Diaries of a Plant Powered Dietitian

Hot Topics in Health

Is the keto craze all it's cracked up to be?

Ketogenic diets have been used as a remedy for children with epileptic seizures for decades, but have gained popularity in recent years as a weight loss diet. Keto is everywhere these days – from keto cookie posts on Pinterest to keto-friendly menus at restaurants, everyone seems to be keto crazed these days. But, is the keto diet all it’s cracked up to be? Read on to find out!

So, what exactly is a “keto” diet?

A true ketogenic diet is one that is very high in fat, low in protein, and very low in carbohydrates. It is comprised of about 80% fat, 15% protein and typically 5% carbohydrate. It’s definitely not a high protein, low carb diet (like the Paleo diet). It’s a high fat, low carb diet. This is a stark contrast to the Dietary Guidelines, which recommend 45-65% daily calories from carbs, 15-20% protein, and 25-30% from fat. Ketogenic diets typically restrict carbs to less than 50 grams of carbohydrate per day, although the exact amount of carb restriction needed to enter ketosis varies depending on the person. Most people will see results with carb restriction in the 20-50 gram range.

What’s the hype about?

Historically, ketosis was the body’s way of adapting during periods of famine. Glucose, or sugar, from carbohydrates is the body’s preferred energy source, and it will do anything it can to turn the nutrients we eat into sugar if stores are low. Even protein foods get turned into glucose if the body needs it. Thankfully, the body has a way of adapting when it enters a period of prolonged fasting by turning to its second fuel source (known as ketones).  When the body is starving and has run out of glucose (sugar) stores, it’s forced to tap into its fat stores and burn ketones to supply fuel to the brain and spare protein for vital organs.

On a very high fat, carbohydrate-restricted diet, since the body is unable to process glucose it digests fat into ketones. Due to its high fat content, a ketogenic diet basically mimics “starvation” mode in the body since it forces your body to tap into its fat stores and burn fat for energy, rather than stored carbohydrate found in muscles, liver, and other organs. The other piece of the equation is insulin. Insulin is a critical hormone made by the pancreas designed to shuttle glucose from our bloodstream into the cells to be broken down, but it’s also a fat storage hormone since it signals the body that we’ve eaten and it’s time to store energy. High amounts of insulin floating around in the body prevent the breakdown of fat, and correlate to weight gain and diabetes.

On a ketogenic diet, insulin needs are reduced since 1) less sugar is being ingested and 2) fat requires very little insulin to be metabolized. The theory is that this results in weight loss, reduced food cravings, and better blood sugar control.

The nuts and bolts of keto:

Ketone bodies are acidic and change the pH of your blood, and it takes the body some time to adjust to this new way of burning fuel. You may have heard this referred to as “keto-adaptation” or getting the “keto flu.” The keto flu is essentially your body getting used to burning ketones, instead of glucose, for energy, and it can last anywhere from a few days to a few weeks. It is very important to stay hydrated during this process and take a good quality supplement with potassium and magnesium, as high blood ketones can cause fatigue, headaches, difficulty concentrating, and dehydration. Typically, once the body adapts to a high fat, low carb and low protein diet, it will enter nutritional ketosis and stay relatively stable. To make sure you’re truly in ketosis, you have the option of picking up urine ketone strips over the counter at any major drugstore.

A word to the wise

Sometimes ketone bodies can become too concentrated in the blood and lead to metabolic acidosis in certain susceptible people. Notably, individuals with diabetes who have a pancreas that makes no insulin. This is called ketoacidosis, and is a life-threatening medical condition. Ketoacidosis is metabolic derailment from lack of insulin needed to metabolize glucose, and it’s very different than nutritional ketosis. Although ketogenic diets can significantly improve blood sugar control in some diabetics (thanks to their low carb content), those who rely solely on insulin should consult their healthcare provider before starting a ketogenic diet, as they will require close monitoring to ensure they hit nutritional ketosis, and not ketoacidosis.

Furthermore, anyone who has a history of heart disease should consult with a dietitian prior to starting a ketogenic diet to ensure appropriate ratios of healthy fats are included. Too often, I see keto crazed folks piling up on bacon, sausage, mayonnaise, cheese, and the list goes on. If it was once taboo before, you name it, they eat it. A ketogenic diet can be done correctly (think avocados, nuts, fish, full fat unsweetened Greek yogurt, organic eggs, olive oil, etc.).

Pros:

  • Rapid initial weight loss is a notable benefit (but weight loss will likely plateau after a while)

  • Improvements in blood sugar control and potentially reduction in insulin resistance

  • Increased levels of HDL (good) cholesterol and lower triglyceride levels, which indicates lower risk of heart disease

  • Reduction in appetite due to the satiating factor of fat (it empties slower from the stomach)

Cons:

  • Health in the long haul remains unknown in regards to ketogenic diets and heart disease, kidney health, liver disease, and even insulin resistance. Some research indicates reduced insulin resistance with ketogenic diets (remember, insulin resistance is what drives type 2 diabetes), while other studies show increased insulin resistance in the liver. Some studies indicate ketogenic diets reduce cancer cell growth by cutting off the cell’s main fuel source (glucose), while other research correlates high fat diets rich in meat and dairy (which are allowed without restriction on a keto diet) to increased cancer risk. Furthermore, colon health and the good gut bacteria (probiotics) we need for health and longevity are fed by fiber and mostly plant-based foods, which are not abundant in a keto diet. The bottom line? We definitely need more research on the long-term health consequences of going keto.

  • Perfectly healthy foods get the kibosh - fruits and certain types of vegetables are no-go’s on a keto diet. Thus, you’ll need to take a good quality multi- vitamin supplement.

  • Ketogenic diets are low in fiber (the diet eliminates most fruits, beans, legumes, all grains, and many vegetables), so you may need to take a fiber supplement. Fiber is necessary for gut health, heart health, and many other things in our body.

  • Quality of life - ketogenic diets are incredibly restrictive and hard to follow (thus making it easier to fall off the wagon).

The final verdict:

A ketogenic diet can promote weight loss, but should be carefully planned to ensure adequate nutrient intakes and a good balance of healthy fats. Typically, I see these types of very restrictive diets work best only in the most motivated, diligent individuals. Be cautious of diets that completely eliminate whole food groups. And remember – all foods fit in moderation.

Sample Healthy Keto Meal Plan:

Breakfast: 2-3 scrambled eggs in butter or ghee with sautéed mushrooms, onions, ½ cup bell pepper and feta cheese

Snack: 6 oz. unsweetened full fat Greek yogurt sweetened with Stevia and topped with slivered almonds and ½ cup raspberries

Lunch: spinach salad with salmon, sliced avocado, hardboiled egg, 5 cherry tomatoes, and vinaigrette dressing

Snack: handful of almonds and sliced cheddar cheese or jerkey

Dinner: spaghetti squash tossed with olive oil, garlic, and parmesan cheese and diced chicken or sausage; served with roasted Brussel’s sprouts in olive oil