Keto - The Most Effective Diet for Weight Loss

Gary Taubes lays out the scientific rationale for a low-carb, high-fat diet and lifestyle in his excellent new book The Case for Keto. Taubes said he wrote this book to help “those of us who fatten easily.” And he identifies himself in this group of people for whom controlling weight is not easy.

Standard diets don’t work for many, in part because the modern diet is chock full of easily digestible and delicious carbs—aka carbage—which causes an insulin spike in your blood. This leads to insulin resistance, where your brain is fooled into thinking it’s starving all the time. In fact, many Americans are addicted to carbs, leaving them constantly craving the sweet and starchy treats that are everywhere in our culture. This vicious cycle makes it all but impossible for many people to lose weight and keep it off.

Some people can get away with eating carbohydrates like products made from wheat (which stimulate the opiate receptors in the brain), rice, potatoes, and foods and drinks with added sugar (which are also addictive), without gaining weight, but many others can’t. Those who tend to have high insulin levels will easily put on pounds when consuming even a moderate amount of carbs.

Insulin is a hormone that tells your body to store the calories you consume as fat around your midsection. Taubes argues that the keto diet can be an effective solution for people who can’t lose excess weight. “Lean folks aren’t like us. They don’t get fat when they eat carbohydrates; they have a choice to live with carbs or not. We don’t.”

For this strategy to work, keto should not be a short-term diet “fix,” but a low-carb lifestyle for the longterm. If you keep your carb intake to less than about 50 grams per day, you will switch your metabolic engine over from a sugar-burning machine to a fat-burning machine.

In this state you melt belly fat, and then your liver turns these fatty acids into ketones—a super fuel that generates more energy and throws off less smoke compared to sugar. Ketones can help you think more clearly, and they also suppress hunger and keep insulin levels low, so you won’t be craving food and longing for carbs.

Following the keto diet means largely eliminating staples like bread, rice, potatoes, sweets, chips, pastries, baked goods, donuts, beer, pasta, and all sugary drinks (including fruit juices). Like many addictive substances, the more you “use” refined carbs, the more you need them. But if you shun these sweet and starchy foods and sugary drinks, they will lose their grip over you, so that it will become easier and easier to avoid them.

Most cardiologists think of keto as a dangerous diet, and for good reason. People on a keto diet need to get 70% or more of their calories from fat, and traditionally this has been done by eating mostly foods high in saturated fats like cheese, butter, cream, fatty red meat, poultry skin, and coconut and palm oils. These foods may help you lose weight if you avoid carbs, but will skyrocket your bad LDL cholesterol— which is a recipe for igniting atherosclerosis (plaque build-up) in your arteries and heightening your risk of heart attack and stroke.

But there is a healthy way to follow keto by getting most of your calories from healthy foods naturally high in unsaturated or monounsaturated fats. This is, unfortunately, a relatively short list that includes nuts, seeds, avocados, olive oil, and fatty fish like salmon, trout, herring, and sardines.

The other crucial part of the heart-healthy keto diet is consuming a ton of non-starchy veggies like broccoli, leafy greens, onions, garlic, tomatoes, cucumbers, peppers, mushrooms, and asparagus. Beverages ingested should be almost exclusively water, sparkling water, unsweetened coffee and/or tea, and if desired, a modest amount of alcohol in the form of dry (not sweet) red wine or distilled spirits. The standard keto diet is highly effective for weight loss, and lowers blood glucose and triglyceride levels, quelling the fires of chronic inflammation. The healthy keto diet will also accomplish these things while generally keeping your blood cholesterol in the normal range.

Many people find it easier to follow a keto diet if they take a daily fiber supplement like unsweetened psyllium (such as Metamucil), mixed in a large glass of cold water. This helps to prevent constipation that can come from cutting out fiber-rich foods like whole grains. Additionally, you may need to be on a cholesterol-lowering drug like a statin if your bad LDL cholesterol levels rise on the keto diet.

Kristin is a 56-year-old who has always been an exercise enthusiast and takes very good care of herself. She is of normal weight and is highly fit. Out of the blue about seven years ago she developed latent autoimmune diabetes in adulthood (LADA)—which is essentially late-onset type 1 diabetes.

Shortly after being diagnosed with diabetes, Kristin had a severe life-threatening spell of hypoglycemia (low blood sugar) triggered by an accidental overdose of insulin due to a malfunction of her insulin pump. So, she decided to control her type 1 diabetes predominantly with diet, not insulin, a radical plan. But Kristin is a highly disciplined and intelligent woman who figured out that if she avoided eating sugar and virtually all starchy carbohydrates, she could get by on very little insulin.

Kristin said, “My insulin needs are minimal due to the healthy keto diet. My daily need for short-acting insulin is only 7 to 9 units (about 90% less insulin than most people with type 1 diabetes), because of the way I eat. I hate to call it the ‘keto diet’ because it’s really a lifestyle that’s a sustainable way to live a high-quality life. You’ll have more energy and focus, with fewer cravings and less inflammation. And a person can adhere to this diet whether they’re a lazy cook or a great cook. I wish more people would make a conscious choice to eat this way. The benefits are astounding.”

Now Kristin never has low blood sugar spells anymore, and her hemoglobin A1c, which is a measure of long-term glucose control, is 5.3, which would be excellent even for a person WITHOUT diabetes.

The specific eating style that Kristen follows is the low-carb, high-fat keto lifestyle that is rich in foods like nuts, seeds, avocados, fatty fish, and extra-virgin olive oil. It also is very high in non-starchy vegetables, along with about one-half cup of berries per day—the exact diet I am proposing in this article, and pretty close to what I eat myself.

To summarize, this low-carb, high-unsaturated fat eating style that is rich in vegetables will keep your insulin and hunger levels low and make it easier to get rid of excess baggage around your waistline. Ask your doctor if this type of diet might be good for you. If you get the thumbs up, give it a try. What do you have to lose?

In Good Health,
James O'Keefe, MD, FACC