A Polarizing Topic
Few topics are as polarizing as ketogenic diets, and there doesn't seem to be a middle ground. People either believe keto is the one and only correct way to eat, or that it's a dangerous fad, no better than any other diet that creates a caloric deficit.
Proponents of keto will say there's a huge metabolic advantage. They'll tell you how it programs the body to use fat as your primary fuel source. They say it's more than just a caloric deficit. They talk about the great enhancements in mood, energy, cognition, and their capacity to deal with stress.
Some say it gives them the ability to see unicorns and ride them around on rainbows made of kittens. (I'm exaggerating, but just a little.)
Those against it will argue that it's much harder to build muscle on a keto diet; they argue that high intensity performance can drop; They argue that cortisol will increase; that it becomes hard to sustain over the long run, and that recent studies report similar fat loss regardless of the carbs/fat ratio (if protein and calories are equivalent).
Who's right? Is there a middle ground?
What is Keto?
Ketotsis, or keto, refers to a dietary approach that mimics the effect of fasting by minimizing insulin release. It does this by heavily limiting carbohydrate intake. Once glycogen stores are depleted, the body will start to produce ketone bodies which can be used efficiently as fuel by the muscles and brain. Once your body begins to use these for fuel, you're said to be in ketosis.
A Ketogenic diet is comprised of primarily of fat, with clinical ketogenic dieters having as much as 80-90% of their caloric intake coming from fat. The version typically used by the average person and lifters would have more protein; the breakdown for that looks something like 65-70% fat and 30% protein.
The goal is to reach what's called "keto adaptation," a state where the body produces a lot of ketone bodies from fatty acids which which act as the primary fuel source.
Keto adaptation normally requires a few weeks. Prior to reaching that state it's possible to have a drop in energy, mood swings, and problems concentrating. Once adapted, these side effects should level out.
The Main Keto Mistakes
The Bacon Phenomenon
The primary mistake I see is what I call the "bacon phenomenon." Some people go on a keto diet and see it as an all-you-can-eat bacon, cheese, cream, and butter fest. In theory, that's fine because it upholds the keto ratios. However in practice, the kinds of fat present in these foods are not "health promoting" when consumed in large quantities.
I recently did a keto experiment and foolishly started with a high amount of the foods mentioned above. Within three days my blood pressure shot up from 115/80 to 155/110! Not exactly healthy. Once I changed my food intake and types of fat (fish oil, olive oil, salmon, avocado, etc.), my blood pressure returned to normal.
First Lesson: Even on keto, food choices matter.
Too Much Protein
Another common error, especially among lifters, is eating too much protein while trying to do a "keto" diet. In this case, it's a mistake. See, protein can be turned into glucose by the liver (gluconeogenesis). If you ingest too much, you'll simply use that protein for fuel by turning it into glucose, and keto adaptation will be a lot harder.
Second Lesson: To actually be on a keto diet, you have to use the correct nutrient ratio. Protein can't be higher than 25-30% of your caloric intake.
Thinking Calories Don't Matter
Keto dieting seems to blunt hunger once you're adapted, so while you have the illusion of "eating as much as you want and not getting fat" in reality you're simply satiated with less food, thus ingesting fewer calories.
While there may be a metabolic advantage to keto dieting thus allowing you to eat a bit more calories without gaining fat, it's not significant enough to say that calories don't matter and that you can eat all you want. Consume a significant caloric surplus on a keto diet and you'll gain fat.
Third Lesson: You still need to match caloric intake to your goals.
Keto Cycling is Not Real Keto
The final mistake is using a cyclical "ketogenic" approach in which you eat with a keto ratio for 5-6 days a week, then have a pretty large carb intake on the other day(s) to replenish muscle glycogen. I'm not saying these approaches don't work; they can. However, they are not truly ketogenic diets.
Being in ketosis is very hard to maintain on this approach. A large carb-up or cheat meal could decrease ketone production for 2-3 days (3-4 if you count the high-carb day itself) so you essentially spend each week trying to re-establish keto adaptation the first three days after the carb-up because on these three days you heavily rely on stored glycogen for fuel.
Then you'll have the three days where you use more ketones for fuel and you carb-up on the last day. Even though it works just as well for fat loss, you feel like crap and will have huge carb cravings most of the time.
Fourth lesson: A true keto diet means changing your way of eating all the time, not just a few days a week.
Benefits Of Keto Dieting
Less Anxiety and Better Mood
A lot of people love this approach because once they're in ketosis, they feel better mentally – calmer, more focused, less anxious There are three main reasons why keto can have a positive impact on cognition:
It increases GABA levels and activity
GABA, along with serotonin, is one of the neurotransmitters responsible for "neural inhibition." It calms the nervous system when it is over activated or excited. Anxiety is nothing more than your neurons firing too fast and you start overthinking, even to the point of paranoia. You experience tension and are prone to worrying.
