I review the pros and cons of the Keto Diet and if it leads to weight loss.
I wasn’t planning on writing about the ketogenic diet but that all changed with my recent YouTube video. My girl Abby Langer and I found a hilarious Reddit thread that shared some keto-followers favourite “strange but delicious” keto-friendly meals and snacks. Let’s just say, it was extreme. I was by no means under the impression that everyone on the Keto diet ate that shit. I get why some viewers on youtube maybe thought that and they got PISSED. Like, viciously pissed.
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I decided to share what I ACTUALLY think on all things keto. I want to give you a comprehensive review of the diet so there’s no confusion. At the end of the day, ‘haters gon hate’ but at least I can sleep at night knowing I’ve done my due diligence in whole heartedly giving you all the necessary information around this diet.
Let’s dive in.
What Is the Keto Diet?
If you haven’t already jumped on the keto diet bandwagon, I’ll give you a brief introduction. Basically, the ketogenic diet is a super high in fat (65-75% of your diet is fat), a super low carbohydrate (<5% of your diet) and moderate in protein (15-20% of your diet). Surely, not the most balanced of diets considering Health Canada your diet should contain 10-35% of protein, 45-65% of carbohydrate and 20-35% of fat. So how to you meet that skewed macronutrient distribution? Well, you load up on keto diet staples like meat, fish, butter eggs, cheese, heavy cream, oils, nuts, avocados, seeds and low carb green vegetables. And you cut out all your go-to carb sources like grains, rice, beans, potatoes, sweets, milk, cereals, and fruits. These kinds of restrictive diets tend to make nutrition professionals like dietitians run for the hills but I’m going to give it my honest unbiased account.
dietitian’s keto diet review
Dos and Don’ts of a Keto Diet
PROTEIN
Dos: Most proteins are fair game with a keto diet, however it is encouraged to enjoy organic, grass-fed or pasture-raised meats. On a keto diet you can enjoy a variety of protein sources such as whole eggs, fatty fish like salmon, seafood, organ meats, steaks, pork, poultry and more.
Don’ts: While the majority of proteins are okay in a keto diet, any meats or protein sources with added sugars is a no no.
OILS AND ADDED FATS
Dos: Fat makes up a huge part of the keto diet because it’s basically your main fuel. That is why it is encouraged to choose organic and grass-fed whenever possible. Excellent fat sources include olive oil, mayonnaise, coconut oil, butter, lard and other non-hydrogenated or unprocessed oils.
Don’ts: As long as there are no added sugars to the fat source, most fats are fair game.
NUTS AND SEEDS
Dos: Nuts and seeds are the best snack to fuel your day on a keto diet. Excellent sources include almond butter, flax seeds, macadamia nuts, brazil nuts and pecans.
Don’ts: Nuts covered in sugar are a no no.
DAIRY
Dos: Enjoy all of the cheese you would like on a keto diet. On top of that other great dairy sources include whole milk, full fat Greek yogurt and cream.
Don’ts: Avoid yogurts and creamers that are sweetened because they can quickly add to your overall carb count for the day.
FRUITS AND VEGGIES
Dos: To avoid constipation, load up on low carb veggies like kale, spinach, cabbage, mushrooms, green beans and green bell peppers. Some lower sugar fruit options include blueberries, blackberries and raspberries, but eat them sparingly.
Don’ts: Since fruits are high in sugar and carbs, they are usually a no go except for the few mentioned above. Fruits that are usually avoided on a keto diet include oranges, grapes, mangos, apples, papaya, pineapple, bananas, dried fruit and fruit concentrates. Avoid highly starchy vegetables like potatoes, corn, parsnips and yams.
GRAINS
Don’ts: All grains, even whole grains, should be avoided on a keto diet. A high intake of carbs will interfere with ketosis.
BEANS AND LEGUMES
Don’ts: Due to their high starch content, beans and legumes should be avoided.
What is Ketosis?
Ketosis is natural and normal, though arguably not optimal.
Our bodies run well on glucose (carbs)–they give us the necessary energy we need to function on a daily basis. When our body doesn’t get enough glucose (either because we’re cutting carbs too low, OR we haven’t eaten in too long), our body kind of freaks out and looks for other forms of energy to satisfy that role. That’s where the fat comes in. Without carbs, our insulin levels drop and fat is released from our cells. The fat overwhelms the liver which turns it into ketones, our body’s second choice to carbs for energy.
So, to confirm. Yes, your brain CAN function without carbs, but carbs are still your brains favourite good and some brain cells can only use glucose for fuel.
Ketoacidosis in Diabetes
It’s important we distinguish between the process of ketoacidosis seen in type 1 diabetes and this ketosis that so many people on the keto diet are striving for. If someone with diabetes lacks enough insulin and/or does not eat enough carbohydrates, they risk entering a state known as ketoacidosis. For those with uncontrolled diabetes, this can increase the levels of ketones in the blood, increasing the acidity of the blood, and potentially leading to a coma or even death. In ketosis for a healthy individual, the level of ketones in the blood never reaches these crazy high levels so it’s generally safe for the average healthy individual.
