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Keto: Fad diet or health benefit?

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  • Agnese Walker MS, RDN, 6th Medical Operations Squadron Nutritional Medicine Clinic

“Keto diet” was the most-searched diet term on Google in 2018. We have three registered dietitians working on MacDill to help our patients answer this question.

Although the specifics can vary, ketogenic eating generally recommends consuming a diet that is high fat, moderate protein and very low carbohydrate. Carbohydrate intake is often less than 20 grams of net carbohydrate or 5% of calories per day. The goal of this strict restriction is to get the body into a state of ketosis. 

Patients tend to be interested in ketogenic diets for weight loss and studies that typically last 1-2 years show that patients randomly assigned to low-carbohydrate or ketogenic diets tend to lose slightly more weight than those randomly assigned to other diets. 

It is theorized that being in ketosis helps with appetite regulation and improves fat burning, and that high dietary fat intake increases satiety. However, research also shows that weight loss is highly variable and tends to be greatest among people who are most adherent to dietary changes, regardless of what eating pattern they are following.

In addition to potential weight loss, ketogenic diets also typically result in decreased blood sugar, triglycerides and blood pressure and increased LDL cholesterol. Total cholesterol and LDL cholesterol tend to decrease or remain stable, especially among patients who have lost weight, although individual differences exist.

Ketogenic diets are not recommended for women who are pregnant or nursing and patients with kidney, liver, or heart disease or eating disorders. Side effects could include dehydration, constipation, vomiting, or, in rare cases, kidney stones. Bone health should be monitored over time. Research into the impact of these diets on long-term cardiovascular health, and the microbiome is ongoing.

A registered dietitian should also help patients ensure they are meeting their nutritional needs. There is a wide range of foods that people can eat and still be technically following the diet and producing ketones. Individuals could be eating a diet of quality foods that includes vegetables, nuts, healthy oils, avocados, meat, fish, eggs, and cheese. Or the diet could be highly processed and deficient in many micronutrients. A multivitamin is always recommended and additional supplementation or diet adjustments may be needed. Any time multiple food groups are restricted, it is possible for deficiencies to develop without careful planning.

Ketogenic diets can be presented as an option to individuals who could benefit and in whom it is not contraindicated. Some patients do very well on the diet, but it is not for everyone and it is not always necessary. Contact your primary care manager and ask for a referral to see a registered dietitian to see what diet would be best for YOU!