As a RD, I have gotten so many questions about the fad diet du jour: the "Keto" or "Ketogenic" diet. I finally decided to just write down the research in a reader-friendly version. Additional video on the history and use of the ketogenic diet at the bottom of this post. Here you go-
The ketogenic (or “keto”) diet is just another fad diet.
The Keto diet is an amped-up Atkin’s diet (that we all know now was/is terrible for your cardiovascular system, and not a sustainable way to keep weight off) where the majority of what you eat comes from fat, and carbohydrates are extremely limited (In contrast, a healthy diet should be a much more balanced macronutrient distribution of 20-35% protein, 45-65% carbohydrate, and only 10-35% fat). This skewed macronutrient distribution is actually very dangerous for the human body for several reasons -
#1, We use carbohydrate as fuel for our brain. Glucose is needed for cognitive function, and many people on the Ketogenic diet experience brain fog and difficulty focusing. Ketone bodies (specifically: beta-hydroxybutyrate (built up in blood serum), acetoacetate (found in urine), and acetone (responsible for that bad breath)), which are created when carbohydrates are not present, are not as effective (or healthy) for our brain. This may also cause metabolic acidosis which is characterized by a reduced pCO2 and/or lower pH (we need to stay in balance!).
#2, On a ketogenic diet, your intake of fruits and vegetables is extremely limited (if eaten at all) and we all know how important the fiber, vitamins, minerals, and other compounds in fruits/veggies are. On that note…
#3, The keto diet is extremely low in fiber! Fiber is not only protective against many gastrointestinal cancers, it is also a big factor in fullness and weight loss. Furthermore, constipation is very common on low-fiber diets like the Keto diet.
#4, Ketosis/ketoacidosis is what is happening in the body/brain on a chemical level – this is the body making fat into something the brain can use when carbohydrates are not available. It's a lot of work for the the body to produce, not as efficient as carbohydrate, and can be incredibly dangerous for diabetics. Additionally, we have some cells with few-to-no mitochondria. These cells are carbohydrate-dependant and must be fueled by glucose. These cells include certain cells with no mitochondria in our blood (erythrocytes), eyes (cornea, lens, and retina); cells with few mitochondria include renal medulla, testis, and leukocytes. (https://link.springer.com/article/10.1007/s11883-003-0038-6)
#5, “Keto breath.” Halitosis (bad breath) from (acetone) ketone bodies makes for an acetone-like smell on your breath that no amount of brushing/mouthwash can fix. Medical professionals look for (smell for?) this in malnourished patients.
#6, High blood lipids/cholesterol/blood pressure. It’s a high fat diet- you didn’t see this coming? The body can only break nutrients down at a certain rate, and high levels of fat in the diet may lead to high levels of blood lipids are responsible for blockages (atherosclerosis), and other cardiovascular complications up to death. While you can reverse the numbers, the plaque buildup in arteries is almost impossible to reverse. Not worth it! (note: some people do see lowered blood lipid profiles on this diet).
#7, Following this diet is often a form of disordered eating or may lead to an eating disorder (just as with any restrictive diet). Cutting out whole food groups is not healthy. We need all 3 macronutrients in appropriate proportions (majority coming from carbohydrates) to have a healthy body. Our body needs a variety of foods for best health. The reason this diet “works” for weight loss is that it restricts the types of foods that people tend to over-do-it-on like chips, candy, pastries, etc. Any diet that cuts out your favorite foods will cause weight loss, but at what cost (physically and mentally?)
#8, Not all fats are created equal. Most people starting a Keto diet are not differentiating between saturated (solid at room temp, and not something we want in large quantities) and unsaturated fats (liquid at room temp, and “healthier”). Getting this wrong also increases complications from the diet. Additionally, many people who followed a diet high in medium-chain-triglycerides (MCT) experienced undesirable digestive issues.
