Obesity Weighs In

The detriment to health by being chronically overweight has become a top-level public health issue. There’s no dodging this subject any longer. The trends read “Out Of Control”. The New England Journal of Medicine recently reported that “57 per cent of children aged two to 19 in the U.S. in 2016 will be obese by the time they are 35 years old”. Authorities seem paralyzed. The official mantra to manage weight by caloric restriction is dead. People don’t like being hungry all day long and besides it doesn’t work.

The one approach to weight management dietetics that is in favour is a ‘paleo’ or ketogenic protocol. Powered by mountains of popular books, via social media, by peer review studies and by changing clinical practice, programmes that seriously restrict carbohydrate, with moderate protein and more saturated fats are being widely applied. Such is the demand that the food industry has responded pouring out new ready-to-eat paleo products. It’s a growth market! 

Nutritional ketosis is a condition where the body burns fat as its primary fuel instead of sugar. Sugar as fuel is ingested as carbohydrates. Ketones are liberated by the liver from stored fat. A person who cuts out carbs forces the body to burn fat thereby losing weight. Ketones are a good, safe and satisfying fuel for humans. We are designed that way. Ketogenic diets have been around for decades and so much is known about how they should best be undertaken.

For example, the peer reviewed “Ketogenic Diet for Obesity: Friend or Foe?” concludes with “A period of low carbohydrate ketogenic diet may help to control hunger and may improve fat oxidative metabolism and therefore reduce body weight”. Or, “Long-term effects of a ketogenic diet in obese patients” which finds “The weight and body mass index of the patients decreased significantly”. The list goes on. The case has been made. It is a problem that following a nutritional ketogenic diet cuts across so much of conventional health and medical opinion. Low fat for heart health. Whole grain cereals. The benefits of fruit. There are decades of acrimony between camps of the well credentialed. Just say “Atkins Diet” in a crowded room. Understandably, both the public and clinical practitioners stand to be confused. But the obesity explosion is such a crisis that all these older debates are being superseded. Something has to be done NOW.

There are no drugs. They’ve all been tried without good effect. Surgery is only for the few. Caloric restriction has some but not sufficient promise. The paleo-ketogenic heresy is the only route in play. And, if establishment academicians and physicians and regulators don’t get up to speed there are large constituencies of their peers who are leading the way. Besides, the public will just do what it wants. Which is where matters stand at this time. When a person is in ketosis they are typically shocked at how well they feel. Off the carb/sugar treadmill, they are not driven mad by hunger. Their energy is a steady as their supply of ketones is. Old symptoms fall away. In particular, insulin and blood sugar levels stabilize. A person, a patient wins motivation from the experience. They fall off the wagon and feel like their bad old selves. Compliance returns.

Well, if it was that easy, if the benefits were that obvious why haven’t people generally been more attracted to paleo/keto diets? Because it’s not that simple. There are challenges to entering nutritional ketogenesis. It plays havoc with electrolytes. There are severe carb food withdrawal symptoms. Thyroid function can be impaired. Constipation, tiredness, weakness. Many people are not healthy enough to undertake such a severe change in diet. However motivated a person is, however well read they may be any person planning to undertake a ketone diet is well advised to consult with a qualified medical practitioner – a physician or doctor of naturopathy.

There are two controversies about applying a keto protocol to note. Most popularisers and practitioners favour the consumption of endogenous or food sourced saturated fats – coconut or palm oil or medium chain triglyceriedes (MCTs) as suitable fats. A contrary opinion, especially where weight management is the issue, is that saturated fats should be withheld so as to better induce the body to liberate and burn its stored fat. This school tends to favour intermittent fasting. 18 – 24 hours of no food at all maybe once a week. 

The other controversy concerns the consumption of protein. Conventional opinion holds that over consumption of protein results in a rise of blood sugar that threatens a state of ketosis. So, conventional keto diets are ‘low protein, high fat’. But there is a contrary opinion about this which is that the amount of protein consumed has no effect on blood sugar. This latter protein issue can be best illustrated by the considerable number of successful ‘bacon eating fasts’ which any interested consumer can hardly avoid if roaming the internet.

As people get older such a state engenders or aggravates other health conditions. The pressure is on to deal with this. Until and unless some more effective therapy emerges – and this may not happen – a ketogenic dietary approach will be a pillar of therapeutics.