As a nutritionist, I have to say this is one of the top questions I am asked, and it was one of the top google search terms for 2019. Do you know what that means?
There are lots of shady people out there that are going to try to capitalize on your hopes and dreams that keto will solve every problem in life from excess weight to toenail fungus.
If you’ve been following me for a while you know I preach bio-individuality; what that means is that I think what’s right for one person is not necessarily what’s right for another.
So while I’m not going to tell you whether you should or shouldn’t do keto – because I don’t know you, and you could be different from someone else – I am going to give you some REALLY IMPORTANT education on what the keto diet is, some potential pros and cons, and how to do it properly, so those shady people can’t take advantage of you just to sell you their program or product.
And as an aside, if you see someone out there preaching that everyone should do keto forever (or the reverse, which is “no one should ever do keto”), run, don’t walk, in the other direction because it means they have no understanding of bio-individuality, genetics, nutrigenomics, metabolomics, or potentially anything else to be honest. Everyone’s dietary needs are unique, and the best way to find out what’s right for you is to educate yourself.
“Keto” = being in a state of “ketosis”
“Ketosis” = the body is utilizing “ketone bodies” for fuel rather than glucose (sugar) for fuel.
“Ketone bodies” = a water-soluble molecule containing a ketone group produced by the liver from fatty acids
Our bodies have two main energy sources. One is ketone bodies made from fat, and the other is glucose made from sugar and carbs. If you don’t have enough glucose on board (ie: if you’re fasting or eating low carb) your body will turn to ketone bodies for fuel instead.
Steps to ketosis:
The body breaks down fat stores (triglycerides) into free fatty acids
Free fatty acids are sent off to your liver
Your liver converts the fatty acids into the ketone bodies beta-hydroxybutyrate (BHB), acetone, or acetoacetate.
These are converted to acetyl-CoA and then used as energy in the form of adenosine triphosphate (ATP)
But how do you get the body to tap into these triglyceride stores and use it for fuel? Is it….
During periods of time when your body does not have food coming in to break down into fuel sources the body will switch over to burning your fat stores as ketone bodies for fuel (and during extremely long periods of fasting once the fat runs out it will then switch to breaking down muscles for fuel also known as muscle catabolism).
Carbohydrate restriction. Similar to the fasting scenario above, if the body does not have a glucose fuel source to utilize it will turn to fat stores to produce fuel sources from fatty acids.
One of those 4,000 keto products on the market.
A will get you there the quickest.
B will get you there the easiest.
And C is totally unnecessary but if you want to spend a lot of money on them, they can potentially help bridge the gap from sugar burning to fat burning.
Your body is fully capable of producing ketone bodies on its own, and you do not need to pay $100 to guzzle it in the form of a powder or a pill or a drink or whatever. If you find you have “keto flu” sometimes this helps provide a little bridge to get you to the land of ketosis, but in general, these are a waste of money. For the most part, these are ketone salts that you see on the market, and to date most research shows that ketone esters are much more effective, yet not readily available to the general public cuz they cost like $1,000 for one dose. So I recommend you just put yourself into ketosis and save that $1,000 for something else.
Ketosis was first used in medical literature as a treatment for children with refractory seizures in France around 1911. It was observed that children with severe epilepsy that did not respond to medications had a significant reduction or disappearance in seizures when their body switched over to burning ketone bodies for fuel rather than glucose. Originally they used fasting to allow the children to enter a state of ketosis, but since this can only be maintained as long as one has fat stores, eventually they would have to stop and symptoms would return. Researchers went on to discover that high fat, low carbohydrate, moderate protein diets were able to keep these children in ketosis without forcing them to remain in a fasted state of chronic starvation.
Keto has since gone on to be studied in many other brain-involved disorders such as brain cancer, Alzheimer's, Parkinson's, and more. Glucose is the brain’s “food of choice” but it is capable of using ketone bodies as well. Mechanisms of action are not yet fully elucidated, but researchers are investigating two areas: one is the protection the brain seems to receive by being flooded with ketone bodies, and the other is impaired glucose metabolism in the brain and the issues that can cause (which are eliminated when glucose is eliminated).
Eventually, researchers also started to notice side benefits of burning ketone bodies for fuel rather than glucose like more energy, weight loss, better blood sugar balance, etc., and the keto diet started to trickle into the mainstream (which has since turned into a flood as we know it).
The original medical keto diet is pretty hardcore and consists of an awful lot of cream and oil with very minimal protein and vegetables. An example of a medical Ketogenic diet for pediatric epilepsy as seen in the Journal of Nutrition in Clinical Practice is laid out here by Zupec-Kania and Spellman (2008):
Breakfast: 40 grams of heavy cream, 32 grams sausage links, 24 grams has avocado, and 5 grams of canola oil.
