Being a cardiologist, the most frequent question coming my way for the last few years is “Doc what do you think about the “keto” [ketogenic] diet.”

All foods contain both micronutrients and macronutrients that are essential for the body to function optimally. The human body requires macronutrients in large amounts, which include carbohydrates, proteins, and fats. These nutrients provide energy for your body in the form of calories. Micronutrients are nutrients needed in trace amounts by the human body for normal growth and development, including vitamins, trace elements, phytochemicals, minerals, antioxidants, and fatty acids. Micronutrients help slow down the aging process, protect your body from disease, and ensure that nearly every system in your body functions properly and optimally.

Micronutrients do not provide energy like macronutrients, so they can’t be measured in calories, and most of them are not listed on a food’s nutrition label, which can make them a little more difficult to track.

While all foods contain macronutrients, not all foods contain large amounts of micronutrients.

The ketogenic (keto) diet is a high-fat, very low carbohydrate diet typically means eating fewer than 50 grams of carbs a day. Getting most of your calories from fat forces your body to use different energy pathways. Instead of carbs for energy, the body burns fat, entering a state called ketosis.

After a few days of these diets, glucose reserves (i.e., glycogen stored in the liver and skeletal muscle) become insufficient to provide body energy needs. This leads to the production of ketone bodies by the liver, which will be used as an alternative energy source notably by the central nervous system

As many as half of young people with epilepsy had fewer seizures after following the diet. And some early research suggests it may have benefits for blood sugar control among people with diabetes. There is very little evidence to show that this type of eating is effective and safe over a long period of time, for anything other than epilepsy. Plus, very low carbohydrate diets tend to have higher rates of side effects, including constipation, headaches, bad breath, and more. Also, meeting the diet’s requirements means cutting out many healthy foods, making it difficult to meet your micronutrient needs.

The high level of unhealthy saturated fat combined with limits on nutrient-rich fruits, veggies, and grains is a concern for long-term heart health.

It is imperative to carefully monitor the intake of ketogenic foods to avoid micronutrient deficiency. No animal products are safe. Red meat increases cancer and cardiovascular mortality. Animal food contains heme iron, Trimethylamine N-oxide (TMAO), and nitrates, which increase cardiovascular mortality.

The leading cause of death in the United States is cardiovascular mortality. There is a lack of understanding about dietary myths.

Results regarding the impact of such diets on cardiovascular risk factors are controversial, both in animals and humans, but some improvements notably in obesity and type 2 diabetes have been described. Unfortunately, these effects seem to be limited in time. Moreover, these diets are not totally safe and can be associated with some adverse events.

In humans, ketogenic diets are known to be an effective weight-loss therapy (on average, up to 5 percent of body weight at six months), but the mechanisms are not clearly established.

The low-carbohydrate diet should contain proteins and fats from foods other than red and processed meat.

Restrictive diets are often associated with poor long-term adherence. A meta-analysis of 13 clinical trials with the keto diet showed a 31 percent increase in cardiovascular mortality.

It should be not be done if your weight loss is more important than your life.

A whole food plant-based diet with unprocessed carbohydrates from an organic source is recommended highly by many nutritionists and cardiologists as a protective heart diet.

Deepti Bhandare is a cardiologist. 

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