Why Won’t the Ketogenic Diet Die?
Abstaining from carbs is not the solution to the obesity problem.
This article was originally published on my personal Medium account.
It has become impossible to remain deaf to the ever-escalating, decades-long obesity epidemic. Estimates produced in the late ’90s and early 2000’s pinned the global obese population around 250 million, forecasting a gradual expansion to 300 million by 2025. According to the World Health Organization in 2016, we’ve managed to blow past those figures to roughly 650 million obese adults and 1.9 billion overweight adults worldwide.
Although the current narrative surrounding the crisis is evidently grim, many victims have taken it upon themselves to seek solutions. Intrinsically, the core problem is rather simple: weight gain is produced by eating more calories than one manages to stave off via the combined efforts of their metabolic and conscious activity in a single day. Nonetheless, the reasoning for which people induce the conditions necessary to become (and stay) fat is complex. As such, people feel a need to augment the core disciplines of eating less and moving more with dietary patterns and tools allegedly designed to produce faster results, mitigate hunger, and improve aesthetics.
So how did a hundred-year-old diet, concocted to aid epileptics, come to be one of the biggest fads in fitness? The ketogenic diet, which was long-believed to be a defunct means of treating epilepsy, has evolved into water-cooler banter as the most effective dietary protocol for rapid fat loss, replete with oil, cheese, and bacon. Unfortunately, reality is far less glamorous. When it comes to weight loss, a keto-based diet which does not adhere to the nonnegotiables of energy balance will be no more effective than any other. Thus, it begs the question: why does it persevere as ubiquitously as it has?
A Brief History Lesson
Long before the conception of the ketogenic diet, fasting was utilized in order to treat illnesses, especially those neurological in nature. From potentially before 500 BC, humans have deliberately starved themselves to allay the frequency of epileptic seizures. It wasn’t until the early 1900s, just a century ago, that we began to develop a stronger grasp on the chemical and physiological processes behind the efficacy of this practice.
Several scientists had narrowed down the physiological mechanisms by which seizures were blunted or completely eradicated by starvation: the production of ketones appeared to be consistent across all subjects exhibiting promising results. Thus, in an attempt to incur ketone production without starvation, the ketogenic diet was developed and prescribed to patients with epilepsy for a time. However, around 1938, the scientific community at-large shifted their attention away from the ketogenic diet, in conjunction with the development of diphenylhydantoin, towards the continued development of antiepileptic drugs.
Research receded on the matter until 1994, when NBC aired a story on their Dateline program detailing the miraculous curing of a young Charles Abraham’s seizures by utilizing this long-lost diet when contemporary medicinal solutions proved fallible. Thus, research surrounding the diet accelerated, and many in the fitness space began seeking applications beyond its intended medicinal use.
In short time, this led to new research well into the 2000’s and onward which began to revitalize interest in ketosis-inspired diets of the 1970’s, such as the Atkins diet. When podcasters like Tim Ferris and Joe Rogan began interviewing prominent researchers and figures around keto, (such as Dom D’Agostino, a leading researcher in the keto-sphere), the topic hit the limelight, and many people desperate for a solution to their health and weight woes clung to gross misinterpretations of the literature and bountiful anecdotal evidence across the internet. Soon after, Instagram’s “Explore” page and fitness “subreddits” would be replete with unbelievable ketogenic transformations.
How Does Keto (Supposedly) Work?
Physiology
In order to enter the fabled state of “ketosis”, one would have to subject themselves to a paltry carbohydrate intake below 20 grams per day. Eventually, glucose reserves would become too low to produce oxaloacetate for normal fat oxidation, and there wouldn’t be enough glucose to sustain the central nervous system (CNS). Because the CNS cannot utilize fatty acids (they don’t cross the blood-brain barrier), acetyl-CoA from the Krebs Cycle derives substitutes billed as “ketones” (acetone and beta-hydroxybutyric, or AcAc and BHB).
Debunking Alleged Benefits
Ketogenic pundits would have you believe that said physiological mechanisms and ketones induce increased clarity, improved fat loss, and even increased athleticism. Scientifically literate advocates would direct you towards a popular, cherry picked study or two (or even three), from which they would extrapolate remedial and fat loss miracles of the ketogenic diet.
What many fail to acknowledge about the approaches taken in the presented research is that these studies don’t equate protein intake when comparing ketogenic dieters with their carb-ingesting counterparts. For reference, many of the alleged benefits of the ketogenic diet can be reaped simply by increasing protein intake, regardless of carb intake, including increased fat loss, muscle hypertrophy, and improved health markers. What’s worse is that studies analyzing groups of participants where protein is equated find no major differences in fat loss results, but find lower energy levels amongst keto-participating members and worse health markers, including lower micronutrient counts, increased cholesterol, and a pittance of fiber intake.
Athletes and frequent gym-goers executing more performant exercise regimens will find greater performance output in consuming carb-rich diets. Contrary to the common assertions in favor of fat-laden diets, carbohydrates provide more immediate access to energy via glycolysis and suppress cortisol better than protein and fat alone. In extreme circumstances, increased carbohydrate intake can even fend off disease for overexerted athletes. While fat’s slower metabolization may be beneficent towards highly specific endurance athletes, and the ketogenic diet might lend itself well to extremely sedentary individuals who don’t otherwise have a need for constant access to glycogen (in other words, they don’t move enough) (or, in rare cases, exhibit legitimate symptoms of carb-sensitivity), most people would probably still stand to benefit from a more balanced alternative.
Have Your Steak and Eat Your Potatoes, Too
The engines of misinformation (such as social media influencers) surrounding the ketogenic diet continue to proliferate misinterpretations of its scientific basis, compounded by loosely supported anecdote often conflated with placebo delusions, in order to sell a product or service. In reality, keto and its applications for those seeking fat loss is little more than a buzzword. Unless executed to a tedious degree of calculation and preparation, one may end up feeling worse, being less healthy, and having worse results than if they were to simply eat a more balanced diet.
At the end of the day, we can give disparate proportions of carbs, protein, and fat whatever fancy names we desire, but it’s ultimately a matter of palate. Keto and its sibling protocols are fads which won’t save us all from our obesity-inducing habits. They come and go, but the fundamentals always remain. Buzzwords can dress up the non-negotiable scientific truths with glitz, glamour, and promises, but never replace them outright.