Keto diet and diet comparisons: Mayo Clinic Radio

welcome back to mayo clinic radio i'm dr elizabeth cozzin and i'm tracy mcrae according to dr google the most searched question of 2018 was what is the keto diet keto short for ketogenic is a high fat very low carbohydrate diet the idea is that getting most of your calories from fat forces your body to use different energy pathways instead of carbs for energy the body burns fat entering a state called ketosis he tells us what could go wrong sounds like a great plan sounds a little dangerous to me that's why i've not tried it well

here to discuss the benefits and the drawbacks of the keto diet is mayo clinic dietitian kate zaratsky welcome back to the program kate it's nice to see you again good to be here thank you what is this thing yeah what is it it's the most googled question so it must be something right and and i'll have to say from my background and and i've i've worked with mayo clinic for 19 years and when i started and was working more so in pediatrics this was a diet that we used in the hospital and then sent children

home um on this diet so it would help control their seizures and that's really how i was introduced to and knew of the ketogenic diet so when people started talking about oh i'm on the keto diet and i'm doing the keto diet i i was like really i asked several people if they had seizure disorder history i said no right and and i thought in in in my experience you know i would spend an entire day doing calculations of how much fat how much carbohydrate even how much protein and the ketogenic diet as it's used

to control seizures is really done in very strict ratios and you're very cautious about weighing and measuring and being very precise with the amount and the types of foods to make sure that you have the response you want to help that child so a ketogenic diet you're saying is maybe different than what people consider a kato diet yes so i think what what we're seeing today um where when people are describing to me well i'm doing the keto diet i'll often ask like well how are you doing and in often times in their description they're

eating fat and protein in large quantities and eating very few carbohydrate-rich foods and so in in my opinion that sounds more like a modified atkins type diet where you're you're allowing yourself ample quantities of both protein and fat um and just limiting in the carbohydrates and i know there are people who are now you know talking to more people and reading more about it there are people who are looking at this in true uh carbohydrate restriction but also um maybe some protein restriction but i think that's maybe a difference that we're maybe seeing across the

board that i'd i'm not sure people fully understand what that means people are using this for weight loss right right right and i think you know so really to have there's and i think one thing to understand there's differing degrees of keto ketogenic you know being in ketosis and so oftentimes that's measured by people measuring their urine ketones and so people will get you know test strips and and test their ketones and it may say that it's they're in ketosis but probably the degree of ketosis is probably a variable um to be taken into account

there and i think maybe that's you know the difference we see between and i think that's when i think about ketosis sometimes i get a little nervous i think well gosh we don't really actually want you in ketosis but can you tell us about that right and i think and i think this is something that is the unknown with when people are saying well i'm going to put myself on a ketogenic diet and be in ketosis because really when you think about what ketosis is it's a it's a alternative pathway that our body has to

use in times of emergency and times when you're when your brain in particular when your brain needs energy and for some reason there's not food particularly carbohydrate because that's the fuel your your brain prefers when that's not around and so your your body has this kind of a backup system to make sure you survive and so it's able to produce these ketone bodies to keep you functioning and so so you're right it's it's it's something that historically has alarmed us in terms of we don't necessarily want people to be in ketosis it can be very

dangerous ketone bodies are considered toxic your body has uh two two ways of getting rid of them you either exhale them through your breath or you urinate them out and so it is a stressful kind of process on your body too because your your body is trying to rid itself of these ketone bodies well when we were getting started uh dr cosing you and i both said we know people who have several people yeah lost hundreds of pounds people i know socially or people that i um patients of mine big weight loss and they feel

great well and so for them they consider that to be finger quotes successful yeah but possibly we're talking two different languages here so ketosis and those ketones and things that is not some place that you want to be health-wise there's got to be a middle ground here and i think that's i think that's where there's probably where we have a gap in our say our research and our scientific understanding of really what does this mean for somebody long term and i think there's some emerging data but it's fairly short term data that people can lose

weight on a ketogenic or a very low carbohydrate diet over the course of a few weeks into months however like most restrictive diets what were what the literature is saying is that after six months after a year these diets are very difficult to sustain um because people miss eating fruits and vegetables and and pastas and breads and other foods that have carbohydrate because most food does and so it's a very restrictive diet so it is difficult to sustain for any long period of time let's have the conversation then about healthy carbs because that's kind of

where some of the confusion comes from i'm cutting out carbs can mean well for me that means pasta and bread but it also can mean fruits and vegetables right and i think as if you really start looking at what foods have carbohydrates most do i think even you know there's the obvious there's the breads and the pastas and i think now most people recognize fruits and vegetables but even our dairy products have carbohydrate and and are even things like almonds you know you know have some carbohydrates so i think people saying well i'm going to

