Is ketogenic diet healthy?

The dietary protocol that promotes fat consumption

This nutritional system, which practically goes against all nutritional pyramids recommended by medical institutions and health regulators since the United States Department of Agriculture in the 1970s, is revolutionizing the way we eat. But why?

The ketogenic diet is a dietary protocol in which it is recommended that the majority of your daily diet be fat (70%) and protein (25%) while carbohydrates, in the form of flour or sugar, be very restricted (maximum 5%).

Traditional food pyramid

Ketogenic food pyramid and its vegan and vegetarian variations

The ketogenic diet promotes the consumption of fat, including saturated fat, although the latter has been pointed out as the main culprit of all modern health problems. According to medical and nutritional institutions, fat clogs the arteries causing cardiovascular disease, atherosclerosis, stroke, high cholesterol, obesity, type 2 diabetes.

How fat consumption can be beneficial for health

The theories surrounding fat are changing and important medical studies are confirming that the traditional nutritional pyramid is not helping people. On the contrary, there are more and more people who are overweight and have cardiovascular complications because something is not working properly. Let's see what it is.

Since the 1960s, the medical establishment has been recommending avoiding fat to prevent heart disease, but there is growing evidence that saturated fat is not the cause of heart disease. One of the biggest trends in the last 3 years is the ketogenic diet, which has gained prominence by arguing that consuming saturated fat in the context of healthy fats is not the cause of heart disease. Now even cardiologists are agreeing with this statement, and it has even been published in the Journal of the American College of Cardiology (JACC).

This journal presents an analysis among the most important cardiologists in North America on what is the limit of saturated fat that humans can consume. The conclusion is that,

“ The recommendation to limit dietary saturated fatty acid (SFA) intake has persisted despite mounting evidence to the contrary. Most recent meta-analyses of randomized trials and observational studies found no beneficial effects of reducing SFA intake on cardiovascular disease and total mortality, and instead found protective effects against stroke. ”( 1 )

Furthermore, the effects of saturated fatty acids (SFA) depend on the interaction effects of the natural components of the food and the harmful compounds included during processing or preparation. In short, it is important to look at what foods are on your plate and how you are mixing the macronutrients (fats, proteins and carbohydrates) found there.

Healthy or not, the main sources of saturated fatty acids (SFA) come from full-fat dairy products, eggs, some animal proteins and dark chocolate, which are complex food matrices. When analyzing these foods, their natural fats do not pose a risk for cardiovascular disease, diabetes or stroke. Therefore, the specialists in the aforementioned study suggest that recommendations should not be made regarding specific nutrients but rather based on which foods should be avoided.

Since 1977, when the nutritional guide was published in the United States, it was recommended

1. Eat a variety of foods
2. Maintain ideal weight
3. Avoid too much fat, saturated fat and cholesterol
4. Eat foods with adequate amounts of starch and fiber
5. Avoid excess sugar
6. Avoid excess salt
7. Consume alcohol in moderation

As we saw above, this nutritional guide was sponsored by the United States Department of Agriculture. It was rightly recommended to consume foods with “adequate” amounts of starch (flours and products with a high starch content such as potatoes, pasta, rice and bread, claiming that they have sufficient concentration of fiber). The same guide recommends avoiding saturated fats such as those found in butter or ghee and replacing them with margarine (an unsaturated fat derived from vegetable oil) which, in addition, is partially hydrogenated to become what we now know as an artificial trans fat (natural trans fat is also present in some meats and dairy products).

According to the study by the American College of Cardiology that we have mentioned, the recommendations made by the health professional to the patient should emphasize food-based strategies that for the public should be translated into understandable, coherent and solid recommendations with healthy dietary patterns .

The BIG DIFFERENCE between saturated fat in food and the amount of saturated fatty acids in our blood

It is essential to understand that the amount of saturated fat in our blood depends primarily on our consumption of carbohydrates (starches, sugar) through the process of de Novo lipogenesis.

Maria Casacales Angosto in her monograph Lipogenesis de novo and thermogenesis explains,

“De novo lipogenesis is a complex and highly regulated metabolic pathway that converts dietary carbohydrates into fatty acids, which once esterified (the fatty acid is covalently linked to an alcohol forming an ester and releasing a water molecule) are stored in adipose tissue as triacylglycerides (TAG).

