Exploring the Pros and Cons of the Ketogenic Diet
Lately, I’ve been seeing a lot of negative talk about the ketogenic diet, both in Facebook groups and among my colleagues. While it may not be a go-to for many today, it still has a valuable place in practice, especially for those where meds may not be an option or who need a more aggressive approach to nutrition. I really do believe there’s a role for it!
So today, I’m going to break down what the ketogenic diet is, how it works, its pros and cons, and who might be a good candidate for it. You may have tried it yourself or know someone who has. It’s one of those diets that tends to cycle in and out of the spotlight.
If you’re interested in learning more, keep reading and check out the full episode!
Breaking Down the Keto Diet: What to Eat and Why
The ketogenic diet isn’t just about cutting carbs—it’s about finding the right balance of macronutrients to enter a state called ketosis, where the body burns fat for energy instead of carbs. This process can help with appetite suppression and steady blood sugar levels. The key is to focus on high-fat, moderate-protein, and very low-carb foods. Too much protein can interfere with ketosis, so balance is crucial.
To start, most people reduce their carb intake to under 20 grams per day, which is about the amount in a slice of bread or a large banana. Once you’re in ketosis, your appetite decreases, and portion sizes often shrink – many often feel satisfied with two eggs or a few ounces of chicken with vegetables.
Being in ketosis helps stabilize insulin and blood sugar, leading to more consistent energy and less hunger. This means fewer meals, often just two or three a day. For those doing intermittent fasting, keto can help by reducing hunger and make fasting easier.
The diet also emphasizes non-starchy veggies and leafy greens. Aim for two to three cups of leafy greens and one cup of non-starchy vegetables daily. You’ll avoid starchy vegetables (like potatoes) at first but can slowly reintroduce fruit, especially berries, later. Healthy fats like olive oil, nuts, and avocados round out the diet, offering variety and balance.
Fat burning and other benefits on a Keto Diet
One of the biggest perks of the ketogenic diet is its ability to promote fat-burning and eventual weight loss. By switching the body’s main energy source from carbs to fat, many people find they’re less hungry and feel fuller longer, naturally controlling their food intake. This makes it a sustainable option for those looking to manage their weight.
Another major benefit is better blood sugar control. Since carbs are cut down, blood sugar levels stay steady and don’t spike like they would with a higher-carb diet. This can be a game-changer for those managing diabetes or blood sugar issues. However, for anyone on blood sugar-lowering medications, it’s important to talk to a doctor first—combining these with a low-carb diet can lead to dangerously low sugar levels.
I’ve seen firsthand how powerful the ketogenic diet can be. Some patients have reduced or even stopped using diabetes meds, showing just how effective it can be for blood sugar management. That said, sticking to such a strict diet long-term can be tough, especially during social events or times when carbs are harder to avoid. Success often means adopting the diet as more of a lifestyle than a short-term fix.
The Keto Transition
The transition into ketosis can be rough for some. The shift from burning carbs to using ketones for energy can cause what’s known as the “keto flu”—fatigue, muscle aches, and brain fog. This phase usually lasts a few days to a week but can be managed with hydration, electrolyte-rich drinks, and magnesium supplements.
Once adapted, people often feel more energized and focused. That initial struggle can lead to long-term benefits that make the ketogenic diet worth considering, particularly for those ready to embrace its changes.
Cholesterol and Other Risks on the Keto Diet
The ketogenic diet can have both benefits and risks related to cholesterol and overall health. Here’s an overview of the potential downsides:
Cholesterol Changes:
The keto diet may improve lipid panels, particularly lowering triglycerides and potentially supporting better heart health.
However, cholesterol responses can vary; some people may see an increase in HDL (good cholesterol), while others might experience a rise in LDL (bad cholesterol).
Regular cholesterol monitoring is essential, as well as considering individual health needs. Plus, sticking to the diet consistently is vital, as fluctuations between high-fat and high-carb eating can prevent ketosis and lead to negative health effects.
Constipation:
This is a common challenge on keto due to reduced food intake, which can mean fewer bowel movements.
