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The Keto Diet: Why This Dietician Doesn’t Recommend It

By March 5, 2019Nutrition
Reading Time: 9 minutes
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If I type “KE” into my browser’s search engine, “keto diet” automatically comes up as the first guess at what I am typing. Kevin Spacey and Kelly Blue Book are next, for very different reasons I suppose.

You don’t have to be a Registered Dietician like me to notice that the keto diet has exploded. Most of us probably have tried it or know someone who has. Your butcher gives you a nod when he hands you the bacon and beef patty order. He probably ketos, too. It’s like a secret club that’s not so secret on Facebook. Everyone wants to Keto these days.

I love the keto diet. It’s an amazing, life-changing diet — if you are a child and suffer from a specific type of epilepsy. But beside that one specific condition, it’s just another fad diet that demonizes certain types of food. It was created to help those children with epilepsy, but now it has been rebranded as a weight-loss magic show.

So, to bust through the myths and marketing, let’s look at what keto is, what actual benefits there may be, and if you should be considering it or skipping it. I’ll share with you why I personally don’t recommend it to my clients.

The Keto Diet: Why This Dietician Doesn't Recommend It

What Is the Keto Diet, Anyway?

The keto diet is an extremely low-carbohydrate, medium-protein, high-fat diet. How low in carbs? 25 to 50 grams of carbohydrates per day. Basically, if you walk into The Keto Club with a banana, you’ll be asked to leave. Protein levels are adequate, enough to function normally. Fat content can be as high as 90% of the diet. Think bacon, mayonnaise, lard, pure dairy fat, and maybe avocado for a treat.

When the carbohydrate content of your overall diet is extremely low, your body can produce organic compounds called ketones. These are made in the liver from fat and sent out into the bloodstream for the body to convert to fuel. The brain will use them, as well. This phenomenon also has the added benefit of giving your breath a nail polish remover smell. (You may want to rethink going keto before going on a first date.)

Ketones aren’t necessarily the driver of any specific benefit. Their presence, which can be tested by peeing on a pH stick, just gives a sense of how low carb you really are. This works because ketones are acidic, and the pH strip will reflect that increased acidity.

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It is believed that the presence of ketones is linked to decreased appetite, which would be an apparent benefit of the keto diet. That said, drinking ketone supplements, while showing small amounts of promise in a test tube, simply does not have enough evidence behind it to show a real-life benefit — nor any safety information. So, approach ketone supplements with caution (or just not at all).

A low-carb diet such as the “keto diet” will produce ketones in and of itself, and that should generally be safe. Ketoacidosis is when there are too many ketones produced and this is a life-threatening condition. However, only certain medical conditions can lead to ketoacidosis, one of which being diabetes.

So Why Do People Lose Weight on the Keto Diet?

People lose weight on the diet due to a caloric deficit. You can only eat so much bacon and mayonnaise, believe it or not. The high fat intake will contribute to satiety, and you simply won’t eat as much. People also rapidly lose water weight, especially the first few days. This is a big seller for the proponents of the diet, as people love quick results.

As you can tell, I like to poke fun at the diet, perhaps because it’s the next most popular thing on social media behind political posts. But there are some positives — and there are some benefits that can be gained from a short-term keto experiment — so, let’s talk about those.

The Keto Diet: Why This Dietician Doesn't Recommend It

Why Does the Keto Diet Work for Some People?

Some people do really well with a more extreme approach when it comes to nutrition and weight loss. These people are a minority, but certainly most of us know someone who just seems to have that discipline. In terms of a keto approach, the person who is both attracted to extremes and physiologically does well with high fat will rave about the diet.

For the rest of us, experimenting with a different approach can lead to some powerful insights. While you may not maintain the diet for a long time, you can learn about your mindset and how your body handles higher fat. Let’s say you go all in on the keto diet — and end up actually feel great. Long term, it will be near impossible to maintain, but in the interim, you may have discovered you do better with a lower carb approach, albeit not as extreme.

The Keto Diet and FODMAPs

When you cut out the carbs, you will also be cutting out many FODMAPS. Fermentable oligosaccharides, disaccharides, monosaccharides and polysaccharides are what make up the acronym FODMAP. These are certain carbohydrates that some of us do not digest well. A low-FODMAP diet has been shown to have a positive impact for those suffering from irritable bowel syndrome and food intolerances.

While the keto diet isn’t a low-FODMAP diet per se, it does have you cut some of them out:

  • Wheat is the big one you will not be consuming. Wheat contains a FODMAP called fructans, which is why many of us feel better not eating wheat products.
  • For the gluten sensitive, the keto diet will reduce the amount of gluten consumed, as well.
  • Another source of a food allergy is fruit skins. The skin of fruit can contain yeast, which some of us may not tolerate. Apple skins are a common culprit that you won’t be consuming while on a keto diet.

