The Ketogenic Diet: Pros and Pitfalls of a Low-Carb / High-Fat Regimen

Salad Pizza on a Cauliflower Crust is a low-carb combo of keto-friendly vegetables.

(Updated January 10 / 2021)

If you have been following a healthy menu (like the one outlined in my Hot Detox Plan), and still feel like you need help with your health issues, you may want to explore the immune-balancing effects of a lower carb/higher fat menu called the ketogenic diet. It is incredibly beneficial for people who suffer from autoimmune and neurological conditions, and is even being researched for its ability to prevent cancer. However, the keto plan is not for the faint of heart because it requires the complete avoidance of fruit, starchy vegetables, and all grains. Yet for some people the flavour sacrifice is worth the effort. Here are the pros of this regimen:

Is it possible to have a diet that can curb appetite? Yes, it is. The ketogenic diet has been shown in studies to reduce appetite. Many factors play a role in its hunger-suppressing effect, from greater satiety to hormonal alterations. A low carbohydrate ketogenic diet tends to be more filling because of its higher protein and fat content, leading to better satiety and fewer food cravings, resulting in a lower total caloric intake. In addition, a ketogenic diet tends to increase ketone levels in the body, which then suppresses ghrelin (a potent stimulator of appetite).[1]

Weight Loss, Especially Abdominal Fat

When it comes to excess body fat, there is one area where it is especially risky – around the abdomen. Abdominal fat is a strong risk factor for heart disease and diabetes, which is why it is important to maintain a healthy waist-to-hip ratio. The ketogenic diet can help with that. When compared to other diets (low fat diets for instance), the ketogenic diet has a distinct advantage for weight loss, total fat loss, and most importantly, total abdominal fat loss. Although this effect was shown to be more significant in men, it can still offer some benefits for women.[2]

Neurological Conditions and Mood Disorders

It is well known that the ketogenic diet is clinically useful in seizure disorders, and is also potentially favorable for other neurological conditions and mood disorders. This is still in the very early stages of research, but animal studies and/or small clinical studies have found it to be beneficial as an adjunctive therapy for Alzheimer’s and Parkinson’s disease, ALS, and migraines. Mood stabilizing properties have been hypothesized and shown in animal studies, and the ketogenic diet is presently being studied in humans at the University of Tampa in Florida.[3][4]

Diabetes, Blood Sugar, and Insulin

Evidence shows that a ketogenic diet leads to greater improvements of HgA1c, fasting glucose, fasting insulin, and weight loss than a diet that is high on the glycemic index.[5] Ketogenic diets stabilize blood glucose levels, leading to fewer cravings and an improvement in energy. In addition, there is greater improvement of insulin sensitivity and greater weight loss as compared to other diets.[6]

Athletic Performance

Evidence of the ketogenic diet’s effect on athletic performance, muscle growth, and strength is mixed. One study has demonstrated that this diet does increase blood antioxidative capacity and reduce total oxidative stress in athletes. Though the research on whether it can offer some benefit when it comes to athletic performance is inconclusive, for the most part it does not seem to negatively impact athletic performance. Ketogenic diets result in adaptations leading to high rates of fat oxidation, however.

And following the diet has shown promise for free divers aiming to extend bottom times, and all athletes could benefit from additional ketones.[7][8]

Potential Pitfalls

If the keto lifestyle has so many benefits, why aren’t more people trying it? Some drawbacks:

1. It takes amazing willpower to resist healthy carbs in season. How can you miss strawberry season, peach season, and cherry season in Canada, when we have such a short window to enjoy these local foods? Not to mention turning down homemade dinner from a loved one because they don’t understand that a sweet potato will blow you out of the ketogenic state that you fought so hard to get into.
2. You miss out on a lot of nutrition. All fruits and bright starchy veggies (forbidden on the keto diet) contain high levels of phytonutrients that are anti-inflammatory. According to Traditional Chinese Medicine theory, orange starchy veggies like squash are considered as very healing to the digestive system and soothing to the spirit. Further, I would not want people to abandon the resveratrol in grapes, polyphenols in dark fruits like blueberries, or compounds like lutein and zeaxanthin in cherries. In short, the ketogenic menu seems rather monochromatic and those following the diet have to make extra effort to prevent vitamin deficiencies.
3. Constipation is common in people consuming a ketogenic diet because it can be low in fibre. For example, you really have to double down on keto-friendly artichokes, asparagus, and other dark green veggies to get enough fibre to keep your stools bulked up. Luckily, chia and flax will help to keep things regular. That said, many folks find that MCT (coconut) oil acts as a laxative when they first try it, so it’s wise to proceed with caution when trying this key component of the keto diet.
4. The “keto flu” is nasty. When you try to become fat-adapted, prepare for a week of your body complaining. Body aches and extreme fatigue are common while your body switches over to making its own ketones. The most important advice is to keep your electrolyte minerals super high. Ketone production requires major minerals and if you don’t eat enough of them, you may find yourself feeling like a wet noodle.
5. The hardest part of my own ketogenic experiment was crashing blood pressure. As I stated above, ketones require tons of minerals including sodium. People who are slender, athletic, or suffering from adrenal fatigue may find the ketogenic lifestyle is a blood sugar balancing act. My blood pressure went as low as 79/45. That is dangerously low, so double up on unrefined salt in your food to keep blood pressure elevated.
6. The ketogenic lifestyle can be hard on the thyroid. A recent study found that children showed signs of hypothyroidism after nine months on a keto diet. Many adults report this as well, so take caution if you have a delicate thyroid.

