Thinking of trying the keto diet? Here's what to know

By Natalie Romito, RD, LD, Wellness Coordinator & Outpatient DieticianIt's a new year, so that means it's time to start thinking about those new year's resolutions. A common goal for people is to get in better shape and shed those extra pounds gained from one to many Christmas cookies.You've probably heard the hype about the keto diet. The high-fat, low-carb "ketogenic diet", as it's formally called, is all the rage right now. Why? One reason could be because keto diet results are real, and it does work…technically.The keto diet works because when you restrict dietary carbs – your body's main source of energy – your body breaks down stored fat and creates ketones to use for energy instead. But calories still matter. If you overeat on protein and fat, and your total calories are beyond what your body is burning, you will still not see weight loss. High fat, high protein foods (the foundation of this diet) increase satiety, so typically total calorie intake is lower than what your body burns, and weight loss results.The rapid weight loss people experience with their keto diet results initially is also in part due to loss of water weight – your body stores carbs with water, so when you use up your carb stores, you lose water weight. Most people simply don't burn enough calories to lose more than about two pounds of fat per week, so keto diet results totaling more than that are likely due to losses in water weight.Weight regain is extremely common on the keto diet, as most people cannot sustain this diet long-term, and once carbs are reintroduced, people often see weight gain and diminished keto diet results.Is the Keto Diet Safe?While eating a diet with high amounts of protein/healthy fats and fewer carbs is generally safe, you should be aware of health concerns with following the keto diet, including:• Low blood sugar levels, especially among people with diabetes who are taking medications.If you have diabetes and are set on following this diet, I would strongly encourage you to contact your physician to discuss how/if to adjust medications during the diet, as low blood sugar levels can be deadly.• Increased cholesterol levels, which can increase the risk of heart disease.High intake of saturated fats and high-fat meats can lead to increased cholesterol levels, which can increase risk of heart disease.• Nutrient deficiency risk.Eliminating or greatly restricting multiple entire food groups (fruits, whole grains, dairy, and limiting vegetables) puts a person at risk of developing a nutrient deficiency. This risk increases the longer the diet is followed. And yes, you could take a multivitamin, but most vitamins are best absorbed when consumed as food, rather than in a pill, and they don't contain the same antioxidant benefit as whole foods.• Dangers for those with kidney disease.People with kidney disease would want to avoid this diet, as the excess protein that often comes along with this diet may progress kidney disease more rapidly.When you first begin the keto diet, you may experience certain side effects that occur as a result of your body adjusting to a new fuel source. The first couple of weeks can be filled with positive keto diet results that seem promising, but that adjustment period may leave you with symptoms of what people are terming "the keto flu." I want to be clear that these symptoms are in no way an actual flu-like illness, rather the "keto flu" is a nickname for feelings of tiredness, lethargy, mild headaches, cloudy, slow thinking, lightheadedness, and hunger that you may experience when you start a keto diet.Think about it: your body has been used to getting plenty of carbohydrates — its favorite food source. When you drastically reduce the number of carbs your body receives, it will send signals to you through the form of the above symptoms — like slow thinking and tiredness. These side effects are your body screaming, "feed me carbs!" If/when these side effects subside, it doesn't mean your body has adjusted to the lack of carbs, it simply means your body has stopped signaling you.What Should You Eat on the Keto Diet?As a dietitian, I will always recommend long-term, healthy lifestyle changes rather than a fad diet. But if someone told me they were definitely going to follow a keto diet, even if I advised against it, I would make the following recommendations for what to eat:1. Get most of your carbs from non-starchy (lower carb) vegetables, and whole food fat sources such as avocados, nuts, and seeds, and remember that most of the carb in these foods comes from fiber.2. Choose a variety of meats, as different meats have different vitamins/mineral content. Choose fatty fish such as salmon, and low fat meats such as skinless chicken/turkey, loin/tenderloin cuts of beef and pork, and lean or extra lean ground meat (10 percent fat or less).3. If you have a history of high cholesterol, limit egg yolks, choosing mostly whites. Most people can eat the yolks without a big change to cholesterol, but others are very sensitive to the cholesterol in foods, so extra egg yolks often consumed on a keto diet can cause cholesterol levels to increase.4. Limit intake of cheese (1oz is a serving), or choose low-fat cheese rather than full-fat cheese to limit saturated fat intake.5. Choose fats in the form of whole plant foods most often – avocados, olives, nuts/nut butter, and seeds. Cook in liquid oils if needed rather than solid oils (like butter and lard) to help maintain healthy cholesterol levels.6. Take a multivitamin daily.7. Allow yourself as much variety as possible within these food groups to avoid boredom and to get the most nutritional benefit from the foods you are choosing.8. Remember that this is not a realistic lifestyle change for most people, so it is important to have a plan for transitioning off the diet.When you decide to come off the keto diet, don't make the transition cold turkey. Rather, I recommend transitioning off the diet by following these guidelines:1. Reintroduce carbs gradually until you're consuming at least 100-135g per day. You may need to increase to a higher level, depending on what would be a realistic amount of carb intake for you to maintain long-term.2. Choose whole, unrefined carbs, such as whole grains, fruits, and vegetables.3. Expect weight gain with reintroduction of carbs, and know that at least part of the gain is likely due to retaining water as your body replenishes its stored carbs.A Dietitian's Final Words on the Keto DietIn general, the keto diet can produce weight loss results in the short term, but it's not a sustainable, long-term, solution to weight problems. When you transition off the keto diet, you will likely gain the weight back that you initially lost. That's why I will always recommend longer term, healthy, sustainable diet changes rather than short-term diet fads like the keto diet. After all, studies show that healthy, low-calorie diets that include carbs can produce similar long-term weight loss results.Before making any kind of major switch to a weight loss diet, I also recommend mentioning it to your doctor, who can refer you to a dietitian like myself for more information. A dietitian can help determine the safest way to approach the keto diet if that's the route you want to go.But if you're tired of fad diets, short-term fixes, and temporary weight loss that always comes back, talk to your doctor about the weight management clinic at Firelands Regional Medical Center, or give us a call at 419-557-6550. We'll help you create good habits for both diet and exercise that work for your lifestyle and lead to lasting, healthy results.Natalie Romito, wellness coordinator at Firelands Regional Medical Center.