The lean, mean ketogenic diet machine
Developed for epileptics, the high fat, low carb approach to eating known as "keto" has become a popular weight-loss regimen. Corey Mintz finds out why devotees are very satisfied and experts a little skeptical
Dan McKinnon starts his day with a coffee, like anybody else. Except that he puts butter in it. And MCT oil, a supplement high in a unique type of saturated fatty acid.
If there's time for breakfast, the 34-year-old Toronto musician and arts administrator will scramble some eggs with cheese and wolf it down with three slices of bacon, two sausages and an avocado. When he's in a hurry, he'll stop at McDonald's for a sausage and egg sandwich – minus the bread.
A typical lunch is a burger with cheese and guacamole. McKinnon will wrap the burger in lettuce instead of a bun, but since he's trying to eat a three-to-one ratio of fat to protein, he'll load it with as much of his favourite condiment as possible. "I live and die by Sriracha mayo," he says.
Since January, McKinnon has lost 25 pounds. He credits the ketogenic diet, a low-carbohydrate diet designed to fuel the body with fat instead of glucose. For anyone who doesn't read diet magazines or follow #lowcarb, #holdthebun or #weightloss on Instagram or Twitter, it's an ultralow-carb, no sugar, no fruit, no beans weight-loss regimen.
It's also very popular. The Keto Diet by Leanne Vogel is currently the top-selling book in Amazon Canada's diet and weight-loss category, and a slew of celebrities, including NBA superstar LeBron James, are rumoured to be acolytes.
Developed in the 1920s to treat epilepsy, the diet was generally abandoned after the 1938 discovery that the drug diphenylhydantoin could be used to control seizures.
Then, in the early 1990s, Hollywood director Jim Abrahams (best known for movies with exclamation marks in the titles, such as Airplane!) took his son, who suffered from intractable seizures, to Johns Hopkins Hospital in Baltimore. Doctors there had success treating the boy with a ketogenic diet, and his story was featured in a 1994 episode of NBC's Dateline and in the 1997 TV movie … First Do No Harm, starring Meryl Streep. By the mid-2000s, the diet was accepted as an uncontroversial, successful method for reducing epileptic seizures.
The diet's name comes from ketones, molecules produced by the liver in response to an absence of sugar, which the body then burns for fuel. An entirely unintended side effect for people with epilepsy on the diet is that, without glucose, the body turns into a fat-burning machine. Unsurprisingly, it eventually became a weight-loss trend.
"I heard about keto on an episode of Joe Rogan's podcast earlier this year," McKinnon says. Pre-keto, he ate burritos every day and capped the week with a pizza-and-Netflix date with his girlfriend.
Previous attempts at "the low-carb thing" left him constantly hungry, but he decided to give keto a try anyway, intrigued by the high fat intake (as opposed to the Atkins diet, which focuses on protein). Although his early days on the diet did involve what devotees call the "keto flu," a withdrawal phase of headaches and low energy that McKinnon describes as "total hell," he's now a complete convert.
"I never felt better," he says. "I can't imagine eating any other way."
In fact, the diet's ability to sate appetites seems to be a key to its success and popularity.
On a typical day, Michelle Holden of Bradford, Ont., will eat 100 grams of fat and 50 grams of protein and will keep her carbohydrate intake ("religiously") under 20 grams. After bacon and eggs for breakfast, she says she's not hungry again until dinner.
"Oddly enough, when I do feel peckish around lunch, which is rare because I've become fat-adapted," – jargon for growing accustomed to getting energy from fat – "I will grab a piece of bacon and I'm fine after that," Holden says. "There's no cravings. Before, I used to scarf down whatever I could get my hands on."
The 48-year-old event specialist and her husband began their diet in January after consulting their doctor to ensure it would be safe for them. "I was borderline type 2 diabetic," Holden says. "And had already been warned by my doctor that if I continued eating the way I did, it wasn't going to be long before I was type 2 diabetic."
She emptied out her cupboards and cleaned out her fridge, saying goodbye to Wonder Bread, English muffins and her beloved morning tea and toast routine, then said hello to bacon.
Her keto flu wasn't that bad, but she did have a few weeks of "keto breath," an unpleasant metallic taste in her mouth. Giving up fruit has been her biggest challenge, and meal planning on vacation takes a lot of forethought.
"If you're not prepared, that's when it's frustrating. And that's when you want to give up," she says. "You've got to have the proper ingredients in your cupboard and fridge. And if you don't, it's very easy to fall off that wagon."
She and her husband get blood work done every three months to make sure his fatty liver disease and her risk of diabetes aren't being negatively affected.
