We have shined a light (and our thoughts) on the ketogenic diet in a previous blog post, Is a Ketogenic Diet Good or Bad for You?, but today we are taking a more in-depth look at the effects of this popular diet and how it can be supportive or detrimental to your health.
The diet is similar to the very low-carb diet referred to as the Atkins diet in the 1990s, promising quick weight-loss through a high-fat, no carbohydrate approach.
While individuals are getting results, this type of diet acts as a diuretic in your body, meaning it sucks the water from your muscles, allowing you to drop weight fast. It is common for those starting on a ketogenic diet to lose weight fast within the first few weeks, mostly due to water weight.
The overall premise of the diet (high-fat with little to no carbohydrates), has been shown in research to be supportive to those with epilepsy. This goes back in history to 400 BCE, where doctors recommended fasting for those having epileptic seizures.
Fast forward to today, there is evidence showing the connection between epilepsy and our diet. While long-term fasting is not always a viable option, doctors continued to search to see how fasting could best be mimicked. The answer they came to was the Ketogenic diet—a high-fat, low-carbohydrate meal plan.
While shown to be beneficial for those with epilepsy, Parkinson's, Alzheimer's, or metabolic syndrome, there is little to no research on the long-term effects of this diet in healthy people or even athletes.
We have repeatedly seen participants in our Adrenal ReCode program who have been on a highly restrictive high-fat (70-80% of calories from fat), low-carbohydrate diet have fat malabsorption, vitamin and mineral deficiencies, and hormones that are way off balance.
They can’t sleep. Their hair is falling out. They’re anxious.
The diet is no longer working to provide them energy and mental clarity, so they are exhausted. And now, they can’t lose the “spare tire” around their belly no matter how much they restrict carbs.
Ketosis is a state where the body is receiving a low intake of carbohydrate sources and a high intake of fat—often 70-80% of calories come from fat.
The body learns to burn fat for energy by way of producing ketones, which circulate the bloodstream to serve as energy. This process is ultimately mimicking the effects of fasting.
When starting a ketogenic diet, the body begins by going through a process called gluconeogenesis where it uses stored glucose (called glycogen) from your muscles and liver to supply the body with energy. After these stores are used up, the body starts to utilize ketones from fat for energy.
When you blow through your glucose reserves and start burning fat, the next thing to go is muscle (unless you are super diligent about staying in ketosis). The body then has no choice but to go into muscle-wasting-mode, burning protein for fuel. This is what happens when we are dying.
The body prefers to use carbohydrates as fuel and forcing it to burn fat (or protein) gives it no choice but to go into high stress, survival mode forcing the overproduction of stress hormones in the breakdown process—you cannot have healthy stress hormones and be on a long-term ketogenic diet—it's scientifically impossible.
Over time, because you have willingly chosen to take away your precious reserves of energy—energy that provides you with both physiological and emotional stability under times of stress (I’m even talking about skipping a snack or encountering heavy traffic as stress).
It’s like burning out the generator so you have nothing to rely on when the power goes out.
When we are under high amounts of stress (either psychologically or due to illness), we need to use stored glucose as fuel. If we do not have any stores of glycogen, the body has no choice but to secrete cortisol, a stress hormone, which means the body is running off of stress hormones instead of fuel. This is a way to compromise long-term health for short-term benefits (like fast weight loss or “energy” or “brain power” that is being inappropriately powered by stress hormones).
It’s kind of like putting diesel in a car that requires gasoline.
A healthy human body should have 1,400-2,000 calories (or 350-500 grams) of glycogen stored in the muscles and about 400 calories or 100 grams of glycogen in the liver.
Having that backup supply creates stability and resilience in the nervous system and gives you a greater ability to tolerate and rebound from stress because it keeps the body from overproducing or inappropriately producing stress hormones (cortisol and adrenaline) that, in excess, are toxic to your adrenals, thyroid, gut, and immune system.
If we stay on a ketogenic diet long-term, it becomes a detriment to our sleep, energy levels, and mental or emotional health, not to mention our adrenals get burned out from overworking and the thyroid continues to take a hit (losing its ability to convert inactive thyroid hormone to active thyroid hormone or to even make thyroid hormone = hair falling out).
Furthermore, and worse – this creates a gateway to autoimmunity or stress-induced autoimmune diseases.
Those of us who build up our reserves and learn how to burn healthy carbohydrates (watch our show on healthy carbs if you haven’t already) as fuel get the freedom, self-reliance, and strength to live “off the grid” so to speak.
We are not nearly as weakened by external events or significant life stressors the way other people's lives literally stop when high-stress enters their life.
