Is the Ketogenic Diet Right for You?

By Dr. Jamie King, MD, Benefis Health System Family Medicine & Weight Loss Services

It’s a new year, and I’m sure many of you have started on a new resolution. If you are living with a chronic medical condition, I hope you are seeking guidance from your doctor for any radical diet changes.

Some of you may even be considering the ketogenic (keto) diet as one of your resolutions. The keto diet has been widely discussed in the past few years and is still controversial among weight loss specialists.

A keto diet involves significant reduction in carbohydrate intake paired with a significant increase in fat intake. Protein intake remains stable with current Recommended Dietary Allowance guidelines (10-30 percent of your daily calories). A basic keto diet based on percentage of daily calories may allow for 5-10 percent carbohydrate, 20-25 percent protein, and 70-75 percent fat.

By reducing your carbohydrate intake, your body then must create energy by using fats. It does so by breaking down fatty acids through the liver into smaller ketone bodies—acetone, acetoacetate, and beta-hydroxybutyrate. These molecules are small and easy for your brain to use during times of starvation.

There are certain side effects and contraindications to starting the keto diet on your own. Most notably, if you are a diabetic using insulin therapy, you should not try this diet without the advice of your doctor and possibly a dietician. Doing so may precipitate a life-threatening condition called diabetic ketoacidosis.

Also, the early stages of a keto diet can cause electrolyte losses due to increased stress hormones and glucagon secretion. This can produce blood pressure elevations and more frequent urination, so consult with your physician if you have uncontrolled high blood pressure or are taking multiple diuretics.

In the initial stages of the diet, the ketones can cause bad breath as you exhale excess acetone. This normally resolves after a few weeks, but if not, it may be beneficial to increase your carbohydrate intake. Other common early side effects can include fatigue, headache, nausea, leg cramps, heart palpitations, and exercise difficulty.

This diet may be unsafe for certain people with high cholesterol. There have been rare cases where initiation of the keto diet caused a significant rise in HDL and LDL cholesterol. It is not well understood what this means in terms of heart attack and stroke risk while adhering to the diet.

Finally, many people suffer from constipation when they begin a keto diet. This is due to a decreased intake of fiber they were previously getting from fruits and whole grains. Should this occur, you may need to start a once or twice a day fiber supplement using psyllium husk or increase your allowed carbohydrate limit so you can have more high fiber foods. Adult men should get at least 38 grams of fiber per day, and adult women should get at least 25 grams.

While there are many considerations, the keto diet can be a very healthy lifestyle change, especially if you look at it as a modified Mediterranean diet. It may also be easier to first try a low carbohydrate diet (20 to 40 percent of your daily calories from carbohydrates) rather than a strict keto diet.

You can consume a healthy amount of fish, lean meats, nuts, seeds, healthy oils, and vegetables, while avoiding heavily processed grains. You should continue to avoid fried foods and processed or cured meats. There is also still room for whole grains and fresh fruits in moderation. Lemon and lime juices can also be used in preparing foods to provide flavor and vitamin C without adding significant carbohydrate loads.

In summary, I appreciate the simplicity from author Michael Pollan:
Eat food. Not too much. Mostly plants.

You can find out more by consulting with your primary care provider or a registered dietician. Also, please join us on Tuesday, January 29 from 5:30 – 7 p.m. for our Benefis Health Session, “Weighing Weight Loss Facts and Myths with Benefis Weight Loss Experts.”