Decoding that Diet you Saw on the Internet

Keto, Gluten-free, and Fasting

Summer Self Care June 23, 2020

Ru Liu, MS, RD

Who am I?• Hometown: Liuzhou, China• BS & MS in Nutrition at UIUC• Registered Dietitian • I studied how genetics and

breastfeeding affect carotenoid status in childhood

Learning Objectives

• Describe the key features of each diet

• Recognize which population can benefit from each diet the most

• List the potential side effects of each diet

Question

Have you tried or do you know anyone that has tried the ketogenic diet, gluten-free diet, or intermittent fasting?

Let me know in the chat box!

What is Ketogenic Diet?

• Created almost 100 years ago to treat drug-resistant epilepsy in children

• 90% daily calories from fat, < 20-50 g of carbs per day (one banana has about 27 g carbs)

• USDA recommendation: 65% carbs, 20-35% fat, 10-35% protein

• Not all low-carb diets are ketogenic • how much reduction in carbohydrate intake is enough to induce ketosis varies

greatly for individuals • measure urinary ketones to determine ketosis

How Does Ketogenic Diet Work?

• Normally, our body uses sugar (glucose) as primary fuel

• Ketosis: when our carbohydrate intake in limited, our body adapts to use fat as primary fuel (fat ketone bodies)

• It takes days to weeks of eating < 20-50 g of carbohydrates/day to achieve ketosis

Ketogenic Diet and Weight Loss

• Keto diet vs. low-fat diets • More weight loss at 6 months, but no difference at 12 months• Even when KD group had higher total energy intake, weight loss was still greater

than LF group• KD resulted in a reduction in body fat with preservation of lean body mass

• Why?• Initial weight loss: diuresis from glycogen depletion and ketonuria, which

increases renal sodium and water loss • Ketones might suppress appetite• Limitation of food choices

Side Effects for Ketogenic Diet

• Short-term:• Constipation, headache, lightheadedness, muscle cramps, diarrhea, general

weakness, rash

• Long-term • Not well studied in adults for more than 12 months (mostly in children with

epilepsy)• At risk of developing nutrient deficiencies (e.g. fiber, thiamin, folate, potassium,

calcium, etc.)

Other Concerns

• Hard to maintain • Everyone has different thresholds of carbohydrate intake to achieve ketosis• Yo-yo dieting that lead to rapid weight loss fluctuation are associated with

increased mortality

• Might interfere with other health conditions and medications • Affects blood lipid levels • Might have interactions with certain seizure, blood pressure, blood glucose

medications

What is Gluten?

Why is Gluten-Free Diet So Popular?

• Media coverage • Celebrities adopting this diet

• Marketing strategies • > $15.5 billion were spent on retail sales on GF foods in 2016 (more than x2 the

amount spent in 2011)

• Improvement in diagnosing Celiac disease • However, the prevalence of celiac disease remained stable (2009-2014), people

who avoid gluten without the disease more than tripled

Gluten

• Gluten is a protein found in most grains

• It acts like a binder/glue, giving products a “stretchy” quality • Think about stretching out a ball of dough

• Common food sources• wheat, rye, barley, malt• Pastas, noodles, breads and pastries, crackers, baked goods, cereal, beer• Soy sauce

Who MUST Follow a Gluten-Free Diet?

• Celiac Disease • Autoimmune disease • Gluten ingestion leads to an immune response that attacks the small

intestine damaged villi prevent nutrients being absorbed properly • Affect 1 in 100 people worldwide • Many are undiagnosed

• Non-celiac gluten sensitivity and wheat allergy • Similar symptoms as seen in Celiac disease, but test negative for it

Impact of Gluten-Free on Non-celiac Individuals

• Might benefit irritable bowel syndrome (IBS)

• Weight loss?• No conclusive evidence to support this claim • Weight loss can be due to

• Processed foods replaced by fruits and vegetables • Limited food choices lead to calorie reduction

• Weight GAIN has been observed in some studies• Some GF foods have higher kcal than their counterparts • Lack whole grains and fiber

Gluten-Free Foods ≠ Healthy Foods

Potential Harms of Gluten-Free

• Nutrition deficiencies • Minerals, B vitamins, fiber

• Financial cost • GF products were 242% more

expensive than gluten-containing products

• More expensive ≠ healthier

We Need Carbohydrates• Carbohydrates are a major source of fuel and nutrients for our bodies • Not all carbs are created equal

• Choose unprocessed or minimally processed whole grains, vegetables, fruits and beans

• Limit highly processed or refined foods, such as white bread, pastries and sodas

What is Intermittent Fasting?

• Fasting = no food

• Many different regimens • Daily time-restricted feeding (6-8 hours)• 5:2 IF (people only eat one meal on two days each week• Complete fasting every other day• 70% energy restriction every other day

• No restriction of any food groups or nutrients

Rationale behind Intermittent Fasting

Intermittent Fasting and Weight Loss

• Most trials that had an isocaloric control group have reported similar weight loss between IF and control groups

• One study showed a greater loss of body fat (over 4 months)

• IF does not appear to lead to compensatory over-consumption on non-fasting days

• Conclusion: Alternate-day fasting has not been proven to be superior compared to continuous calorie restriction weight-loss plans

Challenges

• Hunger and/or preoccupation with food

• Skipping meals and severely limiting calories can be dangerous for some people

• Diabetes• Blood pressure or heart disease medications

Key Takeaways

• Many of the clinical trials looking at diets were conducted in individuals with overweight/obese

• Dietary components are hard to study separately • Fasting vs. calorie restriction• Keto (high fat) vs. reduction in carbohydrate

• Sustainability is key – find an eating habit that works for you in a long-term

• Take your health conditions/medications into account, discuss with your health care providers before making any drastic change in your diet

Summary and Action Items

Diet Ketogenic Gluten-Free Intermittent Fasting

What it is

90% daily calories from fat, less than 20-50

grams carbohydrates per day

Eliminate anything that contains the protein gluten

(e.g. wheat bread, pastries, pasta, soy sauce,

etc.)

No caloric intake for an extended period of time

Who it is for Children with drug-resistant epilepsy

People with celiac disease or gluten sensitivity No specific population

Possible side effects

Constipation, fatigue, confusion,

lightheadedness, nutrient deficiencies

Nutrient deficiencies, potential financial burden

Intense hunger sensation, preoccupation with food

Resources

• A simple way to build healthy eating habits: MyPlate (https://www.choosemyplate.gov/)

• Podcast on the ketogenic diet: Sawbones

• More information on celiac disease and gluten in food:https://celiac.org/

Next week: The Ins and Outs of Menopause: Research-based Strategies to Improve Your Wellness During Midlife

Katherine Hatcher, Ph.D.12 – 1 PM CDTJune 30, 2020