Imagine two sisters seeing specialists for two different medical conditions. One visits a gastroenterologist with extreme digestive discomfort, and the doctor recommends a colonoscopy, a battery of laboratory tests and a high-fat Paleo or Keto diet. The second visits a cardiologist after having two stents placed in her heart valves during an emergency procedure. The doctor recommends a well-balanced diet with minimal fat.
Both doctors recommend focusing on the “good” fats, but the amount of fat and the treatment of carbohydrates is substantially different. Curious about the difference in recommendations, the second sister returns to her cardiologist and asks why he has recommended a low-fat diet while other doctors are recommending high-fat diets. The cardiologist responds, “We’re trying to heal different conditions. I’m worried about your heart, and he’s trying to relieve your sister’s digestive distress.”
Would you guess that this is a true story that played out in 2018? If yes, you’re correct.
Most people can’t scroll through their Facebook feeds or check up on friends through Instagram without seeing some reference to fat bombs. Health-conscious people are now adding butter to their coffee and making taco shells out of cheese. They’re declaring their love for this diet that allows them to eat all the fat they want as long as the carbs are controlled, or even better, eliminated.
The tide has turned from villainizing fat to fully embracing it, but is it possible that there are consequences to this lifestyle? What about years of research that documented the traumatic impact of saturated and trans fat on the heart? Will we see a rise in heart attacks and strokes in the years to come?
Doctors are continuously under pressure to keep up with diet fads and determine what is and isn’t healthy for their patients, and it seems they’re coming down on opposite sides when it comes to the Keto diet. Let’s take a look at the research and the opinions of some highly esteemed doctors to determine how the Keto diet is treating our hearts.
The Truth About Fat & Your Heart
The Ketogenic diet was originally created for the treatment of epilepsy, so there wasn’t much research into Keto and the heart. Researchers are in the progress of coming up with new studies that put this diet to the test, and some of the results are impressive.
In 2004, researchers studied the long-term effects of the Keto diet on 83 obese people with a body mass index over 35 and high glucose and cholesterol readings. The participants followed a Keto diet for 24 weeks, and the results showed significant reduction in body mass, triglycerides, blood glucose and LDL cholesterol. HDL cholesterol levels also increased, which is the “good” cholesterol.
This study is often cited as proof that high-fat diets aren’t damaging to the heart and won’t put anyone at enhanced risk of heart disease or stroke. The catch is that participants in this study were limited to 20 percent saturated fat. 80 percent of their fats were polyunsaturated and monounsaturated, which is in line with modern research that shows replacing saturated fats with higher quality fats reduces the risk of heart disease.
Many Keto diet followers embrace all fats equally, so their diets may not protect their hearts as much as they assume. The best results come from a consistent diet of limited saturated fats and complete elimination of trans fats. A high-fat diet with too much trans fat is damaging to the heart, so the heart risks associated with a Keto diet depend on the quality of fats consumed.
The Reality of the Keto Diet Today
If the research behind the Keto diet is so encouraging, why aren’t all doctors recommending it to all patients? Dr. Marcelo Campo, MD, voiced some of the concerns of many doctors who aren’t totally sold on this diet when he wrote for Harvard Health Publishing in 2017. He noted that long-term studies into the impact of the Keto diet are yet to come, and that’s likely because the diet is so difficult to follow long-term. He does state that the diet is a good option for some people with certain medical conditions, but he’s correct that most people can’t follow the diet as a permanent lifestyle because it’s so restrictive.
In reality, the diet that researchers use in medical studies isn’t the same diet that most Keto diet followers consume when they’re not under the supervision of a medical professional. Many people jump into the diet after hearing about it from friends who have lost substantial amounts of weight or after reading about it online. They don’t talk to their doctors, and they don’t read books to learn about the diet. They simple cut carbohydrates and start loading up on fat.
Followers who don’t pay close attention to the type of fats that they consume are likely eating enough saturated and trans fat to clog their arteries and damage their hearts. Many find it too tedious to separate trans and saturated fats from higher quality fats, so they either follow the diet incorrectly or give up and declare the Keto diet too difficult to follow.
While you can lose weight if you just eat a lot of fat and treat carbohydrates as the enemy, weight loss and heart health are two different things. It goes back to the story of the two sisters who received two different dietary recommendations. What you eat and how you implement your chosen eating plan comes down to the medical conditions that you’re trying to treat, the health or fitness goals that you’re trying to reach, and your dedication to following the diet correctly.
So, Is the Keto Diet the Best Diet?
It’s clear that there is some research in favor of the Keto diet, especially if you’re obese and want to trim down quickly. This doesn’t necessarily mean that a diet high in fat is right for everyone. If followers treat it like a free-for-all on fat, they will end up consuming enough trans fats to bomb their hearts.
When the diet is followed correctly with limited saturated and trans fats, it becomes more restrictive and difficult to follow forever. This has driven some doctors to develop alternatives that make keto-style diets easier to embrace.
After studying the benefits of the Keto diet and other dietary alternatives, Dr. Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T. came up with the Pan-Asian Modified Mediterranean diet, which he refers to as PAMM. While he notes that an effective Keto diet is around 75 percent fat, 20 percent protein and no more than 5 percent carbohydrate, his recommended PAMM diet is 20-25 percent lean protein, 35-40 percent healthy fat and 40-45 percent low-glycemic carbohydrates.
Dr. Sinatra refers to this as an anti-inflammatory diet, but you can think of it as a tamer version of the Keto diet that many people may find easier to follow in the long term. After all, no diet is worth your time if you can’t turn it into a lifestyle that you follow consistently for the rest of your life. The PAMM diet offers those who struggle with the Keto diet an alternative that allows more carbohydrates and teaches the importance of healthy fat rather than just encouraging excessive fat consumption.