Published on 12 April 2023

    Unlike traditional ketogenic diets, the Healthy ketogenic diet – which emphasises healthy fats, lean protein, and high-fibre foods – promotes weight loss without increasing bad cholesterol levels.

    She once lived an active lifestyle, and would regularly cycle or go for kickboxing lessons to keep herself fit, while also making an effort to eat clean and healthy. 

    But this all changed when Mdm Aisha Binte Aziz started a family – with additional responsibilities on her plate, she was unable to dedicate as much time and energy to exercising. Crucially, she began to find it a chore to control her diet, especially with her penchant for sweet treats.

    This change in lifestyle eventually culminated in Mdm Aisha, a Case Manager at National University Heart Centre, Singapore (NUHCS), growing obese. In January this year, she found herself at her heaviest at 80kg, with an unhealthy body mass index (BMI) of 32.9.

    However, the turning point came when one of her former patients at NUHCS failed to recognise who she was due to her weight gain over the years.

    “I used to be very active in the past, but then I started to eat a lot and didn't take care of my health,” recounted Mdm Aisha. “Then, a few months ago, a patient who I used to attend to a few years back returned to NUHCS. The patient, however, failed to recognise me because I had gained so much weight that I looked different. That was the wakeup call for me to make a change in my lifestyle.”

    Mdm Aisha’s resolve to lose weight and lead a healthier lifestyle was further strengthened after she received the results of her annual health check-up, which showed an unhealthy fatty liver reading, as well as high cholesterol levels.

    The irony of advising her patients at NUHCS to watch their diet, while being obese and eating unhealthily herself, was also not lost on Mdm Aisha.

    Determined to lead a healthier lifestyle, Mdm Aisha started a Healthy Ketogenic weight loss diet programme at the National University Hospital (NUH) in January this year. 

    The programme, which was developed by Dr Lim Su Lin, Chief Dietitian, Department of Dietetics, NUH, sees participants embark on a new Healthy Keto diet that emphasises healthy fats – such as those found in nuts, seeds, avocados, fatty fish and unsaturated oils – adequate amounts of lean protein, high-fibre from non-starchy vegetables, and low-carbohydrate fruits.

    Fat consumption is also kept at less than 50% of total daily energy, while the net carbohydrate level is also kept to 50g or less. This helps to induce ketosis, which is a metabolic state that occurs when your body burns fat for energy.

    This makes it different from traditional keto diets, which tend to have a high intake of saturated and trans fat, while fat consumption can account for up to 90% of total daily energy.

    In a study done by St. Paul’s Hospital-University of British Columbia in Vancouver, Canada, participants who followed a traditional keto diet were found to have significantly higher bad cholesterol (LDL) levels, which increases the risk of heart disease. 

    “Traditional keto diets are high in fat and calories, and allows for the consumption of unhealthy food like bacon or luncheon meat,” Dr Lim explained. “In contrast, a healthy keto diet is lower in saturated and trans fat, and restricts calories according to a person’s profile. 

    “As such, a healthy keto diet can help people achieve significant weight loss without increasing their bad cholesterol. This significantly lowers the risk of cardiovascular diseases, while also helping to reduce a person’s blood sugar levels.”

    Dr Lim added that the fibre-rich Healthy Keto diet helps to keep patients feeling full, while also aiding digestion and promoting gut health.

    “In many weight loss diets, people usually give up because of hunger pangs. The Healthy keto diet, however, induces the body to produce more of the Glucagon-like peptide 1 (GLP-1) hormone, which helps a person feel full,” Dr Lim said.

    “In addition, the diet also reduces levels of ghrelin – known as the hunger hormone – in the body. This helps to reduce a person’s hunger and appetite.”

    The effectiveness of the Healthy keto diet was put to the test by Dr Lim, who conducted a randomised controlled trial of the diet in the middle of 2021.

    The trial, which is still ongoing, involved an initial 80 participants from the National University Health System (NUHS). One group of participants was assigned to the Healthy Keto diet, while the other group was assigned to a standard low-fat, calorie restricted diet.

    Preliminary results from the trial after six months showed that participants from the Healthy keto diet group lost an average of 7.4kg, compared to 4.2kg from the other group. Indeed, participants who followed the Healthy keto diet programme closely were able to lose up to 27kg during the trial.

    Mdm Aisha herself lost 8.5kg in just over two months, while her fatty liver reading also dropped to a healthy level.

    Crucially, none of the participants in the Healthy keto group saw an increase in their cholesterol levels when it was measured again at the six-month and one-year mark.

    Dr Lim elaborated, “We also noticed several other benefits among the participants. For example, all those with diabetes or prediabetes were able to reduce their blood glucose levels. About 70% of participants with high blood pressure also saw it improved. 

    “In addition, all participants with high levels of liver enzymes at the beginning of the programme showed a reduction in their liver enzyme levels by the sixth month.”

    Dr Lim's Healthy keto diet programme also includes weight maintenance strategies to help participants keep to their target weight once they reach it, as well as a "relapse and rescue" plan. 

    “Obesity is a serious global health issue, which affects many Singaporeans,” Dr Lim said. “Keto diets are popular and yet often unsafe with potential side effects. Through this new method, we hope to provide patients with a safe and effective way to achieve their weight loss goals effectively without compromising their cardiovascular health.”

    In consultation with Dr Lim Su Lin, Chief Dietitian, Department of Dietetics, NUH

    Related Articles