The Keto diet: What is it and should you do it?

If you’re new to diet culture, let me introduce you to the Keto diet. The true Ketogenic diet is a high fat, very low carbohydrate, and moderate protein diet intended for the use of medical nutrition therapy administered by registered dietitians. However, many individuals aiming to follow a keto dietary pattern are not really following the recommendations outlined by the original therapeutic diet. Due to the wide array of opinions floating around the internet (largely by *uncredentialed* people) about the best macronutrient composition of a keto diet, it's hard to interpret whether or not the mainstream is actually in the metabolic state of ketosis.

So, where did the Keto diet originate? Funny you should ask. The Ketogenic diet is a therapeutic diet used for the treatment of uncontrolled epilepsy in children. How does this work, one might ask?

Carbohydrates are the body’s main source of fuel and energy. In a state of carbohydrate restriction, metabolism shifts to utilizing fat stores for energy in the form of ketones for the heart, muscles, and brain. In the metabolic state of ketosis, the brain is functioning off of ketones which is beneficial for individuals with epilepsy. However, for individuals who lack this medical diagnosis, the research is unclear.

In order to follow such a low carbohydrate eating pattern as intended by the “OG” Ketogenic diet, consisting of less than 50 grams of carbohydrates per day, the diet eliminates many foods which offer incredible nutrient density. The list begins with fruits and vegetables, whole grains, and beans and legumes. In addition to limiting healthful foods with years of evidence-based research supporting their benefits, the Keto diet promotes consuming approximately 70% of daily calorie intake as dietary fat- if you lived through the 1990’s this is likely making your head spin (but hey, so is mine).

My main point of contention with Keto is that it is a diet intended for therapeutic purposes under the close supervision of credentialed health professionals but has been adapted and marketed to consumers as the next best thing for weight loss, just like the cabbage soup diet of years past. While individuals have experienced weight loss by following a loosely defined ketogenic diet, the long-term impacts are unknown due to the lack of research regarding the efficacy and safety of this dietary pattern for the general public. Even in the context of medical epilepsy management, this strict dietary pattern is not recommended for long duration without some adjustments for patient safety.

Those following a ketogenic diet are at increased risk for nutritional deficiencies, constipation, and the unknown cardiovascular consequences of consuming a diet that is 70% fat. Here is the issue: the research is incredibly limited on the Ketogenic diet in regards to weight loss and blood sugar management and long-term effects have not been studied. In reality, a diet that encourages you to restrict vegetables, fruits, and whole grains without medical necessity makes me raise my eyebrows.

However, as a registered dietitian, I believe it is my professional responsibility to comprehend both therapeutic and fad diets in order to provide the best care to patients. This responsibility requires a mindset of compartmentalization: the therapeutic ketogenic diet can be incredibly effective for the management of epilepsy but does that mean it is appropriate for the general population? It is important to emphasize that even if the ketogenic diet works well for some individuals, it should not be suggested as appropriate for all people- back to our mental compartments.

I also believe that registered dietitians worth their salt will help interested and curious patients “follow” fad diets within certain limits. You will never see me promoting dietary patterns that are harmful, but there are individuals who want to try certain diets regardless of what their healthcare provider advisies. Therefore, as the only credentialed nutrition professionals out there, it is the responsibility of registered dietitians to help those clients chase fad dieting in the safest way possible and hopefully bring them back home to a balanced dietary pattern.

In short, if you are looking for a dietary pattern to support weight management or even healthy weight loss, it can be done without excluding major food groups backed by years of research supporting their long-term benefits for overall health. My personal opinion: eat from all food groups- there is a reason why healthy individuals of all shapes and sizes regularly choose foods from all categories.

P.S. If you want to read the research articles and texts I use to inform these posts, please reach out and I will be happy to share! As always, if you would like to know more, shoot me an email!