While managing constipation is possible with hydration and fiber-rich foods, it’s important to distinguish true constipation from less frequent but still soft and pain-free bowel movements.
Gallstones:
The high-fat nature of the ketogenic diet can increase the risk of gallstones, particularly for women and those who lose weight rapidly.
Gallstones can present as right-sided pain after meals and should be considered, especially for middle-aged individuals.
Gout:
This condition can be a concern for men and those genetically predisposed to it.
The keto diet can raise the risk due to high-purine foods and the body’s difficulty in excreting ketones and uric acid, especially during the initial phase of ketosis. Individuals prone to gout should monitor uric acid levels before starting the diet.
Keto Breath:
This can range from a sweet, fruity scent to a dry, metallic taste.
Staying hydrated and using sugar-free mints or breath strips can help manage this side effect.
Increased Urination:
Common at the beginning of the diet, increased urination occurs as the body sheds water and electrolytes.
Staying hydrated and replenishing electrolytes is key to managing this effect.
Making Keto Work
Long-term success requires dedication and support, whether from online keto communities, friends, and/ or family. Consistency is essential to maintain ketosis and achieve its benefits.
While high cholesterol can be concerning, it is not the only factor in heart disease–inflammation plays a major role. A balanced keto diet can help lower inflammation, even if cholesterol levels increase in some. Of course, it’s also worth noting that high cholesterol does not always lead to heart problems, as seen in the case of my grandmother.
Another consideration–switching between keto and a standard diet or having frequent cheat days can disrupt the benefits and impact both mental health and weight over time. If keto isn’t sustainable, a balanced approach with occasional low-carb days might be more effective for long-term health.
Why Over Relying on Keto Products Can Backfire
Keto products are everywhere these days, from frozen meals and protein shakes to snack bars. While these convenient options can be lifesavers in certain situations—like when traveling or when healthier choices aren’t available—they may not be the best for long-term success, especially when it comes to reducing inflammation.
One of the main issues with many packaged keto products is the presence of sugar alcohols. Although these products often advertise themselves as sugar-free or low-carb, sugar alcohols can disrupt the ketogenic process if consumed in large amounts. Additionally, many of these foods are high in protein, which, when eaten excessively, can also interfere with ketosis.
For those who are leaning heavily on packaged keto products, it might be time to reconsider if this diet is truly the right fit. Eating more than one or two of these items per day can make it harder to achieve the best results and might lead to relying too heavily on processed foods. If the goal is to incorporate a lot of packaged foods into one’s diet, a meal replacement program may be a more suitable option. Such programs offer structured, nutrient-dense shakes and bars that help ease the transition back to whole foods.
A healthy ketogenic diet should prioritize real, nutrient-dense foods. This includes high-quality plant-based fats such as olive oil, known for its health benefits, and should limit processed meats and foods. No diet, keto included, can truly be effective or healthy if it revolves around processed items, which have shown time and time again to negatively impact long-term health.
My Final Thoughts
Over the years, my approach to the ketogenic diet has shifted. I don’t use it as frequently as I once did, partly because I now have access to a wider range of strategies for health and weight management. Many patients I’ve worked with have struggled to maintain success on the keto diet in the long run, which often led to yo-yo dieting—a cycle I strive to avoid. However, I’ve also seen firsthand the positive outcomes for individuals who have found success with keto: improved blood sugar control, decreased medication use, and a newfound sense of freedom from constant blood sugar monitoring.
Critics of the ketogenic diet often dismiss it as an ineffective or even harmful option. But that view is too simplistic. The ketogenic diet is not a one-size-fits-all solution; it’s a tool that can support weight management, metabolic health, and overall well-being. It’s important that people considering this diet discuss it with a knowledgeable healthcare professional to determine if it aligns with their health goals and needs.
If keto works for you, it can be life-changing. If not, that’s okay too. The key is to find what fits your lifestyle and supports your health best. To blanketly reject the ketogenic diet as a viable option does a disservice to those who benefit from it. That’s why I’m here to advocate for an approach that recognizes the nuances of diet and health: flexibility, education, and personal choice.
Want to learn more? Listen to the latest episode for an in-depth discussion!
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