Healthy Keto Diet To Lose Weight

NUH's Department of Dietetics chief dietician, Dr Lim Su Lin, with meals prepared following the Healthy Ketogenic diet. ST PHOTO: NG SOR LUAN

SINGAPORE – Weighing 115kg and standing at 1.74m, Mr Tan Ban Thong had trouble buying clothes. Walking a short distance left him breathless and flying was tough as airplane seats were often not wide enough.

The breathlessness has gone away, and he has better control of his health issues, including diabetes, hypertension and non-alcoholic fatty liver disease. 

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The secret to his success is the Healthy Ketogenic diet developed by Dr Lim Su Lin, the chief dietitian at the National University Hospital (NUH).

The key feature of the diet is keeping to a net carbohydrate level (carbohydrates minus fibre) of 50g or less a day to induce ketosis, where stored fat (instead of glucose) is broken down to provide energy.

“In many weight loss diets, people usually (give up) because of hunger pangs, ” said Dr Lim, at an event to share the findings of a study on the diet at NUH on Wednesday.

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With a healthy keto diet, however, once a person reaches ketosis in typically two to three days, the gut will naturally produce higher levels of glucagon-like peptide-1 (GLP-1), a hormone that helps to increase satiety and reduce cravings, she added.

It is unlike traditional keto diets, where one may eat a high amount of saturated fats and red meats in place of carbohydrates. Such diets have been linked to increased levels of low-density lipoproteins (LDL), or bad cholesterol.

This keto diet emphasises healthy fats, such as those found in nuts, seeds, fatty fish and unsaturated oils, as well as lean protein, high fibre from non-starchy vegetables and low-carb fruit. Fat consumption is kept at less than 50 per cent of total daily energy, unlike a traditional keto diet, in which fat can account for up to 90 per cent of total daily energy. The healthy keto diet also restricts calories according to the person’s profile.

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Dr Lim said that participants on the diet in an ongoing clinical trial showed no increased level of LDL at the six-month, as well as the one-year mark.

The trial involves 80 participants who are National University Health System staff, like Mr Tan. They all had a body mass index – a measure that uses height and weight to work out if one is at a healthy weight – of more than 27.5.

The group assigned the healthy keto diet lost an average of 7.4 kg over six months, while another group assigned a standard low-fat, calorie-restricted weight-loss diet lost an average of 4.2kg. They used the NUH’s nBuddy keto mobile app to help them select their food.

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At six months, all the participants with diabetes or pre-diabetes managed to reduce their blood glucose levels, while 70 per cent of those with high blood pressure saw it improve. Those who followed the healthy keto diet closely also found a reduced dependence on their prescribed medications and overall, a better quality of life. 

Dr Lim Su Lin (centre), chief dietitian at NUH’s Department of Dietetics, with dishes prepared according to the healthy keto diet. With her are trial participants (from left) Shawn Tan, 45, Tan Ban Thong, 61, Aisha Aziz, 48, and Lilis Suryani, 38. ST PHOTO: NG SOR LUAN

In the past, said Mr Tan, he would make a beeline for hotel buffets whenever he travelled, but on a recent trip to Vietnam, he asked the chef to prepare a fish and vegetable meal for him. “I can now taste the sweetness of vegetables, ” he said.

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Another participant, Mr Shawn Tan, 45, who used to weigh 99kg, said he had to buy new clothes after losing 18.5kg. His diabetes, high blood pressure and high cholesterol are now better controlled.

Madam Aisha Aziz, 48, who had a BMI of 32.9 at 80kg and lost 8.5kg, said she had to stop going out to eat with friends for a while. Now she opts for a starter at restaurants instead of a main course.

Data showed that 80 per cent of the participants were able to maintain their weight for up to a year after they switched to the healthy keto diet, said Dr Lim.

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The trial ends in June, after which the healthy keto diet will be made available to NUH patients who have a BMI of 25 and above, Dr Lim said.

She has worked with a local food manufacturer to develop a range of healthy ketogenic ready-to-eat frozen HealthFull meals for those who may not be able to cook a healthy keto meal from scratch.

