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Well Being: February 2019

In Google’s 2018 year in review, the company declared the ketogenic diet, or keto diet, was the most popular diet search on the Internet. In 2019, I am sure the ketogenic diet will continue to remain on top of many diet searches.

February 1, 2019 
By Dr. Elias Markou

A number of my firefighter patients have tried the keto diet in the last few years. For firefighters, there are a few key questions about the ketogenic diet. First, what do firefighters need to know about the keto diet? Second, with such a demanding physical career, should firefighters be on a long-term ketogenic lifestyle?

The ketogenic diet has officially reached ultra-fad status. When lecturing at seminars or working with my patients I am always asked about the keto diet.

Let me take a minute to educate you on the ketogenic diet. It is a diet made up of 80 per cent fat (it can be plant and animal, but most often is animal fat), 15 to 20 per cent animal protein and zero to five per cent carbohydrates. A keto diet requires daily measurement of ketone levels in your urine, as a matter of fact ketosis needs to be happening day and night.

Many people claim to be on a keto diet and use the term “keto diet” loosely when, in fact, they are merely eating a low carb diet and never getting into ketosis. The easiest way to monitor ketosis is by purchasing urinalysis dip sticks from a health food store, pharmacy or online and randomly testing your urine two to four times per day. If in ketosis, your body will positively dump ketones in your urine, and the urinalysis will indicate this. Your urine does not lie. Check this out and test it.

 The number one reason firefighters land on a “keto diet” site on the Internet is for weight loss purposes. The keto diet originated in the 1920s when medical doctors were using it to successfully control seizures in epileptic patients, mostly children. With no carbohydrates in the body, the metabolism is forced to use fat as a source of energy. This fat has been shown to support the brain and reduce the number of epileptic events in children.

Firefighter candidates work super hard to become a professional firefighter. They train, exercise and watch their diet. Once firefighters have passed their gruelling entrance exams and become professional firefighters, diet and exercise regimes are often forgotten. Later on in their career, firefighters want to lose their weight gain and get healthy and active again and turn to diets like the keto diet.

Some of the pros of a keto diet are: it reduces insulin levels and inflammation; can lead to weight loss; you will eat more fat and less sugar.

Some of the cons of a keto diet are: it is a very strict diet and can be very difficult to follow for a long time; many of the fats that you eat will be animal fats and this can be unhealthy; you will not be eating foods that are healthy for your heart; there are some very dangerous risks and side effects associated with a keto diet; there is no research to suggest a keto diet is good for firefighters.

A 2018 Lancet article called, “Dietary Carbohydrate Intake and Mortality: a prospective cohort study and meta-analysis” by Seidelmann et al concluded that a low-carb/no carb diet (keto diet) resulted in a shorter lifespan than those who eat some carbs in their diet.

Another 2018 study in the journal of the European Society of Cardiology reported that people who are on the lowest carb diet/keto diet had a 32 per cent increased risk of death from any cause than those eating some carbohydrates.

Researchers found that people eating a low carb/no carb keto diet had a 51 per cent increased risk of dying from heart disease, compared to those taking in some complex carbohydrates (mainly vegetables).

For firefighters, this study is significant because we can assume that a keto diet increases the risk of heart disease. This is the number one cause of mortality in most of our firefighters. Avoiding a long-term keto diet might be a good idea.

To sum it all up, there is tremendous value in doing a ketogenic diet for a short term. I consider short term to be between seven and 14 days. A long-term keto plan can have many side effects.

Dr. Elias Markou is a naturopathic doctor. He is in private practice in Mississauga, Ont., and is the chief medical officer for the Halton Hills Fire Department. Dr. Markou was a firefighter for six years. He is a firefighter health expert and blogger who is regularly featured on television and radio and in print. Contact him at

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