Dietitian weighs in on the keto diet

‘I wouldn’t recommend the ketogenic diet for weight loss,’ expert warns.
Keto, or ketogenic. diets are one of the latest weightloss fads, but a dietitian warns folks about following it without a health professional's guidance. (For Spectrum Health Beat)
Keto, or ketogenic, diets are one of the latest weight-loss fads, but a dietitian warns folks about following the diet without a health professional’s guidance. (For Spectrum Health Beat)

Another day, another fad diet. There’s Atkins, South Beach, paleo, Whole30, Sugar Busters—too many to name.

These days the buzz seems to be about a weight-loss craze called the keto diet. But it’s hard to sift through the contradictory advice found online. Two pounds of bacon a day? That can’t be good for you.

To help separate fact from fiction, Health Beat spoke with Kirsten Vereecken, RD, CSP, a registered dietitian at Spectrum Health Helen DeVos Children’s Hospital.

What is the ketogenic diet?

The ketogenic diet was developed at the Mayo Clinic in 1924 as a way to treat epilepsy in children. Although it was effective at controlling seizures, the diet fell by the wayside when new anti-seizure medications came on the market in the following decades.

In recent years, the ketogenic diet has made a comeback, and medical teams are again using it as a therapy for kids with epilepsy whose seizures can’t be fully controlled by medications.

The goal of the keto diet is to put the patient into what’s called a state of ketosis through a food regimen that’s high in fat and ultra-low in carbohydrates, with moderate amounts of protein. In simple terms, Vereecken said, ketosis is a metabolic shift in which the body uses fat as the primary energy source rather than carbs.

“When we eat carbohydrates, the carbs are converted to glucose, and that’s our energy source. When we don’t have carbohydrates to do that, then our body burns fat,” she said.

The process starts in the liver, where fatty acids are converted into ketone bodies, or ketones. Elevated levels of ketones in the blood leads to ketosis, which can decrease the frequency of seizures—though experts still don’t know exactly how this works in the brain.

The important point, Vereecken said, is that the ketogenic diet relies on precise ratios of fat to protein and carbohydrates, so it requires a watchful medical eye.

“When we have a patient come in to the children’s hospital and they’re going to be started on a ketogenic diet, they are admitted so that we can monitor them closely,” she said. “We look at their electrolytes, their labs, we monitor the ketones in their urine.”

The whole medical team gets involved, including a dietitian and a neurologist, to help keep the patient in ketosis.

Because this diet is so restrictive and individualized, it isn’t a healthy option for the general population, Vereecken said.

“I wouldn’t recommend the ketogenic diet to an adult patient or a pediatric patient for weight loss.”

Though they might lose weight, she said, “I would just fear that they’d be missing out on too many essential nutrients.”

Top 5 things to know about the keto diet

1. A ketogenic diet isn’t just another low-carb, high-fat diet

There’s a lot of misinformation online about the ketogenic diet, Vereecken said. In popular culture, people think of a keto diet as a modified version of the Atkins diet, when in reality it’s more restrictive than even the induction phase of an Atkins plan.

Celebrities who throw around the term keto don’t help, she said.

Most of what passes for a keto diet is only keto-like, in that it replaces some of the carbs in a person’s diet with fat and protein. That’s not ketogenic in the clinical sense, which limits carbs to as few as 10 grams a day.

But whether a diet is truly ketogenic or not, Vereecken said, a low-carb, high-fat diet has more downsides than upsides.

2. A keto-like diet can deprive the body of essential nutrients

The downfall of a weight-loss plan that’s high in fats and low in carbs is that it may deprive the body of nutrients we need for brain and body health.

“Any time you’re removing a large macronutrient like carbohydrates, your body is going to be losing some of the essential nutrients that come from that food group,” Vereecken said.

“You’re not getting your B vitamins, you’re not getting vitamin C, you’re not getting fiber in your diet, and all these things are needed.” Eliminating carbs may also throw off your electrolytes, like sodium, potassium and magnesium.

