With celebrity followers helping boost its appeal – reportedly, dabblers include actor Halle Berry, a Kardashian (take your pick) and basketball star LeBron James – the keto diet is still very much in vogue. But does it sit comfortably within the natural health sector, asks Jane Wolfe
We’ve all heard of the keto diet, but may well be a little vague about exactly what it is, how it works and whether it is both effective and safe. Ketogenic therapy (classic keto) was created by pioneering researcher Dr Russell Wilder in 1923 to treat epilepsy in patients at the Mayo Clinic. The low-carb, high-fat diet is continuing to gain followers, partly due to the functional benefits it claims to offer – such as increased energy and mental clarity – in addition to significant weight loss. It is also helping to dispel the outdated ‘all fats are bad’ notion, which can surely only be a good thing.
Well, as with many ‘on trend’ diet plans, this one has its fair share of both fans and detractors, and is certainly not without controversy. Headlines have warned about possible negative health impacts – blaming it for everything from insomnia and acne, to liver damage and high cholesterol. In fact when the 2017 documentary The Magic Pill, produced by celebrity chef Pete Evans, claimed the diet helped autism, asthma and cancer, it was highly criticized by the Australian Medical Association (AMA), which called on Netflix to remove it.
In a Facebook response, Evans questioned the AMA’s motives, hinting that the organization was ‘fearful of people in Australia becoming healthy’, and asked: “Does the head of the AMA believe that eating vegetables and fruit with a side of well-sourced meat/seafood/eggs to be a dangerous way of life?”
So what’s it all about? Nutrition expert Patrick Holford explains how it works: “Cells can run on glucose or ketones, derived from fats. If you eat very few carbs (below 50g a day or 15 GLs) and increase your intake of fat, your metabolism switches to running on ketones. The fact that we have this ‘dual fuel’ metabolism is very interesting, and the hottest area of research right now is about switching, from time to time, to run on ketones, thus turning off your glucose engine. This triggers a process called ‘autophagy’ (literally self-eating) which repairs worn-out mitochondria, the energy factories in cells. So, running on ketones is about repair.”
Due to celeb endorsement and media hype, keto is rapidly making its way into the mainstream. “It’s really the latest in a long line of low-carb eating trends, from the Atkins Diet, to Gillian McKeith’s eating plans,” explains Planet Organic buying director Al Overton. “I’d say it’s a natural evolution, not something wholly new. A big part of its popularity can be explained by its usefulness in managing weight loss, but for us the most interesting part is the long-term health benefits and its effects on metabolism. Full-time keto is hard, and not necessarily a good health choice for everyone or if done for too long, but maintaining effective carb and fat metabolism, and the body’s ability to switch between the two, looks like it is good for general health.”
A good fit?
The basic tenet of the diet may appear to be the polar opposite of what many health food stores propose – a balanced, wholefood diet, with a wide variety of grains, pulses, fruit and veg – but it does seem to hold an increasingly important place within the sector.
“It’s an effective way of losing weight and it does contain some healthy foods, including vegetables, oily fish and mono and polyunsaturated fats,” explains clinical nutritionist Suzie Sawyer. “Plus we often forget that it can be used medically to good effect – in cases of epilepsy, as an example. It’s effective if followed correctly. People will often be consuming less calories overall once they start the programme, which will also have a positive effect on weight loss.”
However, Sawyer adds that it doesn’t exactly adhere to the accepted vision of what a healthy diet should look like. It requires people to eat about 60% fat (much of it saturated), so the macros are imbalanced, she says, is very low in fibre and doesn’t fulfil the 5 A Day recommendation. “It’s a different way of eating and needs to be followed closely, so it’s not really achievable within the ’normal’ wholefood, natural diet.”
And, as Holford adds, keto diets are also virtually impossible for vegans to follow. However, they can be achieved as a pescatarian, which he suggests is the healthiest way to go.
Although Planet Organic sees it as an area of probable growth, it doesn’t promote a strict keto diet, but simply a healthy diet, Overton explains. “Keto can definitely be part of that, even without going ‘full keto’ and constantly measuring for the metabolic state of ketosis. After all, it is possible to eat badly on a keto diet. I suppose someone could eat bacon for three meals a day and still adhere to keto principles, but we wouldn’t recommend that!”
