Hey friends!

I hope you’re having a good week this week. Before I get started on today’s episode, which is actually a solo episode, I just wanted to say thank you so much to everyone who has reached out to me about losing my little furry daughter Lily.  Saying goodbye to her was definitely one of the hardest things I’ve ever had to do. I feel like no one really talks about the grief of losing a pet, but I’ve felt the same kind of sadness with losing her as I have from losing a person. She was my dog but she was also my friend, and her companionship definitely enriched my life and brought me a lot of happiness.

I think it’s important to continue to share things even when life gets shitty so that if someone out there listening is going through something similar that you know you’re not alone.

Ep 20: Is the Keto Diet Healthy?

Okay, on to the episode. As I just mentioned, today is a solo episode with just yours truly, and I’m going to be talking about a diet that I get asked about on a daily basis- the ketogenic diet, also known as the keto diet.

So back in season 1 of the podcast in one of my Q&A sessions, I answered a question about the keto diet and basically said I disagreed with it because I viewed it as a diet, and I didn’t think it was maintainable in the long run. Someone sent me a really nice facebook message but basically said that she wished I would have actually explained what the diet was and provided a little bit of education rather than just saying I disagreed with it. And honestly, I thought that comment was pretty fair.

I think as an anti-diet dietitian who really promotes balance, intuition and overall health and wellness, sometimes it’s hard to provide broad nutrition education without also feeling like you’re somehow promoting orthorexia, or this obsession with eating healthy and exercise. So sometimes I’m more inclined to just make a cut and dry statement and move on, unless I’m in a 1-1 setting where I can really provide individualized advice.

But having said that, I’m happy to talk about the keto diet today. Before I get started, I did just want to remind you all that this episode is not intended to give individual nutrition or medical advice. As always, please consult your own provider for personalized care as it relates to your own diet, lifestyle and medical conditions.

Alright, let’s get started.

What is the Ketogenic Diet?

The “Keto” diet is essentially a low-carbohydrate, high-fat diet. While the ketogenic diet seems to be new, it has actually been around for a long time and has been shown to be effective in helping decrease seizures in children who have epilepsy.

Where a conventional diet may be made up of about 45-65% carbohydrates, 10-35% protein and 20-35% fat, the ketogenic diet calls for very little carbohydrates. The majority of your calories coming from fat. Just to give you an idea, the average female could need >200 grams of carbs per day (and that’s really just a random average), and on the keto diet you would generally be consuming 30 grams. Thirty grams of carbs is the same as 2 slices of bread or 2 small pieces of fruit or your average granola bar.

Carbohydrate Metabolism

So what does that mean for your body? I’m going to get a little nerdy here but I will try to explain this in the most simple way possible.

So in a regular diet, our carbohydrates are used as our body’s primary, most efficient source of energy. So we’re talking about energy for our brains, our red blood cells, our skeletal cells… these all need energy to keep functioning. How this happens is carbohydrates are broken down in our body into glucose. We first store that glucose in our muscles and liver as something called glycogen.

Glycogen is just hanging out there for the short-term in case we need it. If our body does need it, we pull that glycogen out, convert it back into glucose and then it’s ready for us to use. For example, let’s say we go too long without eating, or maybe we’re working out, our body is going to take that glycogen and turn it into glucose to use.

Using Fat for Energy

So let’s say we’ve consumed some carbs, we have all of this glucose and we’ve refilled ALL of our glycogen stores. What happens to the rest of that glucose? Well, it’s converted into fatty acids and stored as fat in our bodies. And unlike our glycogen stores that fill up, there’s no real limitations to how much fat we can store. So this is good- because we need fat, and we have those fat stores available to us in case we’re in a situation where we aren’t eating or cannot eat. Our body can then use fat for energy.

But please keep in mind that fat in and of itself is  important. It provides insulation for our bodies, helps us use certain vitamins and it also helps us with our hormones functioning properly.

Ketosis

On the ketogenic diet, your body doesn’t have those carbs to use as your most efficient source of energy, so the body then starts turning fat into energy. This is called ketosis. Your body is taking fatty acids and turning them into ketones that are used for energy.

Side Effects of the Ketogenic Diet

• Constipation – from decreasing the fiber in your diet from fruits and starches
• Bad breath- caused by ketones
• Cramps – due to loss of sodium from fluid shifts, as well as decreased potassium intake
• “Keto Flu” – feeling sick for a period of time as your body adapts to ketosis
• Will almost likely need a multivitamin to compensate for cutting fruit out of your diet

Is Ketosis Bad for You?

We have already established that the process of ketosis is considered to be the “back-up method” in terms of energy sources for our bodies. Our metabolic processes are designed to more efficiently use carbs as energy first, and to turn to ketosis if we don’t have carbs.

Is that actually harmful? I have searched for studies and honestly, I don’t really see anything showing that ketosis is actually *bad* for you, or has long-term negative effects on your body. Even though it’s a back-up method, it really seems like it is actually just another metabolic process.

Ketogenic Diet and Health

Having said that, it is really important to note that there’s not really any conclusive evidence about the long-term health effects of the keto diet. Obviously what we’re really interested in is the heart health aspect of things. And while we know now that fats are really not harmful to us in the way we once thought of, I’m really not sure what to think about using fats to replace things like fruits and whole grains, both of which have been shown to have many positive health benefits. Especially considering plant-based diets have been shown to have SO many health benefits despite being inclusive of carbohydrates. It just seems like it’s not going to end well for the keto diet 10 years from now, you know?

