A dietitians thoughts on the Ketogenic diet

The keto diet. It’s all the rage. I want to preface this by saying I do not endorse doing this diet (or any diet). However, I get asked questions about this multiple times per week, and the consensus is that people are confused. Because my goal is for you to be an informed consumer, I thought we could break it down today. If reading about specific diets is triggering for you, this is probably not the best post for you.

What are the origins of the Ketogenic diet?

The Ketogenic diet was originally developed in the 1920s for children to aid in the treatment of epilepsy. The Ketogenic diet is now widely accepted as a dietary therapy to control and alleviate seizures, in both adults and children. It typically requires an inpatient stay in the hospital as well as a team of dietitians and physicians to properly initiate and implement the treatment. This process requires extensive counseling and training on how to weigh foods, measure urinary ketones, modify foods for special occasions, and working to ensure overall nutritional adequacy. Concerns during this process include: inability to maintain adequate nutrition and/or hydration, dyslipidemia, cardiomyopathy, renal disease, liver disease, concerns about bone health, and the social constraints of the diet itself. Aka, this a lot of work!

What is it exactly?


The typical Ketogenic diet consists of very low carbohydrate, moderate protein, and high fat intake. A ratio of 4 grams of fat to a combined 1 gram of carbs and protein is standard (aka NOT a high protein diet). Without carbs to use as energy, your body will start to break down fat, both stored and from your diet. (This is actually your bodies way of preventing starvation.) This process produces ketone bodies in the liver. You are “in ketosis” if your body is relying solely on ketone bodies for energy.

The average carbohydrate consumption on the Ketogenic diet is typically between 20-50 grams of carbs per day. As a reference, carbohydrate foods include: dairy, fruits, starchy veggies (peas, corn, potatoes), all grains such as pasta and bread, sugar, and desserts. To put this in context, a medium banana contains about 20ish grams of carbohydrates. So you would need to keep your carbohydrate intake to less than 2 bananas per day alone on this diet.

Since this is a high fat diet, it typically includes lots of butter, cream, bacon, higher fat meats, nuts, medium chain triglyceride (MCT) oil, coconut oil, olive oil, and higher fat fruits like avocado.  The type of fat that is consumed may be a cause for concern. The current recommendation for saturated fat is 10% of total calories due to concerns of developing heart disease. Saturated fats include butter, coconut oil, bacon, cream, high fat meats or any fat that is solid at room temperature. Emphasizing heart-healthy fats may be beneficial, but experts disagree on the ideal fat composition of this diet.

Let’s learn more…

When you don’t consume adequate carbohydrates, you will lose water weight. That being said, losing water weight puts you at risk for dehydration and kidney stones.

Cutting out carbohydrates drastically decreases the types of foods you can eat. People often think cutting out foods, especially really appealing foods such as carbs (pasta, bread, cake etc), will automatically cause them to lose weight. But we know that restriction often leads to binging, and a painful yo-yo cycle.

It has been proposed that people who are doing the ketogenic diet experience less hunger, than those who may be on a calorie-restricted diet. Maybe? Lots of anecdotal evidence at this point, and everyone is different.

Foods high in fat aren’t as appealing as foods high in carbohydrates, thus you may eat less. If you think of a meal of broccoli and a small  steak cooked in lots of oil, versus broccoli, steak and a baked potato, you may eat more of the meal higher in carbohydrates because it tastes better! And food should taste good.

If you have diabetes, eating a Ketogenic diet may decrease A1c and improve insulin sensitivity because you simply aren’t eating as many carbohydrates. But we know that this can also happen by moving more and eating more fruits, veggies and whole grains.

You may develop nutrient deficiencies, particularly B vitamins, electrolytes, vitamin D and calcium by not consuming whole grains, dairy products, or as many fruits and veggies.


Another fun side-effect of this diet is the “keto flu” which includes symptoms such as fatigue, poor sleep, constipation, dizziness, difficulty exercising, and lightheadedness which may last anywhere from a few days to a few weeks.

If you are an athlete, your performance will suffer because your body relies mainly on carbohydrates in the form of glycogen to perform at a high intensity. There is little good research to support the use of this diet for improvements in performance.

Most of all, this diet is extremely restrictive, unsustainable for most, and there have not been enough large-scale studies to provide support in the long-term.

So why is everyone doing it?

Good question. Eating this amount of fat makes my stomach hurt just thinking about it. Plus, I enjoy carbohydrate foods, a lot. But, people are doing it. I think it’s normal to see someone who is losing weight, and want to jump on the same wagon. However, that’s a good moment to check in. Remind yourself that 95-97% of diets fail in the long-term. Ask yourself what are you really looking for in a new diet plan (health, connection, visibility, praise?). And can you find those things in other outlets of life? Here are some more questions to consider:

  • What are some reasons I am choosing to diet?
  • What do I hope to gain from dieting? Is this realistic?
  • Will I start to label foods good or bad based on the diet I am on? How will that make me feel?
  • Is this something I can do forever?
  • What happens when I am not on this diet?
  • Will I enjoy the food I am eating?
  • Can I attend social events and feel comfortable eating the food?
  • Will I feel deprived?
  • What happens when I achieve “results?” Now what?
  • What happens if I don’t achieve “results? How has perception of myself changed?
  • How has my body image shifted at different weights and stages in my life? Did I ever achieve that “ideal”? If so, did I feel better about my body or did it stay the same?
  • How will I feel if I eat like this? Will I feel energized?

If you are trying to improve your health, then I would argue that health is much more than how much you weigh. It is more about how you can move joyfully, eat foods that will nourish you and give you energy, how well you sleep, what types of relationships you form, and way way less about your pant size and what everyone else is doing at the start of a new year.

Hope this helps you to think a bit, and cheers to a new week friends!



**NOTE: If you are taking diabetes or blood pressure medication, are pregnant or lactating, have epilepsy, or any other medial condition, you must consult your doctor before starting this diet. This is not a recommendation to start the ketogenic diet.

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