If you follow food trends (or likely a close friend’s Facebook feed), the keto diet is generating plenty of buzz with regard to weight loss.
The keto diet is similar to the Atkins and paleo diets in that it’s low in carbohydrates but focuses more on fat intake than even protein consumption. A typical keto macronutrient breakdown is 70 percent fat, 20 percent protein and 10 percent carbs (some versions up the fat intake as high as 90 percent).
Keto recommends eating healthy, unsaturated fats that include avocados, olive oil, coconut oil and some nuts and seeds; high-protein but low-carb meats such as grass-fed beef; and vegetables that are non-starchy such as broccoli and leafy greens.
When we eat carbohydrates, our bodies break down the glucose in the carbs, which is converted into energy for our cells. When ketosis is achieved, the body starts using its own fat stores, and the fat is broken down, producing ketones for energy.
The keto diet is used as a medical nutrition therapy to treat seizures in children with epilepsy. Ketosis can be confirmed by checking for ketones in a person’s urine.
Local dieticians said they’ve received a few inquiries from patients about keto. They also warned of the “magical answer” notion of the keto diet and other plans that contribute to the country’s diet culture. Popularity of the diets is often tied to celebrity endorsements (like Halle Berry), books and other media, as well as the immediate weight loss people experience when following the plans.
Molly Sleger, a registered dietician at SwedishAmerican Hospital, said her main concern with the keto diet is that it promotes the notion of “bad” vs. “good” foods – certain vegetables are limited, as well as fruits.
“It falls into the diet category, and I rarely recommend any type of diet,” Sleger said. “Dieting just doesn’t work in general. Long-term keto will not work for a majority of people. Diets set you up for failure – you might suffer from food fatigue from high-fat meals and crave more variety. A lot of times when we restrict carbs, there’s going to be a point where we swing the other way and binge. It’s another way of giving food power and shaming us when we don’t have willpower over certain foods.”
Diets such as keto can also promote anxiety and social isolation related to dining out with friends and family because of limited menu options.
Hospital dieticians are often working with patients who have already been diagnosed with chronic diseases such as diabetes and heart disease. Sleger said she starts with practicing habits to set patients up for success: eating three meals a day, noticing levels of hunger when they finish meals, preparing healthier foods in more appetizing ways, etc.
“When we turn off the exterior rules and tap into our bodies and what they want, we’re more in charge. We know what’s best. I’m here to help guide patients, assess how they feel, and help them to not feel guilty if they work in pizza or a cookie,” Sleger said.
Consulting your doctor is a good first step before starting any new diet, especially if you have a chronic disease and/or are taking medications. Sleger even suggested getting your cholesterol level checked before started keto because of the diet’s focus on fat.
Dieticians will do some food elimination-style diets with patients if they express interest. Sleger said she emphasizes adjusting habits to best fit patients’ lifestyles.
Elise Remsen, a registered dietician and quality coordinator for diabetes and nutrition services at Mercyhealth, said sustainability of keto is her main concern. Patients with seizures on the keto diet are managed very closely by medical professionals. She’s not sure how often others following the keto diet are testing their urine or cholesterol.
“I like to shift thinking of dieting for the moment to thinking more is this for the rest of your life,” Remsen said. “If you love bread, and the doctor says it’s healthy to have bread, (keto) is probably not something you want to start doing. Unless you’re allergic or intolerant (to foods), I’m more in the business that all food fits, even cake.”
Keto does emphasize good habits, such as eating less processed foods and making healthier choices overall. People often see big weight-loss results quickly, and that’s encouraging. Fat takes longer to digest, so people also report feeling fuller longer.
Nathan Hamman, a registered dietician and manager of wellness and weight management at OSF Saint Anthony Medical Center, said there’s room for diet variety, depending on the patients. A dietician friend of his works for a fitness center where keto has more interest among athletes and more physically fit clientele.
Hamman said he hears more talk about keto among hospital employees rather than patients. He also said he’d be willing to work with patients if they were “dead-set” on doing keto, although he thinks it’s too restrictive.
“You do lose weight very quickly on it, but it’s not sustainable. Everybody wants quick weight loss right now,” Hamman said. “We try, instead, to find anywhere from two to five goals per month for people. Like eating five fruits and veggies a day. Some patients, we start with three a day for a month.
“A lot of people with this diet and anything catchy with go gung-ho at first but burn out at some point.”
Hamman said he usually tries to give patients as much as he takes away (such as eating more fruits and veggies) and shift the anti-carb concerns to enjoying reasonable servings of carbs that are less processed (with more whole grains and fiber).
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