A Dietitian's Thoughts on Keto

As a dietitian, it’s inevitable that the first question I get when I go out is what my thoughts are on the latest diet. As you may have guessed, right now it’s keto. I’m going to summarize a few of the most common comments about it that I get so you’ll have a baseline of info, and get a professional’s opinion at the same time…Here we go…


Carbs are the devil! 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 – carbs! 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 our bodies’ preferred fuel source and for good reason! 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 (found in complex carbohydrates) means we are getting rid of all those good benefits plus we are forcing our body to use fuel it doesn’t prefer to use – ketones. Our body so loves the glucose that carbs provide that it will create glucose out of non-carb sources for as long as it can (this is called gluconeogenesis). 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.


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. If only! I wish we could eat bacon and eggs every day and cure disease. Wouldn’t that be so easy? Foods that are high in fat, especially heavy saturated fats, are extremely satisfying and, as a dietitian, it is not a struggle to get people to eat these foods. Unfortunately, diets high in animal fats mean quite the opposite for health. 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 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 (fruit, vegetables, whole grains, legumes, etc.). In populations who eat more plant-based foods, we see the opposite. We see a decrease in obesity, overweight, and related causes of death. Populations who eat more animal-based and processed foods do not have these same health benefits. I wish I could twist the facts, but it can’t be done. That’s science. It’s reality.


Keto diet does have a benefit for 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, 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/.


I only care about losing weight. Keto, much like any fad diet, cuts out a food group. Any way of eating that does this can result in weight loss. Some approaches cut out animal products, some cut out carbohydrates, some reduce fat….what I encourage you to review is what benefits can you get from the foods you’re eating WHILE you're making progress towards your health goals. Fats are definitely an important part of a healthy diet; they help with vitamin absorption, and brain function. Removing fat entirely from our diets can cause vitamin deficiencies and a host of effects on our looks (think hair, skin nails). Not worth it, right? Let’s consider the opposite diet – the high fat, low carb diets (this includes keto, atkins, etc.). These diets are missing or reducing a lot of key nutrients that we need to be healthy and function. Let’s go through some of the foods the keto diet asks you to avoid (according to Healthline) - my comments in italics:


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.

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.

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.

Beans or 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.

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.

Low-fat or diet products: These are highly processed and often high in carbs. – Agreed! These are processed and of little nutritional value.

Some condiments or sauces: These often contain sugar and unhealthy fat. – Sure, some condiments and sauces are poor choices…

Unhealthy fats: Limit your intake of processed vegetable oils, mayonnaise, etc. – no argument here. Focus on the good sources of unsaturated fats.

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…

Sugar-free diet foods: 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 our cholesterol and blood pressures…and it suggests you remove many of the food that fight those two things! If you’re like the average American, high blood pressure, weight, type 2 diabetes, and heart disease are things you are at risk for. Many of the foods listed above fight those diseases so cutting them is like gambling…when there’s an option to lose weight AND stay protected, wouldn’t you take it?






Resources

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/.

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