Should I Go Keto? A Rundown of What it’s All About

For some, the struggle to lose weight is real. For others, the struggle to gain weight is real. For most, the struggle to meet societal expectations for physical appearance is a lifelong one. I have seen many patients with many different clinical presentations come for advice on meeting BMI standards, or because their “doctor said to lose weight.”

First of all, using BMI as a standard of which to compare body weight is antiquated; secondly, medical doctors take less than one academic year studying nutrition. Compared to a registered dietitian, their advice is usually not backed by a great depth of knowledge. Any ol’ person on the street can be a “nutritionist,” so the availability of non-science-based nutrition recommendations is hearty during a time when quality is suffering.

The Ketogenic Diet, or “keto,” is no different. This popular diet trend has a life span that has surpassed past-favorites such as Jenny Craig and South Beach. Other names that perpetuate the same messaging as keto include Atkins and Paleo, but a true ketogenic diet is a whole different beast.

It is common to hear different definitions and criteria for what is considered “keto.” While there is no standard or strict criteria on what portion of calories from fat, carbs, and protein comprises the ketogenic diet, it is clear what is not keto. The ketogenic diet is not a “high-protein” diet.The ketogenic diet is a high-fat diet. Carbohydrate intake must be low enough to allow the body to use ketones as fuel, and protein must be moderate but not too high in order to not disrupt ketosis. This leads to a very important claim of the diet: if protein intake is too high, the body has enough of the amino acids glutamine and alanine to convert into glucose, which can knock a person out of ketosis.

However, the research on this claim is not well supported. Ketosis is a continuum, with an increasing amount of ketones with greater carbohydrate restriction. The most commonly used ketogenic ratio is 4:1, which describes a diet that is made of  four grams of fat for every one gram of protein or carbohydrate.

In other words, for every five grams of food consumed, there are four grams of fat and one gram of protein and/or carbohydrate. Someone who is aiming to adhere to the 4:1 ratio will have to use a gram scale for accuracy. A real-life example of this would be one gram of Kalamata olives, which have 0.07g carbs, 0g protein and .28g fat.

Why Is the Ketogenic Diet so popular?

The Keto Diet was initially developed and used to treat children suffering from epileptic seizures, with emerging research indicating the potential for helping those with a specific type of brain cancer. The ketogenic diet has seen a huge surge in popularity in recent years. Supporters of this approach state the high fat intake keeps you full and satisfied, and that the diet boosts energy levels and reduces or eliminates cravings.

Opponents of this diet argue that the popularity of this diet comes from historical popularity of Paleo, Atkins, and other carbohydrate-restricting meal patterns. Many people struggle to limit portions with indulgent foods that contain carbohydrates and sugar, such as cookies, cake, doughnuts, and potato chips. The ketogenic diet nearly eliminates carbohydrates, including fruit and starchy vegetables.

Restricting the diet in this way, especially when paired with physical activity, can result in accelerated weight loss. It should be noted that we have yet to see long-term data to suggest sustained weight loss while following a long-term ketogenic diet.

Related Article: A Personal Trainer on Emotion-Driven Weight-Loss Goals

Should I consider the Ketogenic Diet?

We know there is short-term weight loss benefit, at the very least. Emerging data is
unveiling a potential benefit in type two diabetes. There may also be nothing wrong with short-term adherence to a ketogenic diet followed by weight maintenance with sustained physical activity. While the ketogenic diet may seem enticing based on the proposed benefits, there are still some red flags to consider.

The primary consideration is the basic logic of why the ketogenic diet is useful in those with epilepsy: it deprives the brain of its preferred source of energy. For optimal
functionality, a person should consume, on average, at least 120-130g of carbohydrate
daily to support brain and eye health.

With keto, we find that limiting the brain’s preferred energy also limits activity from the neurotransmitters (i.e. GABA) that cause seizures. If you deal with epilepsy, a personalized ketogenic diet with the guidance of an experienced registered dietitian may be appropriate.

Of note were two interesting studies conducted about keto that further raised some flags. One study of about 400,000 people concluded that those who ate high carb diets and low-carb diets resulted in the same high risk of mortality. The other study reviewed data from about 25,000 people and showed that those following a low-carb diet were 51 percent more likely to die from heart disease, 50 percent more likely to die from cerebrovascular disease, and 35 percent more likely to die from cancer.

The study concluded stating a diet in which 50-55 percent of total calories came from carbohydrates was associated with the least risk of death compared to the other groups. So, while the science is mixed, people have made the decision to go keto without knowing short or long-term side effects.Remember this!

The ketogenic diet doesn’t just eliminate a food group, unlike the Paleo diet, for example, which excludes grains and legumes. It almost completely eliminates a nutrient: carbohydrates. This exposes a person to nutrient deficiencies if they do not plan their food choices well, specifically the B vitamins, calcium, potassium, and vitamin K.

Developing nutrient deficiencies can create serious health problems, including anemia, osteopenia and osteoporosis, joint pain, and inhibited immune system function. Someone who is not good at planning their meals ahead should not consider this type of diet.

Remember that fad diets come and go. Right now, keto is hot. Eventually another diet
trend will come along and steal the attention of the public. Though there may be some real clinical benefit to the ketogenic diet for some, the tried-and-true recommendation of a balanced diet inclusive of all food groups has continued to be the consistent message. When deciding if the keto diet is for you, consider long-term as well as short-term health goals.

More importantly, it is not recommended to embark on a weight loss journey just because you feel pressure from society and media. Registered dietitians are key resources in guiding people along the path to wellness and for overall approaches toward body positivity and acceptance.