The Keto Diet Explained by a Doctor and a Dietitian

Kiah Connolly, MD & Emmie Satrazemis, RD, CSSD
     
Kiah Connolly, MD & Emmie Satrazemis, RD, CSSD

Unless you’ve been living under a rock, you have heard of keto, are on it, or probably know someone who is. Keto is everywhere these days and seems to be the fastest growing diet trend around. But what exactly is keto? Where did it come from and does it even work?

Don’t worry, we’ve got your back on this one! We’ve dug through the research, debated all the facts, and have combined our medical and nutrition expertise to break down this popular style of eating just for you.

So if you’re looking for the most comprehensive, science based information on keto that you can find on the internet, check out our breakdown below.

What is Keto Diet?

You might have heard of the ketogenic diet explained as the no carb meal plan, or increasing your fat intake to lose more weight. But keto didn’t start as a weight loss diet at all. In fact, it has been around since the early 1900’s as a way to help control seizures in kids with epilepsy.

So how exactly did we get here to using keto as a way to lose weight and burn fat?

Well we’ve come a long way in the nutrition world and have been debating macros since the beginning - specifically carbs and fat as they relate to losing weight. Both have been demonized, celebrated and described every which way you can imagine.  

But what does the research say?

It is becoming more and more clearer that there might be something to the argument for choosing a low carb diet when trying to cut calories and drop pounds (1). And while the science is far from conclusive, and the best dietary approaches can differ drastically from one person to the next, we keep seeing more and more people having success with carbohydrate manipulation.

The keto diet, in a nutshell, is the lowest carb diet we have - suggesting an intake of only 20 grams of carbs or less per day. Keto also requires higher fat intake. Actually, a majority of your calories come from fat on a keto meal plan. And it is this combined macro approach that allows your body to switch from carbs as the main source of fuel to fat (a state called, ketosis), through a process called ketogenesis. 

Ketosis is a proven phenomenon, but how beneficial it is for weight loss in particular is still being discovered. So let’s take a look at what we do know.

Keto Diet Plan: Trend or Science Based    

With the current keto-craze, it would be difficult for anyone to deny that the ketogenic meal plan is a rising trend. But does this mean it’s not science based? Not necessarily.

Low carbohydrate diets definitely maintain significant scientific support. While almost any type of diet can be healthy and effective with the right micronutrients and calorie control, some studies do demonstrate a specific advantage of low carbohydrate intake for both weight loss and reducing cardiovascular disease (2).

caprese salad low carb diet

But what about the ketosis part? After all, that is what makes the ketogenic diet unique, right?

The idea is that in a state of ketosis the body may promote more rapid weight loss by actively burning fat for fuel.

But one thing the past has taught us is that the human body is beyond complicated - and theories often don’t work out the way even the highest level experts predict when they’re objectively applied to and studied in people. This is exactly why you may hear so many health professionals so frequently refer to and debate studies. And this is exactly why basing our professional recommendations and decisions on the best quality studies we have - a  practice referred to as Evidence Based Medicine and Nutrition - is so important.

So, is there evidence for ketosis in of itself promoting weight loss and overall health in many individuals? Early studies suggest that it may (3,4,5). However, there has not yet been any good evidence to show that the ketogenic diet is superior to other low carbohydrate diets for weight loss.  

A larger study is currently being performed by Harvard utilizing Trifecta food to evaluate if ketosis is key to weight loss (6).

 

Keto Results

An effective keto diet can lead to many positive results - although it depends what results you’re looking for to determine if this diet is right for you.

In particular the keto diet seems to promote effective weight loss (7), improves glycemic control for diabetics (8) , and can help lower cholesterol and improve high blood pressure (9).

However, it may not be ideal for individuals engaging in high levels of physical activity, such as athletes - or for people who are looking to build significant muscle.

Again, like any diet,  the results are dependent on if you do it right.

Keto Compared to Other Low Carb Diet Plans

The difference between keto and traditional low carb diets like paleo, Atkins  and south beach, is mainly ketosis - which has a lot to do with the overall macro balance. Simply put, the primary difference is even fewer carbs for a goal of ketosis.

A healthy and balanced diet, as recommended by the USDA Dietary Guidelines, suggests a carb intake of 45 to 65% of your calories, or approximately 250 grams of carb per day on a 2,000 calorie diet.