As previously mentioned, there can be a therapeutic purpose to a ketogenic diet, including for those with Type 2 diabetes, metabolic syndrome, epileptic seizures, cancer, and neurological diseases.
There have been positive studies looking at ketogenic diets for a period of 4 to 24 weeks (6 months), the results have been mixed. One has shown the benefits of a ketogenic diet in reducing hemoglobin A1C levels in those with type two diabetes.
Surrounding weight management, the results have been mixed; there have been a few studies showing improvements in weight while others show no improvement when compared to participants with the same caloric intake but a high-carbohydrate diet.
From working with tens of thousands of people, I would not recommend anyone stay on a ketogenic diet longer than 8-10 weeks. There is not enough definitive research to speak to the six-month period of time as mentioned above.
The ketogenic diet acts as a diuretic, so naturally, weight loss occurs quickly (and unnaturally) as carbohydrates hold onto fluid in the body.
This means that the glycogen molecules in your body hold onto the water while they are being removed or burned off.
While we love healthy fat, too much of it and with an unbalanced source of carbohydrates (and protein) can be dangerous because it overloads the liver and gallbladder, leading to fat malabsorption, poor digestion, and poor cholesterol output which means poor sex hormone production.
This highly-restrictive diet can make food choices very limited, and we have seen, for some, that it can become the gateway to developing an eating disorder.
Hundreds of women in our Adrenal ReCode program have come from a ketogenic background and came to us experiencing mood swings, unbalanced or absent menstrual cycles, fertility issues, hair loss, low energy, and vitamin deficiencies.
They thought they were eating healthy and doing the right things. They thought it was just their schedules, their kids, or their age that must be making them feel overwhelmed, exhausted, and out of control until they realized what was really happening.
Fight-or-Flight Mode: The ketogenic diet especially puts a woman's body in persistent fight-or-flight mode, creating high cortisol leading to stubborn belly fat, sleep issues, and anxiety.
Hormones: Long-term this can lead to a drop in progesterone, often leading to estrogen dominance and premature menopause/perimenopause, and infertility. This is very important for women of all ages; fertility issues can be common, often losing a menstrual cycle entirely, due to the body being in survival mode. For some, especially women over the age of 40, estrogen can also take a drop which can put us at risk for osteoporosis and other bone-related health problems.
Neurotransmitters: These chemical messengers in our brain are often depleted due to not receiving the right amounts of amino acids and cofactors which are found abundantly in healthy carbohydrate sources. This affects our mood, cognition, memory, and sleep.
Thyroid: Thyroid hormone production drops with both low-calorie diets and ketosis, especially T3 – the thyroid hormone that gives you energy and affects your weight, digestion, and metabolism. On lab tests, a thyroid hormone called reverse T3 is often increased due to the high amounts of stress and cortisol. Reverse T3 stores away thyroid hormone and makes it inactive, blocking active T3.
For men, the thyroid and neurotransmitters take a hit as well.
Some studies showing how a high-fat diet reduces sperm count, by 43% when compared to those consuming a moderate to low-fat diet.
When carbohydrates are reduced drastically, testosterone production is often decreased which triggers muscle catabolism (the opposite of muscle building).
This is why, long-term, we are seeing muscle-loss and weight-gain in those following a ketogenic diet.
If you have been eating a ketogenic diet for a long time, it can often feel overwhelming trying to come off of it. It can be common that this is coupled with fear and anxiety of the unknown and questioning how your body will react when adding new foods back into your diet.
When starting off, the key is to take it slow and to have patience.
If we go too quickly when adding back in (healthy) carbohydrates, rapid weight gain can be possible. This is due to the fact that your body has not been using carbohydrates for fuel, so it does not know how to utilize them correctly meaning it looks at them as a foreign food it cannot metabolize and puts them aside to be stored as fat.
Similar to the fact that you do not go to the gym and start deadlifting 200lbs, we must retrain your body and start slow.
Try small amounts of healthy carbs (root vegetables and fruit and don't be afraid of tropical fruit)—2 tablespoons to a ⅛ cup depending on how many you're currently eating—to train your body to use them as fuel once again instead of storing them as fat.
If your digestion isn't great, you might want to eat cooked fruits—start with peeled and cooked apples and pears with a little bit of Ceylon cinnamon. While we love the pectin and insoluble fiber in the skin, it can't be digested and is better to leave out when digestion is already compromised.
Treat yourself as if you are healing, because you are and give your body foods that are easy to digest and foods that do not cause inflammation.
Make sure to have protein, carbs, and fat with each meal, but just downwardly adjust your fat and play with your carbohydrates until your body can tolerate and use them again.
The combination of these three things will calm and soothe your system and allow for a more graceful transition to normal, healthy eating that powers your cells and therefore your body and your brain.