When faced with an excess of carbohydrates in the diet, the body responds by generating an amount of energy greater than the body's demands, that is, there is no balance between energy generation and consumption and the body finds itself with an excess of energy that it needs to use, and it uses it in the endogenous synthesis of fatty acids that takes place outside the mitochondria.

Mitochondria provide the necessary substrates, glucose degradation products (acetyl CoA and ATP), for the de novo synthesis of fatty acid chains, which once esterified with glycerol and in the form of TAGs are stored in adipose tissue as an energy reservoir. In humans, this pathway is predominantly active in the liver and adipose tissue, although it is considered to contribute little to serum lipid homeostasis. The alteration of de novo lipogenesis in the aforementioned lipogenic tissues is observed in various metabolic diseases, including obesity, non-alcoholic fatty liver disease and metabolic syndrome. It has been described that de novo lipogenesis is exacerbated in cancerous tissues and in cells infected with viruses, etc. These observations suggest that inhibitors of the pathways leading to de novo lipogenesis may be used in therapeutics.” (Angosto, 2015)

As Mrs. Angosto mentions, this process is activated in the liver and adipose tissue, that is, the liver takes the excess carbohydrates and converts them into fat that tends to be saturated fat to store it in the blood for…”later?”

Back in the 1970s, the reason people thought a low-fat diet would reduce the risk of heart disease was because it could lower low-density lipoprotein (LDL) or bad cholesterol, which is associated with heart disease.

Current research indicates that it is not that simple. Low-fat diets tend to reduce the larger low-density lipoprotein (LDL) particles that would not be the cause of heart problems. In fact, the amount of saturated fat in the diet has little to do with elevated blood levels of saturated fat, while diabetes and other metabolic diseases contribute greatly to heart disease because they have much more to do with the amount of carbohydrates we ingest through the process of de novo lipogenesis.

As a consequence, a higher consumption of fat through the diet will be associated with lower levels of saturated fat in the blood. While a higher consumption of carbohydrates in the diet will be expressed in higher levels of saturated fat in the blood.

Be careful with the treatment given to basic foods

Another thing that has become clear over the past 50 years of research is that a food is more than the macronutrients it may contain: it is not just fat, protein or carbohydrate. Instead, we need to think about the interaction between its natural components and the harmful additives added during processing or preparation.

By 1997, a study called the Nurses Health Study conducted by Harvard University in the United States indicated that no matter how much fat was consumed, it was not linked to the possibility of heart disease. And by 2001, a statement from the school of public health at the same university noted,

“There is now growing recognition that the low-fat campaign has been based on little scientific evidence and may have caused unintended health consequences.”

Frank Hu and W. Willet

Harvard School of Public Health.

In order to be able to intuitively select the food we put in our mouths, it is important to try to ensure that our foods are organic and consume them in the way closest to their natural state, that is, avoiding processes that alter their nutritional structure, such as pasteurizing, freezing, adding preservatives, cooking at very high temperatures.

Second, while the 1997 study claimed that the amount of fat consumed was not linked to the likelihood of heart disease, it should be made clear that this is true as long as that fat is not consumed with carbohydrates and I would add that the amounts do matter because the calories that are not physically used are going to be stored in adipose tissue.

Can saturated fats have a protective effect?

Since 2010, studies have appeared that corroborate this. In that year, a study was published with 58,000 people divided into 5 groups that consumed saturated fats in different quantities for several years. The result was that the group that consumed the most saturated fats was the one that generally had fewer cases of heart disease, stroke or mortality.

According to this study, and others that have followed, it suggests that fat consumption, including saturated fat naturally occurring in foods, may provide a cardioprotective effect.

In 2017, a study published by the Lancet magazine covering 18 countries followed 135,335 individuals for seven (7) years, measuring consumption of total fat, saturated fat and carbohydrates. The results gave the following interpretation,

“High carbohydrate intake was associated with increased risk of total mortality, whereas total fat and individual fat types were associated with lower total mortality. Total fat and fat types were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality. In fact, saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these results.”

All of this evidence leads us to believe that consuming more natural fats and natural saturated fats as recommended in a ketogenic diet protocol does not lead to imminent heart disease, but on the contrary, may have a protective effect against stroke.