Low carb diets typically recommend half of this amount, around 150 grams of carbs or less per day. A keto diet drops this amount even further, recommending less than 20 grams of carbs daily.

In addition, many low carb diet plans substitute carb calories with higher protein intake. But because too much protein is thought to interfere with how ketosis works, a keto diet only suggests moderate protein and focuses primarily on higher fat intake - making up nearly 70% of your caloric intake.

Keto Macros

Bottom Line: The Macros in a Keto diet include even lower carbohydrates, higher fat and moderate protein when compared to other low carb diet plans.

 

Carbs: Are They Really That Bad?

Understanding carbs can feel complicated. Probably because we can’t seem to agree on how many we need in our diet, which types are best, or if we need them at all. We have seen that the right types of carbohydrates can be very good for your body and are included in many successful weight loss diets. But there are also very low carb diets that seem to have promising results in some individuals.

The argument against including too many carbs includes their effect on blood sugar, insulin and fat storage, as well as an easy source of calories. But what exactly are carbs and what do they do when you eat them?

Are Carbohydrates and Sugars the Same Thing?

Yes, sugars are carbs. And it is common for all carbs to be referred to as “sugars”. But all carbs are not created equally, and this definitely doesn’t mean the body equates all carbs to table sugar. Certain carbohydrates are very nutritious and can be exceptionally healthy for us to consume.  This macro group also includes fiber and complex starches that are digested differently than common table sugar. And naturally occurring carbs in foods offering many health benefits like fruit, beans and dairy are not the same type of refined and processed sugars added to many foods.

What is Glucose?  

When you eat carbs, they are broken down into a form of usable energy called glucose. While in your bloodstream glucose supplies the fuel your muscles need to power you through a workout. Glucose from carbs is either used for immediate energy, supplied to the blood to regulate blood sugar levels or stored in your muscle, liver or fat cells to be used later.

Do Carbs Make You Fat?

Insulin is required to store glucose. So it makes sense that you release a surge of insulin after you eat. Insulin helps gather glucose and supply it to your cells for storage. Because this process includes storing glucose in your fat cells, it is often confused with gaining body fat. It is also important to note that this insulin response is needed for muscle gain too.

healthy carbs oatmeal and fruit breakfast bowl grain bowl

But eating carbs alone will not make you gain weight or body fat. In fact, under normal circumstances, dietary fat is much more likely to be stored as fat over any other macro, especially in a calorie surplus. Most people can tolerate 100g to 500g of carbohydrates daily without contributing significantly to fat storage. And even large intake of carbohydrates beyond this has not been shown to translate into additional fat storage. Weight gain has only been shown to  occur if calorie intake exceeds caloric needs (10).

Glucose is your most desirable source of quick energy because it does not have to be broken down and metabolized in as much length as fat or protein. In other words, your body doesn’t have to work as hard to get fuel from carbs compared to other macros.

This may lead some to believe that cutting carbs from your diet can also help you restrict energy or cause your body to burn more energy digesting the calories you eat – but this has yet to be proven. Your body is excellent as compromising and adapting.  It is therefore difficult to take one single bodily process – like extracting glucose for energy – and assume it is the only driving factor, unrelated to the billions of other bodily processes that occur each day. In other words, metabolizing food is just not that simple. Changing one thing often causes a series of chain reactions in your body that help you to maintain internal regulation.

Can You Survive on a No Carb Diet? 

Glucose is important for more than just quick energy. It is also the only source of fuel that is able to cross the blood brain barrier. In other words, your brain loves carbs. This is another reason why your body prefers this macro for energy. Because glucose is the type of sugar found in your blood - it is clearly important for maintaining blood sugar control, and pretty impossible to survive without it.

So what exactly happens when you don’t eat any carbs?

You find another way! Carbs may be the easiest way to acquire glucose, but it is not the only option you have.

How Your Body Makes Glucose Without Carbs

Without carbs, your body has to find other ways to get glucose or find some other usable form of energy that is efficient and able to supply your brain with fuel. Your storage capacity of glucose is limited, and you can become carb depleted fairly quickly. When this happens, your body starts to use dietary protein or stored protein (aka your muscles) as well as lipids to create glucose through a process called gluconeogenesis.

