As a dietitian-nutritionist I preach to my patients the the coining phrase "balance is key." I'm sure you've heard it. The reason being is because although people can have success on a restrictive diet we often don't hear the latter part of their journey with weight loss. Typically, patients will gain it back and then some because of one simple thing: RESTRICTION. Basically to me, restriction is the root of all evil. That's why to me there is no greater evil than.. drumroll please.... THE KETOGENIC DIET. I'll get into it more later on, but basically the ketogenic diet is a highly restrictive and unrealistic sustainable high fat, low carb diet.
It seriously pains me to see such a restrictive diet getting SO much publicity. Especially from highly popular sites such as Tasty and Goodful. Even celebrities are boasting on its effectiveness for weight loss.
Before I start delving into the nutrition science. I'd like to have you mull over on this:
Q: Do you actually think adding heavy cream, butter, AND coconut oil to your coffee (AKA Bulletproof or Keto Coffee) is really nourishing your body? YOU tell me.
(Side note: if you didn't see the post I shared from "Goodful's" keto snacks on my Facebook page you should check it out and see if it makes you cringe as much as it made me cringe).
What is a ketogenic diet?
In short, a ketogenic diet is a diet that is very high fat (80% of your diet), very low carbohydrate (< 5% of your diet), and moderate in protein (15-20% of your diet).
So basically, the Atkins diet on steroids.
Now back to the balance thing. This devilish diet is the furthest from obtaining sustainable balance. To put these extreme percentages in perspective, the 2015-2020 Dietary Guidelines For Americans recommends our diet (for adults) to consist of 45-65% of carbohydrates, 10-35% of protein, and 20-35% of fat.
Food staples in the Keto Diet
Because the extremes of this diet are nearly impossible to reach it is recommended to load up on: butter, eggs, meat, fish, cheese, oils, nuts, avocados, heavy cream, seeds, and low carb green vegetables. Basically, say goodbye to all your typical carb sources like grains, beans, legumes, sweets, rice, milk, yogurt, cereals, and fruits. Say what???
Why is it called the "ketogenic diet"?
When we put our bodies on such a diet we are depriving our body of glucose (AKA carbs - our bodies preferred source of fuel). When our body doesn't get enough glucose, our body is in what is called a fasted state (basically the same state as if we were in starvation mode) and starts looking for other forms of fuel to exist off of. This is where fat comes into play. When glucose is no longer, our insulin levels plummet causing fat to be released by our cells. This fat is transformed into ketone bodies in the liver, a process called ketogenesis.
Ketones are our bodies less than optimal choice to carbs for energy.
Once our bodies are at a state where we are using ketones for energy our body is considered in the metabolic state of ketosis. Here's the thing, although our body can use ketone bodies for energy, our BRAIN still needs some glucose to function. This is where those 5% from carbohydrates come to play.
In short: our body CAN function without carbs however, it is absolutely NOT optimal for our bodies.
The ONE instance a dietitian would prescribe this diet...
There is only robust scientific evidence of the use of a true ketogenic diet to improve epilepsy. The keto diet is not anything new. Evidence of this diet improving severe epilepsy in children dates back to the 1920s. Although the biochemical mechanism is still not fully understood researchers think that the production of ketone bodies may interfere with neurotransmitter activity in neurons in the brain. This interruption may be what contributes to a decrease in seizure activity. In a recent Cochrane Review evidence found that compared to non-ketogenic diet controls there was a 30-40% decrease in seizure activity on the ketogenic diet. Pretty cool stuff, however it is advised that a child following the ketogenic diet needs to be closely monitored by an interdisciplinary health care team to monitor labs.
Now, need I say anymore at the fact that participants should be under clinical supervision when they are following this diet. This is because there are some studied long term adverse effects of following this diet.
Long-Term Effects
Again, this diet does not have a lot of evidence to really support it's pros and/or its cons, but here are a few that have been found in clinical trials.
Mineral deficiencies - including: sodium, potassium, chloride, vitamin D, calcium, magnesium, zinc, and selenium.
Loss of muscle mass - Even if your protein intake remains the same, a ketogenic diet may cause muscle loss. This is because when our body is given carbohydrates we provide insulin which promotes muscle growth. When we are depriving our body of carbohydrates our muscle glycogen is at an all time low, thus taking away from muscle building opportunity.
The "keto-flu" - acetone smelling breath, brain fog, fatigue, headaches and nausea. If this diet is followed long-term these symptoms may go away over time.
Constipation - Shocker. We are pretty much getting rid of high fiber sources when the ketogenic diet is followed hence, this is an unfortunate consequence.
But Jackie... I've heard many people can be really successful with weight loss?
Okay so long story short. Yes, I won't deny the fact that it helps people lose weight. But here's the thing. Check in with these people after coming off of the diet because no person in their right mind will give up carbohydrates forever. It's not a long-term option for many. Many just lose the weight, come off of it and here's the secret you don't hear about. They. gain. it. back. Think about not having cake for 3 months and then you can all of a sudden have cake again. LOL face in cake... amiright?
First of all, people are eliminating a major food group out of their diet. Typically whenever this is done, people will lose weight because they are eliminating their choices for food. Secondly, the keto diet can cause a rapid loss of water weight. Remember all of that talk about glycogen (our storage carbohydrate)? So it is not only used to store glucose, but also water. So hence, when the body's stores are depleted, we remove excess water in our body. So really this rapid weight loss, is mostly water weight.
Why I really don't recommend it
In my field, we can only recommend strategies that are clinically proven to help patients succeed. We base our practices off of sound scientific evidence and nothing, but science. Really, our licenses depend on the fact that we are providing patients with the most up-to-date recommendations and evidence-based nutrition. There's not enough clinical evidence on this diet and it's long-term effects. It's also highly restrictive and it is my job to provide patients with changes that are obtainable and sustainable, NOT something that could potentially cause havoc on their bodies. Keep in mind 95% of diets (NOT lifestyle changes) fail. That's a pretty daunting statistic if you ask me. So for these reasons, I don't recommend it (unless of course the patient is epileptic).
Final thoughts
If you are trying to lose weight, there are much healthier, less restrictive, and sustainable ways to achieve this goal. There is no need to follow such a diet in my opinion based off of the scientific evidence that's out there. Stick to a heart-healthy Mediterranean diet that has billions of studies to support it's amazing effects on the body.
And as always, reach out to a Registered Dietitian Nutritionist for any nutrition advice and support with your weight loss and/or disease prevention journey. You won't regret the invaluable advice you can get from us for a lifetime of health and wellness. Really..... it's scientifically proven. Why do you think health insurance covers your visits with us? ;)
Until Next Time,
Jackie