Holford believes the first generation keto diets, like Atkins, were too high in protein, especially meat and milk, and so switched off autophagy, meaning followers didn’t get the cellular repair benefit. He also highlights the problems associated with consuming too much meat and dairy products, such as colorectal cancer.
“I think it’s a good idea to switch from carbs to ketones every now and again,” he says. Holford’s latest book The Hybrid Diet advocates switching regularly between a slow-carb and a high-fat diet. “The most exciting animal research is showing reversal of autoimmune disease – a kind of ‘reboot’ by doing a five-day ‘fasting-mimicking diet’ every two weeks. I recommend people do this every month to regain health, and once a quarter to maintain health. The more often you switch, the easier it becomes, giving you more metabolic flexibility.”
“For any new diet that people are unsure how to follow, it is always helpful to have signposted brands or products, whether vegan, keto, low FODMAP, etc”
Meeting demand
Mintel’s Stephanie Mattucci believes that as the diet becomes more popular, manufacturers should seek to develop keto-friendly products to help consumers follow this challenging diet. “Possibilities include the use of healthy fats, low-carb ingredients and to align with clean label principles in order to appeal to consumers who are looking to use the keto diet as part of a healthy lifestyle.”
Certainly as the ‘k word’ spreads across the country, demand is rising for specific foods designed to make it easier for followers to keep on track. Cue online specialist My Keto Shop, which launched after Liam Joyce, who created the shop with wife Hannah, decided to give the ketogenic diet a go but found it hard to buy suitable products.
“At the time, the diet was huge in America, but when Liam was finding inspiration on Instagram and various Facebook groups he found some of the foods weren’t available here in the UK,” explains Hannah. “So My Keto Shop was born.”
“We choose products that are 100% keto,” she says. “There are some dieters that may be a little less strict and allow a few ingredients to sneak into their diet such as dextrose, but we won’t stock items that have any ingredient that can raise blood sugar levels, which in turn knocks you out of ketosis.
“A lot of new keto dieters decided to try it after watching the documentary The Magic Pill,” she adds. “However, it is in no way easy – it’s a complete life-style change.” And with this in mind, My Keto Shop is all too happy to offer advice to customers. “We answer every question, suggestion and complaint that is sent to us,” says Hannah. “The smallest thing can make any hard work go to waste and if someone isn’t completely clued up they may make mistakes without even knowing.”
“The business is doing better than we ever hoped,” says Joyce. “We started out in our kitchen and now are moving into new premises to have space to grow. We are opening a low-carb section for people who find the strict keto diet too hard to maintain, and are looking further into the health and wellbeing side so will introduce more vitamins and supplements.”
Planet Organic’s keto-specific offering centres mainly around snacking, which is where everything always seems to start, says Overton. “We have keto snack bars and will soon have keto breakfast cereals too. Keto-branded products will certainly increase in number. Keto is, of course, simply a way of eating, so there are a lot of foods suitable for the lifestyle. However, a lot of these aren’t yet branded as such because until recently it just wouldn’t have been recognized as meaningful brand messaging, and also most of the them are common foods – you don’t need to buy special keto nuts or keto broccoli.
“Keto has become a shortcut for low-carb or low-sugar products, for which there is a big interest in the UK. It can become a mark of reassurance without having to look at nutritional information for every product. For any new diet that people are unsure how to follow, it is always helpful to have signposted brands or products, whether they be vegan, keto, low FODMAP, etc.”
Future focus
Overton believes keto will continue to grow but also develop. “The latest step in the ongoing evolution of low-carb, low-sugar eating, it will eventually evolve beyond keto. It will become part of the growing awareness around understanding metabolism and the benefits of eating to control metabolism on some of the health problems which are particularly prevalent in the western world. I don’t think the future is for all of us to be using breath tests daily to ensure that we haven’t strayed outside a ketosis state. To stay in a metabolic state of ketosis all the time is very hard work. For most people it will be easier to maintain a metabolism that can switch in and out of ketosis effectively.”
“I think it will have a place, at least for a while,” agrees Sawyer. “However, what’s interesting is that its popularity is having no impact on our overall obesity rates in the UK. I think it will always be around, plus of course, there is a general push to reduce our intake of carbs overall, especially refined carbs.
I think those who really need to lose weight for health reasons, who are clinically obese, may often be reluctant to follow such a strict programme. I also think there’s of confusion amongst the population generally about healthy eating. As always, education, from those who are qualified is key.”
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