Protein is not a desirable source of glucose, as its main function is to build and maintain all of the cells in your body (including precious muscle) – this process is essential and cannot be replaced by other macros. This is also why protein is the only macro with a recommended minimum intake. So when protein intake is not high, you have to find other ways to fuel your energy needs. This is where fat comes into play.

Fat is important for storing key nutrients, plays a key role in regulating hormones, and serves as cushion to your organs and body as a whole. Unlike carbs, your body is great at storing fat – as we have proven with the obesity epidemic. Fat is a preferred source of energy storage for a number of reasons besides your almost unlimited capacity.

Fat is also extremely calorically dense, providing twice as many calories, or twice the energy of carbs and protein. This makes it a pretty efficient source of fuel when you need it. And combined, this allows fat to serve as a source of long lasting, sustainable energy for survival – you can live off your fat stores for much longer than your muscle or carb stores.

But the process of using fat for fuel is slow and requires oxygen and some glucose to begin with - making it not a very efficient source of fuel over long periods of time. This is especially true during higher levels of energy output when oxygen is limited (basically any high intensity workout/movement). In addition, it is not directly able to supply your brain with adequate fuel since fatty acids cannot cross the blood brain barrier. So when carbs are absent, your body is forced to find a way to survive off fat that meets your needs. It does this by using ketones.

Where Ketones Come In

Technically, carbs are not essential for survival. Your body has a backup system to keep you going - ketones!

Ketones are produced through a process called ketogenesis when the need to use fatty acids for fuel increases - or when quick sources of glucose become limited. As ketone body production increases you enter a state called ketosis. But even in ketosis, your are still using some glucose to fuel your brain and regulate blood sugar, it is just used more sparingly and no longer the primary source of fuel for daily energy needs - ketones are!  

Ketones act as a source of quick energy when needed and can also supply your brain with fuel to function when glucose is not present. Because this process exists, carbohydrates are not necessarily an essential nutrient for survival. And it is possible to live on a no carb diet (11). 

However, good luck finding a wide variety of food options with zero carbohydrates. Just about every single food that grows in the ground contains carbs – including fruits, veggies, nuts, seeds, grains, etc. and they are also found in dairy. These foods also tend to hold the bulk of many essential nutrients your body needs for survival and good health. So it’s probably well advised to include some carbs in your diet. But how many exactly is still (often passionately) debated.

ketosis keto diet

Switching to Ketones for Fuel 

Every living animal possesses the capability of switching from sugar to ketones for fuel.  So why don’t our bodies do it all the time? In summary, because ketones are not the preferred source of energy by many of the body’s organs ... when carbohydrates are available.

Fat for Fuel

Using fat for fuel is often used interchangeably with using ketones, but this is not exactly the same thing. Even when you are eating a lot of carbs in your diet, you can still use fat (and do quite frequently!) as a source of energy without needing to go into ketosis. The type of fat you are using for this is primarily coming from stored fat (fatty acids). Stored fat is actually a preferred source of energy in-between meals, during rest, and after long duration exercise.  Your body has an almost unlimited capacity to store and use fat compared to carbs, as we’ve seen with the obesity epidemic. And using fat gives you twice as much energy for the same amount of work (one gram of fat is 9 calories whether you eat it or burn it, compared to carbs that provide only 4 calorie a gram) – making it a desirable source of fuel.

Ketones for Fuel

Ketones, on the other hand, are created when there aren’t enough carbs or glucose available. And even though ketones can be used in a similar way as stored fat, they differ from traditional fatty acids because they can be used instead of carbs as a quick source of fuel and a way to provide energy to your brain and other organs that traditionally rely on glucose. In other words, ketones are your body’s way of replacing glucose with fatty acids.

For dieting purposes Ketosis can be achieved in 2 ways:

  1. In a state of pure starvation - who wants that? (and also no one can sustain it)
  2. Extreme carbohydrate restriction

Ketones can also be used in supplement form. While there isn’t yet enough evidence to prove their efficacy in speeding up ketosis or supporting athletic performance, some studies suggest they may be a way to promote ketones to be used as fuel even outside of a ketogenic diet. However, this is different from eating a carb restricted diet as ketone supplements do not require ketosis and are theoretically a faster way to get usable energy. This distinction is important because it is the actual act of ketosis and carb restriction that many pro keto individuals claim is beneficial to this unique style of dieting (12,13,14).

