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Delicious and sustainable keto diet


NUH is serving a fresh take on the traditional ketogenic diet, transforming it into a more appetising plan that aids in weight loss without compromising on heart health.
Issue 1 | June 2023

Delicious and sustainable keto diet

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Amidst the growing consciousness around food intake and health, various dietary plans emerged over the years to mixed success, blurring the lines between fad and fact. Even seasoned dietitians like National University Hospital (NUH) Chief Dietitian Dr Lim Su Lin exercise great care in prescribing what to serve on the plate, accounting for factors like comorbidities and recognising that each person has highly individualised circumstances.

Take the ketogenic diet, for instance, which limits carbohydrate consumption and substitutes it with high fat content. It banks on the body's ability to use stored fats as an energy source when glucose levels run low - a state known as ketosis - but inconsistent results arise from individuals needing different degrees of dietary restrictions to trigger this fat-burning process. Moreover, indiscriminate fat intake can raise the levels of low-density lipoprotein or bad cholesterol, heightening the risk for heart disorders.

"Keto diets are popular but yet often unsafe with potential side effects," says Dr Lim. "Long-term success is also elusive, as people tend to give up because of hunger pangs when following weight loss diets."

While it may be easy to point fingers at a lack of willpower, Dr Lim took it upon herself to craft a dietary plan that inherently would be easier to sustain in the long run. By focusing on healthy fats, adequate fibre and protein, her healthy keto programme not only promotes weight loss, but also holds bad cholesterol in check - and is above all, appetising and satiating.

How much fat is too much?

Fats have a bad rep when it comes to weight management, as many might associate the term with rising numbers on the scale. The keto diet's recipe for success lies in cutting down on carbohydrates and relying instead on fat as fuel. Typical keto programmes call for only 5 to 10 per cent carbohydrates, 10 to 20 per cent protein, and fats covering the rest, even as much as 90 per cent of the total energy intake, without any restrictions on the calorie intake.

"However, the problem with keto arises when one's fat sources are unhealthy - high in saturated fat content such as bacon and sausages - which lead to increased bad cholesterol levels," Dr Lim explains.

Earlier this year, researchers from St. Paul's Hospital-University of British Columbia in Canada reported links between low-carb, high-fat diets and greater cardiovascular disease risk based on UK Biobank data. The study had followed participants for over a decade, finding that nearly 10 per cent of those on keto-like diets experienced at least one cardiac event, such as a heart attack, artery blockages or stroke.

To combat these detrimental effects and yet leverage the strengths of ketogenesis for weight loss, Dr Lim formulated the Healthy Keto diet, rooted in being more deliberate about the types of fats and amounts of calories consumed. In this carefully concocted diet, fat portions comprise less than half of the total daily energy intake, with emphasis on unsaturated fat sources such as nuts, avocados and fish. Carbohydrate intake is kept to 50 g per day to induce ketosis, with high fibre resistant starch included to promote gut health. Lean protein, high-fibre vegetables and low-carbohydrate fruits round out the menu, ticking all the nutritional needs.

Dr Lim further explained that the diet is associated with greater production of a molecule called glucagon-like peptide 1, increasing satiety. It also reduces levels of ghrelin, the hunger hormone, to abate one's appetite and cravings.

"Our healthy keto diet can help people achieve significant weight loss without elevating their bad cholesterol. This lowers the risk of cardiovascular diseases and helps control blood sugar levels," she says.

Sustaining healthy habits

The challenges to sustain healthier eating habits and lifestyles spur Dr Lim to seek better ways to help people improve their relationship with food and take charge of their health in the long run. Although the benefits of losing weight among the overweight and obese are well-recognised, studies have shown that people often revert to their unhealthy lifestyles within a year or even sooner, leading to weight rebound.

"Refining dietary plans takes time, especially because there is often no one-size-fits-all solution and each individual may need a personalised programme," the Chief Dietitian.

Healthy Keto Diet at NUH: By the numbers

To make it easier for people to lose significant weigh upfront and stay on track afterwards, Dr Lim has not only created an assortment of Healthy Keto meals, but is also working with a local food company to develop ready-to-eat meals and packages. These tasty meals make the dietary programme a much more palatable and enticing experience, while also easing the burden on participants who may not have the luxury to do meal planning and prepare their own Healthy Keto dishes. The whole weight loss programme, which also includes strategies to sustain life-long healthy habits, is available in our website.

As research on the healthy keto diet continues, Dr Lim has high hopes for the long-term impacts of the programme - envisioning to empower patients with a safe and effective way to reach their health goals and ultimately lead healthier lives.

Getting started on a new dietary plan can be daunting without knowing what is safe to prepare and include in meals. People looking for cooking inspiration can follow various dietitian-certified resources including this keto-friendly chicken rendang recipe.

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