Is Keto a Good Weight Loss Diet for Older Adults? A Doctor Answers
Welcome to another episode of Dr. Erick Debunks! Today, we’ll be talking about the ketogenic (keto) diet.
A lot of our Mighty Health members are very curious about the ketogenic (keto) diet. My goal is to debunk a lot of questions regarding this low carb, high fat diet and lay a good foundation as to what it really means.
What is the Keto Diet?
Let's first jump in and start by laying the foundation for what the keto diet is, what it was created for, and how it can benefit you potentially. It's so important to break down what exactly is happening to our bodies because when we know this, it will become easier to decide if this diet is actually right for you. I certainly I believe that this diet is not right for everyone.
History of Keto
Let's start with a little history lesson. The ketogenic diet was actually developed in the 1920s by a neurologist named Russell Wilder for the management of refractory seizures in pediatric patients with epilepsy. It was thought that starving the body in this way to bring about ketosis would help stop the brain stop from having as many seizures. Surprisingly, there was shown to be some clinical efficacies.
However, now as we know, the keto diet has become more of a fad used for weight loss.
Keto is More Than Just Low Carb
Let's break down what exactly is the ketogenic diet. The big picture is that keto is a diet containing very high fats, moderate proteins, and very, very low carbohydrates. It’s important to note that there are many different variations of ketogenic diets out there.
If we want to get specific, the European Food Safety Authority determines a legitimate ketogenic diet one where caloric intake consists of no more than 5 to 10% carbs per day. So, this really means consuming anywhere from 20 to 50 grams of carbohydrates per day to qualify as a keto diet. To really give some context, that's around a half a glass of orange juice or two slices of bread per day.
As you can see, it's really not that many carbs. This is why the keto diet is so difficult to maintain.
How the Keto Diet Works: Ketosis and Body Fat
When carbohydrates get broken down during digestion, they produce glucose, which is the body's preferred choice of energy. The main goal of a keto diet is to essentially deplete the body of these carbohydrate sugar stores.
When we deplete this energy source, the body has to switch up. It basically has to recalibrate and find a different way of getting a a source of energy that both the brain and body can utilize.
The body does this by switching from breaking down carbohydrates to breaking down fats. We're counting on our liver to actually break down our fatty acids to then create something called ketone bodies in a process called ketosis. Ketone bodies are essentially the alternative energy source for the body to use instead of glucose.
The big picture is that while on a keto diet, we're depleting all our sugar stores and forcing our body to find a new way of getting energy. That new way is by using fat for energy.
Side Effects of Keto
The keto diet may have some side effects since the body has to completely change what it's known to normally do. You'll often hear about something called the "keto flu."
Once our body starts transitioning to a keto diet, or going into a state of ketosis, it creates normal flu-like symptoms such as fatigue, body aches, headaches, nausea, vomiting, and constipation. These side effects don't last forever, but the keto flu can sometimes take a few days or even up to weeks to to resolve because the body is adjusting to this new and different type of energy source.
Debunking Keto Myths
Let's jump in and debunk a few things now that we have a good foundation and understanding of what the ketogenic diet is and how it works in the body. I know so many people have heard of keto because of how effective it is for weight loss.
Is Keto the Best Diet for Weight Loss?
I'll be the first to acknowledge that everyone's situation is different. But, generally, my answer is that keto is not the best way to lose weight.
Here at Mighty Health, a member once told me something that has always stuck with me. She said, “Eric, when it comes to lifestyle change, I don't think we have to be extreme. We just have to be consistent.” My problem with the keto diet is that it's extreme.
While reviewing the medical literature, I was trying to find as many studies as I could that shed light on the long term effects of the keto diet. The truth is, I couldn't really find what I was looking for because the keto diet just isn't sustainable enough for the long term. My philosophy for lifestyle change is to always focus on sustainability and consistency.
Is Keto Healthy for People Over 50?
A keto diet can be particularly dangerous for older adults. Health risks are often not spoken about enough because a lot of the fitness and dieting programs out there are targeted towards younger individuals.
I want to tell you about a specific case of an older adult patient who was on a keto diet for about a year. This person came into the hospital for nausea, vomiting, and subsequently a broken arm from a fall. While on the keto diet for a year, this patient experienced some positive effects in that they lost 20 pounds and had a big drop in their blood sugar.
However, by doing this keto diet, they actually pushed their body to the edge and too far into ketosis. As a result, the body was was getting into a state where it was starving and not actually getting enough of an energy source. That led this individual to develop the symptoms of nausea, vomiting, and subsequently a fall.
I heard the keto diet is good for patients with diabetes and hypertension? Is that true?
There is some truth to that. As we know, by losing weight, we can substantially lower blood blood pressure and our blood sugar levels. In that regard, you can certainly lose weight and achieve these results while on the keto diet.
However, the keto diet can be very dangerous for diabetic patients who are on medications that already lower blood sugar levels, such as insulin. On a normal diet that consists of carbs or low carbs, you're using insulin t o make to make sure you're lowering your blood sugar every meal. When you're dealing with a keto diet, though, your blood sugar is already very low. If you're still taking your normal amount of insulin, you might actually lower your blood sugar too much to the point where you can start experiencing symptoms of hypoglycemia, or low blood sugar. One of the first symptoms of that is dizziness, which leads to loss of balance. The catastrophic consequences could include a fall and a broken hip or a broken arm.
So, if you're a diabetic patient, the ketogenic diet can be quite dangerous. This is one of those situations where I would definitely definitely recommend speaking to your doctors first.
What are the Health Benefits of a Keto Diet?
I don't want to just scare you off from the keto diet, though. Let's review some of the beneficial short term effects of the keto diet. I took some time to really dig through the literature and and also remind myself of its positive benefits. I think sometimes, as doctors, we can be too narrow minded and a little restrictive about what some patients may want to try.
Here are some results from looking at the literature of small cohorts that underwent the ketogenic diet for 6 months:
Weight loss
Increase of their HDL cholesterol, which is their good cholesterol
Lower the triglycerides in their blood
Increase in their LDL cholesterol, which is their not so good cholesterol
Generally an increase in their overall cholesterol levels.
There are some 6-month health benefits, but a lot of these beneficial effects are no longer seen at the 12-month mark. So all to say, I think there are certainly some short term benefits in doing keto, but there really aren't any good long term evidence based studies out there.
Final Thoughts on Keto
My Mighty Health family, I hope this information has been insightful and that it at least provides a better understanding of the very complex and popular keto diet.
At the end of the day, what matters to me as a doctor is that you're doing what feels right for your body in a safe way. The truth of the matter is that there really is no best diet. The best diet is the one that we can stick to. Like I said before, we don't have to be extreme. We just have to be consistent. Let's be consistent together.