Alert: This is NOT just another post by an angry RDN bashing the ketogenic diet while pointing to the government-set nutrition guidelines. I’m not ANTI-keto, buuuut I’m not in the keto-for-president camp either. 

I couldn’t let this topic go unaddressed for many reasons:

  1. The ketogenic diet is sweeping our culture just like every other fad diet has in the past, but it doesn’t seem to be going away anytime soon.
  2. It can be beneficial for certain conditions IF done correctly and under supervision and/or with planning and research.
  3. It can be harmful IF done incorrectly or haphazardly.

Let me explain.

First off, let’s make sure we are on the same page.

It is a high fat, low carbohydrate, moderate protein diet (we’re talking macros here). The usual macronutrient recommendation is:

~30% of your total daily calories from fat

~50% from carbohydrates

~20% from protein

In the keto diet (let’s just call it keto, shall we? everyone else is), you eat:

65-80% of your total daily calories from fat

5-10% from carbohydrates

15-30% from protein

This usually leaves you with about 30g carbohydrates per day, which is about the amount found in an apple or a quarter cup of black beans.

This macronutrient ratio is designed to trigger a state everyone talks about like the elusive “fat-burning zone” on your elliptical: ketosis. Are you in it? Are you not? How do you know?

When you are in ketosis it means your body is producing more ketones than normal because it is burning fat as a primary fuel source.

Usually you produce most of your energy (ATP, as your cells fondly refer to it) from carbohydrates, which readily break down into glucose (what we call blood sugar). When your body has to break down fatty acids (from fats) into ATP, ketones are produced as a byproduct.

Ketosis is your body’s backup engine for when you go longer than usual between meals. Or sleep. Or exercise vigorously. Or fast. Or starve.

You produce some ketone bodies in your normal daily life. The ketogenic diet aims to increase this production. You can ensure you are in an adequate level of ketosis by using urine test strips. (For more information on testing your urine and why you may want to change testing methods if you are on the diet for a while, go here.)

Science lover? Go here for a more detailed explanation of the catabolism of fats for energy.

What does a normal day on the keto diet look like?

Your meals will be comprised of a protein (best sourced from meat since high-protein plant sources are usually coupled with carbohydrates), some non-starchy vegetables, and fats.

Snacks look like nuts, cheese, avocado, beef jerky, hard-boiled eggs, etc. Breakfast might be Cauliflower Overnight “Oats”, lunch could be Portobello Pizzas, dinner could be meatballs over spiralized veggies and one dessert option is a Fat Bomb. For more ideas, go here or here.

This diet has been used for almost a century to treat those with seizure disorders after researchers found that ketosis significantly decreases the frequency of seizures. Recently, people have been wondering/researching the keto diet to see if it provides other benefits, such as:

-Weight loss

-More energy

-Decreased inflammation

-Better blood sugar management

-The cure-all for everything

Let’s pause here.

If you’ve found yourself considering the ketogenic diet, I’d like to challenge you to stop and consider WHY. What is the root problem you are trying to solve with a diet?

It IS a diet, after all. There are rules. You are either following them or not. Because of this, going on the keto diet buys you a ticket for the Diet Ferris Wheel. First, you will feel excited that you are trying something new…maybe this FINALLY will solve your ____ issue!! You research and plan and talk to others and see other’s successes on social media and think, “Yes, this is for me. I can have a new beginning.”

So you pick a start date and give it a go. It’s probably hard, but you muscle through for several days, weeks, or even months. You begin to realize that most of your friends are not following your same food rules and feel dismay when they all want to go to the new pizza place in town. You decide to go, but not to eat anything. Or maybe you don’t go, and instead comfort-eat coconut butter to deal with your FOMO. Either way you feel isolated. At some point, you’ll probably cave and have just the cheese and pepperoni and just a BITE of the crust or a bite of that donut or a couple glasses of wine or a scoop of sugary ice cream or sushi or anything else that is not kosher on the keto diet.

Cue the guilt. “WHY couldn’t I be stronger? What is wrong with me? Maybe I need to try something else.”

*gets on Instagram, sees a post about the alkaline diet, decides to try it*

And you’re going round again.

This is why I usually don’t recommend following any set of diet rules when weight loss is your goal. (If you’re interested in finding out my alternative method of becoming more intuitive with your body’s needs, you can book a session or drop me a line to find out more.)

What if weight loss isn’t your goal? Or at least not the only thing you’re seeking? What if you have a diagnosis that that you’d like to manage or cure? Is the keto diet the answer?

 

Maybe, just maybe, your health could be improved with a gentler method. Let’s analyze the TYPES of carbohydrates you’ve been eating. Or the types of fat. Let’s look at your gut health, micronutrient status, hormones, eating behaviors, etc.