Going Keto for Weight Loss

The one thing we know for sure when it comes to weight loss is that it can be achieved through eating less calories than you burn. Whether or not ketosis changes this widely accepted conclusion is still being investigated.

So why is it that so many are claiming that going keto is the key to faster weight loss?

The truth is we don’t yet.  It’s possible that the keto diet is successful as just another way to restrict calorie intake. Human research has not yet shown any conclusive mechanism for why a keto diet would be more beneficial than any other calorie-controlled diet for weight loss.However, there are some theories behind why ketosis may be more beneficial in helping some lose weight (15,16,17).

We know the keto diet may help you cut calories a few different ways:  

1. Eliminating common processed foods: A keto meal plan is highly restrictive, which allows people to cut quite a bit of options out of their diet - especially foods that tend to be a source of extra calories, like carb containing snacks, drinks and desserts.

2. Improved Satiety:  Fat is thought to be satiating. And some people on keto seem to feel more full and have decreased appetites, allowing them to cut calories with less food intake overall (18).

But does ketosis itself promote greater weight loss?

While we know that calorie control is the most widely accepted pathway to weight reduction, there are also some existing theories  for why eating for ketosis may independently contribute to weight loss including:

  1. Decreased fat production (lipogenesis) and increased fat burning (lipolysis): Without glucose, the body must burn fat for fuel. Theoretically an increase in fat utilization during ketosis could potentially result in greater fat loss overall (19). However, this is yet to be proven in well done human studies.

So far, the research has shown us that using stored fat for energy will probably only translate into weight loss when calories are restricted. If your calorie intake exceeds your needs, you will still continue to store fat regardless of how much fat you are breaking down for energy - and can actually gain weight in the process.

2. Increased Energy Expenditure: The process of using fat and protein for fuel over carbs causes the body to work harder, and therefore burn more calories digesting your food (20). Your basal metabolic rate (BMR) may also increase on a low carb diet (21). 

It is important to note that while these theories suggest that ketosis induces more weight loss for each calorie consumed, human studies have not yet determined if there is a benefit to ketosis over other low carbohydrate diets for weight loss.

Regardless if science determines keto to be superior, we know the diet does work well for many and could be a promising approach to weight loss and controlling obesity (22). It may be especially effective if your diet preference is already skewed towards fatty foods. In the end, the diet you are able to stick to is the diet that will work for you.

So if the thought of eating lean chicken, broccoli and fruit makes you feel like vomiting; and eating a double hamburger with bacon and cheese leaves your mouth watering for more  - you may be much more likely to consistently follow a keto diet. Which means it also may be the most effective diet that fits you!

How to Lose Weight on Keto

Going keto can be used as an excuse for people to eat an overabundance of their favorite unhealthy fatty calories. Drinking an unlimited supply of nacho cheese is never going to be a healthy choice.

Can I Eat As Much As I Want?

While many people report losing weight on keto without having to count calories - this is likely largely because they have eliminated many unhealthy high calorie carbohydrates. They also often feel more full off of their high fat and protein robust diet. This doesn’t mean gorging on unlimited unhealthy choices will make you lose weight - even if they’re ‘keto-approved’. In the end calories and nutrition will always win the race.

bowl of starwberries how much can i eat keto

Calories are Key

Based on everything we know about weight loss today, it is highly recommended to still use a form of calorie control if you are pursuing a ketogenic diet for weight loss. And because of its restrictive macros, it is advised to track your daily calorie intake and count macros using a program like a phone app, like Trifecta, to ensure you are hitting your diet goals.

Fat is calorically dense which may shrink your portion sizes if you aren’t including the right balance of healthy keto options - like low carb veggies and proteins. And smaller portion sizes with increased calories can actually end up causing you to gain weight if you’re not paying attention. So instead of using keto as free pass to eat bacon and butter everything, pay attention to the quality of your food choices.

Micronutrients

To be healthy, all diets require the inclusion of  key micronutrients. Overall nutrition on a keto diet can be concerning, considering many carbohydrate foods tend to be an important source of micronutrients and nutrition that are thought to promote health, wellbeing and reduce your risk of many chronic diseases (23,24). While going keto may help you get your macros and calories on point for weight loss, nutrition still matters when it comes to your health and longevity. Because the keto diet does have a fair number of restrictions, some people may not know how to make sure to include all of the important nutrients they need.