Bottom line: Ketosis is not ketoacidosis and is generally safe for most healthy people.
Keto Diet History
So where did the ketogenic diet come from? Interestingly enough, this fad diet didn’t spark from a celebrity endorsement or some guy missing a medical license. There’s evidence of the keto diet being used back in the early 1920s to treat severe childhood epilepsy and it’s still being used today for that purpose. Research suggests that the production of ketones may influence neurotransmitter activity in neurons allowing for a reduction in seizure attacks.
A recent Cochrane Review demonstrated a 30-40% reduction in seizures compared with non-keto diet controls. One thing to keep in mind, however (which is a theme when discussing the keto diet) is that it’s generally difficult to adhere to and difficult to tolerate for a lot of people. In other words, people go on it and then come off it pretty damn quick.
Neurological Diseases
Once the medical community acknowledged the keto diet’s effectiveness in reducing seizure episodes, they decided to look further and study its impact on neurological diseases in general. Neurological diseases share a common problem – a deficiency in energy production. Ketones provide that energy for normal brain cell metabolism, and may even be a more efficient when the body is in starvation mode. When patients were put on the keto diet, the number of mitochondria (energy powerhouse) in brain cells increased. Ketones may also act as an antioxidant by inhibiting the formation of reactive oxidant species, which is why they may have promising effects in the treatment of certain cancers in conjunction with chemotherapy.
A 2017 mice study from the University of California found that a ketogenic diet (90% of calories from fat) lead to an increased life span, memory and motor function. Researchers observed a 13% increase in median life span when compared to a high carb diet.
Really exciting stuff, actually. Let’s look at a few other specific neurological diseases and the impact of the keto diet there.
Alzheimer’s Disease
In a study, Alzheimer’s patients fed with a ketogenic diet experienced improvements in their symptoms, which again may be due to the improved mitochondrial function. In another study, patients with Alzheimer’s were given a drug with ketones and after 90 days, they experienced improvements in cognitive function.
Parkinson’s Disease
In a pilot study, five out of seven patients trialed a keto diet for 28 days and showed marked reduction in physical symptoms. Parkinson’s attacks our human nervous system, partially as a result of an abnormal accumulation of a protein called alpha-synuclein. Research suggests that a ketogenic diet may reduce the associated cognitive and motor symptoms.Obviously, we need more research here but its an exciting finding.
Multiple Sclerosis
This also may be too premature, but an animal study found that the keto diet delayed motor neuron death and showed MS improvements, however it did not increase the life span of the subjects. In an exciting 2016 study, the ketogenic diet improved the quality of life, physical health and mental health of patients living with MS.
Cardiovascular Health vs keto reviews
What about heart health and the keto diet? Previous older schools of nutrition would purport that a diet rich in fats (specifically saturated fats) would be detrimental for heart health. However, more recent research suggests that saturated fat is not as bad as previously believed. There is actually a tiny little bit of evidence that a keto diet may improve triglyceride, HDL and LDL levels. Like here and here. An even more recent study found that a keto diet improved triglyceride, HDL and LDL levels. We’ll definitely have to wait to see how that research unfolds.
Type 2 Diabetes vs ketogenic diet review
There have been many attempts at studying the link between type 2 diabetes and the keto diet. In one study, a strict low-carbohydrate diet was administered in obese patients with type 2 diabetes. After 14 days of being on the diet, the glucose levels of participants normalized. Their hemoglobin A1C decreased from 7.3% to 6.8% and insulin sensitivity improved by 75%. Some of this study’s limitations include the short duration, the small sample size and the weak control group. In another study, 84 obese patients with type 2 diabetes were randomized to either a low-carbohydrate keto diet or a low-glycemic reduced calorie diet. At the end of the study, both groups experienced improvements in glycemic control. However the low carb keto group had greater improvements in hemoglobin A1c and higher HDL levels compared to the low-glycemic group.
A more recent 2017 study in the journal of Nutrition and Diabetes found that a low carbohydrate ketogenic diet for 12 months led to greater reductions in HbA1c and body weight. These results suggest that low carbohydrate interventions may be effective at improving glucose control.
Cancer vs keto diet review
There is exciting research on the role of a keto diet as a form of treatment for cancer. In one study, the use of a keto diet on patients with advanced cancer was deemed safe, and some evidence suggested it played a role in stabilizing the disease or resulting partial remission. In another study, the keto diet was used as a form of therapy for patients with malignant brain cancer. The study found that the keto diet may carry anti-tumor effects when administered in experimental animal and human brain tumors. The researchers believe this may be due to the reduction in calories. This reduces the circulating glucose needed for tumor growth. It is still unsure whether a keto diet per se plays a role in this or simply calorie restriction. All of this is to say that the research is preliminary, however still promising.
