“Eat food, not too much, mostly plants”, Michael Pollan’s seven words to healthy eating represents the most reasonable nutrition advice we can give to patients. Plant-based diet is the healthiest, safest and most environmentally friendly diet to consume. Numerous studies have demonstrated the benefits of vegetarian diets in terms of reducing the risk of cancer, hypertension, stroke, heart disease… Adding a small amount of animal protein to a plant-based diet prevents vitamin deficiencies, improves food flavor, and nutrient content. As such the Mediterranean diet, my preferred diet, is one of the best diets to adopt. However, a plant-based diet, rich in carbohydrates is not ideal for individuals who suffer from obesity and diabetes. Unfortunately, the majority of the US population in general and Houstonians in particular suffer from either obesity or diabetes or both. An oatmeal breakfast with fruits like banana is a great energy source for a lean person; but for an overweight patient with insulin resistance such a breakfast is a big problem. In the setting of insulin resistance, a carbohydrate rich meal presents a huge burden for the body to process and metabolize. The end result of such burden is pancreatic islet cells failure with uncontrolled blood sugar requiring escalating doses of short and long acting insulin. When discussing the merits and safety of a diet, an individual metabolic state and the environment in which this particular individual lives, must be taken into consideration.
Is Keto safe for overweight and insulin resistance individuals? The short answer is that we don’t know yet. We don’t have long-term studies evaluating the long-term side effects of keto diet. We know from previous studies conducted on epileptic children maintained on high fat diet that ketosis results in increased risk of osteoporosis and kidney stones. Cardiologists in particular are naturally opposed to a high fat diet fearing the risk of increased cholesterol blood levels and heart disease. Some have suggested an increased risk of early death and cancer. There are however no good quality studies to confirm these claims. For keto advocates, a high fat diet is lifesaving. “Paleo, Atkins, Mediterranean diet… The struggle was real because I tried everything, and nothing really worked. I was thinking that food is my enemy, but with the KETO diet food is my medicine. I am more productive, full of energy all the time and the results are fascinating. Now I eat delicious foods without so many restrictions” said Reese Hutton. It is currently the only diet that bypasses the faulty carbohydrate processing mechanism especially in obese and insulin resistant patients, leading to significant weight loss. Bariatric surgery like gastric sleeve procedure, restores the Magenstrasse pathway of carbohydrate gastric emptying. A normal Magenstrasse emptying pathway initiates a cascade of gastro-intestinal neurohormonal secretion that allow proper carbohydrate digestion, absorption and metabolism. Keto diet, low in carbohydrates, does not require a functioning Magenstrasse emptying pathway. Keto diet results in a state of ketosis. Obese patients with insulin resistance can process ketone bodies without any hindrance. The end result is significant weight loss in the absence of starvation and feeling hungry all the time.
Of note, keto diet is easy to start but hard to maintain. Dietary discipline and commitment are needed to maintain the weight loss. Daily food tracking, regular exercise, and intermittent fasting will help keep you on track. Unlike bariatric surgery, there is no meal size restriction with keto diet. Eating too many calories, however, on a keto diet results in poor weight loss. One advantage of keto diet is the satiety level it induces. You don’t need to snack in between meals when you are in ketosis. Keto diet abolishes the ups and downs of blood glucose levels; hence, it eliminates hunger and associated food cravings especially when fasting. Intermittent fasting is an integral component of a successful keto diet for weight loss. There are many benefits for fasting besides weight loss that I will discuss in a future blog. Last but not least, leafy green vegetables like cabbage, broccoli, asparagus, spinach and peppers are an essential source of fiber, vitamins and antioxidants in any keto diet. Make a commitment to eat a whole food, not junk food, keto diet, with plenty of water to achieve the best possible result.