Obesity is a major health concern for Americans. According to the CDC, approximately 40% of American adults suffer from obesity and obesity affects 1 in 5 children. Conditions that have been linked to obesity include heart disease, stroke, type 2 diabetes, and certain types of cancer. The costs of obesity are not strictly limited to health either; the estimated annual medical cost of obesity-related conditions was $147 billion. Moreover, the average medical cost for those with obesity was $1,429 higher than those of non-obese patients.
As rates have obesity in the US have skyrocketed in the past 30 years, dietary choices have never been more important. Ketogenic diets are a popular low-carb diet trend and have a lot of incarnations: Atkins, South Beach, and Paleo diets all being examples. The main purpose of keto weight loss diets is to facilitate weight loss by minimizing the consumption of carbohydrates and gain the bulk of your calories from proteins and fats. As such, keto diets tend to be high in things like meat, butter, oils, and vegetables, and low in things like bread, potatoes, and other starches. By restricting the number of carbs you eat, the body is forced to burn fats for energy which facilitates weight loss. Keto diets have been shown to:
Unfortunately, like all popular weight loss regiments, there are a lot of myths and outright falsehood surrounding keto diets. That is why we want to take a deep and scientific look at keto diets, the theory behind why they help you lose weight, the proper keto diet to follow, and any potential side effects or health concerns from consuming a keto diet.
We should say at the outset: changing your diet alone will not help you lose weight. Every dietary regiment has to be supplemented with exercise and other changes to life habits. There is no magic bullet to losing weight and a keto diet is no exception. Rather, a keto diet can be a way to help your body maximize the efficiency of your metabolism. If you have any concerns about trying a keto diet, make sure to consult your primary care physician first.
First, let’s take a look at the science behind keto diets and how they are supposed to help you lose weight.
The human body requires 3 essential macronutrients to survive: carbohydrates, fats, and proteins. Carbohydrates, which include simple and complex starches, are the main thing your body burns to get its energy. Carbohydrates are metabolized into glucose, which is used to create the molecules of ATP (adenosine triphosphate) that power every process in the body. Fats are used to store excess energy and provide protection and insulation to the body, and proteins are necessary for the creation and maintenance of cellular structures (i.e. muscles, nervous system, etc.).
Most of the time, your body gets its energy by breaking down carbohydrates. However, if there are low levels of carbohydrates in the blood, the liver will convert solid fat into fatty acids and ketone bodies. Fatty acids and ketones take over the role that glucose plays in creating ATP. The creation of ketone bodies is why these kinds of low-carb diets are called keto diets. Interestingly, ketone bodies seem to be more efficient per-unit than glucose at producing energy.
This is the key theoretical justification behind keto diets; lowering your carbohydrate consumption forces the body to metabolize solid fats instead. By sticking to a low carb diet, your body habituates itself to burn fats and so you lose more weight. After a few days of low-carb intake, your body resorts to burning its stores of solid fat for energy. Moreover, keeping your metabolism active burning fats and proteins curbs your appetite and makes you less susceptible to cravings. In short, keto diets can be described as low-carb, adequate-protein, high-fat diets.
Strictly speaking, keto diets are not new. Keto diets were actually initially developed in the early 1900s as a method to manage pediatric epilepsy. The ketones produced by the metabolism of fats regulate neural firing which lowers the incidence of epileptic episodes. Keto diets have also historically been used as a method to manage type 2 diabetes. Keto diets help regulate your blood sugar level, something that those with type 2 diabetes cannot do on their own. There even appears to be a reference to dietary changes as a means to combat seizures in the Bible in the story of the cured epileptic (Matthew 17:14-21 KJV).
It has only been recently that keto diets have popped into the mainstream as a non-therapeutic diet for weight loss. Of course, this may make people wonder if keto diets actually help with weight loss or if they are just a passing dietary trend. Sure, keto diets have a plausible sounding theory behind them, but how well does that theory stand up to experience? Which leads to our next point…
There is a substantial amount of clinical evidence that keto diets are extremely effective at minimizing the risk of seizure episodes and at managing symptoms of type 2 diabetes. There are fewer explicit clinical studies, however, on whether keto diets help facilitate weight loss, but all available studies seem to paint a positive picture of the benefits of keto diets.
For instance, a 2013 study from Cambridge University Press found that individuals assigned to a low-carb (<50g) keto diet showed greater weight loss and lower blood pressure over a 12 month period than those who ate a primarily low-fat (<30g) diet. A 2007 study published in Nature Reviews found that low-carb keto diets were better at facilitating short-term weight loss than low-fat diets over the same time period. Further, a 2008 study published in The American Journal of Clinical Nutrition found that individuals on a low-carb high-protein diet for a 4 week period showed significantly greater weight loss and decreased appetite than individuals who ate a mid-carb ad libitum diet. Another 2004 study published in the journal Nutrition & Medicine found that low-carb keto diets were significantly more effective than low-fat diets at reducing the amounts of total body fat, torso fat, and maintaining a better ratio of resting energy expenditure to body mass in both men and women.
As it stands, the available clinical evidence indicates that low-carb keto weight loss diets are very effective at reducing total body weight/fat content and effective at reducing blood pressure, LDL and HDL cholesterol levels, and triglyceride count. As such, it seems safe to say that keto diets are one of the better methods to achieve short-term weight loss. We must clarify though that there is less research on how effective keto diets are in the long-term for managing body weight. At this point, the scientific consensus is still out over whether keto diets are better than low-fat diets in the long term.