eat almonds on my ketogenic diet or my low carb diet but depending on the quantity that you eat truly that's going to impact the degree of ketosis that you're in and then i think another piece of this too is that the idea that um again from a survival standpoint our body's able to convert protein into carbohydrate again because that's what our our body wants to run off of and so i think looking at again going back to your question of carbohydrate healthy carbohydrates when we think about the majority of the foods that mother nature has

provided for us probably about 80 85 percent of them really do have carbon right so is the answer just to reduce carbohydrate rather than eliminate or do we right and i don't even know that we we have to say it might be look at the quality of your carbohydrate okay yeah and then that i think it's the the more wholesome mm-hmm that carbohydrate is your whole grain instead of a bag of doritos yeah exactly there's no there's probably in in portions always going to matter um so kind of it's the the quality and the quantity

of the type of carbohydrate that we can share a bag of doritos i would love to share a bag of doritos with you is there any long-term data on the keto diet i haven't i have not seen real long-term data i don't know that there's much data beyond uh the year mark and and the data that i've seen in regards to weight loss in that regard is that people might lose weight that initial six months but by the year mark there really isn't a statistical difference in the amount of weight loss compared to maybe other

diets we've been talking about the keto diet with mayo clinic dietitian kate zaratsky we're going to take a short break when we come back we'll compare the keto diet with other popular diet plans the mediterranean dash and mayo clinic diets welcome back to mayo clinic radio i'm dr elizabeth cozzine and i'm tracy mcrae we've been talking about diets with mayo clinic dietitian kate zaratsky and if people are interested in improving what they eat and you always have to be in favor of that at the beginning of the year trying to turn over a new leaf

every monday is a chance to turn over a new leaf or every day is a chance to turn over a new leaf let's talk about some other diets that possibly would be a little bit better to choose instead of keto and maybe we don't even call them diets i think that's a that's a great suggestion and i think we've even seen that with our with our dietary guidelines for americans that comes from the usda the last iteration that was released they started looking at diet patterns or looking at the patterns or rather than looking at

the way people eat rather than trying to call it a diet and i think that's just it i think because we don't know what the perfect diet is and if one even exists but we we do have um we do have some evidence that says that there's maybe ways or styles of eating um that there's certain foods that within these patterns that may be beneficial to long-term health and i think that's the important part of do you have a favorite pattern to recommend not necessarily and actually actually when i meet with people i i like

to say like tell me about what you're currently eating because as you're saying i think every day is kind of an opportunity to say how am i going to do it today and if we have just if if someone eats a certain way it's part of their habit it's part of their lifestyle and if they're looking to improve that which i think we all could kind of you know hop on that spectrum somewhere that we could say if it's i you know want to eat more fruits and vegetables or if it's more whole grains or

maybe i'd like to you know meet the recommendation of having fish twice a week whatever it might be i think we can all say there's probably a little wiggle room to improve our our diet or and look at eating better are the mediterranean diet and the dash diet the same they're not the same but they're similar and i think when you when you start getting into say the mediterranean diet the dash diet even the mayo clinic diet and other diets that have kind of been recognized in terms of their long-term health benefits you'll start seeing

that there are similarities and i think that just strengthens kind of the cause and the message that these types of foods the types of foods that you're seeing within this style of eating um that there's probably a good reason to eat this way so what are some of the types of foods in the mediterranean diet and so when i think of the mediterranean fish yes i wish i was on the mediterranean right now that sounds great right and i think a lot of people may think of fish in olive oil i think those are two

that that come to mind right away so really if we kind of step back from that it's yes fish in terms of healthy fats olive oil in terms of healthy fats but also when you look at the mediterranean diet and even the mediterranean lifestyle that there is many fruits and vegetables whole grains nuts beans legumes those types of foods it's whole foods more whole foods more plant-based foods i don't hear doritos shoot and that's not the d that's not doritos what's the dash diet and and i would say you know on the dash diet similarly

has similar can remind us what dash stands for yes not doritos are sure the dash diet stands for the dietary approaches to stop hypertension and so similarly it and maybe a bit of history so the mediterranean diet coming out of the mediterranean region and it was a really kind of a look at why are people who live in that region not dying of heart disease and kind of living long full lives comparatively to say their western neighbors or their northern neighbors and so on the um i would say kind of on the u.s side this

