Popular Diets & WLS: Edition 1 “Ketogenic Diet”

Check out Popular Diets & WLS: Edition 2 “Vegan Diet”

There’s always a new hot diet on the rise…always!

The “Grapefruit Diet” was born in the 1930’s.

The “Cabbage Soup Diet” was the thing of the 1950’s.

WeightWatchers was founded in 1963.

We could keeping going – SlimFast in the 70’s, Appetite Suppressants in the 80s, Low-Fat and Atkins in the 90’s and The Biggest Loser in the early 2000’s.

It’s safe to say, our society is always looking for a way to lose weight. So what does this mean for post-ops? Are there diet programs that ARE beneficial to go alongside your surgery? Are they all a terrible idea?

In this FoodCoachMe blog series, I’m going to introduce several new trendy diets including (but not limited to):

The Ketogenic Diet, The Whole 30, Veganism, Paleo, Mediterranean and the DASH Diet. 

Let’s start this series off with The Ketogenic Diet. Sometimes called “The Keto Diet.”

Much like other diets, the Ketogenic Diet has become a lose term and not always a clearly defined diet. It’s called a “ketogenic diet” because the diet is very low carbohydrate in nature. When someone is greatly restricting carbohydrates in their diet, their liver produces ketones to be used as energy. Carbohydrates are broken down to sugar and used for a quick fuel to the body. When the body doesn’t have sufficient carbohydrates, the body has to go somewhere else for fuel and breaks down fat instead. The “byproduct” of breaking down fat in the liver is a ketone.

When the body is using fat for fuel it’s known to be in “ketosis” which is a natural process in the body to help us survive when food intake is low. This isn’t necessary a starvation of calories, but it is a starvation of carbohydrates.

The concerns with a ketogenic diet are the risks when someone takes it to the extreme. A light state of ketosis is beneficial for weight-loss and it’s truthfully how we approach the bariatric surgery diet!

However, we do need some carbohydrates in the body for normal body function. The best way to get those carbohydrates are in the form of vegetables, some fruits, and beans or protein bars on an occasion. We want to avoid the addictive forms of carbohydrates – breads, pasta, rice, potatoes and sweets.

Severely restricting carbohydrates runs a risk of ketogenic acidosis which is primarily a problem in diabetic patients. When someone is in a “diabetic coma” it’s because of something called “diabetic ketoacidosis” which is from the body producing high amounts of ketones. At the end of the day, ketones are a blood acid and in excess can cause great harm. This is not terribly common outside of diabetes but a reminder that a balance of macronutrients IS best and that it’s not necessary or helpful to cut carbohydrates of all kinds out of your diet.

The other concern with a highly restrictive form of a ketogenic diet (while not as life threatening as ketoacidosis) is that commonly the intake of fat is VERY high when carbohydrates are very low. Because there are just the THREE macronutrients…and you have to eat something…if you severely restrict one you are going to increase others. A diet high in fat can cause weight loss to slow because fat is high in calories. In addition, if the fat is from saturated fats there is concern of heart disease and plaque in the arteries.

I found a website with information on the keto diet and put in my height, weight and weight loss goals. The site calculated that I should have 138 grams of fat which is 74% of the calories they recommended I have. They also recommended 87 grams of protein which is 21% and 20 “net” carbs which is about 5%.

Okay…I know what your thinking. I haven’t answered the BIG question yet.

How many carbs a day should I eat? 

If I were to make a list of what top 5 questions I get asked – “how many carbs should I eat a day?” would definitely be on there…so I better answer it here!

I am not a fan of focusing on counting food in gram measurements. I prefer percentages because this approach encourages you to listen to your body’s hunger and fullness cues instead of forcing or restricting food based on gram counts.

My recommendation for bariatric surgery patients is 50% protein, 20% carbohydrates and 30% fat. Very different from the ketogenic diet that calculated me to have 21% protein, 74% fat and 5% carbs. (To track your percentages of macronutrients, I recommend using MyFitnessPal. I published a photo guide on how to do this here.) This is still a low carb approach and will put someone into a “light ketosis.” No, I don’t think there’s a need to pee on a strip to count your ketones. Food journaling is your better bet :) 

Final thoughts:

The ketogenic diet will prove to have weight loss benefits because restricting carbs will force the body to use fat for fuel. My concern is two fold –

1. How long can this eating style be sustained?
2. The imbalance of macronutrients and high fat content can cause further issues long term (we didn’t even talk about the lack of fiber in this type of diet!)

Be sure to sign up for the FoodCoachMe to stay up to date with this blog series on Trendy Diets and WLS as well as other new articles, recipes and video posts!

Sources: What is the Ketogenic Diet