Sports Performance vs ketosis review
In the sports nutrition field, we discuss the importance of timing carbohydrate and fluid intake on improving sports performance. For some time now, research has been looking at the role of very low carbohydrate diets on sports performance. Trailblazers in keto and sports performance research like Dr. Stephen Phinney have been conducting studies in this area since the 80s. In one of his studies, the glycogen stores of cyclists on a keto diet were not completely depleted and lipid oxidation was increased. Researchers concluded that the body was able to adapt to the lack of carbohydrates and preserve what was needed to use the fat as fuel. However, based on the VO2 max breath test, since the body was attempting to preserve the carbohydrate during the exercise, it appears that the intensity of the exercise was limited.
In a more recent study, off-road cyclists following a keto diet experienced small improvements, but still not significant enough to make strong conclusions.
The only difficulty with some of these studies is that they tend to have small sample sizes, like this one that only has five cyclist participants and the data was largely skewed by the fact that only ONE cyclist experienced a large enhancement of exercise capacity after the keto diet. Their studies also tend to be short term. Back in 2014, Phinney and scientist Tim Noakes wrote an editorial that stated that in the past 31 years, there have only been a handful of studies measuring sports performance and low carb diets. Out of a total of 11, only 3 found exercise improvements.
Recently a large study was released which contains a collection of 200+ keto and carbohydrate studies. Pretty big deal. Part 1 of the series looked at the ketogenic diet’s impact on body fat, muscle mass, strength and endurance.
what the research says
MUSCLE MASS
Studies found greater lean body mass loss in individuals following a ketogenic diet. However, since lean body mass contains water, glycogen and muscle protein, it was hard to determine whether lean body mass in the studies meant a loss in muscle protein or water and glycogen.
ENDURANCE PERFORMANCE
Studies found that endurance performance, whether it was anaerobic or aerobic was impaired or maintained with a ketogenic diet. Majority of studies used in this review had small sample sizes, no control group or were very short in duration. Because of this, it is still unclear whether endurance performance is enhanced or impaired with a ketogenic diet.
STRENGTH PERFORMANCE
The majority of the studies found that there was no statistically significant difference between the groups when it came to strength performance. Having said that, researchers had a tough time comparing the diets since protein and total energy were not matched.
To date, no studies have evaluated the long term effects of the keto diet on sports performance. That does not mean that the keto diet won’t be effective. For now we don’t yet have the evidence to draw strong enough conclusions to call it standard best practice.
Weight Loss vs ketogenic diet review
Most people are use this diet for rapid weight loss (surprise, surprise). Let’s take a look at what the literature says.
First of all, I can’t deny the fact that people will lose weight on a keto diet. Here’s why. First of all, you’re eliminating a major food group. When you do that, you limit your food options and most likely your food intake, so it’s not rocket science that you’ll likely lose weight. Second, most people on a low carb diet tend to increase their protein intake in the absence of carbs and there is some evidence that consuming higher amounts of protein may have some weight loss benefits. The large recent study mentioned above also looked at fat loss and found that individuals following a keto diet lost about the same weight as individuals following a different diet when they ate the SAME amount of calories. However, the studies found that individuals on the keto diet tended to lose body weight quicker.
why you lose weight on a keto diet
Here’s why. The reason the keto diet leads to rapid weight loss is due to the loss of water weight. One of the concerns with the keto diet is the loss of muscle mass and the depletion of glycogen stores. Glycogen, which stores our glucose, also stores water, so when stores are depleted, we flush out excess water. In other words, that rapid weight loss isn’t fat, it’s just water.
The keto diet also has an impact on our hormonal levels. Many studies have looked at whether the state of ketosis suppresses our appetite through the actions of leptin and ghrelin. A 2013 study found that after patients lost weight on a keto diet, our hunger hormone (ghrelin) was altered and suppressed. A systematic review also concluded that the state of ketosis appears to be a plausible explanation for the suppression of appetite. So this the keto diet may be good for dieters who can’t stand the discomfort of hunger. Finally, the keto diet also may have an impact on our stress hormone, cortisol. This was demonstrated in a Harvard study where the keto diet resulted in an increase in cortisol in individuals following a very low carb keto diet. High levels of cortisol is associated with insulin resistance, cardiovascular disease and may promote fat accumulation.
So we got the short term effects, but what about long term impacts of the Keto Diet?
So one study looked at the long-term effects of a keto diet in obese patients and after 24 weeks, patients lost weight, reduced their total cholesterol, LDL, triglycerides and increased their HDL. Another study conducted on 132 obese patients found that the low carb (keto) group lost more weight than the low fat group while improving biomarkers like decreased triglycerides, improved insulin sensitivity, and decreased fasting glucose. This all was confirmed in a 2013 meta-analysis, 13 RCTs (1,569 participants) found that patients assigned to a very low carbohydrate diet resulted in greater weight loss compared to those assigned to a low-fat diet.
