Goldilocks and the Ketogenic Diet

My son was reading “Goldilocks and the Three Bears” during his circle time at VPK. He had never heard the story before, so when he discovered it, he thought it was a fairly ridiculous story. He had more questions than answers. Why was a little girl in the woods? What was this little girl doing, sneaking into somebody’s house? Why didn’t the bears just eat the girl? Leave it to my son to be logical when it came to this fairy tale.

Fairy tales and allegories are great teaching devices for children. There’s usually a moral to the story and it helps people develop sound values to avoid the pitfalls of everyday living. Experience is usually the best teacher. Everything we do shapes what we do next. When experience isn’t available, we have to rely on guidance, from a story or a parent, or even doing an online search. For doctors, we rely on research. Research studies in medicine try to verify theories to help us, as doctors, practice evidence based medicine. Sometimes, these studies are groundbreaking. Most of the time, they verify what we already know. The point of doing these studies is to fully realize the impact of medical treatments with their outcomes. Truthfully, not every doctor will have experience treating everything, but with research, they will have the necessary knowledge on how to practice sound medicine.

As an example, a recent study published in Lancet this past month found that diets both high and low in carbohydrates were linked with higher rates in mortality, while those that consumed moderate carbs had the lowest risk of the three groups. Seems obvious, right? Yet, the popularity of the ketogenic diet goes in the complete opposition of this study. I have patients that come in everyday asking about the ketogenic diet and whether it’s a good thing or a bad thing, so maybe it isn’t quite as obvious as it should be.

A ketogenic diet is basically a modified Atkins diet, where the ratio of carbs to protein and fats are skewed. Originally, it was intended to treat kids with epilepsy, but as a result of the significant weight loss that is usual for it, people have embraced it risking their own health. So, how does it work? Carbs are usually the primary source of energy that the body utilizes. By virtually eliminating or extremely reducing them from the diet, it causes the body to start burning up fats as its primary energy source. This causes the body to go into ketosis, using ketones from fat, as opposed to glycolysis, where glucose is the primary source of energy.

The problem with a high fat diet has two parts. The first is that with constant ketosis, the blood acidity increases causing possible damage to the endothelium in the vascular system. The second is that cholesterol will obviously also be affected, contributing to atherosclerotic plaquing of the vascular system. Plus, it makes a person feel lethargic and can potentially trigger a hypoglycemic event. Patients hope to reap the benefits of short term weight loss at the price of long term health. They buy their ph testing kits and constantly check their blood to see if the blood acidity is too high, but it’s nearly impossible to predict if the intravascular complications aren’t already happening. Ultimately, it’s too much risk to do this and not enough reward.

So, it seemed pretty obvious to me that extreme carb cutting will lead to premature heart disease and vascular problems and on the opposite extreme, extreme carb eating will potentially lead to diabetes and fasting glucose problems, which will also lead to premature heart disease and vascular problems. This study reminded me of Goldilocks; too much of an extreme in either direction is bad, and it’s important to find that “just right” middle ground.

Medical studies are intended to help guide sound clinical judgement and to change the skeptic’s perspective, to make the doubters have that momentous realization. For the ketogenic diet, there are consequences that may have repercussions later in life. Now, when patients ask me about the ketogenic diet, I always refer them to Goldilocks and now I have a study to back this up.

By: Dr. Juan Borja
Original post:

Skip to content