Though many people label carbs as bad, not all carbohydrates are created equal. The key is to choose smarter carbs: sweet potatoes, steel-cut oats, quinoa and fruit rather than white pasta, white bread, white rice and pastries.

It’s true that cutting carbs often leads to fast weight loss, Vereecken said, but in the first week or two much of the loss is water weight, because our bodies store water with our carbs.

3. Just because keto is a high-fat diet doesn’t mean all fats are fair game

“People think, ‘Oh, this diet sounds great—I can eat bacon and I can eat cheese and I can still lose weight,’” Vereecken said. “And then they drop pounds quickly and it’s instant satisfaction, instant gratification.”

But a diet high in saturated fat increases the risk of heart disease and stroke.

Keto diet or no, the fats we should be eating are unsaturated fats, which can combat diabetes and lower the risk of heart disease and stroke. For healthy fats, look to olive oil, canola oil, walnuts, avocados and fish.

4. A keto diet can have negative side effects

Those who experiment with a keto-like diet may also experience some unpleasant side effects, Vereecken said, including constipation, leg cramps, loss of energy, mental fogginess and headaches.

All of these can result from a change in diet and deficiencies in vitamins, minerals or fiber.

5. The Mediterranean diet is a better option

Rather than a keto-like diet or other low-carb eating plans, Vereecken recommends the Mediterranean diet, which she said is much healthier over the long term—and much less restrictive.

Spectrum Health even offers a class called Eating the Mediterranean Way. This approach focuses on smart choices in all of the food groups, while paying attention to portion sizes.

“You need a lifestyle that’s going to work for you and to help achieve your goals, but in a healthy way,” Vereecken said.

Learn more about Spectrum Health nutrition counseling services or call 616.391.1875 to make an appointment. Register online for our Eating the Mediterranean Way class.

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Comments (29)

  • I absolutely disagree with this article. The ketogenic diet has reduced my weignt, cholesterol and blood sugar dramatically. Tjis is not a fad but a dramatic improvement in my health and well being. FWIW, I am a “Butterworth Baby” and a health care professional.

  • Per my functional medicine doctor’s suggestion, I’ve been eating a LCHF/Keto diet for the past 4 years and my health has improved greatly. I lost all the excess weight, reversed my T2 diabetes, got off all prescription meds and even healed from stage 2 breast cancer without having to resort to chemo, radiation or surgery! If these are “side effects” of the Keto diet…bring them on!!!

  • I’ve been on a LCHF diet for 16 months, and it’s changed my life for the better, as follows:
    -lost 45 lbs
    -no longer obsess over food. This diet is easy, and tastes great, but doesn’t make me need to eat constantly.
    -energy level is high and consistent
    -lost all of my ADHD symptoms and got off of the medication for it.
    -blood pressure is way down
    -improved mood and focus
    -I love what I’m eating. Butter and coconut oil tasted way better than sugar.

  • A response to your points above:

    1. You state “a low-carb, high-fat diet has more downsides than upsides.”

    Have you actually counted them? Why haven’t you posted the “upsides”?

    I’ve been doing Keto for 5 months. After the initial adjustment phase (took me about 4 weeks), I find it the easiest way to eat. I eat only simple, nourishing foods. Reducingt carbs and eating increasing healthy fats makes me full faster and doesn’t generate cravings.

    2. Not true. You can get plenty of nutrients from low carb veggies, meat and other protein and healthy fats. Do your research. This has been well established by many researchers and medical doctors.

    Problem with electrolytes? Eat more healthy salt. Himilayan, sea salt or take electrolyte supplement. Problem is easily solved.

    3. This is an old myth based on faulty research. Many experts are showing that saturated fats DO NOT cause heart disease or strokes. Read up on it.