There are also studies suggesting that long term carbohydrate restriction diets may result in fast short term weight loss. The caveat is that these people gain it all back in the long term. An RCT put 63 individuals on a low-fat diet or a low carb diet, and the study found the low carb dieters lost more weight compared to the low fat group by month 3 and 6, but that the weight loss evened out by month 12. This was confirmed by a Meta-analysis which found that while low-carbers lost more weight than low-fat dieters but the differences disappeared by the one year mark.
diets don’t work
One thing we know about diets and weight loss is that they don’t work. I’ve written about this in depth with regards to the participants on the Biggest Loser. This was evident in a study analyzing 31 long term studies on dieting, which found 2/3 of dieters put back the weight they lost. Other research has reported the failure rate may be as high as 95%. Any diet that is restrictive and unrealistic may be nearly impossible to sustain.
While the keto diet may result in weight loss, what are the dangers of doing this long term?
Potential keto diet danger
Loss of Muscle Mass
A huge concern with the keto diet is the maintenance and potential loss of muscle mass. Many people will just think: hey, dummy, then just eat more protein. Some research has shown that even if your protein intake remains constant, a low carb diet may promote muscle loss.
A study from the Netherlands confirmed these findings. In the study, participants consumed three diets (high carb, moderate carb, low carb) and moderate protein. The study found that those following a low carb diet experienced increased muscle breakdown. This is because when we eat carbohydrates, we produce insulin which promotes muscle growth. This is why athletes depend on carbohydrates (along with protein) to fuel their performance. When we eat carbs, the insulin release “unlocks” our muscles to let the protein in so it can do its job at building our muscles. When we skip carbs all together, muscle glycogen stores get depleted, we lose out on those muscle building opportunities. Forget about high intensity training. A depleted glycogen store also means our workouts will suffer because we just don’t have enough oil left in the tank.
This was a again suggested in the recent review looking at many ketogenic studies. The studies found that there was greater lean body mass loss in the ketogenic groups compared to the other diets being studied.
Keto “Flu” and Bad Breath
Since our body isn’t used to using ketones, we tend to feel flu-like when in ketosis. Lots of brain fog, fatigue, headaches, nausea and poor endurance. You also get bad smelling breath, sweat and pee from the acetone (a byproduct of fat metabolism). Sexy? Not so much. Thankfully, over time, a lot of people report that most of these side effects start to go away.
Constipation
Constipation is one of the most common onset side effects of following a keto diet. A ten-year study looking at the effects of a keto diet on 48 children found that 65% of the children experienced constipation. A low carb diet means you’re missing out on fibre-rich grains, fruits and certain vegetables.
High Cholesterol
With the high intake of fat, are we concerned about the high intake of cholesterol? YEP. A study using the keto diet as a form of treatment for epileptic seizures in children found that after 6 months of administering the diet, triglyceride levels increased, total cholesterol levels increased, and HDL and LDL increased. These results suggest that over time, a keto diet may lead to an increased risk of hypercholesterolemia and hypertriglyceridemia. In the same ten-year study, 40% of patients developed hypertriglyceridemia and 29% of patients experienced hypercholesterolemia. So, if heart disease runs in your family, you may want to bow out now.
Mineral deficiencies
Strict dietary restriction means we may be missing out on crucial vitamins and minerals. With the keto diet, major minerals that are missed include sodium, potassium and chloride which is why they are typically supplemented with a table salt tablet. Other vitamins that might be missed out on include vitamin D, calcium, magnesium, selenium and zinc. The lack of vitamin D and calcium puts keto dieters at risk for reduced bone health and increased risk for fractures and long term bone diseases.
The Verdict on the Keto Diet
Cutting out a whole food group (or in this case, more than one) is a dietitian’s worse nightmare. First, it makes it a really hard diet to follow. Second, it stresses the hell out of your body and makes it work a lot harder to keep up. In a US News & World Report’s review of 2018 diet, the ketogenic diet came in last place as a sustainable means to weight loss because of its restrictive nature.
the importance of carbohydrates
Carbohydrates make up the life blood of our body’s ability to function. Our body’s need it to run efficiently. Carbs promote muscle growth and endurance in athletes and gives us the energy to get through the day.
We’ve seen the role of a keto diet in neurological diseases and as a form of treatment. The keto diet may also act as a quick fix rapid weight loss tool just like any other restrictive diet. While the risks are likely low if you’re an otherwise healthy individual, I still wouldn’t brush them off as NBD.
More problematic for me is the fact that ANY diet is likely to encourages disordered eating behaviours.
This diet is focuses on how much you can eat and less about the quality of the food you eat. A recent 2018 study found that people who focused on eating plenty of vegetables and whole foods and less on counting calories and limiting food groups, lost a significant amount of weight over the course of a year. This continues to echo the notion that the key to successful weight loss is diet QUALITY and not QUANTITY. And now, there’s research that actually supports that!
bottom line
I’m a big believer that everything – especially carbs – can be enjoyed in moderation. The best diet is just whatever eating pattern you find most pleasurable that also meets your body’s unique needs. Now I need a summer peach, or a pillowy slice of focaccia, or a mindful bowl of pasta.
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Have you tried the keto diet for weight loss?
What are your thoughts on this keto diet review?
Let me know below!
