To Keto or Not to Keto?

Lately, I can’t read any nutrition or wellness article, or scroll through social media feeds, without hearing about the ketogenic, or “keto,” diet. As interest grows on both the pro and con side of the keto diet for weight loss, more research will hopefully become available. While this diet can prove successful for shedding unwanted pounds, like many new (and old) fad diets, it teeters on the tightrope of extremism. There are also questions regarding its sustainability and its suitability for the general public. That’s why I sat down with registered dietitian and certified diabetes educator Lori Lehnert* to help me be more in the know about keto.

Q: Can you explain what the ketogenic diet is?  
A: A “classic ketogenic diet” is 80 to 90 percent of calories from fat, 6 to 15 percent from protein and 4 to 5 percent from carbohydrates. What this means is that, for an average adult, you would be limited to about 15-20 grams of carbohydrate a day. There are various modifications of the ketogenic diet as well that are not quite as restrictive, but the basics are the same – high in fat, moderate in protein very low in carbohydrate. The idea behind the diet is to change the way you eat to force your body to use ketones from fats as your go-to energy source instead of glucose from carbohydrates. People on the diet have high intake of fats from cream, oil, butter and fats in meats. They’re restricted to smaller amounts of some vegetables and eliminate all starches, fruits (with the exception of avocado and small amounts of some berries) and all root vegetables.

Q: Can you share a little history about the ketogenic diet? 
A: The diet was used to treat epilepsy in the 1920s and 1930s, but fell out of favor when medications were developed for this disorder. The diet has had a resurgence in the last few decades in the field of epilepsy, as many people find that they’re able to either reduce their seizures or, in some cases, eliminate their seizures on the diet. People are typically on the diet for two years, and then weaned off slowly. Many studies are being done to see how the ketogenic diet can be beneficial when used to treat other medical conditions, including autism, Alzheimer’s and Parkinson’s disease as well as certain types of cancer. And, of course, more recently, variations of the ketogenic diet and ketogenic products are being promoted for weight loss.

Q: What factors should be considered before starting this type of diet?
A: It’s always recommended to consult with your physician prior to making any drastic changes to your diet. People who have any stage of kidney disease, are pregnant or nursing or have carnitine deficiencies are not recommended to follow this type of diet.  Also, this diet can be very difficult for some people to follow since it’s so restrictive. It’s always important to remember that because certain things work for one person does not mean they are safe, or will work, for you.

There can also be side effects when starting the diet. People typically describe what they call “keto flu” for the first two to four weeks. Symptoms include decreased energy, bad breath, dry mouth, muscle cramps and increased hunger. Initially, there is a large weight loss due to loss of fluid. Our glucose stores in our bodies hold on to water and, as you use up all your glucose stores, you also lose those water stores. This leads to increased urination and, if you do not take in enough replacement fluids, you can get dehydrated.

Q: Are there potential dangers or drawbacks to following the ketogenic diet in the long term? 
A: There is currently very limited research or long-term studies on the ketogenic diet, particularly for the sole purpose of weight loss. We do know that, if someone is not trained and monitored properly on the diet, he or she can be at risk for certain vitamin and mineral deficiencies which can cause other health problems.

Q: Are there any other important points you’d like people to know? 
A: The most important thing to consider in making changes to your diet is to find healthy changes that are true, long-term lifestyle changes! For most people, changes such as cutting out processed sugars, reducing the portions of carbohydrate foods, focusing on fresh fruits, vegetables, and meats/proteins instead of processed ones, will make a huge difference and will be changes they can stick with for the long run.

When it comes to nutrition, there is no one-size-fits-all plan or diet that works for everyone. At TOPS, we encourage members to navigate nutrition trends very carefully and always check with their healthcare professional.

*Lori was introduced to the ketogenic diet by a neurologist who needed assistance starting a dietary program for patients with epilepsy. Through many hours of independent research review, and attending seminars and symposiums by leading experts, they began to develop their program. She received official training on the ketogenic diet through the Charlie Foundation, which is a leader in education and promotion of the therapeutic benefits of this diet.