A Dietitian's Thoughts on Keto
Updated: Apr 10
At this point, I've seen keto frosting, keto bread and keto protein bars. These products are a sure sign that what was once a medical prescription diet for epilepsy, has become yet another fad (and a big money making one at that!). Ketosis is a state of metabolic dysfunction and is not something we should be striving for. It's stressful for the body and is very inflammatory. I consider following a keto diet a very poor choice for health.
I encourage you to think about what you are trying to solve with this fad diet. I promise, there is a way to get there and feel good and protect your body all at the same time. Keto falls short in the health protective and feel good space.
Here's many of the comments I hear about Keto and my responses.
"Carbs are evil!" This one isn’t so much a question as it is an emotion. I get it! You’ve been frustrated with failed diet attempts in the past and the foods we turn to the quickest when we stop a diet are – you guessed it – carby! Cakes, pizza, cupcakes, cookies, power bars, creamy pastas, etc. all these carb-heavy foods are satisfying, delicious and totally off limits in most fad diets. Unfortunately, those foods give good, complex carbohydrates a bad name. Carbohydrates are the body's preferred fuel source. It’s easy to digest, we have stores of it, it’s a common part of plant-based foods (which were much easier to get during the hunting/gathering ages…). Complex carbohydrates not only provide energy, they are chock full of fiber. Fiber is our body’s cleaning powerhouse. Good for keeping us full, maintaining our energy, keeping our hearts healthy, and cleaning out our GI system – fiber seems to do it all.
Cutting out our good sources of fiber means we are getting rid of all those good benefits plus we are forcing our body to use fuel it doesn’t prefer – ketones. Have you heard of the keto flu? That’s the horrible sick feeling keto-dieters experience after eliminating carbs. It’s your body freaking out, and rightfully so, now that we know how much our body needs them. Usually the symptoms include headaches, dry mouth, muscle cramps, diarrhea (or constipation), weakness and rashes (1). Lasting for up to 4 days, that’s a tough price to pay for un-promised results.
"It’s got a lot of health benefits." Some claim that the keto diet is a cure-all for obesity, diabetes, heart issues, and more. But foods that are high in fat, especially saturated fat, and approved for the diet, are what contribute to type 2 diabetes, high blood pressure, heart disease, stroke, etc. by either impeding the ability of cells to use insulin or resulting in fatty plaque build up in our blood vessels.
Fatty foods taste delicious so getting people to eat them is no struggle but the risk isn't worth it. Our standard American diet is already chock full of bacon and eggs and all sorts of other meat and cheesy items. At the rate we eat them, we should be in pristine health! But, as you may know, we have an obesity and chronic disease crisis on our hands and our top causes of death are related to overweight and obesity (heart disease, cancer, stroke, diabetes, kidney disease, etc.) (2).
Related to these diseases is the low intake of plant-based foods that are rich with fiber (fruit, vegetables, whole grains, legumes, etc.). In populations who eat more plant-based foods, we see the opposite of the diseases we are trying to prevent. We see a decrease in obesity, overweight, and related causes of death.
Keto diet can benefit children with epilepsy/seizure disorder. That’s how the diet got started. It is successful in mediating seizures but, not always, and not for everyone. Once better drugs were developed for these conditions the diet fell out of common use and for good reason: the diet can cause stunted growth, kidney damage, bone weakening, liver damage, and more. While many of the related side effects of a keto diet can be managed by an attentive team, some of these risks can – and have – caused death (3,4).
"I heard it helps with Alzheimer’s." There are a few neuro-related diseases that the keto diet has potential for (outside of epilepsy) and this very short list includes Alzheimer’s. The research is still pushing on (and I encourage you to look into joining some of the research studies if you are affected) and I am so hopeful it proves positive. Luckily, diet-related treatments are low impact with few (if any) side effects or risks. Right now, the research shows some promise in those on the keto diet and in some cases with MCT oil supplementation. You can read more about the ongoing research here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119973/.