People with low levels of GABA and/or serotonin have a harder time calming their neurons down. As a result, they are in a more anxious state and are more prone to panic attacks. Increasing GABA would help the brain deal with stressful event/situations.
It can reduce systemic inflammation, including brain inflammation.
It's been theorized that what we typically call "CNS fatigue" could in fact be a symptom of brain tissue inflammation. This would lead to a loss of motivation, drive, discipline, mood, and mental functions.
It can improve insulin sensitivity in the brain.
The brain does have insulin receptors. In fact, evidence points to brain insulin resistance as a potential cause for Alzheimer's disease (some even call it type-3 diabetes). Fixing that issue would have a significant impact on brain function and mood.
Decreased Cravings
One reason keto works well is that it increases satiety; it blunts hunger more efficiently than other diets. If you're not a calorie-counter, you'll likely eat fewer calories on a keto diet.
People seem to lose fat more easily when they go keto: they're consuming fewer overall calories.
Despite the trend among coaches to claim otherwise, caloric balance is the most important factor in losing fat. Other factors play a role, but calories in vs. calories out (especially with an equated protein intake) is the most influential one. Still, having fewer cravings throughout the day and feeling more satiated is a benefit. It makes it easier to stick to the plan.
Drawbacks Of Keto Dieting
Slows Hypertrophy
Gaining muscle mass might be harder than with a more common bodybuilding-style diet. The main reason is a systemic decrease in the hormone IGF-1 and insulin levels.
IGF-1 is likely the most anabolic hormone in the body and insulin also has an important role in muscle growth. Keto will decrease both and it's bound to have an impact on muscle growth. It is not impossible to build muscle on keto, but it's a lot more difficult and slower than it would be if carbs are properly used in the diet.
For some, keto will raise cortisol to a greater degree than diets that include carbs. One of cortisol's main functions is to maintain stable blood sugar levels; specifically, it increases it when it falls too much. Other hormones like glucagon and growth hormone are also used to increase blood sugar levels, so not everybody will get a huge jump in cortisol production during a keto diet. Some will get more of a growth hormone release. Normally those who tend to overproduce cortisol – those who are naturally more anxious, stressed, and are more introverted – will overproduce cortisol.
Faster Fat Loss is Not Proven
Recent studies show that low-carb dieting does not lead to faster fat loss than low-fat dieting if calorie and protein intake are the same. You may also find several studies showing the opposite. Opponents of low-carb diets are quick to point out the studies showing no difference, but forget the large body of work showing an advantage of low-carb over low-fat dieting.
If we were to take a look at a large population as a whole, and not at individuals, the average fat loss should pretty much be the same whether you use a keto or carb-dominant approach, if protein and calories are equal. Some people might do better (for fat loss) on a keto diet while others will do better on a diet that provides more carbs.
Not Always Sustainable
While some people are going keto-for-life, others will get bored on it. Support groups can keep some of these people motivated for a time, but it's a band-aid.
If you enjoy fruit, rice, pasta, potatoes, oatmeal and the occasional cheat, it will be impossible to stick to a keto diet for the rest of your life.
Sure, you can have a treat here and there without getting off the keto bandwagon, but in reality this just delays the inevitable. It's not a discipline issue; you could have tons of discipline. You may be able to follow crazy, restrictive diets to reach specific goals. But can you really see yourself going keto for life? From my experience, any diet that completely discards one macronutrient is rarely sustainable.
Should I Do It?
The evidence regarding health benefits is fairly solid, provided that you make good food choices and don't turn it into a cheese-butter-bacon fest. For fat loss it can work really well for many people, especially those who aren't under a lot of stress and not doing a physical job.
If your goal is to gain muscle or get stronger it's not the best approach for you. Muscle gain will slow for a natural individual and it might become harder to recover from heavy, high-effort workouts. It might even affect strength negatively by decreasing water retention.
If you're a strength athlete, I don't recommend it.If you're a bodybuilder/lifter trying to build muscle mass, I don't recommend it. If you're looking to get lean, it may be a good option to use temporarily, but not necessarily better than other diets.
If you're wanting to quickly look a lot leaner (photo shoot, vacation, big event) it could be useful because it will decrease water retention, giving the illusion of leanness.
It's not as good as its biggest proponents are claiming, but it's not as bad as its opponents make it out to be. Like almost everything related to diet, it falls somewhere in the middle.
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