Dr Lim, who has intellectual property rights over the diet meal recipes, said she wanted the meals to be tasty so that those on the diet will be motivated to stay on it. Each of the meals contains not more than 17g of carbs and uses lower-sodium salt, she said. A one-week trial package contains 14 meals at $12.50 each.

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“Restricting carbs will create a ketotic state, and this will produce keto acids, which are associated with alterations in perceived appetite and modification of appetite-regulating hormones. This will lead to weight loss, ” said Dr Kalpana Bhaskaran, the president of the Singapore Nutrition and Dietetics Association.

“The healthy keto diet focuses on low-saturated fats and trans fats, and this will help to reduce the LDL cholesterol levels. This meal plan also focuses on total calorie restriction, ensuring that 50 per cent of calories is from fats, which is the reason for the weight loss.”

Korean japchae prepared following the Healthy Ketogenic diet. The diet emphasises healthy fats as well as lean protein, high fibre from non-starchy vegetables and low-carb fruit. ST PHOTO: NG SOR LUAN

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A key challenge in the healthy keto diet is how long people can stay on it, particularly as refined carbohydrates form the bulk of the calories in an Asian diet, said Dr Kalpana, who is also the head of the Glycemic Index Research Unit at Temasek Polytechnic.

Protein calories also tend to be more expensive than carb calories, and this diet may not resonate with lower socio-economic groups, she said.

Vegetarians will have limited protein options because legumes and pulses such as soya bean milk, tofu, taukwa, plant-based milk, tempeh and chickpeas all contain substantial amounts of carbs, she said.The Ketogenic diet plan is basically a low carbohydrate and high fat intake diet. It has become popular nowadays due to its ability to shed pounds quickly safely yet effectively. It involves reducing your carbohydrate intake and replacing most of it by fat. This process puts your body in a metabolic state called ketosis, where an increased amount of ketones are produced in the body.

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When this happens, the body starts burning fat very efficiently and turns it into ketones. It lowers the blood sugar and insulin levels, and the body’s metabolism shifts mainly towards ketones from fat than carbohydrates. A study claimed that people lost weight 3 times faster and better than other fad diets. They also had improved cholesterol and overall health levels.

A Ketogenic diet plan requires a person to keep track of the carb amount intake of a person. The daily intake of protein is modified depending upon the height and gender. The typical Ketogenic diet takes 70% calories from the fat present in the body, 20% from proteins, 5-10% from carbohydrate. The ketogenic diet is extremely filling due to its majorly being fat and reduces hunger to a great extent.

The original keto diet was the classic keto diet, designed by Dr Russell Wilder in Mayo Clinic for the treatment of epilepsy. Classic keto changes the intake of various macronutrients to 4 parts of fat intake for every 1 part of carb and protein. 90% of the energy requirement is met by fats in a keto diet, 6% from protein and 4 % from carbohydrates. This ratio changes the way energy is metabolized in the body and induces a state called ketosis. It has a variety of therapeutic benefits for the sick and the healthy too. The body is forced to spend calories from its own fat store rather than depend on dietary intake, making it extremely effective for weight loss. (1)

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When having to eat out, select fat or protein-based diets such as egg and meat. Order more vegetables and opt-out of dessert preferably.

It can consist of 500-600 calories, with 50 gms of fat, 25 gms of protein and 5 gms of carbs. Examples are buttered and poached eggs with heavy cream and bacon.

It can consist of 700-800 calories, with 60 gms of fat, 25 gms of protein and 10 gms of carbs. Examples are grilled chicken with olive oil, salad with greens and ranch dressing.

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It can consist of 500-600 calories, with 50-60 gms of fat, 20 gms of protein and 5 gms of carbs. Examples are grilled steak with butter and heavy cream and broccoli and mushrooms.

1. It increases the body’s metabolism to utilize and burn the fats already present. In case of a high carb diet, the fat present in the body doesn’t get burned easily and becomes very difficult to use at a later point in time. Ketosis helps in