If you haven’t heard about the ketogenic diet yet, it’s only a matter of time.
The ketogenic diet (also known as the keto diet or keto) is the latest diet trend hailed for its impacts on weight and chronic diseases such as obesity, cancer, heart disease, and diabetes.
So… is keto all that it’s cracked up to be? Let’s explore this diet trend together.
Firstly, what actually IS the ketogenic diet? It is a diet which is high in fat, moderate in protein, and very low in carbohydrates. When following the ketogenic diet, your daily intake looks like this:
75-80% of total calories from fat
15-20% of total calories from protein
5% of total calories from carbohydrates
Compare this to the Acceptable Macronutrient Distribution Range (AMDR) from the Institute of Medicine, that is typically promoted as a healthy, balanced diet:
20-35% of total calories from fat
10-35% of total calories from protein
45-65% of total calories from carbohydrates
So what is the ketogenic diet trying to achieve? Nutritional ketosis.
What’s nutritional ketosis? You can read an in-depth, scientific description of nutritional ketosis by clicking here. Basically, we are trying to change the body from using glucose (a type of carbohydrate) as its fuel source to using ketones (a byproduct of fat metabolism). It is important to note: nutritional ketosis and diabetic ketoacidosis are not the same thing.
The ketogenic diet aims ultimately for less than 20-25 g of total net carbohydrate per day! (Net carbohydrate is just grams of total carbohydrate minus grams of fibre.) This essentially rules out the following foods:
Bread and pasta
Cereals
Grains (rice, corn, quinoa, barley, etc.)
Fruit and some vegetables
Tubers (potatoes, yams, etc.)
Sugar (agave, honey, maple syrup, etc.)
Foods permitted on the ketogenic diet include:
High-fat meat, poultry, fish
Eggs
Tofu/tempeh
Leafy green vegetables (spinach, kale, etc.)
Above ground vegetables (broccoli, cauliflower, etc.)
Very high fat dairy products (heavy cream, high fat cheese, etc.)
Nuts and seeds
Avocados
Berries
Sugar-free sweeteners (stevia, monk fruit, erythritol, etc.)
Fats (coconut oil, high-fat salad dressing, butter, etc.)
It is possible to be both ketogenic and vegetarian/vegan, however this will be even more restrictive than a traditional ketogenic diet requiring careful planning and calculation. We strongly encourage anyone wanting to be both vegetarian/vegan and ketogenic to consult with a dietitian to ensure you are meeting your nutritional needs.
The ketogenic diet is more than just high fat and low carb, keto dieters must also be aware of their intake of other nutrients such as fluid, fibre, sodium, magnesium, and potassium which they may not have had to consider before. For this reason, we strongly encourage anyone considering the ketogenic diet to consult with a dietitian to ensure they are doing it properly (i.e. achieving nutritional ketosis) and safely (i.e. consuming adequate nutrients).
The ketogenic diet has actually been around for decades, it dates back as early as the 1920s as a treatment for epilepsy (seizures) in children and is still used for this reason today. However, current research (albeit limited) is now showing it may be helpful for:
Weight loss/management
Appetite suppression
Blood sugar control
Improved mental focus and energy
Improving lipid profiles (e.g.HDL/LDL cholesterol and triglyceride levels)
Improving hypertension (high blood pressure)
Reducing acne
As a result, the ketogenic diet is starting to be used as a therapeutic diet for:
Diabetes
Certain types of cancer
Weight loss/management
Autoimmune diseases
Neurodegenerative diseases
Wow, doesn’t that sound too good to be true? While the medical community is often good at being critical of scientific research, the general public is often quick to jump on board with the latest trends without a second thought.
In fact, there is currently no conclusive evidence that ketogenic diets are superior to a healthy, balanced diet that includes carbohydrates - except in certain clinical cases of pediatric epilepsy and metabolic disorders (e.g. pyruvate dehydrogenase deficiency and glucose transporter type 1 deficiency).
As with any restrictive diet, the ketogenic diet is not without its’ drawbacks.
The truth is, the research (while promising) is still quite small-scale and limited. We just don’t know if the ketogenic diet is right for everyone (i.e. all ages, disease states, genders, ethnicities, socioeconomic statuses, geographical location, etc.), or even if it’s right for anyone long-term. More in-depth, rigorous, and long-term research is needed to truly evaluate the positive and negative effects of the ketogenic diet.
Some of the documented short- and long-term health risks include:
Increased risk of nutrient deficiencies (e.g. selenium, sodium, potassium, magnesium, fibre, etc.)
Decreased muscle mass
Increased risk of kidney stones
High total cholesterol levels in the blood
Low blood sugars
Stunting/poor growth (in children)
Low bone density and increased risk of bone fractures
Hormone imbalances, irregular menstruation, and/or amenorrhea
Abnormal heart rhythm
Constipation or diarrhea
"Keto Flu" (see below)
If you have a medical or familial history of diabetes, cancer, heart disease, high cholesterol, fat malabsorption, digestive challenges, etc. we strongly recommend you consult with your medical team and/or dietitian prior to starting any new diet.
If you are pregnant or planning to become pregnant, we strongly discourage you from following the ketogenic diet and discuss with your medical team and/or dietitian.
Many people experience the “keto flu” when first transitioning into a ketogenic diet. Common symptoms include:
Fatigue
Brain fog
Nausea/dizziness
Cramps
Craving sugar
Irritability
Poor focus/concentration
Abdominal pain
Confusion
Muscle soreness
Insomnia
These symptoms are normally the result of a change in fluid and electrolyte balance in the body and normally improve within 1 week of transitioning into the ketogenic diet. To avoid the keto flu, you can try slowly weaning yourself into the ketogenic diet rather than cutting out high-carbohydrate foods “cold turkey”. If you are experiencing keto flu symptoms, check out this website for strategies to help.
There are many health benefits associated with decreasing your intake of processed foods and refined sugars, however it’s important to understand how restrictive and rigorous the ketogenic diet really is - even people with extensive food and nutrition-related knowledge can find the ketogenic diet daunting to learn and follow.
As with any restrictive diet, the ketogenic diet requires a lot of work and planning, and it may not be suitable for your lifestyle. Restrictive diets often provide short term results (e.g. in terms of weight loss) but aren’t sustainable long term, which can often result in regain of the weight initially lost (and sometimes even gaining more weight than where you started!). Realistic, sustainable, long-term changes often involve making small modifications to your diet and lifestyle over time.
Remember, health isn’t just about physical health. Following a restrictive eating pattern, like the ketogenic diet, may impact your emotional and mental well being. You may also find yourself missing out on meals with family and/or friends or feeling socially isolated as you are following a diet that no one else in your household does. Not only this, but restrictive dieting may affect your relationship with food and you could fall into a disordered eating pattern. ***If you have feelings of guilt and/or shame about eating, are obsessing about food, or believe that what you eat reflects your value as a human being - we strongly suggest you seek help and guidance from a dietitian and/or physician to build a healthier relationship with food!
At the end of the day, you have to decide what works best for you. If the ketogenic diet is an effective, sustainable diet which you can follow safely and fits well into your lifestyle, then go right ahead! But if the ketogenic diet is unsustainable, affecting your health, or is socially isolating - it’s likely not a good fit for you. We prefer to recommend a non-diet dietary approach - a focus on eating healthy and being active, in a way that you enjoy and suits your lifestyle, and promotes a healthy relationship with food. If you are looking for help with making healthy, long-term lifestyle changes, book an appointment with Alex or Stephanie today!