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Is The Keto Diet Right For You?

Look up "keto cookbooks" and you find a plethora of options: Quick and Easy Ketogenic Cooking, Southern Keto, Ketogenic Cleanse, Keto Comfort Foods… it’s fair to say this is a diet craze. But does it really work?

This week on Florida Matters we talk with nutrition experts about the keto diet and how it can affect your health, from weight loss to possibly treating cancer.

Our guests include:

Dom D’Agostino: widely-knownketo expert and Associate Professor of Molecular Pharmacology and Physiology at the University of South Florida

Angela Poff: Research Associate with USF’s Department of Molecular Pharmacology and Physiology

Jenna Bell: Registered dietician, triathlete and Senior Vice President at Pollock Communications

Keto In A Nutshell:

The ketogenic diet, or “keto,” is a very low-carb, high-fat diet.

Breads, potatoes, even some fruits typically considered “healthy” like apples and bananas are out, while meats, cheeses and protein-rich vegetables like olives and avocados are in.

“Ketogenic diet is essentially shifting your body’s metabolism from a carbohydrate-burning metabolism – so glucose would be your primary fuel – to a fatty-acid and ketone-burning metabolism,” said keto expert Dom D’Agostino, an Associate Professor of Molecular Pharmacology and Physiology at USF.

“You start eating yourself.”

Following the diet suppresses the hormone insulin, which causes your body to burn more fat for fuel. Fat-burning in the liver produces ketone bodies, which scientists say can replace glucose (sugar) as a primary energy source for your brain.

Over time, that can help you resist spikes of hunger throughout the day, also known as cravings.

Keto’s Recent Boom

Although D’Agostino said the ketogenic diet has been around since the early 1920’s, when the Mayo Clinic created it to treat epilepsy, it’s only recently experienced mainstream popularity.

Jenna Bell is Senior Vice President of Pollock Communications, a firm that works with Today’s Dietician to publish an annual survey of dieticians about consumer health trends.

“The ketogenic diet was not even on the trends list seven years ago…A couple years ago it appeared…this year it’s No. 1.,” she said.

According to that survey, the second-most popular diet is a plant-based one, followed by intermittent fasting, or only eating when you are hungry as opposed to following a traditional diet of three large meals each day.

“Surveys show that snacks are what people are doing, and that is largely driven by millennials,” said Bell.

Intermittent fasting and keto often go hand-in-hand, as the reduction in cravings caused by ketosis and the high-fat content from the diet can help you feel full for longer periods of time.

Not A Blanket Fix

While the keto diet can work wonders for some people trying to lose weight, others may not be so successful.

“I think more than anything there is just a unique response that any individual will have,” said Angela Poff, Research Associate at USF’s Department of Molecular Pharmacology and Physiology.

“Some people do seem to respond very well to the ketogenic diet, but it’s not always the case, it’s not a blanket, one-size-fits-all kind of thing,”  

Poff said the key is customizing the diet to something that works for you, which could mean setting your carbohydrate intake higher than what a standard keto diet calls for. This is especially true in athletes, she said.

D’Agostino said there isn’t a lot of research about the long-term effects of a keto diet in a healthy person, as it was mostly used for medical purposes prior to the last decade.

He said “bio-markers” like hemoglobin A1C, insulin and inflammatory markers typically go in the right direction for people on the keto diet – in those cases, down – while HDL or “good” cholesterol goes up.

The only biomarker that may raise concern is LDL cholesterol, or “bad” cholesterol, which can elevate in people who eat low-carb, high-fat diets.

“Doctors tend to worry about the elevation of LDL, but in the context of other biomarkers going in the right direction, I don’t think there’s as much of a concern,” D’Agostino said. He still recommends the long-term effects of the keto diet as a lifestyle be studied.

Registered dietician Jenna Bell suggests anyone interested in trying the keto diet talk with their health care provider first and work with a nutritionist to come up with the best plan for them.

“Make sure you’re eating sufficient calories, make sure you have sufficient food intake so you are meeting your nutrient needs, that’s where a dietician can be very helpful,” she said.

“You don’t want to slip into that fear of eating so that you don’t eat enough and find yourself fatigued or suffering from what happens when you have insufficient protein in-take and all of a sudden your hair is looking ratty and you’re falling asleep.”

Bell said to think about why you’re changing your diet, whether it’s for general wellness, to lower your blood pressure, treat a lipid-profile imbalance, etc. Keto may not be your answer.

“You know, people always ask me that there’s got to be a right and wrong, and whether you like it or not, there a million different diets to be healthy on,” she said. “You do need to have some individuality here.”

Medical Benefits

The keto diet has been used medically significantly longer than healthy people have used it for wellness plans.

D’Agostino said the diet was the standard of care for epilepsyuntil drugs came along. It also has been shown to help treat type 2 diabetes and obesity.

His colleague Poff is studying how the keto diet can be used to treat various forms of cancer, including brain cancer and breast cancer.

“We’ve begun to realize that these ketone molecules themselves actually have many benefits associated with them,” she said. “They are definitely more than just an energy molecule that provides energy, they actually have signaling properties. For example, they interact directly with our DNA to alter gene expression.”

“This is an aspect of something that’s being studied as why ketosis can impact cancer, because you can literally alter the genes that are being expressed, and we know gene expression changes is a big issue in cancer.”

The ketogenic diet’s role in suppressing insulin could also have a role in cancer treatment.

“If our insulin levels are high, pretty much all the major drivers of cancer growth and proliferation are linked to insulin-signaling, so a very promising area of research is using this diet to sensitize tumors so other forms of therapy can work,” said Dom D’Agostino.

Ketones have been shown to help reduce inflammation and are also being studied in research on aging, he said.

Research shows the aging brain is less capable of metabolizing glucose, especially in cases of Alzheimer’s disease or dementia, but seems to still be able to metabolize ketones, Poff said. She said scientists are examining whether providing more ketones in the body, whether through dietary changes or a ketone supplement, could help energize the brain as humans grow older .

Most of the research underway is in the preliminary stages or clinical trial phases, so it could be years before concrete results about the ketogenic diet’s medicinal benefits in humans are available. But Poff and D’Agostino said initial findings are promising.

You can hear an extended version of this week’s conversation on the Florida Matters podcast.

I cover health care for WUSF and the statewide journalism collaborative Health News Florida. I’m passionate about highlighting community efforts to improve the quality of care in our state and make it more accessible to all Floridians. I’m also committed to holding those in power accountable when they fail to prioritize the health needs of the people they serve.
Robin Sussingham was Senior Editor at WUSF until September 2020.