Is Weight Loss on Ketosis Sustainable?


“Is Weight Loss on
Ketosis Sustainable?” The new data is said to
debunk “some, if not all, of the popular claims made by
extreme carbohydrate restriction.” But what about ketones
suppressing your hunger? In the tightly controlled
metabolic ward study where the ketogenic
diet made things worse, everyone was made to eat
the same number of calories. So yes, eat the same number
of calories on a keto diet and lose less body fat,
but out in the real-world maybe all those ketones would
spoil your appetite enough that you’d end up eating
significantly less over all. On a low-carb diet people ended up storing 300 more calories
of fat every day. But outside the laboratory, if
you were in a state of ketosis, maybe you could offset
that if you were able to sustainably eat significantly less. Paradoxically, people may
experience less hunger on a total fast compared to
an extremely low-calorie diet. This may be thanks to ketones; in this state of ketosis,
when you have high levels of ketones in your bloodstream,
your hunger is dampened. How do we know it’s the ketones? Because if you inject ketones
straight into people’s veins, even those who are not
fasting lose their appetite, sometimes even to the point of
getting nauseated and vomiting. So, ketones can explain
why after a few days you might feel hungrier
on a low-calorie diet than on a total zero-
calorie diet (a fast). Can we then exploit the
appetite-suppressing effects of ketosis by eating a ketogenic diet? If you ate so few carbs
to sustain brain function, couldn’t you trick your body
into thinking you’re fasting and get your liver to
start pumping out ketones? Sure! But is it safe,
and is it effective? A meta-analysis of 48 randomized
trials of various branded diets found that those advised
to eat low-carb diets and those told to
eat low-fat diets lost nearly identical amounts
of weight after a year. Now obviously, high attrition
rates and poor dietary adherence complicate comparisons of efficacy— I mean they weren’t
actually put on these diets; they were just told to eat that way. But you could see how even just
moving in each respective direction can get rid of a lot of CRAP, which is Jeff Novick’s beloved acronym
for Calorie-Rich and Processed foods. After all, the four
largest calorie contributors in the American diet are refined grains,
added fats, meat, and added sugars. Low-carb diets cut down on
1 and 4, and low-fat diets tend to cut down on 2 and 3. So they both tell people
to cut down on doughnuts. Any diet that does that
already has a leg up. I figure a don’t-eat-anything-that
-starts-with-the-letter-D diet could also successfully cause weight loss if it caused people to cut down on
doughnuts, danishes, and Doritos, even if makes no nutritional sense
to exclude something like dill. The secret to long-term weight loss
success on any diet is compliance. Diet adherence is difficult,
though, because any time you try to cut calories
your body ramps up your appetite to try to compensate. This is why traditional
weight loss approaches like portion control tend to fail. For long-term success, measured
not in weeks or months but in years and decades, this day-to-day hunger
problem must be overcome. On a wholesome plant-based
diet this can be accomplished thanks in part to calorie density—
you’re just eating so much food. On a ketogenic diet it may
be accomplished with ketosis. In a systematic review
and meta-analysis entitled “Do ketogenic diets
really suppress appetite?” The answer, they found, was yes. Also, ketogenic diets
offer the unique advantage of being able to track
dietary compliance in real-time with ketone test strips
you can pee on to see if you’re still in ketosis. There’s no pee stick that will tell you if you’re eating enough fruits and veggies. All you have is the bathroom scale. Keto compliance may be more
in theory than practice, though. Even in studies where ketogenic diets
are being used to control seizures, after a few months dietary compliance
may drop to under 50 percent. This can be tragic for those
with intractable epilepsy, but for everyone else, the difficulty
in sticking to ketogenic diets long-term may actually be a life-saver. I’ll talk about keto diet safety next.