With both backers and detractors, the ketogenic diet is on the minds of many dietitians, nutrition specialists and Average Joes and Janes at the moment.
The high-fat/moderate-protein/low-carbohydrate serves to force the body into burning fats instead of carbohydrates for energy. This process is called ketosis. When your body doesn’t get glucose from carbs, your liver converts fatty acids from your diet into ketones to use as energy.
Maranda Helland, a clinical dietitian with Kootenai Health, said the keto diet has been an especially popular topic of conversation in her field.
“When people find out that I’m a dietitian, they usually ask me about the ketogenic diet,” Helland said. “It’s been all over the last several years, and in all honesty it really is a modified version of the Atkins diet.”
Ketogenic and Atkins share many of the same principles - both are low-carbohydrate diets that emphasize using dietary fat as a source of energy. A standard ketogenic diet keeps the carb count below 50 grams per day to maintain a state of ketosis. A cyclical version keeps this carb level down 5-6 days per week, then jumps up to about 150 grams on day 7 (carb refeed day).
Keto diets also tend to restrict consumption of sugars and refined grains more than other low-carb diets, including a limit on carb-heavy fruits and vegetables.
Tina VanDenHeuvel, a nutritional health coach with Natural Grocers in Coeur d’Alene, said a ketogenic diet is highly individualized, and results can vary based on the individual nutritional needs of its users.
“The diet takes accurate and diligent tracking and adjustment to be effective for healthy weight maintenance,” VanDenHeuvel said. “You need a balance of the right macronutrients and realistic goal setting.”
Core foods in the ketogenic diet include non-starchy carbohydrates like leafy greens and cruciferous vegetables (broccoli, cabbage, etc.), VanDenHeuvel said, with moderate amounts of protein from wild and grass fed meats. These grass-fed meats contain naturally occurring omega 3 fatty acids that can help modulate inflammation, she said.
“The majority of your macronutrients come from healthy fats like grass-fed meat and dairy, free range egg yolks, avocados, nuts, seeds and coconut oil,” VanDenHeuvel said. “It’s not all eggs and bacon.”
A popular “add-on” to the diet is butter coffee, or Bulletproof coffee, which skips the typical cream and sugar in favor of things like butter from grass-fed sources, organic and grass fed protein via collagen, organic ghee and MCT (medium-chain triglycerides) oil.
“They are very popular right now and a great way to increase your healthy fats,” VanDenHeuvel said. “I start my day with a bullet coffee to support my cognitive function and for additional energy support throughout the day.”
There are also supplemental products on the market that claim to provide additional ketones for the body, but VanDenHeuvel warned about their effectiveness as a weight loss tool.
“The amount of ketones from supplements will never reach the amount achieved with nutritional ketosis,” she said. “The goal is to correct your diet and use your own ketones for energy. Just because you have ketones in your urine doesn’t mean your body is burning fat. Remember by supplementing, you have to burn those ketones along with your own. You could be spinning your wheels by supplementing with ketones for fat loss.”
Helland said diets with such rigid restrictions on specific types of foods can also have unintended consequences. For one, people often come off diets eating too much of the foods they avoided and regain much of the weight.
“It is not very sustainable, which is the case with any restrictive diet, and you are going to cause micro-deficiencies in the body you will just have to supplement,” Helland said. “ I also really worry about the lack of fiber (on ketogenic diets).”
Some keto diets encourage daily stretches of fasting, or a modified form of fasting where people will consume only butter coffee and water until the mid-afternoon each day. Helland isn’t convinced this regimen will result in long-term weight loss, and that long-term fasting and consistently skipping breakfast can have negative effects on your metabolism.
“Your body thinks you are in starvation mode and tells itself, ‘I need to hold onto everything I can,’” she said. “However there has been some research of how an (occasional) one day fast can reset your metabolism and wouldn’t be as detrimental as skipping breakfast (long term).”
The process of sustaining ketosis can also be extremely taxing on the kidneys, Helland said, and there is a large segment of people who have health conditions or dietary needs that either make a keto diet ineffective or even dangerous for their health. For example, those with type 1 diabetes can put themselves in a state called ketoacidosis, if they suddenly stop a keto diet and introduce some carbs - the mix of high levels of glucose and ketones can be life-threatening.
“There is a big list of people who shouldn’t try the ketogenic diet, or that should attempt it with a lot of supervision,” VanDenheuvel said. Long-term ketosis is discouraged for those with thyroid or hormone imbalance, adrenal fatigue, poor sleep quality, extreme dry eye and constipation, she also said.
Helland urges everyone, especially people with medical conditions, to consult with a doctor and/or be referred to a dietitian to oversee any major changes to eating habits.
As for a more general and long-term dietary plan, Helland suggests a more rounded regimen. She said limiting carbohydrate intake can also have major benefits to your health, so long as you’re avoiding the less nutritional kinds, like most processed and overly sweet simple carbohydrates.
Helland suggests focusing on eating more natural complex carbs to produce useful glucose in the body for energy.
“The whole grains, fruits and vegetables are more sustainable for your body,” she said.
Helland said a less extreme balance can be both better for sustainable weight loss and your mental health.
“You can create a vicious cycle of making and losing progress,” she said of dieting. “I normally recommend a whole foods diet - lean proteins, your fruits and veggies, and if you can tolerate dairy for the calcium, get the ones without hormones - buy organic dairy. For the healthy fats consume more avocados, fish and nuts instead of red meats and the more processed meats.”
As far as organic vs. non-organic, Helland recommends the “dirty dozen” and “clean 15” approach - the dirty dozen are the 12 most pesticide-ridden foods that you should buy in organic form, while the clean 15 are the foods with the lowest residues of pesticides that would be okay to purchase non-organic.
“I’m all about how I can eat the healthiest without spending a bunch of money,” Helland said. “But anything that comes in a box or a package is probably not very healthy. Basically if you can’t pronounce the ingredients, then you shouldn’t eat it.”
• Nutrition Services at Kootenai Health - www.KH.org/nutrition-services
• Free nutrition-themed events and classes at Natural Grocers, located at 222 W. Neider Ave. in Coeur d’Alene. Visit www.naturalgrocers.com/store-location/coeur-dalene/ for schedule and topics.