Ketone Supplements

My advice is to try a fat-fueled, slow carb program to start, and if you feel great, proceed to jump further into the benefits of ketones! Many people are exploring the use of extra therapeutic ketones that allow a person to use both carbs and ketones as fuel. Therapeutic ketones can provide the body with a secondary fuel source that allows for greater energy and performance without a harsh restriction in carbohydrates.

For those who need extra help with getting into a ketogenic state, consider reaching out to my husband Alan at thinkersmith@gmail.com for more details on the use of exogenous ketones (he has a neuroscience degree from McGill University). Even if you don’t want to try the diet, the use of this ketone supplements can greatly increase the level of ketones in your bloodstream, which your body uses for powering up its vital organs.

RECIPES

Here are some great recipes for you to try that are low carb and keto friendly:

Leek Frittata

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With a flavour best described as green onion with a strong garlic smell, leeks are used in many recipes such as soup and egg dishes. Enjoy the leek greens in this dish as they are low in carbs and high in fibre. Slice thin to ensure they cook well in this easy one pot meal. With olives, pesto, and egg yolks, this dish is rich in lipids that fuel ketone production.

Ingredients:

• 2 free range chicken eggs or 4 goose eggs
• ½ cup chopped dill
• ½ cup chopped parsley
• 1 cup cherry tomatoes
• 15 black olives, chopped
• 1 cup chopped shiitake mushrooms
• 2 cups chopped asparagus
• 1 – 2 cups chopped leeks (green part only)
• 1 cup water-packed artichoke hearts (sold in a jar), drained
• 1 – 2 Tbsp dairy- and nut-free pesto (see below)
• 2 Tbsp water

Salad Pizza on a Cauliflower Crust

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Cauliflower is a good source of vitamin B complex, C, and fibre, all of which are great for detoxification. Cauliflower replaces the flour in this recipe. (Makes 2 pizzas.)

Ingredients:

• 3 cups cauliflower florets (about ½ head)
• 1 clove garlic, chopped
• ¼ cup filtered water
• 2 large organic eggs
• 3 Tbsp almond flour
• 1 tsp dried basil
• ½ tsp dried oregano or thyme
• ¼ tsp pink rock or grey sea salt
• 2 Tbsp dairy- and nut-free pesto(see recipe: “Crush Your Cravings Pesto“)
• 2 water-packed artichoke hearts (sold in a jar), drained
• ½ cup sliced red pepper
• 8 olives, sliced
• ½ cup fresh sprouts (arugula, basil, broccoli, pea, or sunflower)

Crush Your Cravings Pesto

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Here’s a pesto that will please your taste buds while it crushes your cravings!

Ingredients:

• 2 cups fresh basil (or 2/3 cup dried)
• 1 cup kale
• ½ cup sunflower seeds
• ½ cup olive oil
• 2 Tbsp red wine vinegar
• 1 clove garlic
• ¼ tsp pink rock or grey sea salt

Ginger Kimchi

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This recipe is from my dear friend Marni Wasserman, the culinary nutritionist who co-hosts the Ultimate Health Podcast and is the author of Fermenting for Dummies. (www.marniwasserman.com) We both agree that kimchi is better when made with ginger instead of chilli pepper. (Makes 4 cups.)

Ingredients:

• 8 cups napa cabbage, washed, cored and chopped into ½- to 1-inch pieces (approx.½ head)
• 1- to 2-inch piece fresh ginger
• ½ medium onion
• ½ head garlic
• ¼ cup pink rock or grey sea salt
• 1 cup sliced carrots
• 2 Tbsp coconut aminos

Garlic Roasted Asparagus

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Succulent and tender asparagus is one of the most detoxifying items in the produce aisle. Eat it raw when you’re feeling bloated – it’s a natural diuretic. Asparagus is high in both anti-inflammatory and antioxidant nutrients. It contains vitamins C and E; beta-carotene; the minerals zinc, manganese, chromium and selenium; and the amino acid asparagine, which helps insulin transport glucose into cells to be used as fuel. (Makes 8 servings.)

