To Keto or not to Keto.

That is the question…. that I get on an almost daily basis now. From clients in my private therapy practice to friends and even family members.

My answer? The ketogenic diet is a medical diet, not some fad diet to be taken lightly. It offers health benefits for select groups, but also comes with serious risks.

As a registered psychologist working in the world of health psychology, people turn to me for my opinion. My training in mindful eating and nutritional psychology as well as my keeping a finger on the pulse of research in the nutrition field has me wanting to add to the keto conversation out there.

KETO 101

Russel Wilder coined the term “ketogenic diet” and first used it to treat epilepsy in 1921. Fast forward nearly a century and it’s reappeared on the health scene as a rapid weight loss formula, much different than its original intention. So, the question is, does it work? We’ll get to that…

First, let’s break down what this diet is all about. For many I speak with, they plot the keto diet with other weight-loss diets that call for a low carb intake (think paleo, South Beach and Atkins). A big difference is that while those diets focus on protein intake, the keto diet focuses on fat to supply up to 90% of one’s caloric intake.

The “keto” in a ketogenic diet comes from the fact that it allows the body to produce small fuel molecules called “ketones”. Ketones can be an alternative fuel source for the body, used when blood sugar (glucose) is in short supply¹. Ketones are produced by the liver if you have very little carbs and only moderate amounts of protein in the diet.

ADVERSE SIDE EFFECTS OF KETO

Common, short-term side effects of the keto diet have been dubbed the “keto flu”. These include headache, nausea, vomiting, insomnia, difficulty in exercise tolerance, constipation and more². Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies^{1, 3}.

WILL THE KETO DIET HELP ME LOSE WEIGHT?

You’ve probably heard it’s a quick fix diet to lose weight. Yes, the keto diet has been found to bring on rapid weight loss, but only in the short run¹. We simply don’t know if the keto diet for the average person is safe, and research hasn’t found long-term weight loss as a benefit. Scientists agree that only through more research can we learn the predictors of who is going to lose weight to improve health with this diet².

WILL THE KETO DIET MAKE ME MORE COGNITIVELY ALERT?

Many clients come to my practice with the goal of increasing focus. There is a recent trend of people following the keto diet along with intermittent fasting (12-36 hours fasting periods). Self-reports I commonly hear in the community are that this leads to “mental clarity” but given the health risks and impacts, as well as the lack of research into this claim, I cannot stand behind it or suggest anyone do this diet protocol with the goal of boosting attention skills.

Looking for a safe and cheap way to see long term benefits for mental and physical wellness? Build a mindfulness routine! Start with 15-20 minutes of seated meditation⁴.

IS THE KETO DIET FOR ME?

The keto diet in its clinical form is primarily used to reduce frequency of epileptic seizures in children. The diet has also shown promising results for neurological disorders and conditions such as dementia, ALS, and traumatic brain injury in several studies³.

A low carb diet such as the keto diet has been found to improve clinical markers of disease risk for overweight individuals with metabolic syndrome, insulin resistance, and type 2 diabetes³. And even recently, some athletes have been following the keto diet short term with the goal of optimizing changes in body composition during training⁵.

I’m not saying the keto diet isn’t for you. Perhaps it is in its pure form (and if so, seek a trained health professional to support you). Or maybe you could benefit from taking lessons from keto (not seeing fat as bad and finding ways to integrate healthy fat into the diet with some delicious “keto” recipes stacking up on blogs and cookbook shelves).

MINDFUL EATING PRACTICE AND KETO

Two key tenets of mindful eating practice are to eat free of judgement and to pay attention to one’s hunger and fullness cues rather than eating according to a diet plan or the clock. These are practices that are tough to do on a keto diet. Why?

• The keto diet prescribes “good foods” (examples: high fat dairy, stevia, above ground vegetables, macadamia nuts) and “bad foods” (examples: grains, sugar, many milk products, cashews).
• The diet must be closely monitored for ratios of macros (fat, carb and protein).
• Some combine the keto diet with intermittent fasting, that involves not eating for an extended period (eating according to a clock and overriding hunger and fullness cues).
• When not eating the correct macros or food types, you’re “breaking” the diet. Which comes with it guilt, hyper-focus on one’s commitment, and more negative mental side effects.
• Those who perform heavy exercise involving weight training need to loosely monitor physical activity level and carefully increase protein intake with a trained health professional.

So, as you can see, eating isn’t driven by hunger and fullness cues in the keto diet, but rather by number crunching and categorizing foods as good or bad. That said, the keto diet in my eyes has helped challenge the fat phobia developed in our society over the past few decades, stripping the label of “bad” from (most) fats, which can help some develop a healthier and more mindful relationship with food.

FOR THOSE EMBARKING ON OR ALREADY ON THE KETO PATH

To quote the Harvard Medical School: “it’s not the type of diet to try as an experiment”¹.

You should ALWAYS consult with a trained health professional before embarking on a keto diet to review contraindications for your personal health concerns and conditions, have renal functions monitored, and get checked for vitamin and mineral deficiencies, among other reasons. And coming off the keto diet shouldn’t be cold turkey; transitioning to your “standard” diet should be both gradual and monitored.

KETO-FRIENDLY PRODUCTS

Whether you choose to follow a keto diet, healthy fats are an important part of a healthy diet.  If you’re looking for supplements that may align with a keto diet, check out Botanica Perfect Omega and Botanica Coconut Oil!

1. Harvard Medical School. (2018). “Should you Try the Keto Diet?” Harvard Health Letter October 2018. https://www.health.harvard.edu/staying-healthy/should-you-try-the-keto-diet
2. Abbasi, J. (2018). Interest in the Ketogenic Diet Grows for Weight Loss and Type 2 Diabetes. Journal of the American Medical Association. 16;319(3):215-217.
3. Masood, W., Uppaluri, K.R. (2018). Ketogenic Diet. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK499830/
4. Suttie, J. (2018). Five Ways Mindfulness Meditation is Good for Your Health. Greater Good Magazine, a UC Berkeley Publication. Retrieved from https://greatergood.berkeley.edu/article/item/five_ways_mindfulness_meditation_is_good_for_your_health
5. Vargas, S. et al. (2018). Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. Journal of the International Society of Sports Nutrition; 15: 31.