A Dietitian’s Review of The Keto Diet

**Glen’s Note** Diets, especially trend diets, may come with short-term benefits, but they also come with possible health implications that aren’t always covered in the promotional promises. Just because market demands make it look appealing, the decision to undertake a specialized diet program needs to be carefully considered and discussed with your doctor or qualified health expert. We asked Michelle to give us a more clinical opinion in hopes it will help you make an informed decision. Her response follows in our blog – A Dietitian’s Review of The Keto Diet.  

The Keto Diet: A Closer Look

A derivative of the Ketogenic diet, an extremely low-carbohydrate diet prescribed in clinical settings for children with otherwise unmanageable epilepsy, the Keto diet may be one of the most controversial and widely debated weight-loss methods in the modern diet sphere. Does it work and are its potential risks worth the hype? Let’s explore what a Keto lifestyle looks like, and where the research stands.

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Diet Tenants

The Ketogenic diet was first implemented in 1920 as a successful method for treating seizures in epileptic children who failed to respond to traditional medical therapy. The basic principle behind the Ketogenic diet (and its modern incarnation as a weight management tool) is fairly simple: Glucose, a byproduct of carbohydrate breakdown, is the body’s preferred fuel source. In fact, the brain demands it in steady supply. The Keto diet almost eliminates carbohydrates, which causes our metabolism to switch to stored fat for energy.

Once the body has depleted all of its carbohydrate stores, insulin levels drop. Low blood insulin levels trigger the liver to break down stored fat and converting it to molecules called ketone bodies, which cells can use as energy in the absence of glucose. They call this being in a state of Ketosis. How long it takes for enough ketone bodies to accumulate in the blood varies depending on the individual, but on average, the body will reach ketosis in about 2-4 days. It will continue in that state indefinitely unless enough carbohydrate are consumed to provide a steady supply of glucose again.

During this transition period, many dieters experience a cluster of symptoms colloquially known as the “keto flu” that includes fatigue, constipation, headaches, dizziness, nausea, insomnia, and bad breath. These symptoms typically subside after two to three weeks.

Keto in Practice

While there is no singular diet manual for Keto, the generally accepted macronutrient breakdown is about 70-80% total calories from fat, 10-20% from protein, and 5-10% from carbohydrates. Followers must be physically and mentally prepared to reduce their carbohydrate intake to 20-50 grams per day, which is the rough equivalent of two slices of bread.

Unlike other popular low-carb/high-protein diets, Keto goes easy on the protein and heavy on the fat. This is because amino acids, the byproduct of dietary protein breakdown, can convert to glucose. Too much protein though in the diet will prevent or interrupt ketosis.

On the menu are fatty foods such as fatty cuts of beef and pork, lard, and butter. Also allowed are oily fish like salmon, tuna, mackerel and sardines, and some plant foods that contain natural oils such as nuts, seeds, avocados, and olive oil. Off the menu in any significant quantities are fruit, fruit juices, grains, cereals, rice, pasta, potatoes, and other starchy vegetables like corn, carrots, beans, peas, and squash.

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Efficacy and Safety Concerns

Preliminary research is promising but limited. Most studies have shown the Keto diet to be successful in promoting weight loss, as well as improving biomarkers associated with metabolic syndrome like blood sugar, blood pressure, insulin sensitivity, and cholesterol and triglyceride levels. But it’s important to note that the average length of most available studies is only 4-12 weeks. The few studies that have examined effects beyond one year have found that total weight loss using Keto was not significantly different from other, less extreme diet interventions and that many participants could not sustain such a low-carb diet long enough to have their data included. Long-term (beyond one year) studies are needed to assess the effects of chronic ketosis on various aspects of human health.

According to the Academy of Nutrition and Dietetics, Keto is not recommended for individuals with pancreatic or liver disease, thyroid problems, a history of eating disorders, or gallbladder disease including cholecystectomy. The Academy also identifies the potential for digestive problems and deficiencies of key nutrients like vitamin A, C, K, and folate because of the diet’s lack of plant-based, fibrous foods. Other considerations not yet well studied include the long-term effects of high saturated fat intake on the cardiovascular system.

Final Thoughts on A Dietitian’s Review of The Keto Diet

It is important to weigh the risks (including potential risks) versus benefits when considering taking on Keto. Much more research is needed in order to assess its long-term effects on human physiology and overall health, especially if similar weight-loss results and disease risk biomarkers can be achieved by a more balanced and nutritious eating style. We’ve also posted a review of the best and worst rated diets for 2021 per U.S. World News, give it a read when you can!

**Glen’s note** We’re not trying to dissuade you from any decision you feel is right for you when it comes to dieting. We do however, ask that you be safe and discuss with your doctor any changes to your diet that could have long-term implications. 

We hope that you’ve found some useful information with our piece on A Dietitian’s Review of The Keto Diet.  As always, if you don’t see something here you want us to cover, feel free to reach out to us directly through our Contact page or leave a comment below. Stay healthy!

Michelle Monroe has been a Registered Dietitian with the Academy of Nutrition and Dietetics since 2008. She has an array of experience in the field including clinical dietetics, long-term care, diabetes education, food service management, community nutrition, one-one-counseling, and meal planning.

Michelle loves her work and the learning, but most importantly she loves the relationships that she forms with her clients. Being able to help people is one of the most rewarding experiences of her life.