Is a ketogenic diet a miracle cure for obesity? Diabetes? Epilepsy?
Some people say so. And while it certainly can help some people with health concerns, it is considered a “medical diet” that can be risky for other people.
The ketogenic diet or (“keto” diet) for short seems to be trending in the “health-o-sphere” lately, but in fact, it is a 100-year-old diet (that was developed to treat epilepsy), whose popularity has risen lately, in part due to celebrities who say the keto diet has helped them to lose weight. Studies confirm that the keto diet can help some people lose weight (at least in the short term), but there are a lot of ins and outs to low-carb high, fat nutrition and things to know about ‘going keto’.
Have you been wondering if the ketogenic diet is right for you? As a nutrition professional, let me help you better understand what it is all about and some of the things to consider before diving into the ketogenic diet.
What is the ketogenic diet?
Unlike popular ‘diets’ that focus on the amount of protein or carbs you eat, the ketogenic diet (or “keto” diet) focuses on fat. It is a very restrictive eating style that is a very-low-carbohydrate and high-fat diet.
Yes, a high-fat diet!
While fat had been unfairly demonized as the cause of obesity and a contributor to heart disease, diabetes, and cancer, new research in both people and animals suggests this is not the case (but keep reading before you jump into “keto”). Many people say—and some studies show—that it can some help to lose weight, yet it is by no means a magic weight loss diet that works all of the time, is easy to stick to, and contains all of the nutrition you need.
The keto diet is a low-carbohydrate, high-fat eating style that influences your body to burn fat as “fuel.” It works by changing your metabolism from using carbohydrates as your body’s preferred fuel to using fat (and ketones) instead. This metabolic change allows your body to maintain energy levels while consuming fewer calories, hence the weight loss.
How can you change your metabolism like that? Who should and shouldn’t try the keto diet? What foods are ketogenic-friendly? Read on to find out.
Food as fuel: carbohydrates vs. fats in the ketogenic diet
“Going keto” actually changes your metabolism, so it may or may not be right for you. This depends on your personal medical history and health goals. The idea behind the ketogenic diet is to switch your body’s metabolism to its backup mode.
Your body and brain prefer using carbohydrates, or carbs, as their main fuel source. Carbs are mostly sugars and starches that are found in many nutritious foods such as fruits, vegetables, legumes, and whole grains. Glucose is the primary source of energy for your tissues and organs, like your brain and muscles. Because your brain is so important to your survival (and humans evolved to live through periods of little access to food), you have a “backup” system to make sure your brain can still have the energy to help you survive.
Our survival in times of starvation depends on our body’s ability to fuel our brain, heart, muscles, and other critical organs we need to stay alive. So, what does your body do when there aren’t enough carbs to use? It turns to your backup energy source, ketones. Ketones are biochemicals naturally produced by your liver from fat in times of fasting when food is scarce.
It may sound counterintuitive, but the ketogenic diet mimics the effects of fasting without actually fasting. This happens by reducing the amount of carbs you consume so your body adapts and starts using fat. The word ketogenic means that our body is generating ketones and this can continue for as long as you eat a ketogenic diet.
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Is keto is right for you? Benefits and risks of “going keto”
The keto diet is not for everyone because it can be very restrictive and requires a lot of measuring of your macronutrient intake (fats, carbohydrates, and proteins). As you’ll see below, there is very special attention paid to the exact amounts of fats and carbohydrates each day to achieve and maintain ketosis when following a ketogenic diet.
In order to force your metabolism to shift into ketosis, you need to dramatically cut down on the amount of carbohydrates you consume and focus on getting most of your daily calories from fat.
The approximate macronutrient combinations for a ketogenic diet are:
70-75% from anti-inflammatory fat
20-25% from good quality protein
5-10% from low-glycemic, nutrient-dense carbohydrates (up to 50 grams per day)
For an average adult who needs 2,000 calories per day, that adds up to only 20-50 grams of carbohydrates per day. To put this into perspective, one medium-sized banana has 27 grams of carbohydrates.
This varies dramatically from the dietary guidelines that recommend:
25-35% fat
10-30% protein
45-65% carbohydrates (about 130 grams per day).
