What you need to know before trying the ketogenic diet
Why is it popular?
The ketogenic diet is an eating plan originally used to treat recurring seizures when medications don’t work. It recently started to catch on for diabetes care because the very low-carbohydrate (carb) content seems to improve blood sugars. People also tend to lose weight on this diet, causing it to take its turn in the spotlight and outshine other tried-and-not-so-true weight loss diets.
What is it?
The ketogenic diet is similar to a very-low-carb diet in that carbs are strictly restricted to 20-100 grams per day, depending on the plan. The difference with “going keto” is that the protein content is controlled and the amount of fat is high enough to make the body think it’s in starvation mode. To give some perspective, there are roughly 20 grams of carbs in one cup of potatoes. This means saying goodbye to higher carb choices like birthday cake, fries, pasta, bread, chips and sweets.
A typical day on the ketogenic diet might look like this:
- Breakfast: scrambled eggs with spinach, cooked with olive oil and served with ½ an avocado, salt and pepper
- Lunch: chicken salad sandwich filling in lettuce wraps, topped with chopped macadamia nuts and served with a pickle
- Supper: miso sesame salmon served with a salad made with an olive oil-based dressing
- Snack: a handful of almonds and a small portion of berries
How does it work?
Replacing carbs with fat eventually leads to a state of ketosis, where the energy stores found in muscles get depleted and the liver makes ketones from fat to be used as fuel. The initial weight loss is from losing water that was stored with the energy inside the muscles. The ketogenic diet also tends to decrease how many calories are eaten since many go-to foods are not allowed. When matched for calories, the ketogenic diet is just as effective as any other weight loss diet, though people often feel that this diet is easier because cravings are reduced.
The fat controversy
Hearing about this high-fat diet might sound strange for people who remember the low-fat craze. With the media promoting opposing beliefs about food every few months, it can be quite confusing to eat healthy when unsure of concepts like whether butter is good or bad, or how many eggs are okay to have in one week. While foods high in fat are encouraged in this diet, many choices could increase the risk of cancer and chronic illness once the weight loss stops. It is still recommended to limit processed meats like bacon and include healthy sources of fat more often, which come from plants, oils and fish.
It is worth it?
To answer that question, it’s important to figure out your own motivators for considering the keto diet.
- Is it for diabetes control? The ketogenic diet is not included as a recommended treatment option in the 2018 Diabetes Canada guidelines. Their position is that low-carb diets (with carb intake being as low as 4% of total calories) haven’t shown consistent improvements in A1C, a marker of diabetes control. People on certain diabetes medications or who have Type 1 Diabetes also have an increased risk of complications. Speak with a Certified Diabetes Educator or a Registered Dietitian to learn more about recommended approaches to improving blood sugar control through nutrition.
- Is it to lose weight? With weight loss research, it’s important to have high quality, long-term studies. This is because most people initially lose weight on a diet but then regain even more back. This often leads to weight cycling; a situation where weight goes up and down repeatedly, often as a result of trying and then giving up on many diets. Dieting can lead to a higher weight. The ketogenic diet hasn’t been studied long enough to determine if it’s an exception to this rule. Average weight loss on the keto diet peaks around five months, then most people slowly regain that weight afterwards.
- Is it to improve health? Health improvements associated with weight loss won’t last when the weight is regained, and weight cycling is worse for health than simply carrying more weight. Focusing on health behaviors regardless of weight can lead to lasting health improvements in blood pressure, cholesterol and depression to name a few. Keep in mind that it is possible to be healthy at any size.
Very intense diets like this one are typically short-lived, whereas making small sustainable changes to one’s lifestyle can add up for lifelong improvements in health and wellbeing. There are many different approaches to health, which is helpful as there is no eating strategy that would suit every single person. A few other approaches include Canada’s new Food Guide, the well-established Mediterranean diet and the 2018 Diabetes Canada nutritional therapy guidelines. If the ketogenic diet suits your lifestyle and feels sustainable, it is a good idea to see a Registered Dietitian to manage the risks and potential for nutrient deficiencies from the food restrictions.
Michelle Stevens, Registered Dietitian