mixed nuts on table

To Keto or not to Keto: Is this diet trend right for you?

In honor of American Heart Month I want to discuss a trendy topic I am constantly asked about as a dietitian. The most popular fad diet at the moment seems to be the keto-diet. While this diet maybe beneficial for weight loss and heart health in some individuals, if not done properly it could raise your bad LDL cholesterol levels.

With many facilities around island promoting this new trend, I have had many patients come to my office with questions about the keto-diet. So I’ve decided to answer some of the most common ones here.

What is the keto diet?

The keto-diet gets its name from a state in the body known as ketosis. Our bodies transition into ketosis when blood sugar is low and the body is forced to break down fat instead of carbohydrates, or sugar, for energy. As a result of the breakdown of fat, ketone bodies –the compounds acetoacetate, beta-hydroxybutyric acid (BHB) and acetone– are created. Once ketone bodies have risen to a certain level, your body is considered in a state of ketosis, and these compounds can cross the blood-brain barrier to be used as fuel for your central nervous system.

Are you actually in ketosis?

Depending where you go and who you talk to, you will find many variations on keto-diets. Some are more restrictive than others. While research supports many of these extremely low carb diets are effective, its important to note that the carbohydrate intake needed to induce ketosis is typically less than 40 grams per day. Some less restrictive plans may not be designed to promote a constant state of ketosis.

Is ketosis safe?

When following a strict ketogenic-diet it is extremely important to keep your BHB levels, a measure of the presence & intensity of ketosis, within a desired range. If your ketone bodies raise above a certain level you may develop keto-acidosis, a serious condition that requires medical intervention.

While you can find various forms of testing devices online, it is recommended that any individual wanting to pursue a keto-genic diet first consult a physician or registered dietitian. Your medical professional will direct you to the best testing methods and desired BHB levels. It is also important to note that most clinical studies involving true keto-genic diets are conducted over a period of less than 6 months, so the possible long-term side-effects of ketosis are not well known.

Populations that May Benefit from a Keto Diet

The ketogenic diet has proven to be effective in treating adults and children who have epilepsy that does not respond well to medication — although the reason why this works is not completely understood. One theory is that once ketone-bodies cross the blood-brain barrier they may reduce seizures by inhibiting neurotransmitter production, release and uptake.

A keto-diet may also be beneficial for individuals with difficult to manage type 2 diabetes with other cardiovascular disease risks, like high blood pressure or elevated cholesterol. The American Diabetes Association (ADA) has made a statement contrary to their previous recommendations following numerous studies on a keto-getic diet and the results on blood sugar control and insulin-resistance in type 2 diabetes.

The ADA has acknowledged that “…low carbohydrate eating plans may result in improved glycemia and have the potential to reduce antihyperglycemic medications for individuals with type 2 diabetes. As research studies on some low-carbohydrate eating plans generally indicate challenges with long term sustainability, it is important to reassess and individualize meal plan guidance regularly for those interested in this approach.”

Individuals with certain endocrine disorders effecting their thyroid, pituitary, or adrenal glands may also benefit from extremely low carb diets, although the exact cause of this benefit is unknown. For any individual with a metabolic condition that has not improved with normal diet and lifestyle interventions, you should consult with a physician or registered dietitian nutritionist before starting any keto diet plan.

Consider Where You are Starting

Before you begin any diet plan, I recommend you start by making an assessment of your current diet. Track what you eat for a week. Use an app that calculates calories and macro-nutrient breakdown to see how many of the calories you consume currently come from fat, carbohydrates, and protein.

If you currently eat over 60% of your calories from carbs, transitioning immediately to a keto-diet may be difficult. It may also be unnecessary. Cutting the amount of carbs you eat by half or a third and increasing fiber may be enough to see weight loss and improvements in blood sugar control.

However, for someone with complicated medical disorders such as epilepsy, thyroid and pituitary problems, and hard to control diabetes, a keto-diet may offer improvements when other methods have failed.

Common Mistakes

The most common mistake when it comes to the keto diet is jumping into a super restrictive and complicated diet plan as your first attempt at weight loss. For many individuals, a ketogenic diet is probably not necessary to meet your health goals long-term.

Even if you are successful with the keto-diet over a short time period, it is important to have a plan for how you will transition from a keto diet plan to a more sustainable diet. Many individuals fall back into old habits and completely reverse any benefit obtained.

Another common mistake made following the keto-diet long-term is consuming the wrong type of fats. If you are replacing carbohydrates and protein with more saturated fat in your diet, you may obtain ketosis, but you may also be increasing your bad LDL cholesterol. I have heard this from numerous clients — they lost weight after starting keto, but they stopped because their blood cholesterol and/or triglycerides increased.

The bottom line…

Is this the first time you have heard the term macro-nutrients? If you don’t feel like you are familiar with the nutrient composition of foods, then do not start your health journey with a keto-diet. Start by setting some simple goals each week. If you aren’t sure what to do, ask your doctor to refer you to a registered dietitian who can help you develop a plan that works best for your lifestyle. Contact us to make an appointment!

What the experts are saying…

Check out these other resources from Registered Dietitian Nutritionists (RDN), The leading experts in the field of nutrition and diet.

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