When your body gets under 50 grams of carbohydrate per day, like when on a ketogenic diet, the body will initially use its glycogen stores (glycogen is the storage form of glucose) which is found in the liver and muscle until they are depleted. Then the body goes through two metabolic changes. The first one is to make its own glucose (gluconeogenesis) and the second is to make the alternate fuel, ketones. This is how your body shifts into nutritional ketosis. This metabolic state continues as long as you strictly maintain this very low level of carbohydrate intake every day, yet this is only meant to be a short-term diet (up to 6-12 months) with a gradual transition back to a standard diet. As time goes on in nutritional ketosis, hunger subsides and this can result in an overall reduction of caloric intake which contributes to weight loss. Even though this diet can help with short-term weight loss, like most diets, it can be challenging to maintain and hard to sustain over the long run. Eating keto may benefit individuals with certain medical conditions; therefore, being recommended for them. The conditions include:
> Alzheimer's disease > ALS > Autism > Brain trauma > Cancer | > Depression > Epilepsy > Migraines > Obesity > Parkinson's disease |
As mentioned above, there are medical reasons why eating keto could be beneficial; however, there are also a number of health conditions that do not mix well with this diet, as it can make things worse. Being monitored by your healthcare practitioner if following these eating guidelines is important. This is why I also always recommended you consult with a Master’s level nutrition professional who can review your health goals and nutritional status if you are considering keto as an option.
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Most people don’t fall into the above-mentioned categories where a ketogenic diet is medically recommended - or not recommended. For everyone else, the diet comes with a list of potential side effects…with the most common being constipation, affecting between 14-46% of people.
Watch out for these side effects of the ketogenic diet
The long-term outcomes of maintaining a metabolic state of ketosis aren’t well-known right now. However, there are some well-documented short-term (less than 2 years) side effects to consider.
It can take two or three weeks of eating a strict keto diet before your body fully adapts to ketosis and uses fat for fuel. Some of the common short-term side effects, sometimes referred to as the “keto flu” include:
> Headache > Fatigue > Nausea > Vomiting | > Dizziness > Sleep difficulties > Difficulty with exercise tolerance > Constipation |
These “keto flu” symptoms usually clear up within a few weeks and can be minimized by ensuring adequate intake of fluids and electrolytes.
Other side effects of a keto diet can include:
Nutrient deficiencies (e.g., low bone density)
Lethargy, “fuzzy thinking,” and mood swings
Metabolic issues (e.g., dehydration, hypoglycemia, excessive ketosis, metabolic acidosis, and electrolyte imbalance)
Digestive issues (e.g., constipation, nausea, vomiting)
Liver, pancreas, and kidney issues (e.g., kidney stones, and hepatic steatosis or “fatty liver”)
It is also possible, but rare, for some people on a ketogenic diet to have a false positive breath alcohol test.
Because of these reported complications requiring medical intervention, it is recommended that people following a ketogenic diet have (at least) renal function and blood glucose monitored while following the plan.
As you can see, there are many reasons to consult a knowledgeable nutrition professional when starting a new diet and eating plan to discuss your health transformation goals.
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So what does the keto diet look like from a food and meal perspective?
Foods to eat and avoid for a ketogenic diet
Depending on how strict your keto diet is [daily fat to carbohydrate percentage] accurate measurement of the fats and carbohydrates in your diet is essential.
These are some foods to avoid on a keto diet:
Breads and baked goods
Pasta
Breakfast cereal
Starchy vegetables (potatoes, corn, peas, beans
Fruit (except berries)
Sweets
The most important thing – that with any diet you are eating eat [keto or otherwise] – is that the foods that you are fueling your body with are nutritionally balanced and provide you with enough of all of the essential nutrients you need every day.
Keto food for thought
The keto diet is very popular now and it may (or may not) be for you. As with any significant lifestyle change, sticking with a ketogenic diet can be tough. Sometimes the initial weight loss is motivating, but often the variety of food itself can become boring. Plus, if you start feeling side effects, this can be frustrating. More research is needed to know if the keto diet can help people lose weight and keep it off long-term.
Because this diet is restrictive, research says people following it are at risk for deficiencies in essential nutrients. This is because many foods packed with vitamins and minerals, like fruits and vegetables, contain carbohydrates that are highly restricted on a ketogenic diet. Planning is key when following this eating plan to ensure you always have food on hand that meet keto guidelines. Meal planning, shopping, and meal prep will set you up for success.
Some of the fruits and vegetables “allowed” on the ketogenic diet include small amounts of berries, leafy greens, brassicas (cauliflower, broccoli, Brussels sprouts), asparagus, bell peppers, cucumber, celery, summer squashes, mushrooms, onions, and garlic.
Since the ketogenic diet is based on eating a lot of fat, I recommend choosing healthy sources like olive oil, avocados, nuts, and seeds. Here is one of my favorite low carb, high (‘good’) fat recipes you can try:
If you do follow keto and decide to go back to a standard diet, the transition should be slow and well-controlled. Right now, there isn’t much research on how this diet affects people after they discontinue it, or for those that continue beyond the first two years.
Instead of experimenting yourself (and wondering if the keto diet may be right for you), I highly recommend that you consult with a Master’s level nutrition professional who can review your nutrition goals. I can help.
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