Arming yourself with information from trusted sources, and discussing your diet with your doctor and/or a dietitian can ensure you’re moving forward safely and priming yourself for success.

 

Going Keto for Health

keto diet

Is Keto Healthy? 

While the keto diet actually may be very healthy for many people, it has seemed to accumulate a bad name in many social networks. This may be, at least in part, because of some confusion between the ketogenic diet with a very dangerous condition called ketoacidosis.

Diabetic Ketoacidosis (DKA) is a complication of diabetes that occurs when it gets out of control. This condition requires hospitalization and can be deadly. In DKA the body is flooded with excessive ketones. In ketoacidosis urine ketone levels are often above 10mmol/L, however in anything greater than 5mmol/L can start to be dangerous for diabetics at risk of DKA.

In contrary, the ketogenic diet places the body into a state of mild to moderate ketosis without acidosis. The urine may have 0.6-3 mmol/L of ketones. We don’t know of any major negative effects the state of ketosis itself has on the body, and there is building research to suggest that it may be good for the body (25).

But, just like any diet, ketogenic can be bad for you if it’s not done in the right way, or if it’s used by the wrong population.

Keto Diet in People with Kidney Problems

Renal disease is one condition that does not go with a keto diet. Kidneys process much of our bodies waste. When the kidneys function is impaired, broken down parts of protein can accumulate in an unhealthy way. In fact, a low protein diet is usually prescribed to people with kidney problems (26).  Therefore, if you have renal disease, a keto diet is probably not right for you.

Keto Diet in Pregnancy and Breastfeeding

While this hasn’t ever been formally studied, it’s not recommended to eat a ketogenic diet if you’re pregnant or breastfeeding.

The body does phenomenal things during pregnancy. Breast milk takes a large amount of additional sugar from mom in order to provide the baby with everything it needs. This is one of the reasons why breastfeeding can lead to such effective weight loss (27).

While you certainly don’t need to go wild with carb consumption during this time, it is recommended that if you’re pregnant or breastfeeding you consume at least 50g of carbohydrates per day. This is still considered a moderately low carbohydrate diet and allows you to continue being healthy and safe for yourself and your baby.

 

Ketoflu & Other Side Effects  

Many people do feel somewhat uncomfortable when they first start their keto diet - often referred to as the keto flu. The most common symptoms are nausea, headache, constipation, fatigue, decreased energy, and hunger. While this often goes away after approximately the first month, some people experience more significant effects than others.

Vitamin deficiencies can also occur if you’re not vigilant about ensuring you’re getting all of the micronutrients you need. Vitamin D and Calcium are common nutrients that may be missed. If these deficiencies are sustained they can lead to weak bones (osteopenia), among other problems. Other potential consequences include decreased libido, an increased risk of kidney stones and gout (through increased uric acid), and decreased thyroid hormone (T3) (28).

Fighting the Ketoflu

Throw in a Few More Carbs (but don’t go overboard)

If the ketoflu is getting you down, some people recommend slowing down on the diet to allow your body to adjust to your new low carb lifestyle. Decreasing your carbohydrates significantly without fully forcing you into ketosis may allow you enough carbohydrates to get used to this new way of life.

Consume More Keto-Licious Foods  

Another useful tool can be to allow yourself to not worry too much about counting  calories during the first few weeks. Feeding your body with all of the ‘keto-approved’ choices you’re craving may provide you enough fuel to compensate for the carbohydrate deficit you’re feeling.

Other Important Tools

  • Sleep Well and Long
  • Consume Caffeine
  • Drink Plenty of Fluids
  • Take a Multivitamin
  • Meditate

While some of these may seem like simple no-brainer recommendations, they can be extremely useful in making it through those first few weeks and meeting your end goal.

 

Health Benefits of Keto Diet

health benefits of a keto diet

While weight loss alone can offer monumental health benefits to many people, the keto diet may provide additional perks for a variety of medical conditions including diabetes, heart disease and epilepsy.

