A Cautious Take on the Popular Keto Diet

You may have heard about the ketogenic, or “keto,” diet. Some people liken it to the Atkins diet of the past given both are low-carb diets. The keto diet is quite different from Atkins, however,  as it does not emphasize high consumption of protein. Instead, the keto diet is extremely low-carb, moderate in protein, and very high in fat. It is designed to put the body into a state called ketosis. Normally, your body runs on blood glucose (sugar) for energy; in ketosis, your body instead converts fat into an alternative fuel called ketones.

The keto diet is actually not a new diet. In the early 1900’s, it was used as an effective treatment for epilepsy and is still sometimes recommended for use today in hard-to-treat epilepsy cases.

The good news is that the keto diet has been shown in some short-term research studies to improve not just weight loss, but also insulin resistance, blood pressure, and high cholesterol. People who try it report that they don’t feel as hungry as they do on other diets.

However, there are risks involved in this diet, and it is not for everyone. Here are some concerns:

• Increased risk of kidney stones
• Increased risk of osteoporosis
• Increased risk of gout from higher uric acid levels
• Possible nutrient deficiencies, such as magnesium, zinc, or iron
• Low fiber intake
• Restrictive diets can cause or worsen binge eating in some people

Low fiber intake, in particular, is of concern because we don’t yet know how following the keto diet might affect your gut microbiome (the balance of bacteria living in your intestines). We are learning more and more about how important gut flora (bacteria) are for health. Fiber is needed to feed those gut flora and to keep your digestive tract healthy.

If you are committed to trying the keto diet, I would suggest the following:

• We don’t know how the keto diet might affect long-term heart disease risk given its emphasis on high-fat foods. Therefore, instead of loading up on bacon, it might be a good idea to choose heart-healthy unsaturated fats like olive oil, fish, nuts, and avocado as your main fat sources.
• Think of it as a short term diet, and have a plan for transitioning back to a higher fiber, more heart healthy and balanced way of eating in the long term.
• Please talk to your doctor or Atrius Health nutritionist if you are thinking of trying the keto diet (or any diet that restricts certain foods or food groups). We still need more research on its long term effects, so engaging with a healthcare professional is best as we can help you determine if this diet is right for you, your unique health situation and your health goals.

About Catherine Lukas, RD, MS, LDN, CDE

Catherine is a registered dietitian and certified diabetes educator who joined Atrius Health in 2019. She enjoys working collaboratively with patients to help them make sustainable diet and lifestyle changes to support their health goals. She is especially interested in weight management, diabetes education, and managing irritable bowel syndrome.

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