In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.
Saturated fats in food will pack on more visceral fat than polyunsaturated ones, according to a 2014 Swedish study. When subjects ate 750 more calories daily for seven weeks, either in the form of palm oil (saturated) or sunflower oil (polyunsaturated), the former gained more visceral fat while the latter gained more muscle mass and less body fat. The study authors believe different fat types can impact both the way your body forms fat and stores it. What’s more, including healthy fats in your meals can make them more satiating and keeps hunger at bay.
When a person goes off the ketogenic diet and regains much of their original weight, it’s often not in the same proportions, says Kizer: Instead of regaining lean muscle, you’re likely to regain fat. “Now you’re back to your starting weight, but you no longer have the muscle mass to burn the calories that you did before,” she says. “That can have lasting effects on your resting metabolic rate, and on your weight long-term.”
When carbohydrates are used by the body as an energy source, the blood sugar levels become unstable. As the energy source is not consistent it is difficult for your brain to stay focused for long periods of time. On the other hand, when you are in ketosis and the brain uses ketones as a fuel source, which has a consistent fuel source and you can focus for longer periods of time. Hence, you also tend to feel more active and alert.
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed; 24% occasionally prescribed the diet as a last resort; 24% had only prescribed the diet in a few rare cases; and 16% had never prescribed the diet. There are several possible explanations for this gap between evidence and clinical practice. One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.