Here are some common health conditions that may be positively influenced by a keto diet done right: 

Diabetes

Diabetes is a disease that occurs when the body is not able to process sugar properly. Of note, carbohydrates are broken down by the body into sugars. Therefore people are often referring to the same thing when they use the words sugar, carbohydrate and glycemic control in relation to diabetes.

Sugars seem to be better controlled on a ketogenic diet. Multiple studies have shown an improved glycemic control in people on a ketogenic diet as compared to people who are on other recommended carbohydrate controlled diets. Some people are able to even get off of their diabetic medications completely.

The potential benefits of a keto diet in diabetes is likely multi-factorial and includes: 

1. Better Insulin Sensitivity: Insulin is a hormone that is critical in controlling sugar in our bodies - and it is also the hormone that doesn’t function properly in diabetes. Ketosis seems to help insulin work better (29).

This is what some may argue differentiates the ketogenic diet as potentially superior to other diets in people with diabetes.

2. Weight Loss:  Weight loss contributes significantly on it’s own to treating type 2 diabetes. This isn’t unique to the  keto diet. Any way that you are able to lose weight can help to treat your type 2 diabetes (30).

3. Low Carbohydrate Intake: It makes sense for a disease caused by a decreased ability to process carbohydrates to be improved if your body has to process fewer of these carbohydrates. Therefore while this is again not unique to the keto diet, the very low consumption of carbohydrates in the keto diet can be beneficial to diabetics (31,32).  

Important Info When Going Keto with Diabetes

Hypoglycemia

If you are taking medication for diabetes and you’re starting a keto diet, it’s absolutely critical to do so carefully and be prepared. Most people's medication dosing are adjusted and prescribed to compensate for the high sugar they’re eating every day.

So what happens if you stop eating these high sugars and continue taking medications that significantly lower your sugars?

Your glucose can drop dangerously low in a condition called hypoglycemia  - and this can even be deadly.

But didn’t we just say that when there’s not enough sugar around our body can compensate with ketosis? Well, yes it does. But many of these diabetic medications work too quickly in dropping your glucose and your body may not have enough time to compensate for the lower sugar.

Ketoacidosis

Another precaution particularly for people with Type 1 Diabetes is against ketoacidosis. While this isn’t a realistic risk for people on the ketogenic diet without diabetes, people with Type 1 Diabetes  can easily become too ketotic (>10mmol/L), meaning their blood levels of ketones becomes dangerously high - at which point they’re at a high risk of developing diabetic ketoacidosis.

This makes it especially important for people with type 1 diabetes to work closely with their doctor before starting a keto diet - and it is often recommended that they have a higher carb intake (>50grams/day) in order to prevent dangerous complications.

Not Prescribed Medications?

Then there’s no problem.  It’s the medications that cause the risk of dropping your sugar too low before your body can compensate. If your body is regulating your sugars well enough to not yet require medications, then you should not have a problem with this diet.

Bottom Line: be safe by frequently checking your sugars and  working closely with your doctor if you’re planning to start a ketogenic diet while prescribed diabetic medications.

High Blood Pressure

High blood pressure (also called hypertension) can be caused by obesity. Losing significant weight, as often seen on the ketogenic diet can therefore significantly improve high blood pressure.

Similar to diabetes, there are a few precautions to consider if you are diagnosed with hypertension.

spices salt high blood pressure diet dash diet

Watch Your Salt Intake

Your doctor may be begging you to put down the potato chips if you have high blood pressure. This is because salt in your diet is thought to make blood pressure higher in some (33). In fact, the low salt component of many successful diets for hypertension - including the DASH diet - is a main contributing factor to their success.

And the traditional keto diet will recommend a lot of high sodium foods like processed meats and cheese. 

In most healthy people, this temporary increase in salt intake is safe and can help with feeling hungry, water retention, and other ketoflu symptoms like headaches and fatigue. However, it’s important to know that if you have high blood pressure, you should refrain from high salt intake until you are able to discuss further with your doctor for recommendations about what is best for you.

Be Mindful of Your Medications

Because a keto-diet can improve your blood pressure, you may discover that after some time you need lower doses of your blood pressure medications - and you may even eventually be able to stop them all together.  

This is great news! But when this can cause problems is if at some point your anti-hypertensive medications become too strong for you and drop your blood pressure too low. This is similar to how antiglycemic agents can start being too strong for diabetics on the diet and cause hypoglycemia.

