About 13 years ago when I first went on Facebook, I met an interesting young gentleman who had just finished his contract with the Navy. Let’s call him L. Now L had a passion and ambition which had nothing to do with his training or education. As strange as I enjoy writing, he wanted to be a personal trainer. There were two problems. Firstly, he was a marine engineering diploma holder with no training in sports or nutritional sciences. Secondly, he was fat. L decided that he could take care of the first problem by “reading up”. For young people like L, “reading up” meant Googling and YouTubing. As for the second problem, he thought he had found the solution through online research as well – a high fat, low carbohydrate diet.
Even back then, only cave dwellers and dinosaurs who were slow to get on the “information superhighway” would be surprised by the popularity of high fat diets that purportedly make you thin. Suffice to say that L was completely sold on the idea. I had a little debate with him and thinking that he knew more about how the body works than I did, he started lecturing me with his half-baked understanding of fat metabolism. He even showed me pictures of his “progress”. For the record, the pictures did show him slimming down. Not long after that, he started boasting about the weights he could lift. He even claimed that he was head-hunted by a gym to be their instructor. As I recall, gym instructors were in great supply but not exactly in great demand. L continued to post pictures of his “progress”. I was rather impressed by the results, but I told him that his health would soon take a beating. Then, I heard that he was hospitalised. I can’t be sure if it was an accident or a health issue, but I’ve lost contact with him ever since.
Ketogenic or keto is once again the buzzword among weight watchers. There are many diet gurus who claim to be the first to introduce their brand of ketogenic diets, but high fat, low carbohydrate diets were first popularised by Dr Robert Atkins (1930-2003). Atkins graded food on a glycemic index. Glucose has the highest glycemic index as it increases your blood glucose levels immediately while fatty foods often have low glycemic indices. If you believe in what Atkins was telling you, bacon would be healthier than bananas and apples. The standard Atkins diet is high in fat and protein, low in carbohydrate. The Atkins’ diet plan, weight loss books and his lifestyle company, Atkins Nutritionals saw huge commercial success in the late 1990s (thanks in part to the dotcom boom). Even after the dotcom bubble burst, the Atkins momentum was unstoppable. Dr Atkins was named one of the 10 most influential people in the world by Time magazine in 2002.
Why was this diet so popular? There are two main reasons. Firstly, it’s easy to follow. I remember when I was young, my mother has a hard time getting me to eat my rice and vegetables. How nice if I could only eat the meat? Let’s say you have bacon and eggs for breakfast. Just take out the bread and it becomes a high fat, low carb diet. It’s so simple. You practically don’t have to change your eating habits if you were an average American. Celebrities who have tried it also reported great “success”. With their endorsement, the fad really took off.
Then, Atkins suffered from cardiac arrest. Both he and his cardiologist insisted that it was caused by viral infection and not by the diet. In 2003, Atkins fell into a coma after a fall. He died soon after that. A medical report issued by the New York medical examiner’s office a year after his death showed that Atkins had a history of heart attack, congestive heart failure (nothing to do with the virus) and hypertension. His fans were shocked. Doctors who were sued for issuing warnings against the Atkins diet were relieved. Questions about the safety of the Atkins diet were finally raised and with the same speed with which it gain popularity, it gained notoriety. Victims stepped forward with testimonials of how it ruined their health. Eventually, the diet lost its popularity to other emerging diets. In 2005, the late Dr Atkins’ company, Atkins Nutritionals filed for bankruptcy.
Striking while the low carb iron was still hot, celebrity doctor Arthur Agatson came up with his own version of low carb diet which he called the South Beach Diet. Recognising the extreme low carb nature of the Atkins diet, the South Beach diet comes in 3 stages and gradually increases the proportion of carbohydrate consumed as it progresses while simultaneously decreasing the proportions of fat and protein. It stresses good fats, good carbs. Other similar diets like the Zone diet and the Blood Type diet were all merely watered-down versions of good old Atkins. An independent trial concluded that these diets did not result in very significant weight loss. They are safer perhaps, but they were also “ineffective” for weight loss without increasing exercise intensity – in which case diet doesn’t really matter. Micheal Phelps is known to be a big fan of junk food.
Fast forward 16 years from Atkins’ death and I’m quite taken aback that extreme ketogenic diets, Atkins style in various guises, seem to be making a comeback! Weight loss gurus tweaked and patented their own diets to disguise the Atkins influence, but saying Atkins is not ketogenic is like saying that a lion is not a cat because it doesn’t look like one. Like followers of the Atkins diet almost 2 decades before them, many of the followers of the “new” (certainly not) “ketogenic” diets are pleased with the results. Weight loss is rapid and visible.
Why is weight loss from ketogenic diets so rapid? It’s common sense really. For most people, carbohydrates form the bulk of their “normal” diet. So by cutting carbs out, you’re automatically eating much fewer calories. Of course you will lose weight (and feel hungry). There is another factor and that’s the loss of water. Carbohydrates are stored in the body in the form of glycogen and one part of glycogen comes with 3 parts of water. By cutting out carbs, you deplete your glycogen stores along with the water associated with it. You won’t feel thirsty. You won’t be dehydrated yet. Your liver and muscles lose their glycogen stores but make no mistake, losing glycogen also means losing water and not fat. The fat gets thrown into the furnace much later. When that happens, you may get the following symptoms.