#9, It may mess with your thyroid and other hormones – lowering your metabolism (isn’t the point of this diet weight loss? That’s counter-intuitive…), energy, and fertility. Every time we lower our metabolism through dieting it lowers the “set-point” of our metabolism, making it harder and harder to lose weight. This is an adaptive response for mammals in famine, but not what the average person wants nowadays.
Who it the Keto diet appropriate for?
The only population that the ketogenic diet is scientifically proven to be beneficial (and safe) for is a select group of people with epilepsy (seizure disorders). This is the position of the Academy of Nutrition and Dietetics.
The Keto diet especially sucks for athletes (and people working out to lose weight)
Since our preferred fuel source is glucose (carbohydrate) from either blood glucose or glycogen (fancy term for carbohydrate stores in the liver and muscle cells), running exclusively on fat slows athletic performance as the body works much harder to break down fat (dietary and adipose storage).
Additionally, the lower protein intake and change in hormones in the body with a keto diet lower the ability to build and maintain muscle mass. If “mirror muscles” like biceps are not motivating enough to keep you off it- remember that our organs like the heart are also muscle tissue that would be broken down by this diet, causing organ damage or failure.
It’ll get you, mentally and emotionally
Ketogenic diets cause headaches, brain fog, and often irritability and obsession with food. This type of diet will very likely make you think about food an unnecessarily large amount of time, and make it difficult to be social (not being able to eat at the same places as your friends; oh, and that bad breath!).
You may feel more depressed (especially if you are already prone to depression and/or taking antidepressants) as serotonin (the “happy” neurochemical) is produced from carbohydrates. If you take an SSRI know that this class of medications work directly on serotonin that is present, and the diet requires a minimum about of carbohydrate (as we learned from the works of Ancel Keys in his starvation study) to allow the SSRI medication to work.
So, what’s the verdict?
In case you didn’t get it from the above – the Keto diet sucks. Not only is it a fad-diet (aka – not suitable for long-term weight loss/lifestyle), it can be very dangerous.
If you need help figuring out what to eat, contact a Registered Dietitian. In the meantime, if you do need some structure, balanced eating like the Mediterranean diet or DASH diet is a better way to go.
For a YouTube video with more information on this diet: click the image below
Don’t give up the foods you love. There is room for all foods in a healthy diet. We just need to keep proportions and variety in mind to fuel our body optimally.
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(originally posted 7/14/2013. libbysfitnutrition.com)
The Whole grains council lists The benefits of whole grains most documented by repeated studies include:
The grains that are considered whole are:
Amaranth, Barley, Farro, Kamut, Buckwheat, Millet, Oats, Bulgur, Corn, Quinoa, Rice (black, brown, red, wild), Triticate, Wheat, Rye, Sorghum, Spelt, Teff, and Montina.
How many do you eat on a regular basis?
It is easy to incorporate whole grains into your diet. The American Dietetic Association recommends making at least half of your gains whole. Let’s get started with some ways to incorporate them!
* Substitute half of your white flour for whole wheat flour when baking (you can find whole wheat pastry flour for pastry items).
* Mix uncooked rolled oats into bread recipes, and ground meat recipes like meatballs, meatloaf, and burgers.
* Add uncooked oats and other whole grain flakes to yogurt instead of high-Calorie granola.
* Try whole grain salads like tabbouleh, rissotos, pilafs, or your favorite dishes with different grains such as barley, brown rice, bulgur, millet, quinoa, or sorghum.
* Next time you are at the store try bread with “100% whole” listed with the first ingredient. Look for the whole grain stamp ion the package.
* Try whole grain cereals like puffed kamut (a cold cereal), Millet, buckwheat, or spelt. These are often found in the organic section of the store.
* Look on websites such as the wholegrainscouncil.org for yummy recipes with whole grains!
Getting the family to accept new foods…
An easy recipe to try:
Kamut porridge and chopped dates
1 cup rolled kamut flakes
2 cups water
1/8 teaspoon sea salt
dash of vanilla
1 cup dates, pitted and chopped
Soak kamut flakes in water overnight in a small saucepan. In the morning, stir in the salt and bring to a slow boil over medium-high heat. Reduce the heat to medium-low and continue to cook, stirring frequently, for about 10 minutes or until most of the water is absorbed.