Symptoms of low blood pressure can include lightheadedness or dizziness, palpitations, passing out, and difficulty concentrating. Therefore if you’re on anti-hypertensive medications, you should monitor your blood pressure to make sure it’s not getting too low (or too high if you’re consuming more salt!).

Bottom line: blood pressure, salt, medications and other concomitant medical problems you may have presents a complicated picture and requires a delicate balance to manage well.  This is why it’s so important for you to see your doctor to help you handle these conditions when you are dramatically changing your diet.

High Cholesterol

high fat breakfast high cholesterol on keto diet

One would think that eating a high fat diet would make your body more full of fat - specifically cholesterol! But studies suggest that the bad type of cholesterol (LDL) is often lower in people on a keto diet and good cholesterol (HDL) is higher (34,35).

Cardiovascular Disease

Heart disease is rampant in our country and persists as the number one killer of American’s today by way of heart attacks, strokes and heart failure, just to name a few (36). And each of the conditions discussed above - obesity, diabetes, hypertension, high cholesterol - are all major risk factors for cardiovascular disease. Improving any one of these conditions inherently decreases the risk of cardiovascular disease (37).

Cardiovascular disease is such a massive burden on our society that it’s important to emphasize how significantly your diet can influence your health and overall quality of your  life.

Epilepsy (Seizure Disorder)

The ketogenic diet has been studied and utilized as an effective treatment for epilepsy for over 80 years. While it may seem surprising that a diet can demonstrate such dramatic effects on a neurological disorder, multiple well done studies in adults and children alike have found it to be a successful treatment in epilepsy. This diet can help improve and even cure some cases of epilepsy that are refractory to medications (38).

Polycystic Ovarian Disease

Polycystic Ovarian Disease (aka polycystic ovarian syndrome or PCOS)  is a condition in which women have many cysts on their ovaries. While these cysts aren’t cancer and are not usually dangerous, they often cause women pain and they can cause complications.

Because the growth of these cysts can be influenced by insulin, and insulin function is improved by ketosis - the theory is that polycycstic ovarian disease can be improved with a ketogenic diet. Only one study has looked at this thus far and therefore more research is needed to evaluate the influence of the keto diet on PCOS.

 

Additional Potential Health Benefits of Keto Diet

The powerful effect that the keto diet has been shown to exhibit in treating epilepsy and other conditions makes one wonder if there are other diseases that this diet could be an effective treatment for. Clearly something is happening in the brain in those that follow this diet.

Does the ketogenic diet protect the brain? Animal studies and some uncontrolled studies in humans have looked at the effect of the keto diet on a variety of conditions and show some hope that the keto diet may have some role in the treatment of other neurologic disorders (39).  Alzheimer’s Disease, Parkinson’s Disease, traumatic brain injury and stroke have all been suggested to benefit from the keto diet. And other animal studies suggest that there may also be a role of the keto diet in the treatment of some cancers (40,41,42,43).

Some people are really excited about these results - and understandably so. These conditions can be devastating and are largely incurable with our current medical knowledge. And there are few to no medication options that contribute to treating their symptoms.

However it’s critical to not equate these early theories and associations with causation or cures. While these studies can contribute to the groundwork that other research may build on,  remember that these are not the type of studies that allow us to make claims about the effect of the keto diet on these conditions in humans.

 

Keto Diet for Athletes and Active Individuals

keto diet for fitness

A solid amount of evidence exists on the benefit of consuming carbohydrates during high intensity activities (44,45). Therefore this diet may not be the best choice for extremely active individuals and athletes - especially those that require explosive speed and repetitive quick movements like in intramural sports, crossfit and competitive weightlifting (46). 

That being said, fat has long been celebrated as a source of long lasting fuel in sports and a keto diet might actually benefit those who participate in slower, longer duration endurance sports like distance running, cycling and swimming.

There was one study that you may see referenced that concludes there is no difference in the ability to perform cardiovascular exercise when on a keto diet (47). While this may be true, it was an extremely small study with only 5 participants and more research is certainly needed to assess these claims.

