In the 1980s, health and nutrition experts waged a war against dietary fats.
Food companies began to cash in by creating "fat-free" versions of popular foods.
That trend continued into the 1990s and even into the new millennium.
Now, a growing number of health experts, including some doctors and nutritionists, are finding that fat may not be the enemy after all, rather shifting the focus on reducing the consumption of too many carbohydrates.
The shift in philosophy has caused a rise in popularity of a diet called the ketogenic diet, or keto, for short.
The ketogenic diet is a variation of a low-carbohydrate diet, which encourages the process of ketosis. That, in turn, utilizes fat as the body's fuel rather than carbohydrates.
"The level of carbohydrates that are consumed for a ketogenic diet are super-low," said Dr. John Thomas, owner and physician at On Point Primary Care. "Usually carb intake is at 5 percent, versus the normal diet of 45 to 65 percent in the makeup of macronutrients of proteins, carbohydrates and fats."
Thomas explained that carbohydrate consumption has been what he believes to be a leading cause of many health problems.
"All in all, we just consume, as Americans, way more carbohydrates than we need," he said.
A ketogenic diet often is a more extreme reduction of carbs. Thomas said that this isn't always necessary to help.
He recommends a less drastic approach.
"The benefits for most people are just reducing their consumption to maybe moderate levels of carbohydrates and not the extreme," he said.
Unlike other low-carb diets, the ketogenic diet focuses more on consuming a larger portion of fats, a moderate amount of protein and a very low amount of carbohydrates.
"Often times the ketogenic diet has between 70 and 80 percent fat consumption, and proteins are between 25 and 30 percent," Thomas said.
The key for a ketogenic diet to work is to trigger ketosis.
Carbohydrates are used as energy in the body.
From simple sugars to complex carbs, the body relies on the macronutrient as fuel.
However, eating too many carbs causes the body to store fat at a greater rate.
"Our bodies have a tendency to burn carbohydrates pretty rapidly, before we're going to burn protein and fat," Thomas said. "Carbs aren't bad, they serve a purpose. Too much might be a problem and that's where I say we eat too much."
In a ketogenic diet, the low amount of carbs causes the body to adapt to a new fuel utilization.
"You're not really going to break down your muscle tissue unless you're in a starvation mode," Thomas said. "But, we have plenty of fat stores, most all of us do. By lowering carbs drastically, we begin a survival process called nutritional ketosis where we start to liberate fat, typically from the liver, and we'll break that up and utilize it as fuel."
The process produces ketones in the liver, which in turn act like carbs in many ways. Ketones are transported throughout the body, providing fuel.
"The ketones will allow all these cells that normally use glucose to run on ketones," Thomas said. "This allows you to push whatever glucose you do have to the brain."
Chiefly, people use the keto diet to lose weight.
By using body fat as the energy source, the body's insulin (the hormone responsible for fat storage) levels drop greatly.
"If you're burning fat in that way, there's a tendency to lose weight," Thomas said. "Weight loss is probably the major reason people are getting into this."
The ketogenic diet has also been shown to help control blood sugar levels.
Though there are not long-term studies, research has shown several significant benefits to ketogenic, and other low-carb diets.
"We have studies that show that this diet improves blood sugar and lowers insulin levels," Thomas said. "It can lower high blood pressure, decrease weight and improve cholesterol, decrease triglycerides and can reverse fatty-liver diseases."
Keto could help treat diseases like cardiovascular disease and diabetes; however, there are no studies that show long-term lasting effects.
Though the diet is high in fat, it is recommended that a majority of that which is consumed should be from natural sources.
Peanut butter, avocado, some nuts, fish and grass-fed meat such as beef, lamb, goat and venison are recommended staples of the diet.
"The one thing I think is important, and what I try to emphasize when a patient is consuming a little bit more fat, is that those fats are healthy fats instead of high fats," Thomas said. "I like to emphasize the healthy benefits of omega-3 acids."
Oils, too, can be a source of such healthy fats.
"Coconut oils, olive oils ... those should be emphasized as fats to obtain," Thomas said.
High-fat foods, like bacon, can be eaten, but in moderation.
"Bacon would be considered an edible item in the ketogenic diet," Thomas said. "But, it'd have to be mixed with the healthy fats."
While eating low-carbs, it is suggested that the carbs that are consumed come from leafy, green vegetables such as spinach, lettuce, chives, kale, celery, stalk, asparagus, cucumber and summer squash.
A drawback to the diet is what is often called the keto flu.
"It can be presented with headache, fatigue and muscle cramping," Thomas said. "Those are potential side effects with ketogenic diets, or any of the lower carbohydrate diets."
Keto can cause a significant drop in water retention, and without proper hydration, can cause dehydration.
"We encourage water intake, as these symptoms could be secondary to dehydration," Thomas said. "Some will also recommend additional sodium in their diet during that period, or as needed if you're having these symptoms. Again, I caution that sodium introduction may interact with people who have high blood pressure."
These symptoms typically last for only a couple of weeks.
Thomas said the symptoms are similar to having a withdrawal.
"They're similar effects to when people take too much caffeine," he said. "People have severe migraines because of the withdrawal of caffeine."
To combat cravings and symptoms, Thomas said to remain consistent and try salt water.
He also recommends consistent medical supervision.
"Always seek advice from your doctor and nutritionist," Thomas said. "That's super important."
If ketosis becomes too great, it can lead to ketoacidosis.
Ketoacidosis is a pathological response which can be life-threatening.
"Even with your typical American diet, we still form ketone bodies, but the amount we make is super small," Thomas said. "We generally see nutritional ketosis occur when the levels rise about 10 times the normal amount, all the way up to 70 times. When blood-ketone body concentration exceeds 250 times normal, that makes our blood become acidotic, and that's where it becomes life-threatening."
Thomas said this does not occur often, and is usually caused by a pre-existing condition.
"It would generally be rare unless there are some issues, like diabetes," he said. "You'd have to be careful, even Type-II diabetics have that possibility of going into acidosis."
Thomas again recommends working closely with a licensed medical technician when attempting to go on a keto diet.
"Any diet, and something like this, you should be monitored by a doctor or nutritionist and followed closely," he said.
Thomas himself is not necessarily a proponent of a keto diet.
He is, however, an advocate of lowering carbohydrates and tailoring one's nutrition to impact long-lasting change.
"What's important is, and what we try to do at our clinic because we can monitor our patients pretty regularly is, we identify and overcome barriers as they happen," he said. "This is typically on a month-to-month basis. I ask every one of my patience if this is something they can do for the rest of their life."
Thomas explains that diets are only truly effective if they can be sustainable. He suggests implementing a complete lifestyle change rather than creating a temporary solution.
Thus, it is important to tailor these diets to the individual.
"We begin to make this diet that is individualized for that person," he said. "It's no longer a low-carb, ketogenic diet. It's your diet within this (low-carb) spectrum that we've worked with by going back and forth and find out what you can live with for the rest of your life."
llyons@chieftain.com
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