    4. Side effects “constipation, leg cramps, loss of energy, mental fogginess and headaches.”

    These are all part of the adjustment phase and electrolytes take care of all of these symptoms. I had some of these symptoms at first, but they went away after a few weeks of being keto. In fact, I have more energy than ever, have lost a lot of weight, and have incredible mental clarity. Countless others have the exact same experience.

    5. The Mediterranean diet is a healthy diet. But, please PROVE that it is healthier than the keto diet.

  • The Ketogenic way of life has been life giving for me. I have found I eat more nutritionally based meals utilizing Keto than ever in my life. I have successfully maintained a 50 pound weightloss and continue to have metobolic successes each month. Keto has given me the freedom to eat foods I enjoy and obtain health. By the way, I do not eat bacon, everyone has the freedom to choose fat and protein sources, I also haven’t met anyone that eats 2 pounds of bacon, with this way of eating I eat substantially less food because my body is satiated. For those suffering for a deranged metobolic system a Ketogenic approach is life saving. I have only seen individuals successfully reverse diabetes, PCOS and a myriad of other health issues with a Keto approach. #ketoon

  • I’ve done many diets. Low fat ruined my metabolism and gave me insulin resistance. Ketogenic saved my life and I have the numbers to prove it. I’m on no more medications. Going on years doing it now and it’s not restrictive at all.

  • I have been doing the keto way of eating for 9 months, have lost 40 pounds, co.pletely reversed my type 2 diabetes and most importantly, to me at least, my chronic pain from back and spinal issues has become so much better, inflamation is way down. Also my sleep apnea is improving. My dog or is so proud of me and completely agrees with what I am doing. I am 65 , and have so much energy again and feel so much better, I feel like I have my life back again.

  • I’ve been keto for over 2 years and I feel great. I am 49 years old and have more energy and stamina than I had in my 30’s. My fibromyalgia is 90% better, my IBS is gone, RLS is gone, brain fog is gone, my cholesterol numbers are perfect, and I’ve lost 45 lbs. My doctor said I’m in better health now than I was 10 years ago. Everyone should research things for themselves, as I did. Keto is the best thing I’ve ever done for myself.

  • I disagree this this article. By following the KETO diet plan I have lost over 100# and have been able to get off of my meds. I am so grateful I discovered it and follow many Facebook groups for receipes to keep it tasty and no i don’t eat bacon daily.

  • I have been on Keto for 12 months. I have maintained my reversed T2D in that time. As a “sugar burner” I lost 30 kgs and then started to put it back on, now have lost 10kgs again. My brain fog has gone, my bipolar meds have been reduced. I’m feeling healthy with good normal blood tests. I’m now on Keto for life hopefully to dodge Alzheimers. I’m 68.

  • Been Keto since 2015. I have not experienced any of the ill effects described in this article. Aside from loosing a great deal of weight, I sleep better, have more energy, no longer deal with depression. I’m in better shape at 50 then I was at thirty.

  • Ketogenic diets implemented using a smartphone app have been seen in randomized controlled clinical trials to reverse the progression of type 2 diabetes [source: https://diabetes.jmir.org/2017/1/e5/%5D

    For people who are insulin resistant and in danger of failing glycostasis (>55% of all Californians – Source UCLA) controlling blood glucose by making it on demand in the liver is safer than eating it (sugar and starch) and hoping the pancreas can.

    The food pyramid is a fad diet from the 1980s. It has never been properly tested in randomized controlled clinical tests to be safe, or effective. The evidence of our own eyes tells how our society has become diabetic in the past 45 years following that fad.

  • This author way out of date on her science. My wife and I have lost a combined 170 lbs ketogenically. We have never felt better nor had better lab results. A1C…down, FBG…down, BP…down, LDL…down, Trigs…down, HDL…up.

  • I believe the dietician was truly just meaning to say, is to make sure you are doing the Keto diet correctly. I think she is not advocating it without physician or nutritional guidance.
    I would love to hear what source everyone is using to guide them on the Keto journey, I am interested.