"It works for weight loss." Keto, much like any fad diet, aims to nearly eliminate macronutrient groups in favor of one dominating ( cut out carbs and proteins, increase fats). Any style of eating with severe restriction can result in weight loss. Unfortunately, there is a risk of overall lowering metabolism as the body may break down muscle in an effort to use alternatives to fat for fuel. Perhaps the loss in muscle is also seen in this weight loss. As fat is also hydrophobic (repels water), we also see water loss. Dehydration, wasting muscles for weight loss can be damaging long term as that slower metabolism may need to be nourished back when you transition back to regular eating (I don't know anyone that can maintain a true keto diet for a long while so transitioning is inevitable).
Fats are an important part of a healthy diet and they should be eaten with carbs and proteins for optimal health but, like carbs and proteins, they have a role and shouldn't dominate the diet. Fats help with vitamin absorption, and brain function and a whole host of other things. Removing fat entirely from our diets can cause vitamin deficiencies and impact our looks (hair, skin, nails). Much like fat does so much for us, so do protein and carbohydrates.
Let’s go through some of the foods the keto diet asks you to avoid (according to Healthline) and identify the potential issues you may have with their elimination My commentary is in bold italics.
Removes Sugary Foods: Soda, fruit juice, smoothies, cake, ice cream, candy, etc. – Totally agree! These are foods we should be reducing in any healthy eating plan.
Removes Grains or Starches: Wheat-based products, rice, pasta, cereal, etc. – uh oh, these have a lot of fiber and nutrients in them…would not recommend eliminating.
Removes Fruit: All fruit, except small portions of berries like strawberries. – Fruits are our antioxidant powerhouses. They fight disease. They have nutrients, fibers, minerals, and vitamins. They are part of the foundation to health.
Removes Beans & Legumes: Peas, kidney beans, lentils, chickpeas, etc. – these are also great sources of protein, fiber, and vitamins. Countries with high legume intake have associated low rates of heart disease risk.
Removes Root Vegetables and Tubers: Potatoes, sweet potatoes, carrots, parsnips, etc. – These are a cornerstone of good carbohydrates with fiber. Plus, packed with vitamins and minerals, removing these (with all the other fruits and veggies) is asking for trouble. Without the fiber from these and the above product, you are going to have GI issues like dehydration, vitamin deficiencies, and constipation.
Removes Low-fat or Diet Products: These are highly processed and often high in carbs. – Agreed! These are processed and of little nutritional value.
Remove (some) Condiments & Sauces: These often contain sugar and unhealthy fat. – Sure, some condiments and sauces are poor choices…
Removes Unhealthy Fats: Limit your intake of processed vegetable oils, mayonnaise, etc. – no argument here. Focus on the good sources of unsaturated fats.
Removes Alcohol: Due to their carb content, many alcoholic beverages can throw you out of ketosis. – some of the healthiest countries in the world consume moderate wine or beer and have some of the lower heart disease rates. Check out the benefits of resveratrol…
Removes Sugar-free Products: These are often high in sugar alcohols, which can affect ketone levels in some cases. These foods also tend to be highly processed. – Agree here, too!
What I don’t see recommended in this diet is to limit your intake of artery clogging foods that raise cholesterol and blood pressures…and it suggests you remove many of the food that fight those two things!
Cutting out health protective foods from your diet arbitrarily is akin to gambling with your health outcomes. Doesn't choosing a health protective version sound much better?
1. Harvey, C., Schofield, G., and Williden, M. (2018). The use of nutritional supplements to induce ketosis and reduce symptoms associated with keto-induction: a narrative review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858534/.
2. Centers for Disease Control and Prevention. (2017). Leading causes of death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
3. Groesbeck, D., Blumi, R., Kossoff, E. (2006). Long-term use of the ketogenic diet in the treatment of epilepsy. Retrieved from https://www.cambridge.org/core/journals/developmental-medicine-and-child-neurology/article/longterm-use-of-the-ketogenic-diet-in-the-treatment-of-epilepsy/927405527DC6CCF246FBA057EACA60E3.
4. Duchowny, M. (2005). Food for thought: the ketogenic diet and adverse effects in children. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198735/.