Calgary nutritionist Danielle Kot doesn't remember when exactly she heard of the ketogenic diet, only that around January it seemed like "the whole universe was talking to me" about it. Weight loss wasn't her objective. She claims more energy, mental clarity and happiness since switching her diet, as well as being a better wife and mother.
Kot replaced the fibre of keto-shunned starchy, sugary fruits with chia and flax seeds and dark, leafy greens, so the rumoured constipation isn't an issue.
Being invited for dinner at a friend's house is an unavoidable obstacle. Usually, she'll ask what's on the menu and either skip her diet for the evening or get the necessary fat earlier in the day.
"But I'm human. I live. I have kids," Kot says. "I like to drink alcohol, to have carbohydrate binges every now and then. Sometimes I just want that darn piece of cake."
Like McKinnon, she puts butter in her coffee, plus coconut oil and MCT powder. She also takes multivitamins, omega-3, magnesium and exogenous ketones, a synthetic supplement.
Supplements are a common theme of the many Facebook groups devoted to the diet and lifestyle. In addition to sharing recipes for avocado tuna melts and "keto sushi" (maki with cauliflower and cream cheese instead of rice), members are exposed to a constant stream of ads, endorsements and discounts for powdered drinks full of synthetic ketones, said to be a shortcut to the body's natural production of the molecules.
Some groups have a prohibition against ads, and Holden, who is an administrator for the group Keto Canada Eh, dismisses the drinks and supplements as "cheating" that cannot take the place of proper dieting.
Kot, who promotes the supplement maker Pruvit, is the only person allowed to advertise in her own Facebook group, KetoNation Canada.
A reliance on supplements is a red flag for Dr. Rachel Murphy, a nutritionist and assistant professor at the University of British Columbia.
"I worked for a dietary supplement company, and they look for opportunities like this – new populations they can market products toward," Murphy says. "And supplements are really expensive."
Kot describes Pruvit as a multilevel-marketing company – in other words, if she signs friends up to sell the supplements, she gets a percentage of their sales. Joining Pruvit as a promoter involves buying an "experience pack" of 200 servings for $968 (U.S.), plus signing up for a $37 annual promoter membership. The "max experience pack" costs $1,300.
Pruvit describes its product as "a modern health revolution," and promotional videos on its website feature inspirational stories alluding to all manner of life-changing benefits. Surrounded by cheering crowds at something called Ketokademy, CEO Brian Underwood refers to the company as "a movement." The website also boasts that the program is "scientifically pruven."
"The wonderful thing about exogenous ketones," Dr. Andra Campitelli says in one of Pruvit's promotional videos, "is that you don't have to change your diet in order to experience the benefit of having ketones in your system."
But Dr. Jonathan Little, who has been studying the impact of a ketogenic diet on type 2 diabetes – he's seen some positive benefits – dismisses the efficacy of ketone supplements.
"We have no idea whether these things work at all," says Little, who works at the University of British Columbia. "You'll find people that tell you that a ketogenic diet's going to give you more stable energy and less hunger and clear thinking. There's really no evidence for that. Those are anecdotes."
"A little bit of science can be harmful in the wrong hands," he says. "For me, as a scientist, we need to run proper studies to test proper hypotheses for these things, instead of taking a little bit of science on ketones and turning it into 'here's the cure for Alzheimer's disease' or something."
He adds that, even for people such as epileptics who are known to benefit from the diet, precautions must be taken.
"A ketogenic diet can lead to many physiological changes in the body, including increased salt excretion and reduced blood pressure," says Little, whose research is funded by Pharmasave and the Heart and Stroke Foundation. "It is important to work with someone who is familiar with these diets if you are going to start one because there are some things you need to watch out for and adjust, especially if you are on any medications."
While Murphy has no specific criticisms of the ketogenic diet as a weight-loss method, she finds it worrisome that there are no long-term studies of its effects. "Weight is a part of health but it's only a small part. Microbes in your gut change so much in response to what you're eating," she says.
Diet fads come and go, and any good doctor will caution patients away from rapid weight-loss schemes, if for no other reason than they are too challenging to maintain. "We know that the best place to get nutrients is through food," Murphy says. There has yet to be a study denouncing the holy trinity of a balanced diet, regular exercise and sleep.
But keto advocates are positive that unlike the Atkins, Paleo, Zone, raw food, South Beach, grapefruit, morning banana or Suzanne Somers's Somersizing diets, their meal-planning regimen will never go out of fashion.
Holden says that for her and her husband, the diet is not rashly considered. Weight loss isn't the goal, although it's a nice side benefit.
"Your body adapts. And your mentality adapts. I was always looking for that next meal," she says, "before I started keto. And now I don't do that."