Updated on May 12th, 2020
Abbey Sharp is a Registered Dietitian (RD), regulated by the Ontario College of Dietitians. She is a mom, YouTuber, Blogger, award winning cookbook author, media coach specializing in food and nutrition influencers, and a frequent contributor to national publications like Healthline and on national broadcast TV shows.
Stacy says
While I do appreciate the amount of research that went into this article, I need to weigh in here— no pun intended. I am a 44 year old woman who suddenly and inexplicably gained a lot of weight at about age 20 and pretty much (albeit a few bouts of massive dieting and exercising) have remained fat until the age of 42. I had always been thin without having to give my lifestyle much thought before my sudden weight gain — so I have spent the last 20+ years becoming pretty proficient on learning how the body uses fuel. I have had success losing great amounts of weight a few times in my life — twice reducing my calories the “nutritional counseling” way — using the old school and outdated food pyramid and tons of exercise. It took literally having to spend hours and hours at the gym — being miserably hungry all the time — only to achieve slow progress at the scale. Months and months I would spent this way only to gain the weight right back the minute that I let go of the reins. I’m always hearing about “sustainable lifestyle changes” from you nutritionists— an I believe in daily exercise — but that lifestyle was completely unsustainable in the long term which is why so many people are unsuccessful.
Even at what I now refer to my ignorant age of 20 years old — before Atkins became a household word— I remember a nutritionist telling me how the body works, and then telling me I needed to eat carbs and I recall thinking “wait a minute — if my body needs to use the carbs I consume before it begins to dip into my stored fat— why on earth is she TELLING me to eat so many carbs?”
In 2014 — for the first time — I discovered a low carb diet called Ideal Protein. It’s different from Keto in that you also keep a low fat intake as well. I can’t speak for Keto as I’ve not done it personally, but I lost 80 pounds on Ideal Protein in 5 months. It fit into my life as a busy mom and returning college student because I didn’t have to spend hours at the gym. I just ate low carb and moderate protein.
While I admittedly struggled after going off the diet (they have some high protein, low carb,good tasting premade foods that I no longer had access to) with what to eat, I at least had better knowledges of HOW to eat and have been able to maintain my weight loss since. For the first time ever, I realized that I couldn’t eat the “food pyramid” suggested amount of carbs if I wanted to maintain a healthy weight. I even began running because I was thin enough to do so. What people who have never been fat before don’t understand is how much being fat holds us back from trying new things. If only there was a way to get people to quickly and easily lose the weight so they could be successful at dieting and discover such things (tongue in cheek).
I went back to school for Medical Laboratory Science which involved a lot of chemistry and physiology. I pieced together what I had learned through dieting over the years and how the body works — and I have to say that I am really waiting for the medical community — doctors and nutritionists to finally get on board with lower carb diets. If dropping 80-100 pounds isn’t successful then I don’t know what is. I don’t really care how “unhealthy” you call it because of how rapid the weight loss is. How unhealthy is being obese in the first place?
Dieting itself is notorious for setting us up for failure — mostly because the lifestyle changes are unsustainable and people become frustrated with having to work that hard to lose that slowly. If people can lose weight rapidly — it causes a snowball effect more often than not. Maybe someone should conduct a study on that aspect of things.
The medical community is failing their patients by continuing to shove the food pyramid in their faces. Let them lose weight in a manner that works best for them — and let them lose it fast so they see results. Im sick of hearing “it’s a lifestyle change” because diets themselves are not meant to be lifestyle changes — they are meant to be a period of weight loss. Show them the lifestyle changes AFTER they lose the weight necessary to become healthy again. How I see it — where people fail and where you are failing them — is not helping them to realistically lose the weight in the first place and then in not teaching them how to maintain their lifestyle using realistic macros guidelines to do so.
I won’t hold my breath to watch the medical community get on board to this platform. Instead you will just keep shoving the high carb food pyramid at people and then complain that people don’t really “want” to lose weight. And stop calling diets that cut carbs as “extreme”. Working out for 2-3 hours a day to lose 1 pound a week is extreme.
John W. Colby says
Notice that Abbey responses are notably absent when faced with actual results and education on the subject.
Amber says
I’m not sure what the best part about this blog is, your responses saying “hooey” (which i keep laughing at) or all the success stories.
Katie says
I have to thank you for presenting a more rational view of keto than I have seen presented by other dietitians. However I am a Type 1 diabetic, and ahem, also a registered dietitian and since finding keto a year ago would not have any reservation in guiding a pt, especially a diabetic, to eat keto. I find the diet far less restrictive than a vegetarian or vegan diet, and food cravings have completely been eliminated. I’m far more satiated when I eat and I have no problem adhering to this way of eating. The fact that dietitians advise eating 45-60 g CHO per meal to a diabetic (someone who essentially has a carb intolerance) is absolutely ludicrous to me. As a T1D I’m off the blood sugar roller coaster, no longer have dangerous lows and have achieved an A1c of 5.1, which means no long-term complications. I think the main fear in the mainstream media comes from that F word–fat. With the dawn of the low-fat era in the 1960s, sugar and carb consumption skyrocketed, fat consumption plummeted and what happened as a result? Yes, that’s right, rates of overweight and obesity skyrocketed. Insulin is the body’s primary fat storage hormone and carb consumption triggers insulin. The reason a keto diet works for weight loss (more than just water weight from loss of glycogen stores) is because insulin levels stay low, which allows for the mobilization of fat.
