Particularities of the ketogenic diet

• 80% of energy needs in the form of lipids (fats).
• 10-20% of energy requirements in the form of protein. This proportion is very important because if intakes are too high, it promotes sugar production in the liver and prevents entry into ketosis.
• 5-10% of energy needs in the form of carbohydrates. In general, 20 g of carbohydrates per day is targeted for ketosis, 20-50 g of carbohydrates for a moderate version (in some people, it will be possible to enter into nutritional ketosis). At 50-100 g of carbohydrates, being the liberal version, there is no achievement of nutritional ketosis. The state of ketosis requires a mechanism of adaptation. It is not an instantaneous phenomenon. Urinary strips and a breath measurement device are used to measure the ketosis state.

The plausible mechanism : if the body is deprived of carbohydrates (the body's primary energy source), it will draw its energy from ketones (waste products produced by the breakdown of fatty acids). As a result, insulin will be used less, and health problems will be limited.

Recommended or not recommended?

Even if the food is on the list of recommended foods, it cannot be consumed indefinitely. Indeed, the carbohydrate and/or protein intake is not negligible with certain foods. However, it is necessary to aim for moderate protein consumption and very high consumption of lipids. Therefore, it is essential to calculate the portions for each food consumed not to exceed the values that allow you to remain in a state of ketosis. A ketosis breakdown will force you to restart the process over more than one day altogether.

VITAMINS AND MINERALS: SUPPLEMENTS REQUIRED?

It is strongly advised to take a vitamin and mineral supplement. Indeed, this diet can lead to deficiencies in certain B vitamins and electrolytes, such as sodium and magnesium.

WHAT DOES SCIENCE SAY?

Numerous studies have been done on this subject. The majority of these studies have many methodological biases, which hinder evidence-based recommendations. However, some results are repeated from one study to another:

• HDL cholesterol levels increase as these diets are rich in fats from nuts, seeds, avocado and vegetable oils.
• Triglycerides are lowered in response to the severe restriction of sweets and highly processed foods.
• Insulin sensitivity does not necessarily improve: real impact on treatment and prevention of diabetes?
• The amount of blood glucose and insulin remain unchanged.
• Ketosis significantly reduces hunger, which leads to significant weight loss.

All of these observations occur in the first six months of the diet. After that, the effects fade and are equivalent to a weight loss by conventional recognized methods.

What about other health issues?

• Alzheimer's : no demonstrated impact on the disease.
• Parkinson's : improvement of symptoms if the diet includes more than 90% of energy requirements in the form of fat. However, adherence to this type of diet is limited due to digestive side effects.
• Polycystic Ovary Syndrome : no more effective than a diet for slight weight loss. Cancer: studies in progress.
• Cancer : studies in progress.
• Non-alcoholic hepatic steatosis (fatty liver): can be effective if the fats' quality is well controlled. Indeed, a ketogenic diet containing too much animal fat will aggravate this hepatic situation.
• Hypertension: no significant impact compared to the DASH diet, which is known to lower blood pressure. According to the studies, after 48 months of treatment, there is no difference between the two diets, except that the DASH diet is simpler to apply and maintain over the long term.
• Cardiovascular risk: no significant impact.
• Refractory epilepsy: benefits documented in children, but significant discomfort is reported.

The ketogenic diet could harm kidney function. Indeed, there is an increase in nitrogen excretion during protein metabolism, leading to increased glomerular pressure and hyper-filtration.

Reported side effects include constipation, diarrhea, thinning of hair or even hair loss, muscle cramps, bad breath, stagnant weight loss and persistently high LDL cholesterol. Be aware that a "keto flu accompanies the first two weeks", a flu-like condition.

It should be noted that this type of diet contradicts many of the recommendations of theExpert Committee on Microbial Health..

To clarify

An assessment of body composition by a proven method and circumference measurements would be relevant to demonstrate weight loss and not water loss and muscle wasting.

Overall, the ketogenic diet does not currently appear to have superior medium to long-term benefits over other approaches. A diet based on the acquisition of healthy eating habits and physical activity still represents a long-term strategy to decrease, mitigate, limit chronic health problems. And whatever approach is chosen, it is essential to remember that the key to success lies in long-term adherence to the recommendations.

Essential further reading
http://didierbrassard.com/deuxfoismoins/

Prise de position officielle OPDQ sur la diète cétogène dans un contexte de diabète.

http://observatoireprevention.org/2017/10/30/regimes-faibles-glucides-reellement-meilleure-solution-perdre-poids/

http://observatoireprevention.org/2017/06/19/est-ce-que-le-regime-cetogene-ameliore-vraiment-les-performances-athletiques/

Wroble KA, Trott MN, et al. Low-carbohydrate, ketogenic diet impairs anaerobic exercise performance in exercise-trained women and men: a randomized-sequence crossover trial. J Sports Med and Phys Fitness 2018 Apr 04; DOI: 10.23736/S0022-4707.18.08318-4

http://www.fraichementpresse.ca/cuisine/inspiration/regime-cetogene-diete-keto-aliments-risques-avantages-1.3635671

https://health.usnews.com/health-news/blogs/eat-run/articles/2018-01-25/no-one-diet-is-right-for-everyone-but-the-ketogenic-diet-is-wrong?src=usn_fb

Références
Taillefer J. Les diètes cétogènes. Formation Harmonie Santé 117.4, December 2, 2017.
http://www.todaysdietitian.com/newarchives/0917p12.shtml

http://www.afdn.org/fileadmin/pdf/id-regime-cetogene.pdf

https://www.everydayhealth.com/diet-nutrition/ketogenic-diet/comprehensive-ketogenic-diet-food-list-follow/

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