So, you may feel better by going keto for the sole reason that you inadvertently cut out a sensitive food. For this reason, I recommend coming off the diet slowly by adding in foods one at a time. And if you discover you did indeed have a food intolerance, then the diet was a success for you.

The Keto Diet: Why This Dietician Doesn't Recommend It

If You Try Keto, Set a Deadline for Yourself

Sometimes a swing of the pendulum in the opposite direction will lead to balance. If you previously had a diet full of refined sugar and take-out meals, perhaps the keto diet can get your mindset back on track to getting healthier.

When we try less extreme nutrition change, our minds can become bored or we simply don’t believe the change can work. A subtle adjustment like “eat an extra vegetable per week” may seem to us like it couldn’t possibly make us healthier (though, I assure you, it could).

I personally categorize the keto diet as an “extreme” one. I suggest that if you insist on trying it, you go all in and create a timeline for yourself. If you can stay on the diet through that timeline, then you “won.” You can declare a moral victory. And for some us, this might be the boost we need to then come back to a balanced approach to our eating.

The Keto Diet: Why This Dietician Doesn't Recommend It

Why I Caution My Clients Against the Keto Diet

The balanced approach I speak of (and believe in) is why I caution against a keto approach. I believe in loading up on vegetables, getting quality sourced and portioned protein, and consuming a controlled amount of carbohydrate, preferably not refined. Essential fats like fish, avocado, and nuts are also included in my recommendations.

The keto approach clearly restricts most carbohydrates, including fruit, and doesn’t leave a lot of room for vegetables. While any diet, with proper planning and expertise can be adequate in vitamins and minerals, a very low-carb approach can make it difficult to get enough of these essential nutrients. This is because vegetables, fruit, whole grains, and potatoes are great sources for many nutrients. When you cut these things out, it can create a deficit. For a short duration, you may not notice any ill effects. But if you plan on being in The Keto Club for longer then three months, I recommend consulting a Registered Dietitian on how to make sure you are getting enough vitamins and minerals to thrive.

Another reason I would be against the keto diet is for those of us who struggle with emotional eating. Extremes are not a good idea for people who can develop unhealthy behaviors toward food. Restriction may lead to a bingeing on what we are told to restrict. You may succeed at cutting out carbs for a week then hit the bakery for all the sweets you can eat. That is neither an overall improvement in nutrition, nor a path to successful weight loss. If you feel you are prone to going overboard, the keto diet or any other extreme diet isn’t for you.

The Keto Diet: Why This Dietician Doesn't Recommend It

You Need to Know This if You’re Still Going to Try Keto…

I’m sure I will get some comments and messages telling me how wrong I am because a person reading this article or someone they know has had amazing results from the keto diet. I am truly happy about that. I want people to succeed and be their best versions of themselves. However, these stories represent the minority of cases. Most people fail to maintain both the diet and its results long term.

I’ve had several “low carbers” come to me for help because their weight loss stalled and they were struggling to stay on the diet. To get these people going again, we typically have to refeed carbohydrates slowly. In the short term, this means weight gain due in part to increased water retention and in part to a small caloric surplus. This is because being low carb too long, in my experience, results in lethargy and perhaps even hormonal changes.

It takes some time to normalize when coming off a low-carb diet, but with patience and a good exercise program, my clients and I see results. Increased muscle mass, decreased body fat, and increased energy levels eventually come with eating more carbohydrates. When it comes to what “more carbs” actually means — we typically still keep carbs below the standard American diet, usually in the 150 to 250 grams per day range.

So, if you are going to try the keto diet, keep notes as you go. Determine the things that worked and what didn’t work — and learn from your experience regardless of the outcome. While I don’t recommend the diet overall, sometimes you need to find things out for yourself.

That first pound of bacon would certainly make my dog jealous.

Marc Halpern on Facebook
Marc Halpern
Marc started out losing 75 pounds years ago. It was life changing, as it shaped his career and personal life. He went to school to help others realize their health potential, and met his wife in the process. Professionally, he ended up with: Masters in Nutrition Science (University at Buffalo); Registered Dietitian (RD); Bachelors in Exercise Science; Certified Strength and Conditioning Specialist (CSCS); Titleist Performance Institute Certified (TPI).

His philosophy has always been that food and exercise should enhance your life, not stress, hurt, or takeaway from valuable time experiencing other things. There isn't one type of food or style of eating that can universally change the world. These are individual choices and there are many different ways of eating that can work. A minimal effective dose should be used. Unless it's also your hobby, just use the most effective strategies to enhance your life.

Today, Marc runs a personal training and nutrition business out of TPC Summerlin, a PGA-owned golf facility in Las Vegas. He uses golf fitness training as a means to also blend body composition and general health goals. He also consults private nutrition clients all over the country for weight loss and maintenance.