Ketogenic Diet – A Dietitian Review

If I had to nominate the star diet for 2018, Ketogenic would definitely make the cut.

Online sites are flooded with different definitions & guidelines, showing its popularity, yet also making it hard to know what definition is correct. What some may not know, is before Keto was a fad, it was mainly used as a diet to treat epilepsy to reduce brain seizures.

What are my concerns as a Dietitian when someone wants to follow any diet?

  1. Will this diet include enough variety to give your body all the nutrients it needs to function?
  2. Does the person have any health issues that may make this diet unsafe?
  3. Does the individual have an eating disorder – will this diet worsen it?
  4. Will one easily regain the weight lost once transitioning off the diet?

Let’s start with a definition

The Ketogenic Diet

High fat, moderate protein, and very low carbohydrate (ideally maximum of 20 grams per day – but this may vary) in order to achieve “ketosis” for your body to use fat for fuel instead of its preferred carbohydrate source for energy. Some studies have shown that if you consume adequate protein needs, this process should not compromise your muscle mass.

The brains main go-to food is glucose, which is obtained when your body breaks down carbs. You even keep an extra stash of glucose in your liver in the form called glycogen, and this is why athletes do something called “carbohydrate loading” before an event – eating tons of carbs to store tons of glycogen because it’s an energy source the body can easily take out for use. When glucose is no longer available, the body will use other sources such as lipids (fat), as it can break down into ketone bodies, which the brain can use for fuel. Protein can also be utilized for this purpose as well. If we didn’t have these secondary mechanisms, we would drop dead a lot faster in certain situations!  

Examples of what 20 grams of carbohydrate can be:

  1. 1 small fruit (apple, pear, etc)
  2. 1 small potato (regular or sweet)
  3. 2/3 cup grains (rice, corn, quinoa, etc)
  4. 1.6 cup milk
  5. 5tsp sugar, 4 tsp maple syrup, 3.5tsp honey
  6. 4 large tomatoes
  7. 2 large onions
  8. 1 large eggplant
  9. ½ bagel
  10. 1 pint of beer

High carb foods that tend to be excluded to meet the 20g mark: bread, cereals, cakes, cookies, pasta, pastries, pizza, muffins, noodles, sandwiches, sweets, added sugars, etc. Now let’s be honest. If you cut out all of these in general, I think one would have a serious calorie deficit → weight loss. I am not saying this to prove Ketosis does not exist, it does.

Benefits people express with this diet:

  1. Feeling full and satisfied with meals (because of the high fat)
  2. I have less “brain fog” (which people also expressed this feeling on other diets that include carbohydrates, so I figure the actual weight loss is the contributor here)
  3. Weight loss

Not so exciting side effects some claim to get

  1. Acetone breath (because of the acidic ketones floating around in your body)
  2. “Keto flu” – nausea, stomach pain, dizziness – in the early stages of doing keto
  3. Electrolytes imbalances (as the body changes to burning fats vs glucose)

My personal issue with keto:

It makes people think carbohydrates are Bad.

I feel bad for carbohydrates, they have really developed a bad reputation over time, but they also just so happened to find themselves as a vessel for most junk foods. Why? They are inexpensive ingredients that please our taste buds, and our portions sizes are often out of control. I find that most people who make this claim cannot even properly define what a carbohydrate is.

It is a macronutrient that is found across most foods in different quantities (dairy, whole unprocessed grains, fruits, VEGETABLES, beans, and more). Carbohydrates are even found amongst the raved superfoods: goji berries, wheatgrass, spirulina, etc. It’s about quality AND quantity!

When is Keto appropriate?

I think Keto is definitely beneficial to over weight or obese individuals who have a history of failing to loose weight with other means, and need to loose weight to improve serious health conditions (example: high blood pressure, pre-diabetes, high cholesterol, and many more). It should always be first approved by your doctor (as there are cases where keto would not be a safe option), and guided by in detail with a Registered Dietitian.