Stir in the vanilla and chopped dates. As always, whole grains should always be eaten with good dairy products to provide the catalyst for mineral absorption, so serve with a pat of butter or a dollop of cream, and a little brown sugar or maple syrup if desired. Serves two.
(Originally posted 4/16/2013. libbysfitnutrition.com)
You have to put fiber in your body to get, well, a lot of crap out of it.
Here are some facts about dietary fiber, and how to get more of it in your diet.
Why is eating fiber important? An indigestible part of plants, fiber helps normalize bowel movements by bulking up your stool and binding the other foods to make passing them easier, preventing colon cancer and other diseases of the bowel by acting as a probiotic in the large intestine. Fiber helps lower cholesterol levels by binding to fats in the bloodstream and helps control your blood sugar by lowering the glycemic index of the food or meal. Fiber has been studied to aid in weight loss and help maintain a healthy weight, due to the fact that high fiber foods tend to be lower in calories, give the sensation of satiety (fullness), and alter hormone secretion and nutrient absorption in the gut (more food passed through instead of being stored as fat).
There are two basic types of fiber found in nature, soluble and insoluble. Soluble fiber dissolves in water, and is the kind of fiber that helps lower cholesterol. Insoluble fiber does not dissolve, and helps bulk up stool, for easier passing of food. Good sources of soluble fiber are vegetables, legumes (such as beans and lentils), oats, fruit, and barley. Insoluble fiber sources are whole wheat and corn bran, and vegetables (such as potato, parsnip, cauliflower, especially in the skins).
If you choose to supplement, the best fiber choices are psyllium fibers, but supplements miss out on many of the benefits of whole foods such as vitamins and minerals, and bioavailability; however, fiber supplements like the powders you add to water, can help people who are having trouble increasing fiber in their diet, or that have constipation. Also, don’t be fooled by fruit juices, just because they say 100% fruit doesn't mean they have the same fiber as the fruit, in the processing of these products most of the fiber is filtered out, basically leaving you with naturally flavored sugar-water.
The Institute of Medicine (IOM) recommends that people under 50 years old have 38g of fiber a day for men and 25g a day for women. For people over 50 years that decreases to 30g for men and 21g for women. Surprisingly, most American’s do not meet these recommendations, and it’s not at all difficult!
What does a day of recommended fiber look like for a 40 year old woman?
Breakfast: 1/2 cup cooked oatmeal with 1 cup raspberries and 1/2 cup plain yogurt = ~10g fiber
Lunch: 1/2 cup pinto beans, 2 corn tortillas, 1/4 cup cheese, 1/2 cup lettuce, 1 tomato = ~14g
Snack: medium apple with one ounce almonds = ~8g fiber
Dinner: one cup cooked whole wheat spaghetti, 1/2 cup tomato sauce, grilled chicken breast = ~9g fiber
Total: about 39 grams of fiber! That’s more than recommended, and it wasn’t hard.
If your current diet does not include much fiber, increase your intake slowly. Increasing fiber intake too quickly can lead to digestive upset, constipation, bloating, and gas.
Increasing your fiber with food you think taste great is an simple way to help you get on a healthy track.
1. Krause’s Food and Nutrition Therapy. 12th Ed. 2008. p1280.
2. Mayo Clinic. www.mayo clinic.com/health/fiber. retrieved 4/14/13.
3. Mayo Clinic. www.mayoclinic.com/health/high-fiber-foods. retrieved 4/14/13.
4. Slavin, J.L. Dietary Fiber and Body Weight. Nutrition. 2005. Mar;21 (3): 411-8.
This post was published on Rofami Inc. Newsletter, June 3, 2013 at:
Libby is a non-diet Registered Dietitian focusing on eating disorder treatment and prevention. She approaches health from the inclusive standpoint that any "body" can be healthy regardless of size. She is a ally in diversity.
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