally Norton, a Bariatric Surgeon and health expert for her views on the good, bad and ugly aspects of this regime. It seems that there are some good aspects of it until you possibly abuse it … read on for the experts point of view ….
Want the low down on the good points and why they can be no better than the other fads? Read on.
Ketogenic or similar low carb diets are based on a really sound principle – reducing the insulin load. And with it, insulin resistance. What’s that all about?
One in three of us are reportedly pre-diabetic…have some degree of difficulty controlling our blood sugar. One in four of us have high blood pressure and don’t know it. Two of three of us are overweight or obese. Fatty liver disease and type 2 diabetes are on the increase. What ties all of those together? Insulin resistance. Insulin resistance is a condition that is linked to an increased risk of all of these, plus heart disease and more. It is associated with belly fat or fat around our organs and is more common in those of us who are overweight or obese…though can still be found in normal weight people, so called TOFIs (thin outside, fat inside). Our high carb, heavily processed diets and constant snacking means our insulin levels are constantly up and down – and insulin promotes storage of excess energy as fat. The more we are exposed to insulin, the greater the chance of becoming resistant to it..meaning we produce more…and then more…driving weight gain.
Ketogenic diets aim to slash our carb consumption…as well as moderating lean protein that can also raise insulin. Instead they focus on healthy fats and protein-fat combos that lead to a much lower insulin response. This, in theory, reduces fat storage and helps us burn off our excess fat stores, as the fat is broken down to ketone bodies (hence ketogenic) to use for energy instead of sugar. Fats and protein keep you full, you don’t have to religiously calorie count and you automatically cut out the sugar and processed carbs that are lacking in nutrients. So far, so fantastic!
That’s all great in theory but there are all sorts of ways to abuse it. So many diets have a nugget of sound science but people tend to latch on to the bits that suit them without applying common-sense. This popular way of losing fat has spawned a huge number of websites, especially within the body-building community. And some of them make me shudder. Focusing on fats and protein has encouraged various people to believe that a diet of bacon is the way to go. But bacon and other processed meats have been deemed carcinogenic (cancer-causing) due to an increased risk of bowel cancer. And whilst we are on the subject, high fibre diets are another way to protect against bowel cancer and many other diseases. We already eat far less than the 30g a day recommendations…and many keto diet plans I see include very little fibre (as well as vitamins and minerals) as most fibre is found in high carb foods like wholegrains and pulses. No wonder constipation features so highly on keto forums!
Others soon fall out of love with the keto diet when the weight doesn’t shift as they expect. Could it be that they are getting carried away with their fat intake? It should be a highER-fat diet meaning you eat a greater proportion of your energy requirements as fat rather than carbs…not a HIGH fat diet. It’s not a free license to eat as much fat as you can, in the mistaken belief that you won’t put on an ounce!
Aside from justifying poor food choices by focusing purely on the high-fat low carb mantra with no thought to other considerations, there are some who take things to extremes. They obsess about their level of ketosis….if ketosis is good then more ketosis must be better. If low carbs are good then fussing over every gramme is essential. Wrong. As with anything to do with our body, take it to extremes and it tends to fight back. Either by finding a way around your extreme behaviour, or getting sick.
And then there others taking supplements to increase ketosis or try to make up for the nutritional deficits that a poorly managed ketogenic diet can bring. Vitamin and mineral supplements are not generally needed if you eat well. And other supplements to boost ketosis are likely to be unregulated….meaning you may be taking something that is worthless at best or dangerous at the worst.
Finally, who wants to hang out with a boring diet zealot – of whatever type? Going out with friends, bringing up a family and life in general can be a constant hassle if you are obsessively trying to micro-manage a LCHF diet. Eating well should help you regain and enjoy your life – not rule it!
So, if you really want to improve your health with ketogenic diets, don’t replace sugar and processed carbs with carcinogenic, cheap meats and ladles of fatty calories that are way over what your body needs. Don’t turn your back on fibre and vitamin-rich food.
Don’t turn to supplements which aren’t tested. And don’t replace obsessing over calories and the number on the weighing scales for an obsession with levels of ketones and grammes of carbs! And remember, there is a lot more to managing your health and weight than the food you choose, or don’t choose, to eat!
Feature courtesy of Dr Sally Norton. NHS Weight Loss Consultant Surgeon. Health Expert & Writer. www.vavistalife.com