I read that the Journal Of The American Medical Association (JAMA) has published that they will be conducting a study on the ketogenic diet. Does this mean they will make it a legitimate medical diet?

It does mean the medical world is taking the ketogenic diet seriously. The study will run in 2018. Twenty-five overweight and obese adults will be secluded at a lakefront centre in Massachusetts, United States for three months. (I know, it sounds like a dream holiday.)

Before they check in, they have to lose 15% of their body weight on a diet that restricts calories. After that, they go to the centre where they will be randomly assigned one of these diets:

1. A low-fat, high-carbohydrate diet with high added sugars.
2. A low-fat, high-carbohydrate diet with low added sugars.
3. A very low-carbohydrate, high-fat ketogenic diet.

After three months, they will be followed up regularly while another group takes their place. There will be five groups over three years.

JAMA has also published a meta-analysis of 13 randomised controlled trials – the highest degree of medical evidence to push for a treatment or diet – that suggested people on ketogenic diets lose more weight and keep that weight off compared to people on low-fat diets.

How do I begin a ketogenic diet? I’m not used to eating fats. Our Malaysian diet has a lot of rice, noodles and bread in it. I suppose those would constitute a high carbohydrate diet, correct?

Correct. To be on a ketogenic diet, you might have to prepare a lot of your own food. Or at least be mindful of what you eat outside. You can even plan how fast you get into the ketogenic state (fat burning). The more you restrict your carbohydrate intake, the faster you get into ketosis.

However, you are also more likely to get the side-effects. In the very carbohydrate-restrictive sort of ketogenic diet, you are supposed to eat only less than 15g of carbohydrate a day. That is equivalent to 1.5 slices of bread! You basically limit all carbohydrates so that your body will burn calories from fat.

Give me a list of foods to eat and to avoid.

You can eat:

• Meats – chicken, fish, beef, lamb, poultry, pork, eggs, etc.

• Leafy greens – kangkung, kailan, lettuce, spinach, kale, etc.

• Vegetables that grow above the ground in general (because they are not starchy) – broccoli, cauliflower, brinjal, bitter gourd, etc.

• High fat dairy products – cheese, high fat cream, butter, etc.

• Nuts and seeds – kacang putih, macadamias, walnuts, cashews, kuaci, etc.

• Certain fruits – avocado, raspberries, blackberries, and other low glycaemic impact berries. A ketogenic diet does not advocate fruits other than these because most other fruits contain a lot of fructose (sugar)

• Sweeteners – if you really must sweeten your coffee!

• Other fats – coconut oil, high-fat salad dressing, etc.

Don’t eat:

• Grains – rice(!), wheat (bread, roti), noodles, corn, cereal, etc.

• Sugars – any added sugar to sweeten your coffee or tea, honey, maple syrup, honey etc.

• Fruits – apples, bananas, oranges, papayas, watermelon, ciku, etc.

• Tubers – potatoes, yams, etc.

I realise this is going to be difficult for a Malaysian diet. But if you want to go full keto, you have to make the effort. Plenty of Malaysians have done this and lost weight.

Does this mean then that I can eat all that I want within the range of what I can eat?

You should keep your meal ratio at 70% fats, 25% protein and 5% carbs. It is not that easy, trust me, especially on the fats. But opt for fatty meats like chicken with skin and fat on, and steaks with a lot of fatty marbling such as the rib eye.

A lot of people supplement their fats by taking coconut oil or cheeses as a snack. The fat will keep you from feeling hungry and make you feel energised. But you cannot eat how much you like. If you want to lose weight, you have to restrict your calorie intake in the ratio we’ve mentioned.

What are the side-effects of the ketogenic diet?

This is what causes most dieters to drop off. That’s why when you start keto, you should not do a severe version of it but ease yourself gradually into that ratio. Always properly hydrate yourself with liquids and minerals because most of the side-effects are from poor hydration.

The side effects include:

• Keto flu (the commonest) – flu-like symptoms.
• Dizziness and drowsiness
• Inability to sleep
• Heart palpitations
• Frequent urination and diarrhoea
• Muscle cramps

Side-effects are usually the worst in the first week or so, before gradually improving.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.