I understand your reservations on this diet (I was once the same way), however I encourage you to take a deep look into the mechanisms of the diet, and maybe give it a try for yourself. Give it 90 days. Read any number of books on it with an open mind (Keto Clarity is a great one and is a quick read) and perhaps you may find it challenges you to second guess the dietitian dogma that is pushed by the AND.
Carol says
Hi Katy,
As you are a dietician, my question for you is this; how does someone really start on Keto? I ask because I can’t find anyone in my area who can counsel me on this plan. I’d like to try it as I have MS and would love to try Keto to see what the benefits might be for me (besides the weight loss, which would be phenomenal for me). I just need some one -on-one help and am wondering if you could give any advice on how to look for help?
Ilko Dossev says
The devil is in the details. And, in few parts of the post, details were missing. Specifically, weight gain in post-Keto stages are due to?… getting back to SAD, perhaps? Indulging on ice cream and filtered fruit juices?
Ketogenic state can be achieved and maintained with low-carb food balance. Looks like very few people make he distinction between “therapeutic Keto” and “nutritional Keto” and there IS difference! For nutritional Keto, the food intake balance need not to be extremely restrictive, and I submit that every individual needs to find the dietician balance suitable for one’s own body.
This said, I do prefer low-carb balance compared to SAD. I can speculate a lot about SAD and about the non-discrimination of different carbs – like, lactose vs. fructose. It is only my opinion, that fructose has its value in the nutrition (black bears get body fat for hibernation eating fruits) yet somehow we miss to notice that naturally fructose had been available in humans’ diet only seasonally, while nowadays juices of all kinds are available year-round; not to mention fructose additives to sugar-rich products. And yes, fructose is addictive, and yes, this is part of the evolution for 200 thousand years of humans.
I am Keto proponent. I have been through muscle cramps when missing greens while riding my bike for 100 km in 5.5 hours (and I am going on 64!) Getting kale and spinach and parsley is a must, getting the fruit whole is a must. Consumption of “good” fats like coco, olive, avocado oils definitely does not hurt. Consumption of meat – and of organs, yes, organs – is very important. And finally, monitoring the body reaction and measuring ketones and glucose helps; I am doing observations regularly. What about G=4.2 and K=.3 in the morning? It is not ketogenic state per se, but in the morning my muscles do not need much fuel, and my frontal cortex and red blood cells need only minimum glucose. What about G=5.4 and K=3.6 in the third hour of bike ride, with acetone in the breath high and ketone disposal in urine very low? What about post-exercise levels of G=4.4 and K=1.2, with almost no acetone in breath and urine levels going sky-high because the body needs not ketones any more?
My submission is, that a healthy body – liver, pancreas, kidneys – know how to maintain the right balance and produce or dispose of fuel, either glycogen or ketones as needed. I disagree that glucose is the favorite fuel, it is only the easy fast fuel for the body, which has one great advantage – PERFORMANCE! Both muscle and brain, fast performance is fueled by carbs. But, for ENDURANCE, it is ketones which are the best fuel, and moreover, burning ketones leaves less waste to be disposed off. I think that for athletes, the challenge is how to find the right performance-endurance balance.
High-carb diet – like SAD – is outright harmful and statistically it is proven, since the overall health of North American population deteriorates steadily since the 70s. Low-carb, high-fat diet is definitely less harmful; in my opinion it could be beneficial for the vast majority of humans. Whether one can plough through the addiction of sweets, that is totally different story.
Lisa J Little says
“the fat overwhems the liver” What evidence do you have that the liver finds this overwhelming? The liver is designed to do all sorts of things. Wouldn’t breaking down fat be a good thing if you’re trying to lose weight?
Just because glucose is burned first, doesn’t mean that it’s preferred. High glucose levels in the blood can damage tissues and organs, so the body has to manage it. Ketones are “cleaner burning” in that they produce less free radicals
Insulin is not the only hormone that helps build muscle. When insulin and glucose are low, the body produces more human growth hormone. And other studies have found the low-carb, high-fat diets did a better job of preserving muscle mass.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384055/
I have found eating low-carb, high-fat to be easier than other diets because I feel satiated, and I have good energy and feel warm (I usually feel cold in the winter). I can also skip snacking because I don’t get “hangry”. I totally understand if it’s not for everyone; people are different with different genetic expressions, and their bodies will respond in different ways. But if you’re going to give it a try, it make take a couple of weeks before your body is adapted to burning fat instead of glucose. Make sure to get enough salt, and eat lots of vegetables (if you don’t like spinach salad, roasted cauliflower or fired mushrooms, this diet may not be for you).
