Keto Diet

Hello, I am hearing so much about the Keto Diet. What does everyone think about this ?

I'll be honest with you. Keto isn't healthy. It is very popular, like so many other diets are, but it is contrary to good health principles of what your body needs. The thing is that because people on Keto lose weight in the short term, because they are conscious of what they are eating and because they are kicking out most carbs. The real problem is the extremely high fat intake that is really bad for your heart, liver, etc even IF the science "proves" the weight loss element. People justify the protocol with numbers on the scale rather than the overall longterm health of your body.

Many of us here have found that post-WLS that a protein focused diet and keeping the carbs low is a healthier way to maintain. All fat isn't bad and as long as it is moderate and doesn't cause weight regain or your heart health to be compromised, healthy fats should be included in your diet. Focus on getting your carbs from veggies, small portions of fruit, dairy and limited portions of fiberful, unprocessed grains. AND get lots of non-sugary fluids each day.

The old saying of "just because everyone else is doing it..." certainly applies here. Keto is popular, not because it is healthy but because it sells. Don't fall for it.

I think many in the keto community encourage binging on "safe" foods which I find problematic because, weight gain aside, it does not change the reasons we became obese, either.

A lot of the newer research seems to indicate that it's insulin rather than high amounts of fat which are bad for heart disease, because it's insulin and glucose which causes vascular damage. Transfats are another matter, but there is some debate regarding saturated fat being far more benign as was previously thought. At any rate, that's why diabetics go blind and lose toes - it's not the fat, it's the damage caused by the uncontrolled blood sugar over time. Glucose also gets converted to fat and stored, as insulin primes the body to store excess energy so that blood sugar levels don't rise to dangerous levels. This is a part of the reason why diabetics rotate insulin shots daily...if you don't, you get a gigantic lump of fat in the injection site because the insulin causes it to be stored there en masse.

I think genetics also plays a factor too, though. There isn't one good answer which can be universally applied to all humans though some commonalities in biochemistry apply. If I eat grains I gain weight even if my calories are low, or at least start stalling. Many fortunate people don't have that issue. Some even hypothesize that mitochondrial DNA causes significant degrees of variation in what is a healthy diet between people, though I'm not as familiar with that research as much.

You should read "The Big Fat Surprise" by Nina Teicholz to start. All we have been told about eating the "right way" has never been based on scientific research. I was following the Standard American Diet and continued to gain weight even though keeping my calories to under 1500 (being male I was told to keep them at about 1800) and ended up overweight and with Diabetes type 2. Since going on a ketogenic diet I am eating about 2000 calories but with about 150 grams of bat and 85 grams of protein and less than 30 grams carbohydrates and all my metabolic syndrome levels have returned to normal and no longer diabetic.

Curious, have you had bariatric surgery? Were/are you able to lose weight on 2000 calories per day?

Also-- I did some quick Googling, and I found some assessments that this book is quite biased and the science is not terribly sound. The fact-checking here seems pretty damning.

https://thescienceofnutrition.wordpress.com/2014/08/10/the-b ig-fat-surprise-a-critical-review-part-1/

https://thescienceofnutrition.wordpress.com/2014/06/30/the-b ig-fat-surprise-a-critical-review-part-2/

I believe the only way to lose weight and keep it off is to take in less calories than you burn. The average woman needs 10 calories a day to maintain one pound of body weight. If you want to weigh 100 pounds you need 1000 calories, if you want to weight 150 pounds, you need 1500 calories.

There is no magic in any combination of foods. All diets work because the food gets boring and we eat less of it. When you go back to consuming more calories then we gain weight back.

Counting calories and measuring portions is the only thing that has ever worked for me long term.

I lost 300 pounds on a ketogenic diet before having WLS, and was not unhealthy. The answer to whether or not it's good for bariatric patients is more complex. Obesity is a disorder of hormone dysregulation caused by excess consumption of fuel. I'd argue that behavior is really the cause of most obesity independent of food type, but that's a tangent. At any rate, many things are factors, and once we are obese it is not quite the same to lose weight as it is for someone who was not as obese because we enter a hormonal state of insulin resistance. Someone without weight loss surgery can see this reversed on a ketogenic diet because serum insulin is kept low and the body heals. WLS does this on a far more significant order of magnitude and also far more rapidly, with the permanent addition of a tool.

WLS patients and ketogenic diets are more complex, as well, because we typically need more protein on average. Ketosis isn't actually unhealthy; it's what the body does when the body needs fuel and can't eat glucose. Most people go in and out of ketosis at times when this is not possible - you can't eat during sleep, for example. Breastfeeding babies are in ketosis because the ketone bodies fuel their exceptionally rapid brain development. Caloric restriction also causes ketosis to occur, because our stored fat gets metabolized, broken down, and used for fuel.

It is true that you get a caloric bonus with a ketogenic diet, because ketosis functions at an ATP deficit. What does this mean?