1. Frequent Urination
2. Constipation
3. Keto “Flu” Syndrome – headaches, drowsiness, lethargy, confusion, irritability
4. Insomnia
5. Bad Breath
6. Reduced Physical Performance
With all these symptoms, our body is obviously telling us that something is wrong! Why do people still stick to such diets? Because the gurus assure them that it’s safe. To be fair, they are completely right to say that ketosis is a natural state that our ancestors found themselves in when a hunt failed to bring in a good catch or prolonged drought caused the crops to fail. What did our ancestors do back then? They didn’t drink oil for sure. They just starved and survived on their massive reserves. Right, the reserves are massive. Theoretically, the caloric value of an average human (if he can be burned off completely) is sufficient to fuel a 750-mile run. The longest recorded fast is 382 days. That may be unique to the record holder but most people can survive without food for a month. What if you try to beat the system? What if instead of fasting, you change your diet and deliver a fasting fuel to your body without enduring hunger pangs? Atkins has already shown that you’ll lose weight quite quickly, but what is really happening in your body?
Let me get a bit technical here. Our body generates energy by “burning” glucose. Since our body cannot tolerate combustion, we have to have a different chemical pathway assisted by enzymes. There are two main stages in carbohydrate catabolism (chemical breakdown to produce energy). The first stage is called glycolysis. The end product at this stage is something called acetyl coenzyme A or acetylCoA. This substance enters the mitochondria of our cells and the second stage of carbohydrate catabolism – known as the Citric Acid Cycle turns acetyleCoA into carbon dioxide and water, generating energy in the process.
The keto gurus don’t tell you that fat catabolism may take place in much the same way. Fat is broken down into free fatty acids and glycerol. What happens to the 3-carbon glycerol? It gets synthesised into 6-carbon glucose, entering the same cycle that carbohydrates go through. The fatty acid component undergo a process called beta oxidation and what’s the final product of beta oxidation? AceetylCoA – which enters the Citric Acid Cycle just like the acetylCoA that is derived from glucose!
So far so good, but if the body detects that glucose levels are low and if there is a glut of acetylCoA from beta oxidation floating around, the Citric Acid Cycle will stall. The liver steps in to manage the excess acetylCoA. The final products of this process are D-beta-hydroxybutyrate, acetoacetate and acetone. These are your ketones. We have finally stumbled upon the stuff that gives ketogenic diets their name. Ketogenesis is triggered by low insulin and low glucose. This situation occurs in some diabetics. It occurs in fasting or starvation and it occurs in diets deficient in carbohydrate. To the keto diet gurus, it means switching from one fuel to another – indefinitely if you want to maintain your weight loss. Is it that simple?
One keto diet guru had the nerve to say that fat is a cleaner fuel than glucose. They probably don’t want you to know about beta oxidation and what ketones really are. Yes, both muscle and nerve cells can make use of ketones to generate energy, but starvation is not a favourable condition even in paleo times. Even though the concentration of ketones in someone on a ketogenic diet is far lower than that for someone in with diabetes, diet-induced ketosis will still increase your urine output and predispose you to dehydration, kidney stones, loss of muscle mass, decreased athletic performance and bad breath.
The keto gurus deny all that and start pointing to populations that consistently consumed a high fat, high protein, low carb diet – the Eskimos. Sometimes cooked, sometimes uncooked, the meats of birds, caribou, seals, walrus, polar bears, whales, and fish form the bulk of their meals. Claims that Eskimos are free of cardiovascular disease are simply not true. Studies have revealed that a huge contributor to mortality in predominantly carnivorous Eskimo populations is cerebrovascular strokes. Besides that, they also have low bone mineral density. Their overall mortality is nearly two times as high as that of most urban populations. The lack of fruits and vegetables in the diet also cause the aging process to speed up. Drop me in an Eskimo community and people will think that I’m in my late 20s even though I’m in my 50s. Someone my age probably looks like my father who is close to 90.
There is something else which the ketogenic cult may not be aware of. It’s the protein content of the diet and the process of gluconeogenesis. When glucose levels are low, the liver strips the amino group from amino acids and turn the carboxylic acid group into glucose. See how difficult it is to escape from glucose and go ketogenic? Could it be that your body is unwilling to get into that state? Some keto gurus have suggested diets low in protein! A few of them actually advocate that that to keep the body in that ketogenic state, you would need to go on a diet with at least 75% fat. We know how important proteins are. They are needed to repair worn out parts of the body and older fogies are especially susceptible to suboptimal intake. Go on one of those low carb, low protein diets and you may be jeopardising your health in a very big way.
Fasting is technically also ketogenic. About 12 hours after your last meal, your liver’s glucose and glycogen stores are partially depleted. There’s still quite a bit of glycogen in your muscles, but a tiny bit of your fat reserves start to get mobilised once you get those muscles moving. Free fatty acids forces the liver to make ketones which are metabolised by both muscles and the central nervous system. It’s very easy to achieve a state of healthy ketosis. Just skip breakfast, go for a 10km run in the morning and you’re burning fat – albeit just a little bit of it as your muscles would still be be holding some glycogen. To lose fat this way, you’ll need to repeat the process for months and eat a light, protein-rich brunch after that. Certainly not easy and certainly slower than low carb dieting. That’s why when the keto gurus offer an easy way out – lots of eggs, cheese, bacon, steaks, sausages etc, you see a huge following regardless of how many times such fad diets have come and gone.
Personally, I’m not in favour of a completely plant-based diet. Cooking and eating are pleasures. Food is meant to be enjoyed and restricting our enjoyment of food too much equates to restricting our enjoyment of life. However, the video below shows how doctors dispel the myth of low carb diets. A lot of it is pseudoscience or half truths meant to sell books and build a cult following. People just love to hear good news about their bad habits.
The one thing I agree totally with these doctors – low carb diets are scams. And if anyone tells me that even doctors are on it or promoting it, the video has the answers for you.