Lunch: 40 grams heavy cream, 20 grams baked cod, 43 grams roasted cauliflower, 23 grams of butter.
Snack: 10 grams sliced strawberries and 28 grams whipped heavy cream.
Ummmm heavy cream anyone?
Today’s keto can look anything like living off butter coffee, and bacon, all the way over to “MCT keto” which allows for higher amounts of non-starchy carbs to be consumed while still staying in ketosis through the utilization of medium-chain triglycerides as fat sources. This is what I call “Clean Keto” and I even made an e-course on it that you can purchase here: Jump Start to Keto!
When it comes to implementing keto, people tend to get confused. How many grams of carbs can I have? How much protein? Is it high fat, low carb and low protein, or high fat, high protein and low carb? What do I eat for goodness sake?! How do I know if I’m in ketosis? How long can I stay in ketosis?
And that’s why I created my course. My goal is not to give you a one size fits all program, or hand you a “fish”; in my course, I “teach you to fish”, aka teaching you how to customize the keto diet, macros, calories, etc to your lifestyle, height, weight, and activity level. In my course, I also preach “clean keto” (high in MCT oils, vegetables, and even low glycemic fruits) over “dirty keto” (bacon, butter, and cream).
You don’t need a Ph.D. in nutrition to understand that removing almost all forms of vitamins, nutrients, and minerals from your diet by eating butter and bacon alone for years on end could be problematic. This is why I preach a clean keto approach that keeps fruits and vegetables on board! Plants have many phytonutrients that have been shown to prevent cancer, slow signs of aging, protect brain health, eye health, and more. Some other concerns of keto done wrong are constipation due to changes in the microbiome and lack of fiber, electrolyte imbalances, dehydration, muscle loss, and hormonal changes. These are all issues I touch on in my course as well in order to help you navigate these complexities.
Did you hear the story of the teenager that ate only French fries for years until he LITERALLY WENT BLIND? (story here: https://www.health.com/nutrition/boy-goes-blind-after-eating-french-fries-everyday). It’s a great example of what happens when we eat only one or two things forever.
As you can probably tell, when it comes to Keto, I have concerns. Concerns over a lack of nutrients, concerns over consumers being taken advantage of with expensive keto drinks and foods, and concerns that a one size fits all program isn’t one size fits all.
But I also think Keto can be an incredibly useful tool when used properly.
#1: Calories still actually matter here if you are doing this for weight loss. If your body burns 2,000 calories a day and you are eating 3,000 calories a day where do you think that extra 1,000 goes…? It will be stored as fat for a later date and time. This is ketosis, not a magic trick. Now if you burn 2,000 calories a day and consume 1,500 calories a day where does your body get that 500 calories from? From breaking down stored fat for fuel in the form of ketone bodies. Hellooooo fat loss!
#2: In the whole “carb and fat” discussion people often forget about protein. If your glucose sources are low and fat sources are high BUT your protein sources are high too, your body can turn this protein into glucose in the liver in a process called gluconeogenesis. This will keep you from burning your body’s fat stores for energy because it’s easier for the body to use what is floating around (aka what you just ate) than it is to tap into the fat stores and break them down into a complex chemical process that produces ketone bodies. So if your protein is super high you may not be able to get into ketosis because that protein can be turned into glucose.
1. Weigh the pros and cons for you personally.
2. Ensure you are embarking on a well-formulated ketogenic diet if you decide to proceed.
3. How long do you plan to do keto?
If you’re going to do it, please make sure you think it through thoroughly, make a plan, get some help, and do it right.
Gleeson, M., Dickson, R. C. (2016). Quelling inflammation with ketosis and steric chemistry. Clinical Translational Gastroenterology, 7(2). doi: 10.1038/ctg.2016.6
Marengo, K. (2019). How the Ketogenic diet works for Type 2 Diabetes. Retrieved from:
O’Neil, M. (2019). A Teenage Boy Went Blind After Eating French Fries Everyday. How Does That Happen? Retrieved from: https://www.health.com/nutrition/boy-goes-blind-after-eating-french-fries-everyday
Sumithran, P. Prendergast, L. A., Delbridge, E., Purcell, K. Shulkes, A., Kriteos, A, Proietto, J. (2013). Ketosis and appetite mediating nutrients and hormones. European Journal of Clinical Nutrition, 67(7). p. 759-64. doi: 10.1038/ejcn.2013.90.
Yang, H., Shan, W., Zhu, F., Wu. J., Wang, Q. (2019). Ketone bodies in neurological diseases: focus on neuroprotection and underlying mechanisms. Journal of Frontiers in Neurology 10. P. 585. doi: 10.3389/fneur.2019.00585
Zupec-Kania, Beth & Spellman, Emily. (2008). An Overview of the Ketogenic Diet for Pediatric Epilepsy. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 23. 589-96. 10.1177/0884533608326138