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[8 min read] Do your patients ask you about the keto diet?

Recently, there has been growing interest in the ketogenic diet. Do you have the knowledge to deal with the increasing number of patients asking whether the diet is safe and recommended for them?

Despite the recent hype, the ketogenic (or keto) diet has actually been used in medicine for almost 100 years to treat epilepsy, especially in children. It was popularised in the 1970s by Dr Robert Atkins’ very low carbohydrate diet for weight loss that began with a strict two-week ketogenic phase and, over the years, other fad diets have incorporated a similar approach for weight loss.

What is the keto diet?
The keto diet causes the body to release ketones into the bloodstream. Most cells use blood sugar, which comes from carbohydrates, as the body’s main source of energy. If a person consumes a very low amount of carbohydrates, resulting in the absence of circulating blood sugar, their body will begin breaking down stored fat into molecules called ketone bodies. This process is called ketosis. Once the body reaches ketosis, the cells will use ketone bodies to produce energy until the person starts eating carbohydrates again. The shift from using glucose to breaking down stored fat as an energy source usually happens over two to four days of eating fewer than 20 to 25 grams of carbohydrates per day. This varies from person to person, and some people need a more restricted diet to start producing ketones.

What foods does the keto diet include?
A ketogenic diet is high in proteins and fats, and typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds, and fibrous vegetables.

What risks does the keto diet carry?
Carbohydrates normally account for at least half of the typical diet, so patients often struggle to follow the keto diet long-term as it is quite restrictive. A major concern with the diet is that many people eat too much protein and poor-quality fats from processed foods with very few fruits and vegetables. Some side effects from following the diet include tiredness, bad breath, nausea, vomiting, constipation, and sleep problems. Patients with kidney disease need to be cautious because the keto diet could worsen their condition.

Does the keto diet treat neurological conditions?
The keto diet reduces seizures in epileptic children, sometimes as effectively as medication. This raises questions as to its possible benefits for other brain disorders such as Parkinson’s, Alzheimer’s, multiple sclerosis, sleep disorders and autism. However, there are no studies to support recommending the diet to treat these conditions.

Does the keto diet treat diabetes or high cholesterol?
The keto diet has been shown to improve blood sugar control for patients with type 2 diabetes in the short term. There is controversy about the effects of the diet on cholesterol levels, as some research suggests that some patients have increased cholesterol levels at the start but see a fall in cholesterol levels after a few months. There is no research on the diet’s long-term effects on diabetes and high cholesterol.

Does the keto diet help with weight loss?
Weight loss is the primary reason most patients enquire with their GP about the keto diet. There is evidence that patients on a ketogenic or very low carbohydrate diet achieve faster weight loss compared to patients on a more traditional low-fat or Mediterranean diet. However, the difference in weight loss seems to disappear over time. This study further discusses the keto diet as a tool for weight loss.

Key keto takeaways
The keto diet may be an interesting alternative to treat certain conditions, and may accelerate weight loss. However, little is known about the diet’s long-term effects, and so-called “yo-yo diets” that lead to rapid weight loss fluctuation are associated with increased mortality.

GPs should consider their patients’ individual circumstances when recommending the diet, as it is hard to follow and can rely too heavily on red meat and other fatty, processed, and salty foods that are notoriously unhealthy. It is important to encourage patients to embrace change that is sustainable over time rather than following a popular diet that may only last a few weeks.

A balanced, unprocessed diet that is rich in fruits, vegetables, lean meats, fish, whole grains, nuts, seeds, olive oil, and water offers the best evidence for better health.

Read more about the importance of nutrition care in general practice.

Want to learn more about managing your patients’ nutrition concerns in general practice? Upskill in Medical Nutrition Management.

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