Ketogenic or low-carbohydrate and high fat (LCHF) diets have increased in popularity recently. Published data have shown that LCHF nutrition is extremely effective for weight loss, prevention or treatment of type 2 diabetes, and many other conditions[1-5]. LCHF nutrition also has favorable effects on biomarkers including fasting glucose and insulin, inflammatory markers, and most lipid markers  – notably triglycerides and HDL .
At Keyto, we are excited about the potential of ketogenic diets to radically improve human health. Since founding the company, we have explored all that is known about the relationship between nutrition (especially dietary fat) as relates to health and cardiovascular risk. We performed a comprehensive literature review, spoke to world experts in nutrition and medicine, and integrated all of our findings. This was our “Best Known Method” to accomplish the ultimate goal: Design the most scientifically sound nutrition program possible.
The Best Known Method philosophy is especially pertinent in nutrition, as every human needs to eat, and long-term gold-standard nutrition studies are rare and expensive. When performing our research, we confirmed so many benefits of the conventional keto diet. However, we also found it was ripe for improvement – an upgrade. Think of it as keto optimized or keto 2.0. We saw an opportunity to make subtle but important improvements that would enable all the benefits of ketosis, while offsetting the nagging concerns over the primary potential problem, increased levels of LDL cholesterol.
It is well known that some people adopting conventional ketogenic diets can see dramatic increases in LDL and other known blood markers of cardiovascular risk. It may be true that the increase in LDL is potentially offset by improvements in other markers such as insulin or triglycerides. It also may be true that increased LDL levels due to LCHF may not affect hard outcomes such as heart attack. However, the strong association between higher LDL and risk of cardiovascular disease is impossible to ignore.
We ultimately landed on a set of guiding principles that form the foundation of what we are now calling the Keyto Program – a Mediterranean-Style Ketogenic Program. It was a thorough and open-minded process, one which is ongoing and will continue to evolve as we learn more from our own studies and those of others. In the meantime, here are the core principles of Keyto:
- Low-carbohydrate, high fat or ketogenic nutrition is a powerful and sustainable weight loss program with many other health benefits.
- Intake of monounsaturated and polyunsaturated fats have favorable impacts on blood cholesterol levels, and diets high in these fats have been associated with reduced risk of cardiovascular disease[7,8]. We view these fats as healthy fats.
- Foods rich in healthy fats come largely from Mediterranean-style foods, namely plants and fish.
- Conventional ketogenic diets are typically high in saturated fats derived mostly from animal sources and these may increase blood cholesterol levels (in some people). The effect of this on cardiovascular outcomes is unclear, but the science is concerning. Importantly, there are great alternative options: replacement of some saturated fat in the diet with unsaturated fats can improve blood lipids without compromising the other benefits of ketogenic diets.
- It is perfectly reasonable to eat some saturated fat. Those that do not see an LDL increase from saturated fat, and those that are not concerned with LDL can have more saturated fat.
With these principles, our best known method led us to conclude that a Mediterranean-style ketogenic diet that prioritizes plants and fish with healthy unsaturated fats is optimal for heart health. Food from animal sources can be enjoyed in moderation.
This is just the beginning of our mission to create the optimal nutrition program for those who want to lose weight, improve health, and feel better. Importantly, the program also needs to be doable and sustainable, which is why we consider the Keyto Breath Sensor and Keyto app essential tools to be used as part of the Keyto Program.
– Ethan J. Weiss M.D. and Ray Wu M.D.
- Hallberg, S. J.et al.Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Therapy9, 583-612, doi:10.1007/s13300-018-0373-9 (2018).
- Hallberg, S. J., Gershuni, V. M., Hazbun, T. L. & Athinarayanan, S. J. Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients11, 766 (2019).
- Athinarayanan, S. J.et al.Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Frontiers in Endocrinology10, doi:10.3389/fendo.2019.00348 (2019).
- Yancy, W. S., Olsen, M. K., Guyton, J. R., Bakst, R. P. & Westman, E. C. A Low-carbohydrate, ketogenic diet versus a Low-Fat diet to treat obesity and HyperlipidemiaA randomized. Controlled trial. Ann Intern Med.140, doi:10.7326/0003-4819-140-10-200405180-00006 (2004).
- Westman, E. C., Tondt, J., Maguire, E. & Yancy, W. S. Implementing a low-carbohydrate, ketogenic diet to manage type 2 diabetes mellitus. Expert Review of Endocrinology & Metabolism13, 263-272, doi:10.1080/17446651.2018.1523713 (2018).
- Bhanpuri, N. H.et al.Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovascular Diabetology17, 56, doi:10.1186/s12933-018-0698-8 (2018).
- Estruch, R.et al.Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. New England Journal of Medicine378, e34, doi:10.1056/NEJMoa1800389 (2018).
- Kris-Etherton, P., Eckel Robert, H., Howard Barbara, V., St. Jeor, S. & Bazzarre Terry, L. Lyon Diet Heart Study. Circulation103, 1823-1825, doi:10.1161/01.CIR.103.13.1823 (2001).
- Kwiterovich, J., Peter O., Vining, E. P. G., Pyzik, P., Skolasky, J., Richard & Freeman, J. M. Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children. JAMA290, 912-920, doi:10.1001/jama.290.7.912 (2003).