Dragonvrod says
I had high blood pressure, was going into atrial flutter, obese, tired, moody and hurting and miserable, I kept having allergic reactions to the medication for my blood pressure which enhanced the atrial flutter, my doctor and cardiologist suggested that I go off all medication and approach this by getting rid of the problem, being obese. I started with a lower fat version of a Keto diet (I needed the fat on my body to be used before the fat in my diet). I eat small amounts of fruit and about 2 lbs a day of veggies and I manage to stay under 30 g of carbs a day, which works for me. I lost 40 lbs in 10 weeks. Here is the clincher, every 2 weeks by blood work was done by my doctors and everything is improving drastically, also I was getting the bod pod completed every 2 months to check my body weight / fat percentage, and I am not losing muscle, I am losing fat. I noticed that it was mentioned that it is too hard to sustain this way of eating, but there is really only one choice for me..putting that crap in my mouth is just putting poison in my system and I don’t want that ever again. I eat better now that I have ever ate as I am eating real food. I know dietitians were taught and trained to help people lose weight, but like any industry things evolve and change and things progress, and one must be open minded that there are different approaches that work for different people, and that as a professional dietician, I would expect them to see that there is more than one option to help people. Some people do just fine on 100 g carbs a day and I don’t, as I was addicted to carbs / sugar and now I am free of those drugs and I am healthy and happy. Everyone keep an open mind and try adaptations that work for your body and situation.
Cheers
Erin Seal says
Hi, when you say a lower fat amount what do you mean and how do you figure that out? I’ve been struggling with getting enough fat into my day. Thank you!
Lynn says
Abbey, I appreciate the article, it’s helped me come to a decision on KETO. I’ve been on KETO for over 3 months, I’m a woman of 55 and post menopausal with a good 40 lbs of fat to lose. I work out 3-5 per week at an intense level doing cardio, HIIT and weight training and I have NOT lost any weight (ok, a single pound). I am in Ketosis most of the time (testing often) and I’ve been eating 1,200 to 1,300 cals per day. My carb intake around 15-20 grams per day, Fat around 90 grams and protein was about 45 grams until I increased it after learning I had lost muscle mass confirmed on a SECA scale.
I’m throwing in the towel but will continue working out as I LOVE it. I am going to eat sensible, keep up the weight training and see how it goes. I feel like I gave it a good run but if I haven’t seen results in 90 days I don’t feel this is the best way to eat for my body. I’m curious if anyone else has had lack luster results like mine while being diligent with a strick KETO diet.
Abbey Sharp says
Hey Lynn, thanks for sharing your story with us. I’m glad you were able to listen to your body and so what worked for you! Good luck 😉
Claudia Parker says
My friend suggested this diet for weight loss, but I have never been comfortable with elimination diets. Thank you for your research.
Abbey Sharp says
I hear ya! Thanks Claudia
JRS says
I recently went to a walk in lab and found that I have high cholesterol and I am pre-diabetic. However, I am well on my way to healing my body with nutrition and supplements. I was able to reverse all my pre-diabetic symptoms in a few days (brain fog, blurry vision, thirst, frequent urination) and I have amazing energy and mental clarity now. I’m losing weight without hunger or counting calories. I eat low carb produce, poultry, fish, nuts and dairy. I believe that the key to avoid diabetes is to drastically reduce or eliminate grains, sugar and any type of processed food or cured meat from your diet. For cholesterol, I take plant sterols/stanols before meals and tumeric & black pepper, fish and flax oil. I believe that everyone who eats meat should take plant sterols (Try Minute Maid Heart Smart OJ!). It is the ultimate preventative, because it is not usually not possible to reduce your cholesterol enough with diet and exercise alone.
Abbey Sharp says
Thanks for sharing your view, and glad you found something that worked for you.
Melissa D says
Thanks for an in depth analysis! I’ve been researching this diet, and good to hear how it may be harmful. Learning to cook more, eat balanced and healthy.
Abbey Sharp says
For sure. Keep it simple, I always say 🙂
rob says
Done Keto diet for over a year now. I started it due to increased liver enzymes showing a start on a path towards low-level diabetes due to being about 30 lbs overweight (229 lbs, 5’10” endomorphic, muscular build). After a year, my Cholesterol is excellent, I dropped to 192 lbs (37 lbs lost), maintained muscle mass through maintenance workouts and cardio, resting heart rate is 50bpm, EKG shows perfect results, blood pressure is excellent, and full panel of bloodwork shows zero abnormal liver enzymes.
Here’s what you got wrong…Keto is about a balanced fat and protein diet with very low carbs and high nutritional content. No one on keto shoots for an 80% fat intake, that’s just impossible to achieve and isn’t what keto is about. I targeted 110g of protein and 90g of fat in a day … and under 20g of carbs. I ate a lot of leafy/dark green vegetables and got most of my carbs from other veggies and fruits like tomatoes, onions, and berries (with a high GI). This is what most people target, a 40/40/10 ratio of protein, fat, carbs … but the common misconception is that the fat amount is a goal, whereas it’s a limit. The protein is more important to a healthy body, but the fat teaches the body to release/produce the ketones in the bloodstream.
