Is the Keto diet safe for diabetics? Is it only good for short-term weight loss? Does it increase cholesterol?

I recently saw a 23-year-old obese (weight 92 kg, BMI 33 kg/m2) girl. She was smiling but looked unsettled. She told me, “Doc, I have been on a Keto diet for the last two months and have lost 4 kg of weight. Yet I feel feverish, fatigued, dizzy, have plenty of cramps, insomnia, my breath smells so bad. And I have trouble eating all that high fat-oil laced diet daily.” So, she did lose weight but suffered from some long-lasting side effects in the bargain.

What is a ketogenic diet?

The story of Keto diets started with Atkins diets, which rapidly gained popularity. “Dr Atkins New Diet Revolution: The High Calorie Way to Stay Thin Forever” has sold 12 million copies and remains a bestseller till this day. Predominantly non-vegetarian Western populations loved this diet (Breakfast: Greasy ham, bacon and eggs; lunch, steak with plenty of cheese; and dinner, fish, crab, and chicken cooked in a whole lot of butter). This diet leads to rapid weight loss in many individuals. Low carbs (less than 30 gm per day, equivalent to about one-and-a-half rotis) lead the body to find alternate routes to energy generation from acidic ketone bodies (hence the name ketogenic diet). These ketone bodies provide energy in an efficient manner and suppress appetite. Since then, several similar diets have emerged due to two reasons. First, to consistently consume very low carb, high fat and protein daily is difficult, hence the quantity of carbs per day has been increased in the modified diets. Second, it is not possible for vegetarians to eat a diet designed by Atkins, hence, ghee, coconut oil etc have been added in surplus.

What are pluses and minuses?

There are several plus points for this diet. Rapid weight loss can be achieved, sometimes more than that seen in usual calorie restrictive diets. In patients with diabetes, blood sugar levels and sensitivity to insulin improve and the need for anti-diabetic medications decreases. The diet may help patients with polycystic ovaries as well by improving their metabolic environment. Interestingly, robust evidence indicates that these diets have been known to decrease seizures in children resistant to high dose medications. Further,…

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