Typically, glucose is the primary fuel of the body, and the body turns this (eventually) into ATP which is the gas that makes the engine run. The body is efficient at converting glucose to energy because we chiefly evolved with it being a less abundant energy source. Ketosis occurs when you deplete stored glucose and minimal amounts come from diet. Many organs, particularly the heart and brain, actually prefer ketone bodies; it's a myth largely that the brain needs glucose predominately to function. Only cells too small for mitochondria require glucose. At any rate, in order to make ketones from lipids, it requires more ATP than energy which is received. There's basically a caloric advantage but it's small, really.

The reason people without WLS do well on keto is that it is very good at suppressing hunger. Protein and fat create high degrees of chemical and physical satiety. They do not have the tools surgery provides us with. Overnight after my first procedure not eating was, well, extremely simple. Ask me to eat 400 calories only two weeks before? Hoo boy, forget it. Y'all remember that liquid diet was heck.

I'd argue most of us are in ketosis the majority of the time when losing weight actively, though we are not following a ketogenic diet necessarily. There are other purported benefits to ketosis, but I remain dubious about some. There is growing evidence that it does help with many psychiatric disorders, and more research needs to be done on that front.

I function best on a highly modified form of a ketogenic diet. I adhere to my protein requirement and strictly limit carbohydrate to 40g a day or less. The rest comes from fat. I try to stay at 800 calories or less to keep losing weight, so I'm really not eating much outside of protein.

To be pretty honest, since the revision I generally only have room for my protein and fat, anyway, and I need extra fat and protein since I have a longer bypass. I pretty much eat only meat or animal products most days to make sure these two are adequately high. I don't worry about the rest in general, as the doctors have stated my progress is good, and that (aside from unrelated recent autoimmune issues) my last labs were decent.

Not everyone finds a ketogenic diet sustainable for whatever reason and that is fine too. It does work very well with WLS (especially with a DS or distal RNY I'd argue) but we have to make sure we get our protein first. That means that we often eat less fat by necessity. The macros that non-WLS peeps use have to be adjusted for us. We also tend to have more food sensitivities post-op, like lactose intolerance, which eliminate a lot of food groups they use.

I see many people struggle on ketogenic diets to lose weight, too. They then will try eating one meal a day or fasting and start to lose weight. While there are other mechanisms at work that facilitate this (autophagy) ultimately they are still limiting food which reduces the release of insulin and makes weight loss move forward. I do think it's worth trying pre-op just to see if surgery is avoidable, because avoiding major and permanent procedures is always desirable, but in my case it was not enough. My basal metabolic rate was so low from having been malnourished and obese for so long, that without surgery I was not able to sustainable eat low enough calories, keto or no.

It depends on you. Would you be able to sustain a keto diet? I know some folks who do a "bariatric" keto which is more protein and a bit less fat because of our need for more protein although, now, there are some surgeons who are saying that after the initial weight loss phase, your need for protein drops. I don't know if I totally buy into that theory so I continue to eat more protein.

But in the end, if you do keto, #1 can you get sufficient protein to meet your bariatric needs, #2 a year from now, can you maintain this same lifestyle. I say lifestyle on purpose. To my way of thinking, a diet is for a certain time, significant calorie restriction and not something you will do the rest of your life. In contrast, a lifestyle is something you can do forever. I eat now the way I intend to forever eat and the only real difference between the way I eat now and the point I reached "regular" food 17 months ago is I eat more, have found a few more foods to like and try, etc. Will I eat perfectly, no but how I eat is sustainable for me. My favorite foods are meat and veggies. I eat a lot of whole grains, i.e. brown rice, quinoa, farro and truly enjoy those. I've never been a big fan of bread or pasta and so not eating that is fine. As a rule, I avoid bread and pasta and I'm fine with that. So all that to say, the way I eat is sustainable. Would keto be a sustainable way to eat for you?

That being said, if you decide to do keto, proceed with caution. There are no long term studies of a keto diet and its health benefits or lack of benefits. If you do intermittant fasting in addition, can you eat enough calories in your eating window to sustain energy and not end up with nutritional risks which is a real concern for the RNY population? Personally, just getting rid of the junk in your diet would be the best way to go in my way of thinking. Whole foods, real food, less processed foods, etc. and you will be eating in a way that is healthy and at least, to me, sustainable.

I think lay opinions on something like this are moot; I think an evaluation is best left to the experts. This article gives a very easy-to-read summary of the science on keto diets:

https://www.skepticalraptor.com/skepticalraptorblog.php/keto genic-diet-scientific-evidence

Summary from the article:

There does not appear to be overwhelming evidence that the ketogenic diet actually has any advantage over any other diet for weight loss other than it may actually reduce calorie consumption and increase adherence to the diet. It has no magical properties to make the weight loss mechanism any better or worse than any other fad diet.

Well, the three worst things to talk about on the internet are diets, religion, and politics - and not necessarily in that order.