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Should You Go Keto?

As I wandered through the mazes of bookshelves at my local public library last week, I was struck by the shelves upon shelves of diet books that were buried there. There must have been hundreds of them. Each one still dressed in a cover that hinted at its age. Each one representing the hard work of an author, editor, graphic designer, and publishing team. Each one promising weight loss and better health. And each one sitting sadly there… having been replaced by newer, sexier, alternatives available in print or online.

There are plenty of fad diets out there, and there will be new ones next week. Many have catchy names and promise miraculous results. But the vast majority of these trendy meal plans fail to hold up under scientific scrutiny, and most of them will eventually find their way to the graveyard of diet books at my library…. and yours.

This article will explore the “ketogenic diet” and will explain why it is not the best choice for most people, why the keto books will wind up on a dusty library shelf someday soon, and what you should be doing instead.  

What Is The Ketogenic Diet?

You wouldn’t know it by the books and the headlines, but the ketogenic diet is not new. But it is certainly having its day in the sun, based on the promise of inducing rapid weight loss, fueling high athletic performance, decreasing disease risk, and promoting longevity.

Ketogenic diets are being touted as a way of achieving the benefits of fasting, without denying yourself food. Sound too good to be true? Keep reading.  

For most people, the supposed benefits of a ketogenic diet will not outweigh the well-established risks. Having said that, there are a limited number of medical conditions where this diet may have some efficacy. But, generally speaking, this is a diet that most people will want to stay away from. Let’s unpack the important details and things you need to know about the ketogenic diet.

The basic premise of a ketogenic diet is to consume about 70 to 80 percent of your daily calories from fat, 15 to 20 percent of them from protein,  and less than 5 percent from carbohydrate.

This formula turns basic nutritional wisdom on its head, which suggests that people get up to 65 percent of their calories from complex carbohydrates (including healthy fares like oatmeal, whole grain cereals, and starchy vegetables). Advocates of the ketogenic diet claim that this unconventional approach forces the body to burn fat as fuel.

The ketogenic diet was originally developed about 100 years ago, not as a weight loss plan, but as a treatment for children with epilepsy who did not benefit from traditional anti-seizure medications. The thinking behind this approach is that epileptic patients who ate a high-fat but low carb and calorie-restricted diet could alter their energy metabolism and minimize seizure activity as a result. And…It turns out that it works. Seizure activity can indeed be reduced in frequency and severity with a ketogenic diet.  

There’s no doubt that eating high amounts of dietary fats while drastically reducing calories from carbs does alter the way the body metabolizes energy. With most traditional diets, the body meets its energy needs by breaking down carbohydrates into glucose, which is the fuel for cellular processes.  But when there are no carbs available, the body needs an alternative fuel…so it turns on the backup generator.

That backup generator uses a process called ketosis where the body breaks down stored fat as a form of fuel. It’s a reliable secondary system for getting keeping the body systems running when the primary fuel (glucose) is in short supply.

Keto Drawbacks

Keto advocates frequently argue that the ketogenic diet transforms the body into a “fat burning machine” which supposedly justifies its use as a weight loss method. But there are several reasons to think this idea is misplaced. First, the food options available on a ketogenic diet are extremely limited. And worse, those options rely heavily on foods most people should keep to a minimum — high-fat animal-derived foods like bacon, eggs, butter, cheese, and meat. There is a large body of evidence that demonstrates that increasing our consumption of animal-derived foods (especially the high-fat variety) is a bad idea. So, on a ketogenic diet, there is reason to be concerned about the foods that are you are eating.  

The second, and perhaps more concerning, feature of a ketogenic diet has to do with the foods you are not eating. In order to maintain a ketogenic state, you need to eat extremely low levels of carbohydrates which excludes most vegetables, fruits, grains and beans. By excluding whole grains, fruits, vegetables, and legumes people in ketosis become deficient in important vitamins, minerals, and phytonutrients which are essential to optimal health in so many ways.

The ketogenic also comes with fairly serious side effects. As the body shifts into ketosis, many people initially experience things like muscle cramps, constipation, insomnia, and brain fog. The symptoms can be so intense that there’s even a name for the phenomenon — “the keto flu.”

In addition to all these drawbacks, there’s also very little real scientific understanding about how the diet works. There’s no doubt that most people will lose weight on a ketogenic diet, but the research suggests that some of this weight loss is in the form of retained water and muscle mass (not just fat). Typically, people who stop their ketogenic diets tend to gain weight very rapidly once they are off it. And almost everyone who tries it doesn’t stick with it for the long term.  

People Love Carbs

And therein lies the rub. A ketogenic diet is very hard to sustain for a very obvious reason. People love carbs. And they almost always “cheat” at some point along the way. All it takes is a piece of fruit or a serving of rice and the body will kick out of ketosis.  And when that happens (which it will) that person is now on an extremely high-fat, nutrient-poor diet, no longer in ketosis, and will gain weight and increase chronic disease risk just like everyone else in America.

For a diet to be successful it’s important that it can be sustained over time. It’s just that kind of long-term track record that the so-called Mediterranean diet has demonstrated year after year for generations.

A case in point are the residents of the Blue Zone countries, who have been living long healthy lives, but without most of the chronic lifestyle diseases that plague so much of the developed countries.

There’s nothing fancy about this dietary approach — just consume more plant-based foods:  vegetables, fruits, whole grains, legumes, and nuts (instead of red meats, processed foods, and simple carbohydrates). This way of eating may not be the diet plan that launches the next best selling diet book…but it works for most people most of the time. So unless you have epilepsy, stick with a minimally processed plant-based diet and steer clear of keto.

Be well,

Dr. Josh

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