is almost like our our kind of reflection or our answer to a mediterranean type of diet looking at um the types of foods you eat but we took the approach of looking at nutrients and so what what nutrients are we getting from certain food groups that may be beneficial in terms of lowering your blood pressure and those nutrients are that they specifically looked at were eating less salt but also in combination with having more calcium more magnesium and more potassium reflective the foods that give you those nutrients calcium coming from dairy foods being most obvious

but calcium can come from other plant foods like leafy greens or broccoli or even almonds and uh potassium primarily coming from fruits and vegetables but coming from other foods as well and magnesium nut seeds and cocoa good good sources of those great one of the things that you get to do when you said it when you fill in for dr shives is you get to ask questions about anything yeah i had mine on the tip of my tongue i'm really interested in veganism and i've been reading a lot about you know the blue zones and

so those are the areas of the world where people live again long full lives beyond just the mediterranean so for example there are parts of japan where the life expectancy i think is into the late 80s early 90s and they found that these people have relatively low stress and tend to eat more of a whole food plant-based diet so very little very few animal products on any sort of regular basis i'm just curious what you think about that right and i think that is a really interesting kind of way to look at say nutritional research

even because i think it's a it's a difficult thing to do it's difficult to get really good long-term data in nutrition and i think so when we start looking at patterns of ways people eat and then looking at that in combination with their lifestyle and what are their outcomes um looking at thing areas like blue zones give us some insight into that and so i think when you again look at the idea that people in these blue zones are maybe eating uh more plant-based diets or incorporating more whole foods you know it's kind of real

whole foods even if it um if we go to maybe northern recent regions of the world where they're eating just more fish as a kind of a part of their diet but maybe not as many plants you know we see we see those types of things so i think in terms of vegetarianism or veganism you know the idea that you can eat a very nutritious and well balanced diet you can meet all your nutrient needs with plants for the most part and yeah i say there's those there's those couple um nutrients that we will pay

a little closer attention to one being b12 the other being iron just because it's a little more difficult to absorb and and and from plant sources and and also we'll want to make sure you're getting enough vitamin d too yeah how has it been at your house well i was telling tracy that we did a little vegan experiment at my house and it was quite gassy but it was you know we thought we got a lot of vegetables we were we were big veggie eaters before so it wasn't a huge lifestyle shift but when i

i did it for a couple reasons now i'm not trying to lose weight but it was to kind of see what it was like because you know i recommend these patterns of eating to people and i wanted to see is this a change that i could potentially make you know in minnesota in the middle of winter and it was fun it was actually really kind of stimulating to try some new diets and the gas got better and we've kind of settled on a low animal product lifestyle occasionally sustainable yeah i think fewer than we were

less certainly very infrequent red meat and less chicken fish than we were eating before well you can change your taste buds i know that's what people think there's no way i could ever give up steak or there's no way i could ever but you can start to change your taste buds buds and kind of modify that that is a fact isn't it right and i'm not imagining that you're you're not i think we all we all have preferences okay we do and and that's okay that's what makes us kind of unique individuals and humans but

the the what you're describing is the idea that there's a i was gonna say there's a name for that because there's a name for everything it's flexitarian and so the idea that if you still wanted to have a steak or or fish or whatever it might be you could still do that but the idea that the base of your diet the kind of the majority of your diet is planned sort of the intentional base of what you're doing yeah yeah there's eating eating more plants i think sets you up for kind of kind of the

baseline of kind of what your health picture is going to look like and just because i have to ask because i'm actually getting my kids to look at the labels it's taking a long time they're teens now but they will actually turn around and look at the label the less ingredients on a label the kids are starting to notice that that makes a difference and it's funny because they'll be comparing two yogurts or something like that first and one of them will just have like three ingredients and the other one has got a whole page

of ingredients that just fails down what difference does that make for someone when you're choosing products if you're choosing a greek yogurt what difference does it make if there's a lot of ingredients or only a few yeah that's a really good question and it's it's i think we want to say absolutely that the the one with fewer understandable words right is the one to choose um and i'd say as a as a general rule i think that's an oh that's okay but i think we also have to remember kind of on the flip side um

that living we have the privilege of living in a society where we have safe food and so the idea that there are some preservatives put in the food to maintain its safety i think there's also something to be said for that so sometimes when we see big words that we don't necessarily know how to pronounce it doesn't necessarily mean it's a bad thing but if it makes you take a pause and think twice about what you're eating i think that's a good thing um because the more we can eat food that is looks like its

whole real as mother nature intended self then that's really what we're going after if it needs to have a few preservatives in it to keep it safe that's okay too i have no doubt we could keep talking diet questions but we have to be done we do we do we've been talking about diets and healthy lifestyle choices with mayo clinic dietitian kate zaratsky thanks so much for joining us thank you