Many of you have probably heard about the keto diet. As a matter of fact, many well-known celebrities like Kim Kardashian and Lebron James have raved about the keto diet. But there are many questions you should ask before you consider switching to this diet. The keto diet is very specialized and should always be carried out with the care, supervision, and guidance of trained medical specialists. 

Essentially, the keto diet is a very low carbohydrate diet, high in fat and moderate in protein. This diet forces the body to primarily burn fat for fuel, rather than carbohydrates. The way it works is your body goes through a metabolic state called ketosis when it doesn’t have enough carbohydrates from food for your cells to burn for energy. As part of this process, it burns fat instead and the body makes ketones. If you’re healthy and eating a balanced diet, your body will control how much fat it burns and won’t normally make or use ketones. But if you cut back too much on calories or carbs, your body will switch to ketosis for energy. However some people have different levels of tolerance. In the beginning stages of the diet, ketosis can lead to hypoglycemia (low blood sugar), metabolic acidosis, and electrolyte imbalances leading to symptoms of fatigue, nausea, vomiting, and headaches.  Meeting with a dietitian prior to starting the diet can help provide education on how to minimize these side effects. 

Good to know: The ketogenic (keto) diet is a trendy weight loss diet that has been all over the news. But did you know keto was first introduced in the 1920s and 30s as a therapy for epilepsy? This diet was one treatment option for children with epilepsy whose seizures are not controlled by antiepileptic drugs.

The keto diet is safe for most people but having certain types of medical conditions can make it unsafe. There are also some rare metabolic syndromes that the ketogenic diet would be unsafe and even life-threatening. Anyone with medical conditions such as diabetes, heart and kidney diseases, pregnancy, and any type of metabolic syndrome, should consult their doctor as the diet may increase complications and require changes in treatment.

Good to know: Children are at higher risk for complications associated with the ketogenic diet or any low-carb diets due to the need for good, balanced nutrition for growth and development.

Currently, there is insufficient research to either promote or discourage the keto diet during pregnancy. The risks of metabolic ketosis to the fetus and while breast feeding is unknown. The concern is about getting sufficient energy and nutrients for fetal growth and development. If you’re losing a lot of weight while pregnant this could affect fetal development. In addition, if the mother is inadequately nourished, production of breastmilk may be compromised.

Good to know: Bottom line, this diet should be discussed with your doctor beforehand and possibly avoided until there is more data.

Is it Safe for Someone with High Cholesterol?

Very low carbohydrate diets appear to have a positive impact on the markers known to increase cardiovascular disease. The ketogenic diet has shown improvements in some lipid levels, including triglycerides and HDL cholesterol (the good kind). Your blood pressure may improve as well, and medications used to reduce blood pressure may need to be adjusted by your doctor.  It’s important to have regular cholesterol and lipid testing, including particle size, when on a carbohydrate-restricted diet. The particle size is important in understanding cardiovascular risk.

Good to know: The ketogenic diet doesn’t increase (in number) the LDL cholesterol, but increases the size of the LDL which is more protective (increasing the number would be less protective, smaller size particles are less protective).  

Is it Safe for Diabetics?

To manage diabetes, there is increasing interest in very low carbohydrate diets. However, the evidence is still preliminary. We know that insulin sensitivity improves on the keto diet, in addition to improved weight loss, and it can improve hemoglobin A1C and reduce the requirement for medications. 

Good to know: People taking insulin or oral hypoglycemic medications for diabetes are at a very high risk of severe and even life-threatening hypoglycemic events. Consult with your doctor to safely adjust medications while initiating the diet.

Is it a Weight Loss Solution?

Will you lose weight on the keto diet? Most likely, yes. However, calling it a solution isn’t an accurate description. People on the ketogenic diet often experience rapid weight loss initially, partly due to the diuretic effect (water loss) in the beginning. Afterward as the body adjusts to utilize fat stored for fuel, the rate of weight loss continues, but at a much steadier pace.

Good to know: Many people feel less hungry on a keto diet, which often reduces caloric intake, thus aiding in weight loss. 

What Foods Can You Eat?

Since the keto diet is high in fat and low in carbs, you can mostly eat all fat and protein sources. Fruits and vegetables are also allowed and encouraged if they’re within the restricted carbohydrate goal. To stay in ketosis, you eat approximately less than 50 mg of carbs per day.

What’s the Difference Between Low-Carb and Keto?

The ketogenic diet is just one version of a low-carb diet, many people eat low-carb, yet it’s not considered ketogenic. A typical American diet of 2,000 calories per day equates to approximately 225-325 gm/day (likely upward to 400 gm due to over-consumption) of carbohydrates. A diabetic diet is roughly 150-200 gm/day. So frankly, a low-carb diet can be considered anything less than 150 gm/day.

Is it a Fad Diet?

According to the Academy of Nutrition and Dietetics, “Fad diets, as their name implies, are short-term quick fixes that actually set many dieters up for weight-loss failure.” Extreme restriction usually results in lack of sustainability that may result in more sporadic eating behaviors, and even weight gain. However, there are cases where an individual has jump-started weight loss with the keto diet and then gradually worked it into a more balanced, sustainable diet afterward. Do your research, and consult a dietitian to find this balance.

Good to know: Generally with fad diets, once you stop the diet the weight usually comes back. The key to maintaining a healthy weight is to find a balance to create a healthy lifestyle that can be sustained over a long period of time. It’s difficult to do this when any diet restricts entire food groups.

Get Nutrition Counseling

Nutrition counseling is widely covered by many insurance plans. Most SelectHealth plans reimburse up to five visits a year for a majority of health conditions. Call your insurance today to find out. Learn more about nutrition counseling at Intermountain.

https://intermountainhealthcare.org/services/nutrition-services/services/nutrition-counseling/.