This series on Women’s Health is brought to you by Tryon Medical Partners, an independent practice of nearly 90 physicians who joined forces because they share the core belief that the patient-doctor connection is the foundation for better health.

If everyone you knew was on the Keto Diet last year, but it sounded like yet another crazy fad diet to you, well, you were at least a little bit right. The Keto Diet was the #1 most popular diet search according to Google in 2018, and fell way, way down the list for 2019. However, before you rule this low carb, high fat diet out entirely, it’s worth a look at the good, the bad and the ugly of the Keto Diet.

Exactly What Is The Keto Diet

The ketogenic (keto) diet is high in fats, moderate in proteins and low in carbohydrates. The classic keto diet is 75% fat, 20% protein, 5% carbohydrates, according to  Dr. Caroline Lee Wilds, MD at Tryon Medical Partners (Tryon Med). This extremely low level of carbohydrates ~ current dietary guidelines call for carbs as 50% of your daily diet ~ places the body in a metabolic state called “ketosis.” Ketosis allows the body to burn fat for energy instead of carbohydrates (sugar), and this accelerates weight loss.

“Studies have shown the keto diet can decrease inflammation and oxidative stress on the body, possibly improve chronic disease states and improve memory and cognition” Dr. Wilds tells us. [Interesting fact, the Keto Diet was actually originally tested & developed nearly 100 years ago by the Mayo Clinic to treat children with epilepsy.]

High Protein, Low Carbs is Nothing New, So What’s Different About Keto?

Atkins, the J.Lo Diet, the Carnivore Diet ~ all of them cut out most sugar and carbs and are high on protein. True, but there are key differences:

The Ketogenic diet:

  • Carbs are limited to 20 to 50 grams per day.
  • Protein is restricted.
  • Goal is to increase blood levels of ketones.

Typical Low Carb diet:

  • Carbs can vary from 25–150 grams per day.
  • Protein is not restricted.
  • Ketones may or may not rise to high levels in the blood.

The Keto difference lies in the strict adherence and measurement of your food intake (made easier with apps like MyFitnessPal) to manage the percentages and maintain ketosis. Too many carbs interfere with ketosis, as does too much protein. While that may sound weird, Dr. Wilds explains that “When more protein is consumed than needed, it turns into glucose (sugar) which prevents the ketosis process.” Ketosis is critical to healthy brain function when you have restricted your carb intake, as ketones are able to fuel the brain when glucose is not there to do so.

What Does It Do for You?

In the short term, at least, you should lose weight. The high levels of fat in the diet should help with hunger pangs, although not with your sugar cravings. The good news is that these usually diminish after a week or so if you persevere, and once your blood sugar stabilizes you should feel a more consistent state of energy all day. Even better, there is some science that says that the ketones themselves dampen your hunger, allowing you to maintain your weight loss plan for longer periods than simple calorie restricted or low carb diets.

“It is very difficult for people to remain in true ketosis as this diet is not easily followed in its truest form.” says Dr. Wilds. “But focusing on the lower carbohydrate diet is typically the key for many as it keeps people focused on healthier food choices and typically they will consume less calories overall.”

There is also some evidence that a ketogenic diet improves insulin sensitivity and lowers blood sugar, helping with diabetes, pre-diabetes and metabolic syndrome. And studies have proven that the keto diet can decrease inflammation and reduce oxidative stress on the body, and show improvement in memory and cognition.

How Does It Work?

Without carbohydrates for fuel, your body slips into nutritional ketosis whereby the liver breaks down fat for energy. Dr. Wilds says it takes 2-4 days to enter ketosis if you eat few than 50 grams of carbs per day, but other factors will play a role including activity level, metabolism, and age. 

You can use a specialized meter to detect ketones – typically through breath or urine strips if you are doing it at home.  It is easy and cheap but not as reliable as blood testing. You can measure your state of ketosis using blood ketone strips and a monitor found here (amazon link), but Dr. Wilds tells us that you don’t necessarily need to test for ketones if you are strictly measuring food intake.

Once you are in ketosis your body will burn fat to provide energy instead of carbs, and you should lose weight and body fat.

What Can You Eat, And Not Eat?

