Doc: Benefit of keto diet doesn’t warrant extended use

Keith Roach
To Your Health

Dear Dr. Roach: What is your opinion of the keto diet? I have been doing it for a few weeks now and lost a few pounds, but it goes against everything I usually eat — high quantities of red meat, lots of full-fat foods and dairy. Since I am losing some weight and actually feel better and am sleeping better, I like the short-term results, but I cannot see this as a long-term way of life. I am concerned about all that fat going into my body and clogging my arteries. I exercise every day with Zumba, jogging, etc.


Dear J.P.: The ketosis diet favors very large amounts of fat — 60 to 80 percent of calories, with 15 to 20 percent of calories from protein and 5 percent or less from carbohydrates. The theory is to cause ketosis, a physiological condition of ketones in the blood as a result of high fat intake. It has been used since the 1920s as a treatment for seizures, but now is used for weight loss.

Like every diet, it has both good and bad aspects. On the good side, it is effective at short-term weight loss. However, much of the apparent early weight loss is due to water weight, which is a universal finding on a high-fat diet. Weight gain is likely when stopping the diet.

It is highly restrictive. Further, many of the foods that you can’t eat on this diet are those that have been shown to be associated with improved health, especially vegetables and most fruits. Most people will have a substantial increase in cholesterol levels (by as much as 50 percent). The red meat and saturated fat probably present an independent risk of heart disease and cancer (even apart from its effect on cholesterol), although this remains somewhat controversial.

I do not recommend the keto diet for long-term use, at all. It may have some benefit in helping with short-term weight loss, but I think there are much healthier alternatives for most people.

Dear Dr. Roach: A couple of years ago, a letter writer asked if you knew anything about the effect of Advil on men with enlarged prostates. It seemed that ibuprofen decreased his trips to the bathroom. I have found the same thing myself. Taking two Advil allows me to wait five to six hours before having to urinate. Has there been more research on why this happens?


Dear S.Z.: There is some more information. Men with symptoms of enlarged prostate often have increased urinary frequency, combined with incomplete emptying. This makes sense; if you can’t empty your entire bladder, you will have to empty it more frequently. So it seems the ibuprofen is letting you empty the bladder more completely. There are two major reasons for incomplete emptying, and different theories for why ibuprofen might work on each.

Benign (not cancerous) enlargement of the prostate is one reason. In this case, it is hypothesized that ibuprofen stops the growth of cells in the prostate, but the exact mechanism isn’t clear. Reducing the size of the prostate can allow better, more complete urine flow.

The other common cause of the prostate symptoms is inflammation of the prostate. In this case, ibuprofen’s anti-inflammatory effect reducing symptoms is easier to understand. The fact that it works so quickly for you suggests that the anti-inflammatory effect is more important in your case.

Ibuprofen has possible side effects, but two ibuprofen once a day is unlikely to cause significant problems.

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