 

What are healthy fats?

When following a ketogenic diet, the proportion of fat is higher, while the proportion of protein in your plate is moderate and the proportion of carbohydrates is minimal.

Some of the healthiest sources of fat you can add to your diet are,

1. Avocado and avocado oil . Half of a medium avocado contains 9 grams of total carbohydrates, of which 7 grams are fiber. Swapping animal fats for plant-based fats like avocado can help improve cholesterol and triglyceride levels.

2. Nuts . Although nuts differ in composition, for this purpose Brazil nuts, pecans, almonds, and macadamia nuts are the best choices. Macadamia nuts have been stigmatized for their high content of palmitoleic acid, a class of omega-7 monounsaturated fatty acids associated with a 67% increased risk of heart disease and a 52% increased risk of stroke. However, as explained above, new research suggests that palmitoleic acid may be a signaling molecule that may help prevent weight gain. The work is consistent with earlier observations by Glen Power and other scientists at the Department of Biochemistry at the University of Oxford , who concluded that palmitoleic acid, among a range of other fatty acids available in the diet, is used by key enzymes that control fat oxidation at extraordinarily high rates. ( 2 )

3. Flax seeds . A quarter cup (42 grams) of flax seeds provides 11 grams of fiber, 7 grams of protein, and 18 grams of fat, half of which comes from omega-3s.

4. Hemp seeds . Three tablespoons (30 grams) of these seeds provide 15 grams of fat. They are also one of the few plant-based sources of complete protein, containing all essential amino acids and good amounts of vitamin E, calcium, iron and potassium.

5. Chia seeds . In 1½ tablespoons (15 grams) of chia seeds, you get 4 grams of fat, mostly omega-3s, as well as 4 grams of fiber.

6. Olives and cold-pressed olive oil . Olives and their oil contain healthy fats and also vitamin E, as well as other compounds that reduce chronic conditions such as heart disease, cancer and osteoporosis. 10 large olives or 20 small olives (green or black) contain 200 calories. 8.2 gr. of fat; 4.8 gr. of carbohydrates and 0.6 gr. of protein.

7. Coconut and unrefined coconut oil . Coconut and its oil provide a natural source of medium-chain triglycerides (MCTs), a type of fat that is easily absorbed and used by the body.

8. Cocoa nibs . Cocoa nibs are a form of raw, unsweetened, unprocessed chocolate. Just 28 grams provide about 12 grams of fat and a whopping 9 grams of fiber.

9. Eggs . Eggs are as nutritious as they are versatile, making them an easy addition to a keto diet. A single 56-gram egg contains about 5 grams of fat, 7 grams of protein, and 80 calories.

10. Ghee . Ghee is butter without the milk solids. When heated, the milk solids collect at the bottom of the pan. The milk solids contain the calcium. Separating those milk solids results in ghee, or clarified butter, which has a higher smoke point than butter, at 485° F. 15 grams of ghee (1 ½ tablespoon) contains 130 calories, 15 grams of fat; 0 carbohydrates and 0 protein.

The right amount of fat per day if you are following a ketogenic diet

According to the Harvard School of Public Health,

“Generally, the most popular ketogenic methods suggest an average of 70-80% of total daily calories from fat, 5-10% from carbohydrates, and 10-20% from protein. For a 2000 calorie diet, this translates to about 165 grams of fat, 40 grams of carbohydrates, and 75 grams of protein. The amount of protein in the ketogenic diet is kept moderate compared to other low-carb, high-protein diets, because eating too much protein can prevent ketosis.” ( 3 )

These quantities and proportions are in case you want to practice this protocol to lose weight, lose stored fat and have more energy. However, making the transition to ketosis implies that the body stops using sugar as its main source of fuel. If you want to start with this protocol, it is best to consult a health professional who can guide you. In addition, here is the link to inform and prepare yourself through these articles where I explain the step by step.

Now, for people who want to include healthy fats in their diet, but consume carbohydrates and proteins, the proportions of these macronutrients are different, as are the quantities on their plate. Thus, the diet for a sedentary person should be 50% protein, 40% carbohydrates (mainly in the form of green vegetables) and 10% healthy fats such as those mentioned in this article.