Can the Ketogenic diet followed by late actress Mishti Mukherjee kill you? Facts, myths, studies

Dubai: The ‘Keto’ diet is the latest in a long list of heavily debated new dietary styles. While this particular low carb-high fat diet has been around for decades, it is only in the last few years that the diet gained momentum as a proclaimed game-changer for weight loss and health. Halle Berry, Kim Kardasian, Megan Fox, Adriana Lima – a lot of stars also claim the diet works wonders.

As with all such diets, the Keto diet has die-hard fans and harsh-hitting critics, no one seems to be winning. However after reports that Mishti Mukherjee, a Bollywood actress, died of renal failure due to the Keto diet, the debate could get even more heated. We look at available studies and medical journals online to understand the effects, claims and issues with the diet.

This article is based on secondary research and is not to be considered a guide to the effects of the Keto diet. Discuss all diet changes with your doctor keeping in mind your current health conditions or age.

What is the Keto diet?

The ‘Keto’ part of the diet’s name comes from the process which occurs when on this diet. Ketogenesis or ketosis is a metabolic process in which the human body stops depending on glucose for energy and instead burns fat and uses ketones as fuel instead. In simple terms, dependence on carbohydrates for energy is replaced by depending on fat.

The diet requires over that 75 per cent of calories be consumed through fats, including saturated fat and healthy fat. Protein is limited to 20 per cent while carbs make up only 5 per cent of daily calorie allowances. This usually means consuming less than 20 grams of net carbs which is calculated by subtracting dietary fibre from total carbs consumed. The advocates for the ketogenic ‘lifestyle’ claim that the restriction of carbs regulates glucose and insulin levels while burning fat for fuel and shedding pounds.

The original Keto diet

The official coinage of the Keto diet was in 1923. Dr Russell Wilder was a researcher in diabetes and metabolism and coined the term ‘ketogenic’ diet when recommending it as a dietary solution to some forms of epilepsy. He made the discovery after years of research into the efficacy of fasting to treat epilepsy episodes in children.

At the time, the shares of macros were as follows: 1 gram of protein per kilogram of bodyweight, 10-15 grams of carbohydrates and the rest of the calories from fat. For a person weighing 70 kilograms with a calories allowance of 1,200 per day, this would translate to 70 grams of protein [280 calories], 15 grams of carbs [60 calories] and 95.5 grams of fat [860 calories].

These macro percentages have shifted slightly now, but the premise remains the same. Therefore, the keto diet was originally formulated to replicate the effects of fasting and its benefits for epileptic patients without the actual fasting. The diet allows for fat sources such as meat, butter, eggs, chicken, cheeses, avocados, fatty oils and some fruits and vegetables. It heavily restricts all forms of sugar, grains, fruit juices, most fruits etc.

The science behind the diet

Ketosis essentially occurs when the liver starts producing ketones when there is a lack of sugar or glucose in the system. Ketones are chemicals produced by the body when fat is burned for energy instead of glucose. These by-products of the fat-burning process are released into the bloodstream which muscle groups can then use for energy.

One can measure ketones in circulation by checking urine or blood samples. The levels can range from normal to extremely dangerous – so from less than 0.6mmol/L (millimoles per litre) to more than 3mmol/L.

‘Nutritional ketosis’ is what is advocated for weight loss and other purported benefits of the keto diet. This would show ketones in the range of 1 to 1.5 mmol/L in individuals following the diet. This state is considered a natural metabolic state which converts the body’s fuel mechanism from carbs to fats. Since carbs are so heavily restricted, the liver automatically switches to burning fat instead and then producing ketones which muscles use as fuel.

Ketones can also be produced when not following a ketogenic diet. Diabetics, women in some stages of pregnancy, people doing excessive exercise, or suffering from chronic vomiting could also be producing ketones without actually being on this specific diet. While ketone production is a natural metabolic body process, excessive levels of ketones can lead to dangerous situations, according to research, especially for people with Type 1 diabetes.

Some companies also produce and sell ‘exogenous’ ketones which purportedly speeds up the ketosis process and fat burning. No large-scale studies were available to prove how effective or damaging ingestion of these substances are.

Claimed benefits of ketosis

Apart from burning fat and resultant weight loss, ketosis is credited by many as being an efficient fuel source that also helps regulate health issues. In a 6-month study conducted in 2004 on 83 obese patients, the keto diet was found to have reduced glucose, LDL and triglyceride levels and improved HDL levels while helping the patients to reduce weight.

The Netflix documentary ‘The Magic Pill’ had critics calling for its removal from the streaming platform after claims were made by people on the show that the ketogenic diet was responsible for helping with major medical conditions including cancer.

Cons and side effects

While no major side-effects have been recorded while in long-term ketosis, constipation, nutrients imbalance, hair loss seems to be commonly cited by people on the diet. There is no study available yet that measures effects of the diet for more than two years on a randomised sample of cases. Kidney stones, gallbladder issues and extremely dangerous ‘ketoacidosis’ are also shown as possible effects of being on the diet. However, as with the benefits, studies proving that ‘nutritional ketosis’ could lead to these issues is non-existent.

In addition to this, there are now people doing a version of the keto diet called ‘dirty keto’ where fats are consumed from heavily processed sources or high saturated fat sources. This includes consumption of processed cheese, excessive amounts of butter or lard, processed meats etc. People sharing their ketogenic lifestyle of over two years online are seen advocating healthy keto as the way to go to maintain nutritional health along with managing weight.

Keto dieters also have the problem of no ‘cheat’ meals. Medical and nutritional journals online report that switching to keto and back can affect metabolic processes adversely in some people. Again, studies recording exact effects of this are scarce. For diabetic patients who use insulin medications, there is risk of extreme low sugar and ketoacidosis.

But is there a possibility of death?

While we can’t say based on our research that the ketogenic diet can lead to fatal conditions, excessive production of ketones in the body can lead to fatal conditions. This does not apply to everyone and is extremely rare. The critical part to remember is that this can occur in people who are not on the keto diet.

How does this happen?

Ketoacidosis is the villain here and not ketosis. In ketoacidosis, the liver burns fat too fast producing excessive amounts of ketones which are released into the bloodstream. Diabetic ketoacidosis (DKA) occurs when insulin production is close to nothing and the body’s cells are unable to use glucose for energy. At this point, as a response mechanism the liver starts burning fat and expelling ketones, excessive amounts of which can cause the blood to become acidic. This condition could lead to acute renal failure. DKA can also lead to diabetic coma, fluids in lungs or brain damage. This condition is more common to Type 1 diabetics.

Starvation, overactive thyroid conditions and alcoholism can trigger ketoacidosis. In people following a low carb diet, in case the body goes into starvation mode due to energy restrictions with or without other conditions such as pregnancy, lactation, Type 2 diabetics, thyroid issues, it could lead to ketoacidosis.

So, if you are looking into metabolic benefits of ketosis or fasting, anything over 1.5mmol/L ketones in a urine or blood test is not ideal when following nutritional ketosis. Mild ketosis at lower than 1mmol/L is also reported to be effective for health benefits of fat burning.

As with any dietary change, contact your doctor and make sure your health permits the change. Always monitor body changes and symptoms and report to your health practitioner to see if the changes are a result of a dietary restrictions.

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