The truth is we don’t know how well a keto diet plays in the fitness and athlete world yet. The research is severely lacking in this area, and we can only go off what we know using traditional approaches that have worked. Regardless, some active individuals feel strongly about pursuing their keto diet with their physically intense lifestyle. And more power to you, provided that you are maintaining adequate micronutrient intake to support your metabolic needs.

Another option for those active individuals determined to go keto is to utilize variations of the keto diet that allow for the selective inclusion of carbohydrates. For example, the Targeted Ketogenic Diet permits additional carbohydrates during workouts while the Cyclical Ketogenic Diet introduces carbohydrates at specific types during the week. However it’s important to note that these alternate diet schemes have not been well studied for weight loss.

Keto Diet for Building Muscle

lifting weights keto diet for building muscle gaining muscle strength training on keto

While all forms of significant weight loss may result in some muscle loss, there may be an increased likelihood of muscle loss in people on a ketogenic diet, especially if calories are restricted too low. Because while in ketosis the body doesn’t have enough sugar to burn, it may also break down proteins for energy, in addition to churning through fat. This may be somewhat compensated by the moderate protein included in the diet and if you are actively lifting weights.

On the contrary to this theory, there is also an argument that ketogenic diets adequately preserve muscle mass (48). Maintaining existing mass primarily requires adequate protein and training, so this could very well be feasible on a keto diet depending on your individual needs and nutrient timing.

Where this gets even more confusing is in the area of gaining muscle. Traditional massing diets suggest higher levels of carbs and protein to promote adequate calories and amino acids for growth, but carbs and too much protein can both affect your ability to stay in ketosis. Not to mention, excess calories from fat are typically stored as body fat not muscle.

The question remains if there is a target amount of protein you should be striving for to gain muscle and still maintain ketosis. And whether or not excess calories from fat can contribute to muscle mass as effectively as carbs while in ketosis. Or whether or not gaining mass is as effective on a keto diet compared to the commonly recommended high carb, high protein, low fat diet.

Until more evidence emerges, a different diet may be a better choice if your goal is to build a significant amount of muscle.

 

Is a Keto Diet Right For You?

Ultimately what it boils down to is that the best diet for you is the one you can stick to - and provides you all of your nutritional needs for a long and healthy life. There really is no one size fits all approach to healthy eating, and what works for one might not work for many others. So don’t feel the need to force something on yourself that just isn’t making you happy in the long run. Not to mention if it is making you feel out of whack, tired or just plain bad. Listen to your body and choose the diet option that meets your needs. And when it comes to making sure you are getting all the required nutrients, speak with your doctor and work with a dietitian.

Keto Diet Long Term

When it comes to getting results on any diet, the key is consistency not perfection. But maintaining ketosis over long periods of time requires some serious dedication and may be a challenge for many people. A keto diet can be quite restrictive and you’ll need to consider how long you are willing to commit to this type of meal plan. In addition, the longer you are restricting carb intake to such low levels, the more likely you are to encounter nutritional deficiencies if you aren’t monitoring your overall nutritional intake closely. This is where tracking your daily food intake and working with a dietitian can be extremely helpful.

Poor nutrition is common on many popular diets when food quality is not carefully considered, especially when the diet eliminates major food groups and macros (49).

Because keto restricts many higher carb, plant based foods like beans, legumes, whole grains, some fruits and veggies, as well as milk, nutrition concerns of a keto diet would include low fiber intake, and reduced intake of magnesium, potassium, and vitamin D. Taking supplements, like a multivitamin, may be beneficial if your looking to go keto for more than a few months.

It is also worth considering that majority of the research looking at the success of keto for weight loss has not been from long-term studies. So even though ketosis is relatively safe, and early studies look promising, we aren’t 100% of how well this phenomenon works in the long run.

 

Keto Diet Plan

keto meal plan

Getting on the best keto meal plan for you might take a little bit of strategy and learning. But with a few key steps, you should be able to get started and increase your chance of seeing the results you want more quickly. Here are four key steps to consider as you start planning:

  1. Calculate how many calories you need to eat a day to lose weight
  2. Learn how to count keto macros
  3. Download the Trifecta app to track your calorie and macro intake
  4. Get started with meal prep for weight loss and discover your favorite keto recipes

Want to make life even easier and ensure your meals are always keto? Or at least cut down on meal prep and cooking time? Consider trying keto meal delivery like Trifecta. 

GO KETO

 

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