A dietitian weighs in on the ketogenic diet

As diet trends go, the ketogenic diet, it would seem, is having a moment. Despite its recent rise in popularity, the prescription has been used to manage epilepsy dating back as far as the 1920s. We asked Jenna Walker MS, RD, CD, Certified Weight Management Educator, Parkview Weight Management Center, to help us understand the benefits and the risks of this fat-focused trend.

The history of the ketogenic diet.
The ketogenic diet is the latest trendy, popular approach to weight loss. Despite the recent hype, a ketogenic diet is not new. It has been used for almost 100 years to treat drug-resistant epilepsy, especially in children. In the 1970s, Dr. Atkins promoted his very low carbohydrate diet for weight loss, which began with a very strict two-week ketogenic phase. Over the years, other fad diets have incorporated a similar approach for weight loss.

Understanding ketosis.
Ketosis is a normal metabolic process that occurs when the body uses fat for energy instead of sugar. Normally, the body (specifically the brain) uses glucose (sugar) for energy. Ketones are produced in the liver, from fat. Entering into a state of ketosis is when the body uses fat instead of sugar, which requires severely limiting carbohydrate consumption.

How does one achieve ketosis?
To achieve ketosis, a person would have to avoid eating carbohydrates. Carbohydrate intake would need to be below 50 grams per day, ideally 20 grams. A rough guideline for intake daily for a ketogenic diet is 5-10% energy intake from carbohydrates, 15-25% protein and 70-75% or more from fat. The diet typically includes plenty of meats, eggs, processed meats, sausages, cheeses, fish, nuts, butter, oils, seeds and fibrous vegetables. Avoiding all grains, beans, legumes, most fruits, starchy vegetables, most milk products and sugars is ideal for a ketogenic diet. Because it is so restrictive, it is very hard to follow long term. Carbohydrates normally account for at least 50% of the typical American diet.

What does ketosis look/feel like?
Signs of being in ketosis include bad breath or a “fruity breath” smell. Ketones can also be identified in the blood and urine. When you have a large amount of ketones in your blood, your body eliminates them through urine and breathing. When starting a ketogenic diet, it is reported that people often have brain fog, tiredness and feel sick. The term for this is called the “keto flu”. This typically lasts for 3 days to a week. Long term it is reported that there is increased focus and energy while following a ketogenic diet.

The ketogenic diet and disease.
There is concrete evidence showing that a ketogenic diet reduces seizures in children, sometimes as efficiently as medication. Because of these neuroprotective effects, questions have been raised if there would be benefits for other brain disorders, such as Parkinson’s, Alzheimer’s, multiple sclerosis, sleep disorders, autism and even brain cancer. However, there are few human studies to support recommending ketosis to treat these conditions. A ketogenic diet also has been shown to improve blood sugar control for patients with type 2 diabetes, at least in the short term. There is even more debate when considering the effect on cholesterol levels. Research has shown increased cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing its effects over time on diabetes and high cholesterol.

The ketogenic diet and weight loss.
Weight loss is the main reason many people use the ketogenic diet. Research shows evidence of a rapid weight loss when patients go on a ketogenic or very low carbohydrate diet compared to patients on a more traditional low-fat diet, or even a Mediterranean diet. However, that momentum in weight loss seems to disappear over time.

The risks.
There are many concerns when an individual starts a ketogenic diet. Anyone with a chronic health problem, such as diabetes or heart disease, should not attempt a ketogenic diet on his/her own without medical supervision. In fact, it is recommended that anyone following this type of meal plan be under medical supervision even if you are healthy.

The verdict.
From a dietitian’s perspective, it is not recommended that you cut whole food groups out of your everyday diet. Carbohydrates make up a lot of our body’s ability to function. Our bodies need it to run efficiently, to help promote muscle growth, endurance with physical activity and sustain energy to get through the day. Choosing healthy carbohydrates that are portioned is key. Eating a balanced diet of healthy vegetables, fruits, lean proteins, high fiber whole grains and healthy fats can help with healthy weight loss that can last long term and be maintained.


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