There are lots of foods that you will need to reduce or eliminate on the keto diet, and while this is not an exhaustive list, it’s a good guide. (Any food that is high in carbs should be limited):

  • Sugary foods: No Soda, fruit juice, smoothies, cookies, cake, ice cream, candy, most desserts.
  • Grains or starches: No Flour, rice, pasta, cereal, quinoa, millet, barley, oatmeal, all breads, crackers, etc.
  • Fruit: Eliminate All fruit, except small portions of berries like blackberries.
  • Beans and legumes: No Peas, beans, chickpeas, hummus, peanuts
  • Potatoes and Root Vegetables: No Potatoes, sweet potatoes, carrots, parsnips, turnips.
  • Low-fat or diet products: These are highly processed and often high in carbs.
  • Some condiments or sauces: No Ketchup, BBQ Sauce, premade Salad Dressings, etc. These often contain sugar. Check the labels.
  • Alcohol: Many alcoholic beverages contain high levels of carbs.
  • Sugar-free diet foods: These are often high in sugar alcohols, which can affect ketone levels in some cases.

Foods that you can eat on the Keto Diet.

  • Seafood. Most Fish and Shellfish have very few if any carbs, although some, like oysters, clams and mussels, octopus and squid, do have 3 – 7 grams per 3.5 oz serving.
  • Low Carb Vegetables. You can use the NET carbs for the veggies you eat, which is carbs minus fiber, since your body does not digest and absorb.
  • Meat and Poultry. Grass fed and/or organic if possible. You may want to limit your red meat consumption if you are concerned about your cholesterol, although studies are mixed.
  • Cheese and Cottage Cheese. Your friend on Keto. High in fat and protein, very low in carbs. Cheese is high in saturated fat, however, and some doctors suggest limiting it.
  • Eggs. Including the yolk.
  • Avocados and Olives. Be sure to use NET carbs to count your avocado carbs.
  • Olive Oil. Extra-virgin olive oil is high in heart-healthy fats and antioxidants making it perfect for salad dressings, mayonnaise and adding to cooked foods. Not for cooking at high heat though.
  • Coconut Oil and its medium-chain triglycerides (MCTs) go directly to your liver and are converted into ketones. So it can actually add to your ketone levels. You can cook with it, even at high heat, or add it to your coffee or tea for flavor.
  • Nuts and Seeds. Be sure to check the NET carbs, as some nuts have more than others. Also, peanuts are legumes, not nuts, and are on the NO list.
  • Berries. Blackberries and Raspberries, Strawberries and Blueberries.
  • Butter and Cream. In small amounts. Ghee is better than butter as it has less saturated fat. Avoid non-fat and low-fat dairy entirely as its carb count is higher per serving.
  • Coffee and Tea. No sugar or sweeteners, but cream is ok (not flavored creamers though).

What Are The Drawbacks?

It’s Hard to Keep It Going

Limiting yourself to fewer than 20 grams of carbs a day is basically less than one apple a day, so it’s super hard to maintain long term. Plus, you can get really tired of the limited list of foods, even if you are a whiz with the Keto Recipe Versions.

There are Unpleasant Side Effects

Initial negatives include fatigue, “keto flu”, insomnia, and digestive issues.  However, these will all typically improve if you stick to the diet. Bad Breath, and sometimes even a mild “ketone body odor,” can happen when you’re in ketosis. Constipation can result if you don’t focus on fiber. Your diet can become deficient in vitamins, nutrients and electrolytes if you are not vigilant. And there can be kidney stones.

Additionally, dieters can over-indulge in saturated fats like butter, cheese, full fat dairy, red meat, etc. to reach their daily fat intake goals. Even the much-touted coconut oil should be consumed in moderate amounts, as it is very high in saturated fat. Try to get as many fat calories as you can from the unsaturated healthy fats, and focus on consuming lean proteins and fibrous veggies.

It’s Not Ideal for Athletes or Building Significant Muscle

Moderate carb diets may be better if you are half or full marathon training, or looking to add a lot of muscle.

The Conclusions

So, is it Keto just another carb restricting, high fat, low carb, sugar-is-the-enemy diet? Or is it a path to weight loss and better health? We asked Dr. Wilds for her thougths. “The bottom line is that a true keto diet difficult to follow but could offer health benefits.  As with any diet, the best answer is that if you are losing weight, enjoying the food, feel healthier, and feel you can follow the diet long term, it’s worth staying with.  If not, a modified keto diet or a different plan may be needed.”

This series is brought to you by Tryon Medical Partners, an independent medical practice dedicated to maintaining trusted patient-doctor relationships, providing excellent and personalized care, and giving you the choices in healthcare that you deserve. With eight convenient locations throughout Charlotte, Tryon Medical Partners specializes in primary care as well as cardiology, dermatology, endocrinology, gastroenterology, pulmonary, rheumatology and sleep medicine.