What’s the Deal With Keto?

Happy 2018! I had taken a social media break for a few weeks (which turned into months), and it seems that the blog came along for the ride. That being said, I’ve been planning this post for a while, so here’s the good, the bad, and my opinion on the ketogenic diet.

Have you heard of the ketogenic diet, or “keto”? It’s been around for a while, but only lately has it been getting crazy popular. I recently did some research on it (as in, a few months ago when I started this post) and came across some surprising data. I’ll get into it all below, but in case you came for the quick answer:

It is a very-low-carbohydrate, moderate-protein, and high-fat diet. You’ll rapidly lose some weight and maybe have a small, temporary improvement in cholesterol. If you previously suffered from seizures, you might have some relief. Soon you will have really bad breath, you will not be able to go to the bathroom, and your friends will taunt you with pizza. Then you will give up, regain the weight you lost, and be much happier.

So, as described, the ketogenic diet is a very-low-carbohydrate, high-fat diet. Contrary to popular belief, it is not high protein.

Let’s talk science: Your brain runs almost exclusively on glucose, a type of sugar. This explains why you feel irritable, have trouble concentrating, and maybe get lightheaded when you haven’t eaten in a while (i.e. “hangry”). When glucose is unavailable, certain amino acids (the building blocks of protein) can be converted to glucose to provide brain fuel. Unfortunately, fat cannot be converted to glucose.

When following a diet high in fat and low in carbohydrate, your brain needs an alternate source of fuel since there is no glucose available. Our incredibly adaptive bodies figured out that they could run on a type of fuel known as ketones. Ketones are compounds that are produced from fat when there is no glucose available. Hence, ketogenic diet. Someone who is producing ketones is said to be in ketosis. In summary: low carb, low protein = low glucose = ketone production.

Can you lose weight on keto?

Yup. As discussed, keto is a very-low-carbohydrate diet. This means you are cutting out several major food groups (starches, fruit, beans/legumes, most vegetables, milk and yogurt), limiting another (meat, eggs, fish, and poultry), and relying on fat to get your calorie needs (oil, butter, lard, some nuts/nut butters). Anytime you cut out food groups you will (probably) lose weight because you are limiting calories. In addition, when carbohydrates are the group you cut out, you lose a large amount of associated water weight. Another interesting thing: ketones may actually suppress appetite, therefore leading to fewer calories consumed.

What does keto look like?

It varies, but about 20-30 grams of carbohydrate per day. If you eat any starch, it will take up the majority of those grams (1 slice of bread is about 15-20 grams of carbohydrate). About 80% of your calories should come from fat, and the remaining from protein. Since amino acids (the building blocks of protein) can be converted to glucose, eating excessive protein can theoretically throw someone out of ketosis, therefore messing up the diet. High calorie oils and heavy creams are the foundation of this diet. Now, about that appetite…

Why would anyone go on this diet?

Well, you will lose weight. Seeing results reinforces behaviors even if they have unpleasant side effects. And, once you get over the initial adaptation period, I hear that you feel pretty good. There is no calorie restriction. It offers a black-and-white plan to follow (eat this, not that). Also, some studies have shown some temporary improvement in cholesterol levels (more on that below). As mentioned above, the diet is being studied clinically for the treatment of seizures. Overall, it is a trendy, popular diet provides straight-forward answers and produces fast results. Atkins diet 2.0.

So what’s the problem?

Why I don’t recommend the ketogenic diet

I don’t like restrictive diets.

95% of diet fail. They are unsustainable. This diet in particular makes it impossible to “cheat”. Once you are in ketosis, any excess carbohydrate can quickly put you out of it. Remember: your body prefers to run on glucose (carbohydrate), so as soon as glucose is available again, it is going to stop producing ketones. So if you commit to this diet, you are really committing. Some people are cool drinking oil for the rest of their lives; most are not.

It eliminates an entire food group.

Including fruits, vegetables, and whole grains. As a result, it is too low in fiber, vitamins, minerals, and phytonutrients and antioxidants. Fiber is important for bowel health and it provides fuel for your gut microbiome. Plant compounds, vitamins and minerals can help prevent chronic diseases such as heart disease, diabetes, and certain cancers. Remember: eat more vegetables.

The cholesterol improvements in the literature were short-term.

The longest study I found was done for up to 56 weeks. One-year is not really “long-term” when you consider a life span. Modest weight loss (5-10% body weight loss) over 6 months has been shown to be beneficial in lowering cholesterol, blood sugar, and risk for chronic disease. It’s possible that the cholesterol improvement can be attributed to the resulting weight loss rather than the diet itself. Furthermore, some people may be more sensitive to saturated fat intake than others, so I wouldn’t take these cholesterol results as a rule.

Ketones give you bad breath.

This might alienate you from your social support. Having a strong social support is associated with positive health outcomes.

I am truly fascinated by this diet. I love learning about it and discussing it… but I am not sure I could recommend it, even if there is some positive data. There are dietitians out there helping individuals follow a ketogenic diet. I don’t think they’re wrong, and if someone is set on doing it, I think dietitians are the most qualified individuals to help guide them successfully. My goal is to look at food from all angles – how will it fit into your lifestyle? There is a lot of gray-area in food, and this diet is as black and white as diet can get! As always, I like to look at the big picture: are you eating regular meals? Do you eat a fruit and vegetable once in awhile? Are you willing to try new foods? Do you have healthy coping methods for stress and emotions outside of food? If so, you’re probably doing alright.

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