Ingredients:

• 2 lbs fresh asparagus, ends trimmed, rinsed, patted dry
• 3 Tbsp coconut oil
• 1 to 2 cloves garlic, minced
• ½ tsp pink rock or grey sea salt, more to taste
• 1 Tbsp organic lemon juice, more to taste

Artichoke Skordalia

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Skordalia is a lemony dip from Greece that I find truly addictive. Normally made with insulin-spiking potato, this artichoke version will cleanse your liver while making all the food you eat with it taste sweeter. Artichokes can relieve the pain and discomfort associated with indigestion, acid reflux, bloating, lack of appetite, nausea, and mild diarrhea or constipation. Artichokes are also rich in fibre that breaks down into short chain fatty acids to boost ketones! (Makes 2 cups.)

Ingredients:

• 3 cups water-packed artichoke hearts (sold in a jar), drained well
• ½ cup raw cashews
• 3 Tbsp organic lemon juice
• 2 Tbsp hemp hearts (or extra cashews)
• 1 to 2 cloves garlic, minced
• ½ tsp pink rock or grey sea salt
• ⅓ cup extra virgin olive oil, plus more for garnish
• ½ cup fresh parsley leaves
• ½ tsp dried oregano, to serve

In a food processor, blend the artichokes, cashews, lemon juice, hemp hearts, garlic and salt. With the motor running, slowly add the olive oil and parsley, processing until smooth.

Transfer to a serving bowl. Garnish with a drizzle of olive oil and oregano.

(Tip: The leaves of the artichokes should be very soft; otherwise, the dip may be slightly stringy. If you only have stiff artichoke leaves, separate them from the bottoms (the hearts), and save them for stir-fries. Just remember to buy two jars of artichokes! Look for artichoke hearts that are water-packed and in glass.)

Sugar-Free Key Lime Pie

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When on a keto diet, keep this pie on hand in case of cravings. You’ll wish you could turn back time with the last bite of this pie – proof that nutritious food can taste good. Avocados are packed with vitamin B6, which supports the liver in metabolizing and balancing certain hormones such as estrogen. It’s the perfect non-chocolate rescue for PMS. The lime juice helps protect the avocado flesh from oxidizing (darkening). (Makes 8 servings.)

Crust Ingredients:

• 1 cup unsweetened shredded coconut
• 1 cup pecans
• ¼ tsp grey sea salt or pink rock salt
• ½ cup sugar-free dried cranberries

References:

[1] Sumithran P., Prendergast L., Delbridge E., Purcell K., Shulkes A., Kriketos A., Poietto J. “Ketosis and appetite-mediating nutrients and hormones after weight loss”. European Journal of Clinical Nutrition (2013); 67: 759-764.

[2] Volek J., Sharman M., Gomez A., Judelson D., Rubin M., Watson G., Sokmen B., Silvestre R., French D., Kraemer W. “Comparison of energy-restricted very low-carb and low-fat diets on weight loss and body composition in overweight men and women”. Nutrition and Metabolism. (2004); 1: 1-13. www.ncbi.nlm.nih.gov/pmc/articles/PMC538279/

[3] McClernon F., Yancy W., Eberstein J. Atkins R., Westman E. “The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms”. Obesity. (2007); 15: 182-187. https://tinyurl.com/y92nlzoe

[4] Stafstrom C., Rho J. “The ketogenic diet as a treatment paradigm for diverse neurological disorders”. Frontiers in Pharmacology. (2012); 3: 1-8. www.ncbi.nlm.nih.gov/pmc/articles/PMC3321471/

[5] Samaha F., Iqbal N., Seshadri P., Chicano K. “A low-carbohydrate as compared with a low-fat diet in severe obesity”. The New England Journal of Medicine. (2003); 348: 2074-2081.

[6] Westman E., Yancy W., Mavropoulos J., Marquat M., McDuffie J. “The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus”. Nutr Metab (2005); 5: 1-9. www.ncbi.nlm.nih.gov/pmc/articles/PMC2633336/

[7] Paoli A., Grimaldi K., D’Agostino D., Cenci L., Moro T., Bianco A., Palma A. “Ketogenic diet does not affect strength performance in elite artistic gymnasts”. Journal of the International Society of Sports Nutrition. (2012); 9: 1-9. www.ncbi.nlm.nih.gov/pubmed/22835211

[8] Rhyu H. Cho S., Roh H. “The effects of ketogenic diet on oxidative stress and antioxidative capacity markers of Taekwondo athletes”. Journal of Exercise Rehabilitation. (2014); 10: 362-366. www.ncbi.nlm.nih.gov/pmc/articles/PMC4294438/

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