I say “gentler” because the keto diet is anything but. Getting into and staying in ketosis is tricky.

If you can’t do it exactly, best case scenario is you’ll end up eating something like a modified Atkin’s diet. In this situation, you are tracking your carbs like crazy, but consuming fats and proteins freely. This version is much easier to follow and has shown to still be effective for folks using this as treatment for epilepsy. Not so bad.

The next possible scenario is that you have a hard time figuring out what to eat on the keto diet. You resort to eating more protein foods and don’t get enough fat to put you in ketosis. In this case, you are pretty much following the old-fashioned Atkin’s diet.

What if you decided you’re going to give the keto diet a good effort, but not going to sacrifice your social engagements or your fave foods. If you’re not following this through, you will essentially be consuming a high fat diet with occasional carb splurges that take you out of ketosis. So…what’s the point?

But for argument’s sake, let’s say you hit the nail on the head and reach ketosis.

Once you are in ketosis, here are some of the side effects you may experience:

Halitosis. Those ketones are likely going to give you acetone breath.

Withdrawal. When reducing your carbohydrate intake to that extreme, you may experience symptoms such as headache, mental fog, nausea, fatigue, etc. for a time. This is why it is very important to hydrate with water and electrolytes while on the diet, especially in the early stages.

Weight loss. You may experience weight loss from trying the keto diet. Is this because you are all of a sudden consuming less calories than you were before? Possibly. Whether you are eating the same amount of calories as before or not, you will likely experience an initial surge of weight loss from the water your body releases as part of the process of breaking down its energy stores (built up from carbohydrates) before converting to ketosis. This weight will be quickly regained if you consume normal levels of carbohydrates again, allowing your body to build those stores back up.

Micronutrient deficiencies. Cutting out grains, all fruit except berries, and several vegetables makes it more difficult to consume sufficient amounts of many micronutrients. In addition, being in ketosis may increase your need for certain nutrients, such as the minerals calcium, magnesium, sodium, and potassium.

Alterations in gut flora. Following the keto diet by consuming high levels of fat may alter your live-in bacteria and maybe not in a good way. This is still being researched.

I could go on. But my main point is…this diet comes with potentials cost and potential gains. Is it worth it for you?

There are two primary issues I would caution you to consider before trying the ketogenic diet for therapeutic reasons (i.e. to treat a condition or generally improve your health).

1) Are you able to digest and process copious amounts of fat?

2) Is it worth the risk for you personally, given that there is still much research to be done and it has not been researched in every condition?

As of now, is it NOT recommended if you have the following:

-Deficiencies or genetic defects in the pathways that converts fat into ATP

-Impaired gastrointestinal motility or history of gastric bypass (fat slows stomach emptying)

-Pancreatitis (pancreas produces lipase, which breaks down fats)

-Gallbladder disease

-Impaired liver function

-Kidney failure

-Pregnancy

If you decide to follow it, you must do it well. You will need to be more proactive about getting the nutrients your body needs to function well since your food sources are so limited. None of this loosey-goosey eat-the-rainbow-and-you’ll-get-everything-you-need applies here.

In my opinion, the best route would be:

  1. Get genetic testing to make sure your body will be able to support this alternative state without harm to your body or long-term negative effects. I recommend 23andme and then running it through Found My Fitness, Promethease and/or Genetic Genie.
  2. Tell your family and close friends what you will be doing and that you need their support.
  3. Decide how you will test for ketosis (urine strips, breath tests, etc.)
  4. See a dietitian to set up a game plan and take the time to come up with menu ideas.
  5. Try it for a few weeks at least.
  6. Analyze how it’s going and whether you wish to continue. It may take a couple weeks up to several months to experience the benefits of being “keto-adapted.”

All this to say, I am open-minded about the keto diet and am excited to see promising research in the areas of Alzheimer’s, Parkinson’s, cancer, and type 2 diabetes (see some of the articles cited below).

I’m going to continue to cheer on the researchers, but in the meantime, I want you to have a realistic, balanced perspective on what this diet really is and what we know about it so far! Hope this helped!

I used the following articles when writing this post and recommend them for further reading:

https://ketogenic.com/guides/beginners-guide-ketogenic-diet/

https://ketogenic.com/therapeutics/ketones-your-brains-preferred-fuel-source/

https://ketonutrition.org/

http://pediatrics.aappublications.org/content/102/6/1358.short

http://www.fasebj.org/doi/abs/10.1096/fasebj.31.1_supplement.636.37

http://obesity.imedpub.com/benefits-of-ketogenic-diet-for-management-of-type-two-diabetes-a-review.php?aid=14629

https://www.researchgate.net/publication/256648326_MICRONUTRIENT_CONTENT_OF_AN_OPTIMALLY_SELECTED_KETOGENIC_DIET