The keto diet has been a popular weight loss diet for several years, and I often get questions from my patients if the keto diet is right for them.
There are four things I consider when making the recommendation for keto or not.
But first let’s talk through some basics.
The purpose of the ketogenic diet is to use ketones as fuel source. You eat to fuel your body. Your body takes fuel and turns it into energy, which is called ATP, and all your cells need ATP to do their jobs. You can eat sugar or food that converts to sugar, and glucose will be turned into ATP. Or you can make ATP through eating fat; fat is broken down into ketone bodies, and ketones are used to make ATP. (This is a simplified description of the scientific pathways).
If someone is eating a diet that is high in sugar or carbohydrates, then the body will use sugar as it’s main fuel source. This means there is considerably less fat burn, because the body is using sugar as fuel. So when people are trying to lose serious weight, going “keto” is appealing because eventually, with restriction of carbs, you will use up much of the excess sugar in storage, aka glycogen, and then you will start to use fat as a source of fuel.
Making ATP from glucose is a long process. Making ATP from ketones is a “cleaner” pathway, but when utilized less, takes a lot of metabolic effort by the body to switch into that pathway again. That’s why the transition from a standard diet to a keto diet can create symptoms like the “keto flu.” The keto flu happens because there is an imbalance in electrolytes that occurs with going keto (so those electrolytes need to be replaced), and because the process of transitioning from being a sugar-burner to a fat-burner can cause symptoms of brain fog, headaches, and some fatigue.
Now let’s get to those three points.
- What are your goals/ purpose of going keto?
- Do you have any evidence of metabolic in the present or in the past?
- Do you have any issues with thyroid?
- Are you working with a health professional that can advise you?
I first ask WHY people want to go keto because keto isn’t for everyone. There is this “buzz” that keto will solve all evils, and that is not the case. I sometimes see keto cause more problems than it solves! Keto is effective for a very particular set of people.
- People who are 30+ pounds overweight
- People who are insulin resistant
- If the person is male
In general, males tolerate macronutrient restriction (changes in protein, fat, carbohydrate levels) well, unless there is some underlying metabolic issue. This is because men are wired to adapt to stressors (and diet changes of this magnitude are a type of stressor for the body) in different ways than women. Men, unlike women, are not physiologically programmed to create and carry babies. Because men’s bodies do not have to potentially nourish a human every month, most men can handle stress much better than women, simply because of this hormonal difference. Women’s bodies are more physiologically sensitive to stressors (life stress, diet stress, emotional stress, physical stress), and I see this all the time in my practice.
The keto diet should not be a long-term diet, because the keto diet does not have enough diversity to support the microbiome long term. The keto diet is also very restrictive. The mainstream keto diet that you research on the internet is devoid of vegetables, and is high in meat and dairy. Because of this I recommend a whole foods high fat, moderate protein, low to moderate carbohydrate diet, as a long-term diet template after keto. It is similar to a paleo diet.
Insulin resistant people do well on keto. This is because with very little dietary sugar being consumed to disrupt blood sugar, less insulin is made overtime, and so cells become “more sensitive” to the normal signal of insulin again. I use a keto diet for typically 3 months in insulin resistant people; sometimes 6 months if they need extra support.
Let’s talk about point #2 – if a person has a history of chronic stress, restrictive eating, overexercise, and/or diagnosed eating disorder, I do not recommend keto to these women. The reason is because there has been past damage to their metabolism, and assuming their metabolism is now functioning correctly, adding in keto can signal to the body that “famine” or a time of not being “safe” is coming, so the person ends up feeling more metabolically suppressed and it affects their adrenal function and mental/emotional wellbeing.
#3 Keto is not for people who have thyroid issues, because it can decrease T3 levels in the body with the severe restriction of glucose.
And lastly, if someone is not being monitored by a licensed health professional, I don’t recommend the keto diet. Keto diets are hard to maintain because carbs are kept so low (usually less than 30 grams per day), and with the transition to keto, some people have a rough time, and may miss some concerning symptoms that indicate they need to stop, or they might need specific supplemental support (example: leg cramps due to electrolyte imbalances of sodium, magnesium and potassium). I also see people who “go keto” only eat meat and cheese – and this is not a healthy diet. For keto diets to be “done right” you need to eat low carb non-starchy vegetables often, vary up the kind of fats you eat (cheese, olive oil, nuts/seeds, coconut oil, fish oils), and make sure you’re getting moderate (not too high and not too low) levels of protein. Working with someone who has a strong nutrition background is key for this.
From my perspective, if you’re going to committ to a restrictive diet – you WILL need support – and if you’re going to commit, then you want to do it right to make sure you get the results you were looking for, and all the work and effort you put in wasn’t wasted!
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