The biggest win for your body is the loss of all sugars, both natural and artificial. Sugar is sugar is sugar…honey, raw, brown, etc. And artificial sugars, as you well know, trick your body into both a physiological and psychological reaction to it as if it was real sugar (kicking off addiction and liver/insulin responses).
I achieved my goals without fasting, but fasting is growing to be one of the most healthy ways of eating that are available to a human. The fasting process initiates a lot of systems in the body that remain dormant in a regularly fed human. That, in conjunction with the presence of ketones (which encourage fat consumption for energy), make fasting during ketosis massively effective for both weightloss and a healthy body.
I like the list of health benefits you talk about here. But I seriously reject most of the side effects you claim without any basis. The only real risk that all keto dieters face, is constipation. I never encountered it, as I drink ample water and ate ample vegetables until I got sick with the flu and dehydrated. But that’s easily manageable. As with any diet, you should have your doctor regularly monitor your blood pressure, cholesterol, and other blood panel stats.
I also hardly can see how you can call it a fad diet when it’s been around, in science studies, for almost 100 years.
Abbey Sharp says
Hey Rob, so glad it worked for you. I call it a fad diet because it’s only recently been used as a diet for “rapid weight loss”. Before that it was used as a therapy for seizures. Thank you for your comment!
Mole says
A vegan not approving of keto. What a huge surprise. I think you may be biased.
Abbey Sharp says
I’m not vegan.
Sal says
I tried it and it is a complete rubish and unrealistic.
First of all I was miserable, hungry most of the time, felt guilty if I accidentally ate even a small amount of anything with mid-high carb.
What really killed it for me was the unrealistic restrictions of the entire day carbs count you should end up with – there is no f***ing way I can get by one full day with 20 grams of carbs and under. Just one of my meals ended up with at least 15 grams of carbs (half small onion-small red bell pepper-half cup chopped mushrooms-cup green beans), sometimes 20-25, times 4-5 meals (amature bodybuilder) and I end up with ~100 grams of carbs per day, at least.
How the hell these “gurus” decided 20 grams of carbs for all? that is total rubish.
One additional concern is what happens on social gatherings, such as a birthday party, are you going to be the only a-hole who will hold up on eating a cake while everyone else enjoy it?
Abbey Sharp says
Hey Sal, sounds really awful. I know I could never last having only 20 grams of carbs a day. And interesting point you made about social gatherings. Definitely puts a damper on everybody’s party. Thanks so much for sharing your experience 🙂
Jim says
No offense, but the fact that you lacked the willpower to do something doesn’t make it rubbish my friend.
I lack the willpower to be a Navy Seal, but they are far from rubbish.
Josh says
So for all the dangers you listed on this, my dietician prescribes this diet to everyone who comes into his office looking for weightloss, he has a stack of packets with standardized information regarding the specific diet. For what it’s worth, most of the side effects you listed, I did go through, although the sugar withdrawal was the worst, but after a couple weeks, that passed too. Now I’m on the same 1200 calorie, <20g carb, 0 sugar diet, and it feels VERY sustainable. The only thing I really miss is pizza, and even then, there are keto friendly chicken based crusts that really hit the spot. I guess one thing that sticks out to me is my doctor told me that the human body doesn't need any sugar to survive, and while he makes the distinction between simple and complex carbs, still cuts them out in a normal keto diet style (no potatoes, corn, most beans in larger quantities, etc). Should I be concerned about my doctor? He came as a referral and has a large track record of long term success with his patients.
Abbey Sharp says
Hey Josh, I can’t really tell you what to do about your doctor, but it doesn’t hurt to get a second opinion! Knowledge is power so hearing a different perspective can be beneficial. Thanks for sharing your experience.
Meagan says
Sounds like you have a well informed doctor.
Anna says
I asked my neurologist what she thought about me going keto to help with a seizure disorder (just RD2B things…), but she said it wasn’t worth the difficulty trying to adhere to the diet. Especially with my mild situation and age, she didn’t think it would make a difference at all! So glad I read this 🙂
Abbey Sharp says
Hey Anna, it’s great you got a second opinion! Thanks for reading 🙂
Rashelle says
I tried the ketogenic diet and it really helped me even out my energy levels and I don’t grave sugar anymore. I had issues absorbing my B vitamins. I had high candida and l-acidophylis levels. I was also addicted to sugar. I started this 3 years ago, and since about a year ago, I’ve added fruit. Now I enjoy a little rice and potatoes as well. I even had a bite of chocolate cake and didn’t die. I started out at 112, lost 10 pounds within a month and have slowly gained most of it back. I am happy I did it, but I will be more confident to add more carbs, although it will mostly be in the form of more fruit and starchy veggies. Thanks for your article.
Abbey Sharp says
Hey Rashelle, I’m glad you found it helped you! Thanks for sharing 🙂