To keto or not to keto
Local experts answer your questions about the popular diet
Butter, cream, cheese. With the ketogenic diet, aka the keto diet, these foods are no longer taboo, but are actually go-to choices. In fact, fats are fabulous and whole grains, fruits and vegetables, along with carbs, are limited.
Fans of the popular diet, which was originally developed as a way to control seizures in children, claim the keto diet has helped them lose weight where other plans have failed. But, is it healthy, and is the weight loss long-term?
Pros and cons
According to Ellen Behan, a registered dietician with Exeter Health Resources in Exeter, the keto diet can help you lose weight.
While on the keto diet plan, dieters must get 70 to 80 percent of their calories from fat, 15 to 25 percent from protein, and less than 10 percent from carbohydrates – roughly the equivalent of eating a bagel.
This type of eating forces the body to burn fat instead of carbohydrates through a process called ketosis. In ketosis, acids called ketones are produced in the blood. These are what our bodies and brains use for fuel.
“The diet can also yield some other health benefits as well,” she said. “You will see better blood sugar levels, lower blood pressure and better cholesterol numbers. Some people feel that they have higher energy levels as well, and many dieters say that they don’t feel hungry while on the diet.”
Dieters notice that not only do they lose pounds they also lose inches in key areas such as their waistline. But the losses don’t come without concerns.
Behan said those on the keto diet have an increased risk of kidney stones and increased levels of uric acid, a risk factor for gout.
Because many natural forms of nutritional hydration are banned from the diet (such as whole grains, and many fruits and vegetables), dehydration is an issue. Keto dieters need to drink at least eight glasses per day. Constipation, bloating and tummy troubles are also common because of the lack of fiber.
Dr. Neal Malik, an assistant professor of nutrition at Bastyr University in San Diego, Calif., said, “We are learning that a high-fat diet changes the gut’s microbiome and may decrease the amount of good bacteria found there.”
Keto followers are advised to eat keto-approved vegetables such as leafy greens, bell peppers and broccoli and to take a fiber supplement.
While any diet can make you grumpy, Behan said those on the keto plan may complain of irritability and “brain fog.” In addition, the diet is hard on your liver.
Researchers at Harvard say that the liver works overtime for those on the keto diet, and that this could have long-term consequences. “The liver is responsible for metabolizing protein and producing ketones. With this diet, an extra burden is placed on the liver due to the increased intake of protein and reliance on ketones.”
Vipra Rai, a registered dietician and clinical director of Functional Medicine, Diabetes, Nutrition and Wellness Services at Derry Medical Center in Derry, agrees there are concerns, but that many can be addressed or mitigated if the diet is followed under medical direction.
She also said the health benefits, especially to those with diabetes or pre-diabetes, can be significant.
“The keto diet isn’t just a diet, it is a lifestyle, and it can be difficult to follow and difficult to eat in a healthy way if you are not fully educated about this kind of eating,” she said. “You can’t ‘go keto’ just because you like bacon and want to eat bacon all the time. You need to understand the diet’s shortcomings and realize that it is a long-term commitment.”
“We have patients who have been on the keto diet for a year, both for weight loss and due to health issues,” she said. In patients with diabetes or pre-diabetes, “We have seen incredible improvements. Blood sugar levels have dropped dramatically; some patients who were insulin dependent no longer need insulin; patients who were on the verge of developing diabetes are no longer at risk. These are major health benefits. However, in order to do keto in a healthy way, you need to be educated and start under medical supervision.”
At Derry Medical Center, patients have their health assessed, blood drawn, their ketone levels are checked, and they are given a recommended diet plan to follow.
Blood work is done periodically as they follow the plan. During the eight weeks, they attend regular workshops where they learn meal plans and cooking techniques that allow them to get the nutrients they need while on a keto diet.
“We do a lot of cooking,” Rai said. “We show them how to add more vegetables, more fish, how to get healthy fats from avocados and cook with healthy oils like avocado and olive oil. We add in items such as nut butters and sunflower seeds. The goal is to create a healthy diet, and one that you are likely to follow on your own. A lot of the information online is not accurate, so this way, you are getting expert advice from medical and nutritional professionals.”
Rai adds that the keto patients also share information so they get helpful tips from others regarding recipes and what motivates them to stick to the plan.
“We even have a keto support group,” she said.
Behan said there is not a lot of data showing long-term results for keto, but data that is available indicates that if a person leaves the keto diet, the weight tends to come back on.
More concerning, the other health benefits — lower blood pressure, cholesterol and blood sugar — also don’t last unless other measures are taken to ensure that they remain at healthy levels.
The Bastyr University studies caution that excess dietary fat may cause the body to produce byproducts called lipid peroxides, which can damage cells and tissues, including those in the heart. If a person commits to keto for the long-term, having regular checkups and blood work would be wise, noted Rai.
The other challenge, Rai said, is that people get bored with the food limitations and the challenges of “cooking keto.” Many people often abandon the plan for those reasons.
Counting calories still works
According to Behan, monitoring your calorie intake is critical.
“To maintain a healthy weight, that usually means 1,200 to 1,500 calories for women per day, and 1,500 to 1,800 calories for men per day,” she said.
“You also have to get moving. In terms of a diet that is both effective and healthy, the medical community recommends the Mediterranean diet. It’s full of lean protein, whole grains, veggies, and healthy fats, such as olive oil. It offers a wide range of food options so you don’t get bored, and, it’s also a lifestyle change. The Mediterranean diet isn’t just a diet; it’s rethinking how you eat. It’s about savoring your food — cooking healthy, and sitting down to eat a relaxing, leisurely meal. It makes eating more about the quality and experience of food than how much you eat. People who truly adopt this mindset tend to have healthy weight loss, and keep the weight off.”
Rai said keto is not for everyone and “there is no ‘one size fits all’ when it comes to dieting.” She said keto is working for some, both for weight loss and in achieving better health.
Crystal Ward Kent is a freelance writer who has written for numerous local and regional magazines. She owns Kent Creative in Dover, a creative services agency providing writing, design and marketing, and is also the author of several books and children’s books.