The Keto Diet: Is it Right for You?

What’s up with everyone “doing keto”? I was at a friend’s house for dinner and all her salad dressings were “Keto” and the café I was having a PTA meeting at had “Keto friendly” salads for lunch. As I began inquiring, the endocrinologist in the crowd chimed in saying that she has patients coming in regularly complaining that they’re tired and fat and they want to begin the keto diet under physician supervision.

The theory behind the Ketogenic Diet is high-fat, low-carbohydrate (carb) and moderate protein food intake. By restricting the body of carbs, one will eventually reach a state of ketosis – a metabolic state where fat is burned for energy. Ketosis can only occur when carbohydrates are kept at extremely low levels (usually below 30/40 grams per day and some plans restrict intake to below 21 grams per day). Percentage-wise, the diet suggests a daily intake of foods that consist of 75% fat, 25% protein and 5% carbohydrates.
Initially used by the medical community to treat epilepsy patients with seizure disorders, there is some preliminary data showing that a ketogenic diet may benefit patients with certain types of other diseases.

One woman in our community told me that she had been diagnosed with glioblastoma (brain cancer) and through online research learned that a ketogenic diet may prevent recurrence. There actually is data to back this claim, though much of it is still preliminary. There is also increasing data revealing that the keto diet may help patients with neurologic diseases and with diabetes. “My tumor was resected in January,” she said, “and I began Keto about three weeks ago. It’s not too difficult to follow and I’ve lost about ten pounds.” I asked if her doctor was supportive as the diet was based on information she found online versus information that was physician-provided. “My doc was supportive but warned that it might be hard to restrict carbs to 21 grams per day. It hasn’t been too difficult though.” (I didn’t think so either until I realized that my one cup of yogurt contained an entire day of Keto- Diet carbs!)

Another person here in Scarsdale said she saw a classmate of hers lose “…oodles of weight on the Keto Diet so I thought I would try it. The first two to three days were really tough…I was light headed so I spent of lot of the time laying down. I ate lots of cheese. I did the diet religiously for 20 days and I must admit that my clothes fit better and I lost six pounds quickly.” She explained that being from an Indian family, she felt she could not continue the keto diet. “I went back to India and of course pigged out on the carb rich diet and realized I could never go back on keto!” She learned a lot though and did lose weight quickly and noticeably. “My skin brightened up with all the veggies,” she said, “but as soon as you stop the diet, the weight piles back on. I also didn’t like the feeling of being cranky and not having the energy to work out.”

There are other issues that come up surrounding the Keto Diet. For example, my endocrinologist friend told me about her keto diet patients feeling extremely tired and cranky at the start of severely reducing carbohydrates. Some patients even describe themselves as not thinking clearly. Other people have termed this “Keto flu” as the body adjusts to limited glucose availability and people actually experience flu-like symptoms. These issues usually resolve within a week or two.

I reached out to long-time nutritionist Elizabeth DeRobertis, MS, RD, CDN, CDE, Director of the Nutrition Center at Scarsdale Medical Group to get the facts and her expert opinion on the ketogenic diet.

Do you have patients coming in asking about the Keto Diet? What are the most common reasons patients want to begin this diet?

Yes, I do have patients coming in asking about the Keto Diet, usually inquiring because they have heard of someone who has lost weight doing it and heard that they did not feel hungry. I believe the biggest draw is that people say they feel full/satisfied and are losing weight at the same time.

How does it stack up against similar diets, like Paleo or Atkins, in terms of weight loss and sustainability?

Keto is similar to plans such as Atkins and Paleo and everything else that reduces carb intake. The difference is the focus on increased fat in the Keto Diet versus increased protein in the others. Any plan that reduces carbs ultimately reduces calorie intake and thereby results in weight loss. An increase in protein and an increase in fat helps people to feel satiated. People seem to crave carbs less when they all but eliminate them. When you start your day off with a higher-carb breakfast, your body needs to produce more insulin and that extra circulating insulin can actually make you feel hungrier and crave even more carbs. With a higher protein breakfast, your body does not need to produce insulin in response to that meal so a higher protein breakfast helps people feel full quickly and feel full for longer. Protein and fat both promote satiety (or feeling full) so therein lies the success of the Keto Diet.

In your professional opinion, what type of patient is a good candidate for the Keto Diet (and who is not)?

I think it’s reasonable for someone try a Keto type of approach if they want to lose weight and they don’t feel satiated with their higher carb lifestyle. The Keto Diet is based on increased fat, however, and it allows that fat to come from saturated fat. The downfall to this is that I have seen this raise LDL (“bad”) cholesterol, in people who previously did not have high LDL cholesterol. Saturated fat is the type of fat that can cause plaque to build up in the arteries. The American Heart Association (AHA) recommends 13 grams or less of saturated fat per day. The Keto Diet includes coconut oil which in and of itself has 12 grams of saturated fat per tablespoon. The AHA recently made a statement that coconut oil should not be ingested because of its high saturated fat profile. As a nutritionist, I believe that people can achieve the same level of success with this plan by choosing unsaturated fats over saturated fats. Fat does help people to feel full and modifying the type of fat can make this plan a healthier option. For example, I would suggest nuts over cheese as a snack on the Keto Diet as nuts contain healthier fats than cheese. If we compared the satiety of a snack such as a 100-calorie bag of pretzels to a 100-calorie portion of veggies with guacamole dip, the guacamole would likely promote greater satiety because of its high fat and low carbohydrate make up; and avocado is high in unsaturated or “healthy” fat. This is especially important for people with a personal or family history of heart disease; I advise using olive oil over butter, turkey instead of salami and other unsaturated-fat food options.

Do you have any other thoughts on the Keto Diet from your perspective as a nutritionist?

It’s okay to follow a more restrictive plan initially, but it is extremely important to have a transition plan and a longer-term plan in place. For example, when the weight loss goal is achieved or if a patient is feeling bored or like they are veering off course, rather than giving it up completely and returning to old unhealthy eating habits, it would be a good time to start to add versions of foods they have been missing in small quantities. Take a bagel, for example. Rather than indulging in such a high-carb food, a Keto dieter can add two slices of a whole grain healthier bread as part of their lunch. (As a side note, my new favorite find is Dave's Killer Bread at 60 calories a slice!) I have learned that different things work from each of the many diet plans that have been popular over the years. There is some truth in each of them, but the key is to find what works for the individual in order for the to sustain the lifestyle.

Have you tried the Keto Diet? Please share your experiences in the comments section below.