Diet Review: Keto

Is keto, actually, neato?

Sooooo being a runner, I sometimes spend hours at a time running with friends. In between the times we are cursing ourselves for signing up for yet another marathon sometimes the topic of food, health, yes diets comes up.

Enough people have asked me about my thoughts on keto that I thought I’d do a post.

So first of all, what is “keto”?

Keto, is short for ketogenic, ketogenic refers to a high proportion of fat in the diet/presence of ketones. Ketones or ketone bodies are a by-product of the body utilizing fat as its predominant fuel source- this as opposed to glucose/glycogen from carbohydrates.

The general “rules” of keto indicate a high fat, moderate/lower-ish protein, and low/very low carbohydrate intake. For most it will typically be 20g of carb or less per day (depending on the person), and then 30-50 g per day in the maintenance phase (again depending on the person, activity level, etc). Overall, about 90% of more of the daily calories come from fat.

Does keto produce rapid weight loss?

Actually yes….and no, many people who transition to a ketogenic diet see pretty quick results – the reason is that as we cut carbs, our body burns through our glycogen stores pretty quickly – glycogen bonds with water in our bodies. So depletion of glycogen means shedding that stored glucose and therefore the water bonded to them (water weight) – which means losing inches within the first week or so.

This “water weight” it will very likely return once you build back muscle glycogen. So despite the lost inches- you aren’t “burning fat”. Yet.

Once your sweet sweet glycogen stores are depleted, your brain will DEMAND energy so you super smart body will start to turn protein into energy, (gluconeogenesis), and dip into your body’s fat stores for consistent energy, using fat stores (aka “BURNING FAT” is what results in your body being in ketosis. Ketones are a by-product of utilizing fat as fuel.

Everyone is different but ketosis can result when you get into the neighborhood of 50 g of carb or less (depending on the person).

How the flip do you know if you’re in ketosis?

You either pee on a strip, or buy a blood test meter (the meters are cheap, the strips are kind of pricy) the urine strips test for a by-product of ketosis called acetoacetic acid, and the blood meters look for Beta-Hydroxybutyric acid (BHA).

Urine ketone strips are cheap…but they are small, and obviously can get messy.

Here is the big freakin’ deal though (that we conveniently forget, all of the dang time) our bodies are REALLY flipping smart. So as long as you maintain your ketogenic diet you will continue to lose weight, and once you hit your goal, you CAN maintain weight, but you’ll need to increase your carb intake only slightly. So what the fudge happens if you do keto, lose weight, then start eating like “normal” again – you’re going to gain weight back like nobody’s business.

Why tho?

So long story short, glucose provides our body with a continuous supply of ATP, a source of fuel in which our body loves so much. The other piece of the this, is when the the body has “sufficient” Carb intake the process to get ATP from glucose is energy producing whereas to get energy from protein is energy requiring. This is the most succinct way I think I can outline the reason why, metabolically our bodies prefer to use carbohydrates over protein and fat to produce energy. Also, this is not me saying I support the traditional American Diet of 300+g of carb per day – but that’s a different blog post entirely.

SO here is the bottom line – if you’re going to keto, you better plan to do it foreverrrrrrrrrrrrr, otherwise you will more than likely experience the frustration of some weight re-gain/loss yo-yo type of pattern. If you’re mentally prepared for this – God, bless you.

Who shouldn’t do keto?

(Gentle reminder that this is for general health info, and not to take the place of seeking out your health care team).

Patients with Type 1 Diabetes should be carefully monitored and be working with their health care providers to ensure their insulin needs and settings are adjusted as needed and that additional education regarding ketone testing is provided.

-You’ll actually notice here that I did not say folks with diabetes should NOT do keto – and that’s because I will be doing a follow up post to this on Diabetes specifically and keto. In a nutshell I think reducing the amount of carbs you need to dose insulin for, and increasing the quality of carbs you do consume needs to be more of a focus than it is currently in the frame work of our Standard American Diet (SAD).

There’s another group of folks for who should not do keto, those looking for a quick fix, and not willing to consider this will essentially become a way you will live to maintain this potential weight loss.

Besides weight loss is there any real benefit to keto?

The keto diet has been shown to be beneficial for pediatric patients with epilepsy & cystic fibrosis, as well as individuals with degenerative neurological diseases such as Parkinson’s, and Alzheimer’s.

Additionally the keto diet has been shown to be helpful with women who are experiencing struggles with infertility and/or PCOS. There is still some speculation as of why but one avenue of thinking is fewer carbs mean less stimulation of insulin secretion and therefore less circulating insulin, which can provide some benefit if hormones are “out of sorts” (yes that’s the medical terms). Also it the pre-conception weight loss can also reduce risks for mom and infant once conception occurs.

The downside to this that can emotionally taxing is- you lose weight to gain weight during pregnancy. This can be very stressful in an emotional sense so it’s really Important here to discuss your options with your Healthcare team (RD Included)!!!

The same thing goes with PCOS as patients with Type 1 Diabetes, whereas what may actually be beneficial and work for a longer period of time, is just reducing carbohydrate intake (especially refined/processed carbs), and replacing with nutrient dense complex carbs, adequate plant, AND ANIMAL fats, and protein – changing the overall diet in both of these can yield much long(er) term results and improved glucose sensitivity without putting the body into ketosis and worrying about maintaining that for years to come- therefore making this a much more sustainable eating pattern.

What are the downsides of keto? (Takeaways)

I see several major downsides with keto

1.) You are locked into it to lose weight and maintain weight loss. Regaining weight is something that can be stressful, emotional, and downright frustrating. It doesn’t fall in line with out body’s normal metabolic function, so while you can manipulate your body into burning fat – if you ever resume an eating pattern that includes carbs greater than what is needed to maintain ketosis you will regain weight.

2.) As a Registered Dietitian, I legitimately wonder how an individual is going to meet all of their micronutrient needs, for someone to do this, and ensure they are meeting all of their micronutrient needs, as well as fiber, it would take a significant amount of logging and tracking starting out, to ensure all micronutrient needs are being met. To be honest, many people do not want to put this much work in, and therefore may end up not getting enough fiber, and certain vitamins and minerals.

3) It’s restrictive, AF. Again, thinking about sustainability here in being able to follow this forever. Also restrictive diets can develop into disordered eating patterns, as well as unnecessary stress around food/meals.

In closing I think there is a happy medium between doing Keto, and our current framework of the Standard American Diet – where individuals can: reduce their carb intake, increase their fat (yes, animal fat) consumption, and lose, or maintain weight while eating a very nutrient rich diet – that is sustainable (meaning you can follow this pattern for years to come).

1 Comment

  1. Thank you for this post. I just had a runner who insisted on this diet and finally she threw in the towel because she “felt like crap all of the time.” It’s very difficult for an endurance athlete to do this. It also drives me nuts that certain gyms hand out a page of a “diet” for everyone to follow and it basically is keto. People swear by it because they immediately shed pounds, but the gym is smart. It’s all water weight. I have a hard time keeping my mouth shut as I see people posting about their gym and this diet and then suddenly someone comes to me because their running has gone downhill and they can’t figure out why.

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