Ask the Dietitian: What is Your Opinion of the Ketogenic Diet?

Ask the Dietitian: What is Your Opinion of the Ketogenic Diet?

Trinh Le, MPH, RD
by Trinh Le, MPH, RD
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Ask the Dietitian: What is Your Opinion of the Ketogenic Diet?


Full-fat everything you want — it sounds like a dream diet to lose weight on, right? The ketogenic diet, or keto diet for short, has risen to diet trendom. Health-wise, the ketogenic diet has also been shown to be beneficial for mental disorders, epilepsy, type 2 diabetes  and even weight loss. Even so, this diet is  quite controversial.

Let’s explore this diet together, so you can make an informed decision for your personal health.

WHAT IS THE KETOGENIC DIET?

The ketogenic diet is a high-fat, low-carb and moderate protein diet. Despite recent popularity, the “classic” KD has been used for almost 100 years to treat children with epilepsy. It was later adapted into the well-known commercial weight-loss program, the Atkins diet. Different versions of this diet exist, but these two are among the most common:

  • Classic Ketogenic Diet: This diet uses a ratio of 3:1 or 4:1 for fat to nonfat (Think: protein and carbohydrates) in grams.
  • Modified Atkins Diet: This diet restricts carbohydrates to 20 grams of “net” carbs daily. “Net” carbs are defined as total carbohydrates minus dietary fiber.

Take a look at the chart below to see how the KD stacks up against what experts recommend; the difference is drastic. Keep in mind that the definition for a “classic” KD may be different than what people who practice a more mainstream ketogenic lifestyle for weight loss will consume. A modified version of the KD is more flexible on the number of carbs you can have in a day, so low-carb vegetables (think: broccoli, spinach, lettuce) won’t count against you. High-fat, keto-friendly foods include those higher in saturated fat (e.g., bacon, cheese, butter) and lower in saturated fat (e.g., olive oil, avocado, nuts and seeds).

*Note: A well-balanced diet rich in fruits, veggies, whole grains, lean protein and healthy fats will likely have a macronutrient (e.g. fat, protein, carbs) profile within the “acceptable macronutrient distribution range” (AMDR).

HOW DOES THE KETOGENIC DIET PROMOTE WEIGHT LOSS?

You may wonder how eating up to 90% of your calories from fat while turning a blind eye to calories can lead to weight loss. Nobody knows exactly but researchers have a few good guesses:

  • Fuel Switching. Eating a lot of fat and severely limiting carbs pushes you into “ketosis,” a state where mostly fat is burned instead of carbs. Even the brain, an organ that preferentially uses glucose (a sugar) for fuel must adapt to using fat in the form of ketones.
  • Appetite Control. Those on the KD claim it dampens their appetite. This is because ketones may play a role in signalling satiety within the brain.
  • Metabolically Expensive. Just because you transitioned into ketosis and can burn fat more efficiently doesn’t mean your body won’t need carbs at all. To keep blood sugar within a reasonable range, the liver converts protein into glucose through a process called “gluconeogenesis.” OK, biology lesson stops here. Just know that this process demands a lot of energy and burns an additional 400–600 calories daily.

The KD may be great for short- and medium-term weight loss, but there’s no clear outlook on what it will do to your health in the long run — and this puts many experts on edge.

WHY IS THE KETOGENIC DIET SO CONTROVERSIAL?

The US News expert reviews give the KD about 2 out of 5 stars. Right off the bat, here are two major reasons why this diet sank so low:

  1. It promotes foods high in fat, even saturated fat, which is bad for heart health. A diet that puts few limits on bacon, butter and full-fat cream automatically draws backlash.
  2. It can eliminate whole food groups if followed stringently. This includes high-carbohydrate vegetables, most fruits and whole grains. This could lead to nutrient deficiencies in the long run.

READ MORE > EVERYTHING YOU NEED TO KNOW ABOUT THE DASH DIET 


ARE THERE ANY BENEFITS?

Despite the controversy, let’s balance pros and cons. Yes, the KD is solid therapy for children with epilepsy, but they’re always under careful clinical supervision to correct for any micronutrient deficiencies. The KD is showing promise as therapy for Type 2 diabetes, cancer and neurological disorders such as Parkinson’s, Alzheimer’s, autism, etc. but the science isn’t yet well-established. The same applies for long-term weight loss.

THE VERDICT

Hopefully I’ve given you enough food for thought. In my opinion you should still try to lose weight first by following a well-balanced diet full of fruits, vegetables and whole grains. But, to be frank, I’m flexible on the ketogenic lifestyle, especially if you’re pursuing this diet with the help of a qualified health professional.

Clearly, the KD is restrictive and isn’t for everyone. Be realistic about whether this diet will align with the lifestyle you want. If you have a sweet tooth or love your fruits and veggies, you will likely struggle on keto. Those who are vegetarian or vegan will also find the KD challenging.

Finally, just because the diet is a poster child for all-you-can-eat bacon doesn’t mean you have to eat this way. There are healthy fats to choose including avocado, olive oil, walnuts and fatty fish.

About the Author

Trinh Le, MPH, RD
Trinh Le, MPH, RD
Trinh is a registered dietitian by day, blogger at Fearless Food RD by night. She loves helping folks develop a better relationship with food, which includes lots of cooking, eating and learning about nutrition. When she’s not snapping mouthwatering shots of (mostly) healthy food, you can find Trinh HIIT-ing it at her local gym. For more, connect with her on FacebookInstagram and Pinterest.

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