Last week I typed "keto recipes" into Google and in .45 seconds, 95 million results were populated, ranging from Instant Pot Crack Chicken to Bacon Blue Cheese Deviled Eggs. While these "healthy" dishes may sound delicious, the ketogenic weight loss trend behind these recipes has become a divisive topic among registered dietitians and other healthcare professionals.
Nearly 10 years ago, I was first introduced to the ketogenic diet during my clinical rotation at Stony Brook University Hospital. But it wasn't being used for weight loss, instead it was medically-prescribed by healthcare professionals as a treatment option for drug-resistant epilepsy, specifically in children.
But in recent years, it has been touted as an effective form of weight loss and I now receive weekly calls from clients asking if it's safe. To answer that question, it's important to explain the difference between the medically-prescribed ketogenic diet and this emerging weight-loss trend.
The ketogenic diet is a process that involves consuming high amounts of dietary fat with minimal carbohydrates. This process forces the body into ketosis, a natural, physiological condition that occurs when there is not enough glucose (carbs) to break down for energy, causing the body to turn stored fat into fuel. Naturally this is appealing to people who wish to lose weight, but this was not its original intent when it was developed in the 1920s to treat epilepsy and other neurological conditions.
To give both methods their respected spotlight, I interviewed two mothers; one whose son depends on the ketogenic diet for quality and sustainability of life and one who used the diet to slim down post pregnancy. Here's a look into the two different lifestyles sustained by keto for two very different reasons.
Erika Ream is the mother of 3-year-old Hayden who has Dravet's syndrome, a rare and catastrophic form of epilepsy that begins in infancy and is characterized by multiple and frequent seizures that are resistant to currently available medical therapies. During Hayden's first year of life he suffered one to two life threatening seizures a week, despite trying several medications to control the seizures. After Hayden's first birthday, clinicians at Children's Hospital of Philadelphia prescribed the ketogenic diet, which mimics starvation and changes the body's chemistry in ways that help control his seizures.
Hayden's diet requires that each of his meals be made up of 90 percent fat, 7 percent protein and 3 percent carbohydrates. The diet must be followed strictly for it to work. Because his diet limits several nutrients needed for growth and development, close medical supervision is required through blood draws to monitor for any side effects and insufficiencies in vitamin and mineral intake.
Typical meals for Hayden do not include trending "fat bombs" or "no egg breakfast bakes." Most of the more than nine million ketogenic diet recipes available on the Internet are for weight loss keto and often involve more grams of carbohydrate and protein than Hayden is allowed. So what does Hayden eat on a given day? "Cheese Soup," which is made with heavy whipping cream, butter and shredded cheddar cheese, is one example. To fulfill his carb option with his soup, Hayden will typically eat 5 blueberries or one Cheetos cheese curl puff. Other examples include scrambled eggs with mayonnaise plus strawberries served with heavy whipping cream to drink on the side or "mac and cheese", which is less than a small handful of plain cooked ramen noodles topped with a mixture of heavy whipping cream, butter and cheddar cheese. With such little variety in Hayden's diet, Erika's staple ingredients include mayonnaise, butter, vegetable oil, heavy whipping cream, fish oil and sour cream.
With such restrictions placed on his intake, Hayden does not get complete nutrition from his diet, hence why he has routine blood work drawn every three months and is followed closely by medical professionals at CHOP. If Hayden's lab work is abnormal, doctors will add supplements. Last month 3-year-old Hayden had high triglycerides and cholesterol, so Erika was instructed to use fish oil as a replacement for butter and mayonnaise in some of Hayden's meals to help lower his numbers. Aside from an abnormal lipid panel, Hayden's overall health from the diet is good. Though there are some downsides to the strict diet, Erika says the keto diet is the only consistent remedy that has kept Hayden to only four seizure episodes in the last two years.
Weight Loss Keto
Jessika Warnick is a mother to a 4-year-old son and newly turned one-year old daughter who has successfully lost and kept off 20 pounds since starting the Keto diet in June.
Jessica first learned about Keto for weight loss when she was eight months post –partum. She tried other diets in the past: eating less calories, eating less fat, "cleanses", etc. with little success. She wanted a diet that focused on whole foods and had clear-cut boundaries.
On this diet, 70 to 80 percent of her calories come from fat, 5 percent come from carbohydrates, and the remaining 15-20 percent from protein.
The food staples that Jessica relied on were mostly kale, cheese, avocados, butter, olive oil, and tons of raw veggies for snacking.
When Jessica dined out, she had to be mindful of her carb intake. For example, she could order a cheeseburger without the bun and swapped out fries for a double side of broccoli. Salads with protein were allowed as long as there was no sugar in the dressing. Typically defaulting to oil and vinegar.
Unlike Hayden, Jessica could allow herself the occasional treat. For example, at her daughter's first birthday party, she had a slice of cake.
And after she reached her weight loss goal, Jessica slowly worked carbs back into her diet, starting with 30-40 grams per day vs. 20 grams that she had previously limited herself to. Jessica strategically added back in fruits, and non-refined carbohydrates like quinoa, sweet potatoes and oatmeal; choices that continue to help her maintain her weight loss.
A dietitian’s take
My takeaway is that the keto diet worked for Jessica, not simply because its "keto" but because she chose a plan that forced her into a routine through clear boundaries that ultimately helped change her mindset, behaviors and relationship with food.
When considering if the keto diet is right for you, it really boils down to which approach is the most sustainable for you. What method suits your lifestyle, personality and food preferences? It's likely that your nutrition routine doesn't follow keto protocol so using it as a long-term diet is not recommended. But you could use keto as a short term (I stress short term) method to help recalibrate your relationship with food like Jessica and so many others have.
Ultimately, the nutrition routine that's right for you is one you can follow consistently to help you build respect towards your health and achieve long term sustainable weight loss.
Theresa Shank, RD, LDN, is a Philadelphia based registered dietitian and the founder of Philly Dietitian.