Seems that the popularity of new fad diets never ends, and registered dietitians have their hands full! In the clinic, patients tend to be more on top of these diets than I am, which leaves me scrambling to research them.

The ketogenic diet or keto diet is the new hot ticket, with a large and growing community of fervent devotees. It’s super high in fat and super low in carb. Probably one of the oldest therapeutic diets around, it was used in the late 1800s to treat diabetes and was later a common treatment for children with epilepsy, in whom traditional medications and therapies had failed. It has soared to popularity in recent years as a weight loss option due to a growing acceptance of lower carbohydrate diets, even among the medical community. It’s also probably due to the desperation of people who have tried other diets that haven’t worked. Why is it that the more diets fail people, the harder people want to punish themselves and progress to an even more grueling program?

There are three macronutrients in our diets: carbohydrates, fats, and proteins. If you change one, it affects the others because they all must equal 100%. A keto regimen is about 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. The protein actually stays about the same as in mainstream healthy diet guidelines. But the carbs are dropped extra low to make room for a lot of fat. And it’s a whole LOT of fat. You’re basically filling half your plate or more with pure fat: oils, butter, cream, avocado, fatty meats, nuts, etc.

Healthier fat choices on a ketogenic diet

A very low carbohydrate diet that may dip to 20-30 grams of total carbohydrate a day causes a condition called ketosis, where your body makes ketone bodies that the brain uses for fuel in the absence of carb (the brain can’t use straight out fat). Ketosis causes a dip in appetite and some side effects like fatigue and headaches in the early stages. Then there’s the other challenge of bumping your fat intake to more than 150 grams daily, which takes some meal planning and a specific taste preference.

I recently wrote an article on the ketogenic diet for The Nutrition Source. It took a long time to research but took an even longer time for the review process, as nutrition scientists who reviewed the piece had differing opinions. Because there isn’t a whole lot of clinical research on the ketogenic diet specific to weight loss, we were relying on theories alone. And that’s understandably where the controversy and disagreements came in. We tried our best to keep it balanced. You can’t discount the fact that thousands of people swear by the diet, but you also have to weigh potential risks, especially because it excludes entire categories of foods like fruits, dairy, whole grains and legumes. The finished piece was a hit with readers and went viral in less than 24 hours. We were pleased that the keto community noticed our great effort to provide balance: “An honest and balanced look…” “surprisingly measured” “rather unbiased” “very little judgment” “helpful and honest look at keto.”

If you’re considering the keto diet, check out the article as it is comprehensive and a good read before jumping into the diet. It’s also a good resource to show your physician if you sense hesitation on their part.

Here’s my thoughts about the keto diet from what I’ve learned so far:

• The keto diet can cause weight loss but in comparison with other diets, even other low-carb diets, it doesn’t necessarily cause greater or longer-lasting weight loss.
• The keto diet can be modified to include healthful fats like nuts, seeds, avocado, and unsaturated oils. Nonstarchy vegetables are actually a large part of the diet, which is a huge plus as most Americans don’t get enough if any at all. It’s important that keto followers eat a variety of foods listed on the diet, not just fatty meats and fat! Including all types of fats and eating too much meat is clearly not healthy—for the average person but especially for people with heart disease, diabetes, cancer, and other inflammatory conditions.
• The keto diet can be used short-term, say 3-4 weeks, and then modified to gradually allow increasing amounts of unrefined carb, say from fresh whole fruit, legumes, or starchy vegetables like sweet potato or squash. Let’s be real: people don’t gain weight gorging on apples and beans. They gain weight by chowing down on refined carb like white bread, pasta, chips, and crackers. If anything, the keto diet will help clear out your kitchen of these foods. It’s best to check in with a registered dietitian at the start to ensure the diet is well-rounded and includes key nutrients. If not, a vitamin supplement may be recommended.
• The keto diet may be worth a try for people with insulin resistance or type 2 diabetes who have difficulty processing carbohydrates and therefore develop increased insulin levels, which may indirectly make weight loss challenging. Because the diet is so low in carbohydrate, not as much insulin is secreted and levels remain low. Still, most patients I see with type 2 diabetes improve their blood glucose and lose weight with more mainstream diets, as long as they keep the weight off and eat right. So it’s really about being open to adding keto as an option for people who have been unsuccessful with other plans.
• As with any diet plan, there are potential risks if you jump in with a lack of nutrition knowledge and do not take the time to carefully plan out meals. Seek a registered dietitian with expertise in this area before starting a new eating plan, and it will save you frustration and confusion later on!

Feel free to comment below if you’re familiar with keto and can share any experiences on the diet, good or bad!