The keto diet seems like it would be very hard to follow, and it may be the type of thing you could stick with for a few months and then not be able to stick with. I also think it’s VERY, VERY important to note that there IS a correlation between yo-yo weight gain/loss and mortality risk.  So I think that is a very important part of the conversation.

Understanding Studies

Before I get into talking about some specific studies,  I think it’s important for you as a consumer to really understand what to look for when you’re looking at studies. Nutrition is really difficult to study! It’s difficult to control variables when you’re dealing with humans, and it’s also difficult to establish that cause and effect relationship. I have noticed sometimes that I’ll see a news headline basically coming to a conclusion from a study, and then I will read the study itself and I feel like the study is so poorly designed

When I am reading a scientific study, I am looking at a few things:

• The first would be the sample size. How many people participated? If the group is small, like 5-10 people, then that is a red flag to me. That’s completely different than having a sample size of 100, or 200 or even 500 people.
• Another thing I look for is how many people dropped out of the study. If you start out with 20 people and 10 people don’t even finish it then that should tell you something. Especially when we’re talking about eating habits, and voluntary eating habits at that.
• A third thing I would recommend checking is the length of the study and what kind of follow-up is included
• Something else important to look at is the control group. The control group of the study is what you’re comparing things to. I’m especially brining this up talking about the ketogenic diet because a lot of these studies seem to either not have control groups at all, or they have control groups that aren’t really making any sense.
• Lastly, I do think it’s important to at least be aware of a the funding source of a study. If someone is financially supporting a study, then they are doing so because they want the study to benefit them. If a supplement company is paying tens of thousands of dollars to do a study, it’s because they want the results to show how beneficial their product is so that you will be more likely to purchase the

Examples of Studies of Ketogenic Diet

I’ve pulled a few articles promoting the ketogenic diet just to give you a little bit of food for thought for the next time when you hear about it in the news. I will kind of walk you through what I see as a dietitian.

Study #1

The first study I want to talk about is one that popped up on every single search I did for the keto diet. It was published by the Journal of Experimental and Clinical Cardiology in 2004 and it is titled “Long-Term Effects of a Ketogenic Diet in Obese Patients” . 83 participants with a BMI >35, elevated blood sugar and elevated cholesterol were followed for 24 weeks on the ketogenic diet. The study found statistically significant decreases in weight, cholesterol, LDL cholesterol, blood sugars and triglycerides. Participants had a statistically significant increase in HDL cholesterol. So here are a few things I would point out… there is no control group with this study. What are the results being compared to in order to determine the results were specifically from the actual ketogenic diet. How many calories were they consuming? Was this controlled? The study doesn’t say but that would make a large difference. The study states participants were given their carbs in the form of green vegetables and salad, and protein was given in the forms of fish, shellfish, eggs, cheese, fowl and meat. No real specifics beyond that. I guess my question is were the findings of the study showing a correlation between the ketogenic diet and health benefits, or were the results actually showing a correlation between eating Whole Foods and health benefits. Do we really know? I don’t really think so. Lastly, something else that just kind of irked me. The study is touting long-term findings. It was done for 24 weeks. That isn’t even 6 months… that is NOT long-term. However, in the conclusions section of the study, they state, “Different methods for reducing weight using reduced calorie and fat intake combined with exercise have failed to show sustained long-term effects”. Guys, they then site studies that were done over a 5-year period. You cannot actually compare 24 weeks with 4-5 years.

Study #2

I also wanted to mention a recent study that I have seen pop up several times online, and I actually read the whole thing after my local dietetics association posted it on their Facebook Page. It’s called, “Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year“. It followed 349 participants as they went through a diabetes education program that consisted of being placed on a ketogenic diet, extensive nutrition education, and customized care and follow-up from a health coach. At the end of the year, 83% of the participants remained in the study and they saw both weight loss and improvement in their blood sugars.

The primary reason I pulled this study to talk about is because it was used as the primary source for a news article all about the benefits of the ketogenic diet in treating Type 2 Diabetes, and yes these participants did follow a ketogenic diet. However, you should note that the intervention section of the study is actually focusing on going through this company’s “continuous care intervention” where they receive extensive nutrition education, personalized plans as well as constant follow-up with their own health coach. The control group was patients going through “Usual Care” diabetes education like they normally would. I’m not sure if you’ve seen the state of our medical care system right now, but please note that usually care does NOT provide much continuous care. So I would say to associate the results of this study with the ketogenic diet moreso than the education model is really misleading.

Another thing about this study is that the participants were self-selected and the study was non-randomized, meaning that they were offered the study knowing they would get to go through the program and they decided to participate. These participants were likely highly motivates, which is why self-selection is a considered to be a study bias.

Lastly, the study was funded by the company who runs this program. Just some quick research shows that it costs $370 per month. So I think we need to consider whether or not this is a realistic option for the average person.

I hope giving these two examples of studies has shown you a few things to look for the next time you see something in the news.

My Overall Thoughts on the Ketogenic Diet

So, what are my overall thoughts on the ketogenic diet?

I have to approach this diet using my experience and also common sense as a dietitian. When I’m providing medical nutrition therapy, I’m looking for health promoting behaviors- are you eating fruits and vegetables, are you consuming whole grains, how’s your hydration? are you exceeding alcohol recommendations… how’s your stress? are you getting enough sleep? are you moving your body? These are all things that affect health.  If you’re dealing with high blood sugar or elevated cholesterol and not hitting it out of the park in these areas then is the magic answer to eliminate carbs? I don’t think so. I really don’t think that is going to make you healthier in the long run. I also think the fact that it doesn’t address sleep or stress, two areas which have been shown to increase blood sugars and affect overall health, is huge.

I hope you enjoyed this episode. I would love to hear what you think about the ketogenic diet.