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Is the Keto Diet Safe for People With HIV?

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Fad diets are nothing new. Even low carb fad diets are nothing new, as most of us forty-somethings can recall, and perhaps even tried, the famous “Atkins diet” in our 20s. (Eat bacon and lose weight? I’m in!)

The newest low-carb diet trending like crazy right now is the ketogenic diet, known to most simply as “keto,” which works by consuming high fat, moderate protein, low carb meals. Actress and comedian Melissa McCarthy attributes her recent major weight loss to keto — but is it safe?

While both the Atkins and keto diets encourage cutting carbs, Atkins recommended gradually increasing carbs over time, while keto places hard limits on carb and protein intake. This depletes the body of glucose, forcing it to primarily burn fat and produce an alternate source of fuel called ketones. A typical ketogenic diet follows this calorie breakdown: no more than 10 percent from carbs, no more than 20 percent from protein, and fat makes up the rest (about 70 percent).

These type of low-carbohydrate, high-fat diets continue to be popular because, well, they work — if your goal is a quick 10-20 pound shed before an event or vacation. But the maintainability of a low- or no-carb diet can be very difficult for most and many experts warn they may not be healthy for everyone, especially those living with chronic health issues such as diabetes, HIV, obesity, or heart conditions.

Last month, three doctors published an essay in JAMA Internal Medicine warning that using the keto diet as a treatment for obesity and diabetes “outpaces” current evidence, as reported in The New York Times. The authors noted studies that suggests keto has little advantage over more traditional lower fat diets in terms of leveling blood sugar, and that it could cause adverse side effects like constipation, fatigue. Worst of all, they say, for some it could increase LDL cholesterol particles, a risk factor for heart disease.

“The greatest risk, however, of the ketogenic diet may be the one most overlooked: the opportunity cost of not eating high-fiber, unrefined carbohydrates,” the authors wrote in the essay. “Whole grains, fruits and legumes are some of the most health-promoting foods on the planet. They are not responsible for the epidemics of Type 2 diabetes or obesity, and their avoidance may do harm.”

Still, other experts argue that low carb diets can have vital health benefits. Dr. David Ludwig, an endocrinologist at Harvard Medical School and the author of a best-selling book on low carb diets, said that because blood sugar levels will remain more stable after a low-carb meal, resulting in lower levels of insulin, a hormone that causes weight gain.

“Insulin is like a Miracle-Gro for fat cells,” Ludwig told The Times. “By lowering insulin levels, fewer calories from the meal may get stored in fat cells, leaving more to fuel metabolism and feed the brain. As a result, you may feel fuller longer after eating.”

But what about people living with HIV — are low carb diets like keto safe for poz folks? Again, expert opinions vary.

New research published on the online HIV resource TheBodyPro.com found that a low carb diet may actually be very beneficial for older people living with HIV. You see, keto may be trending, but it isn’t new. Doctors have been using it for years to treat for certain types of epilepsy and is now being studied in other conditions that involve inflammation, like diabetes, cancer, and Alzheimer's disease. And new research presented at the Association of Nurses in AIDS Care (ANAC) conference in Denver suggests that the keto diet may be beneficial for older people living with HIV who experience cognitive decline (supported by similar findings among older HIV-negative adults).

Though researchers haven’t been able to pinpoint why older people living with HIV are likely to experience more severe cognitive impairment than their HIV-negative counterparts, they do feel it may have something to do with the body's inflammatory response to the virus.

The research team, based at University of Alabama at Birmingham's School of Nursing, evaluated the keto diet’s effect on 14 HIV-positive older adults with cognitive impairment, splitting them into two groups. The first group ate a normal diet, and the second ate a combination of high-fat proteins and nuts and low-carb veggies. After 12 weeks, the keto group saw a significant improvement in executive function (they scored better on tests meant to evaluate memory, processing speed, and ability to switch tasks quickly). They also scored better on other cognitive measures, like attention span and spatial recognition.

Researchers concluded that the ketogenic diet might offer a viable non-drug solution for treating cognitive decline in older adults with HIV— which could lower the amount of drugs that need to be taken, therefore lowering toxicity levels. 

However, other major HIV resources raise concerns over the diet’s safety in regards to related HIV/AIDS conditions.

“The primary concern with this kind of diet is that the muscle is prone to loss or wastage,” argues a recent report on AfroAIDSInfo.org about the keto diet in terms of poz people. “Aside from that muscle tone degeneration may also experienced. In a normal diet, carbohydrates are typically used for the production of glucose. Due to that, the protein turns out to be the one responsible for muscle repair.”

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