    • There are several good books out there: The Art and Science of Low Carbohydrate Living by Dr’s Phinney and Volek. Keto Clarity by Jimmy Moore. The Obesity Code by Dr. Jason Fung. I found listening to the Keto Talk podcast and Two Keto Dudes podcast quite helpful as well. Ketogenicforums.com is a wonderful resource as well, with many experienced and knowledgeable people, tons of great recipes, and links to science based articles. Best of luck!

      • I agree with all the books mentioned by Anna and I would also add, I see a functional dr. She works with me to make sure I’m staying healthy. A good dr. is very important. Plus the book Undoctored by Dr. William Davis is great too.

  • I had to chime in too, I don’t think any dietician is really even allowed to back the keto diet, seems like it’s pretty taboo in their circles. However, it does work and it is so much healthier than a standard American diet!!

  • I follow the Duke University Lifestyle Clinic protocol of 20 grams total carbs (or less for me) for the past 3 years and feel fantastic. Reversed Type 2 Diabetes, got me off 2 1/2 of 3 blood pressure meds. No need for statins. In sum, I feel great and all of my doctors are loving my results, including the 40 pound weight loss. Results I was NEVER able to achieve with a “healthy” diet.

  • I have witnessed first hand the healing powers of Keto in not only myself, but my husband, my sister, and many many friends and co-workers.

    My husband and I started eating the Keto way one year ago. He was suffering from metabolic syndrome, as was I surely, and we started as a way to love some of that weight that had creeped up over the years. We found many reputable resources online, through podcasts, and books. Our doctors started seeing the results we were getting, not only with weight loss (which is a great SIDE EFFECT by the way), but also with our biomarkers of disease, they encouraged us to continue on. My A1C dropped from a nearly pre-diabetic range of 5.6 to 4.9. I lost 25 pounds, and much of it from my waist where I was carrying that dangerous visceral fat. I stopped snoring. My HDL went up, and my triglycerides went down. I had energy to live my life again, and I did not fall into the depression that typically happened over the winter. My husband dropped his triglycerides from 800 to a normal range! He went off of his statin. He lost 30 pounds, again from that visceral area. His A1C is now 5.3.

    The one very great thing that Keto has done for our family was improved fertility! I was able to get pregnant and stay pregnant after two losses. We are expecting our very healthy Keto baby in February. Keto is helping me keep my blood sugars controlled through my pregnancy, as I develop Gestational Diabetes almost immediately.

    All of this through eliminating starchy sugary foods, grain, high carb veggies, most fruits except berries, and by eating the protein amounts right for our bodies and healthy fats!

    I could go on and on about the benefits, but obviously these comments and testimonials speak to themselves. As a nurse I want to encourage anyone who wants to feel better, while still eating delicious food, to research Keto and try it!

  • Thank you all for sharing your testimonials regarding a high-fat, low-carb diet. We’re glad to hear you are doing so well. We suggest that everyone make sure to discuss any diet, especially a diet that is particularly restrictive, with your physician. Of course, everyone may do what they like, but we prefer to make sure you are safe in your dietary habits. Spectrum Health’s dietitian was advocating a more well-rounded diet as a safer long-term choice. Best wishes to you all.

    • If eliminating unhealthy and fattening food is considered “restrictive,” then which of them should be reintroduced to make it well rounded?

    • I agree about having your Dr. onboard with LCHF diets or any diet/way of eating. Having your vitamin levels, cholesterol levels, thyroid levels, etc. checked regularly is always important. Thankfully, all of mine have improved with keto.

  • OMG, OMG , OMG…NO. I’ve doing the ketogenic diet for almost 16 years. Now to know that I will die is quite upsetting. I mean, what do I have to do prevent dying from it? Do I have to avoid getting hit in the head from a chunk of frozen butter or pot roast? I know, I can prevent my demise by not choking on a piece of cauliflower.

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