In addition to these scientific studies, several keto-centered websites are filled with testimonials from individuals who vouch for the efficacy of keto-diets. To be clear, anecdotal stories are not on par with clinical evidence, but they still are a kind of evidence and provide justification for the claim that keto diets are effective at facilitating weight loss.
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Yes—keto diets can have negative side effects. The most common side effect of keto-diets is hypoglycemia (low blood sugar) which can cause symptoms such as:
In the vast majority of cases, these side effects are small and tend to disappear once the body gets used to its new dietary regimen. Low-carb high-fat keto diets are also associated with higher blood lipid and cholesterol counts compared to low-fat diets. Again, most of the time these changes are mild and will dissipate after a few weeks of following the diet. In rare cases, keto diets can lead to a condition called ketoacidosis in which ketones in the bloodstream build-up, causing nausea, vomiting, abdominal pain, weakness, and acetone-scented breath. The risk of developing ketoacidosis from keto-diets is much larger in those who already have metabolic conditions such as diabetes. There is also some evidence that keto diets can affect bone growth and structure.
Luckily, the majority of these side effects are very well understood and there exist countermeasures for them. Proper hydration can combat excessive thirst and eating proper foods reduces the need to urinate. Sleep and regular exercise can help with fatigue and vitamin/mineral supplements such as B12, calcium, and iron help with other symptoms. Most importantly, once you get used to your new diet, these side-effects tend to go away.
Now that we have all that boring science stuff out of the way, let’s get to the real meat of the issue (pun intended): What does a proper keto diet look like? As stated previously, keto diets are low-carb, adequate-protein, and high-fat. So a proper keto diet is about consuming the appropriate ratios of these macronutrients.
There are two major kinds of keto diets that have been extensively studied: standard ketogenic and high protein ketogenic diets.
Standard Ketogenic Diet
The standard keto weight loss diet is a very low carb diet with moderate levels of protein and high levels of fats. These kinds of diets usually have a 75%20%/5% ratio of fats/proteins/carbs. Standard keto diets seem to be the most effective at burning fat, though individuals may feel more tired than usual initial because of the lower protein amount.
High Protein Ketogenic Diet
High protein keto diets keep the same amount of carbs but up the amount of protein. The ratios for these kinds of diets are usually 60%/35%/5% fats/proteins/carbs.
Aside from these two versions, there are also cyclical and targeted keto diets that allow for carb refeeds and targeted carb addition after workouts. These kinds of keto diets are usually followed by athletes who need to burn fat but maintain high energy levels. These kinds of keto diets have not been studied as extensively, so they will not be covered here. All nutritional information/dietary guidelines covered are for standard and high-protein ketogenic diets.
Here is a simple example with some numbers to flesh out the number of nutrients you need to consume. If you are on a standard keto diet, 75% of your daily calories should be from fats, 20% from proteins, and 5% from carbohydrates. Assuming a 2,000 calorie diet, this translates to roughly 165g of fat, 75g of protein, and 40g of carbohydrates a day. Most ketogenic dietary plans require you to limit carbohydrate consumption to at least 50g a day and some regiments go further and only allow 20g a day.
There is no such thing as a one-size-fits-all diet, so you will have to do some research based on your desired daily calorie intake to find the appropriate amounts. You will have to calculate how much of each nutrient you need based on your daily calorie amount.
Here are some foods that are good for keto diets. Good foods are ones that have high fat/protein content and low carb content.
Fish and seafood are probably some of the best foods to eat on a ketogenic diet. Fish and seafood tend to be low carb, a very high protein content per unit mass, and stores of healthy monounsaturated and unsaturated fats like Omega-3 fatty acids. Fish like salmon, sardines, and mackerel are also very rich in B vitamins, potassium, and selenium. Some shellfish, such as octopus, oysters, or squid, are a bit higher in carb count and so must be eaten sparingly. We recommend consuming at least 2 servings of fish daily.
A quick note on fish: if possible, try to buy free-range wild fish and not farm-raised fish. Farm-raised fish, while larger and containing more meat, are often raised with hormones and other chemicals. Farm-raised fish is also more likely to contain trace amounts of carcinogens such as dioxins and microplastics.
Non-starch vegetables are not only low in carbs but have high amounts of vitamin C, iron, and important minerals. For instance, 1 cup of cooked spinach contains less than 1 gram of carbohydrates but nearly 25% of the daily recommended amount of iron and almost a full serving of calcium. Leafy green vegetables also have lots of fiber which promotes healthy digestion. You should, however, avoid starchy vegetables such as potatoes, yams or beets. These kinds of root vegetables have high carb content and even just one serving of potatoes can put you over your carb count for the day.
Leafy green veggies also contain antioxidants that soak up free radicals that damage cells and they can be used to mimic the texture of higher carb food. For example, cauliflower can be used as a rice substitute and you can create noodles from zucchini and squash for pastas.
Cheeses are very low in carbohydrates but high in fats and have a moderate amount of protein which makes cheeses perfect for keto diets. Cheese also contains large amounts of calcium. For example, one ounce (28g) of cheddar cheese has 1g of carbs, 7 grams of protein, and 1/5th of the daily recommended amount of calcium. Cheese is also very high in saturated fats and it has recently been discovered that cheese may help prevent atherosclerosis.
People don’t call avocado a superfood for nothing. Avocado contains several beneficial vitamins and minerals and a large amount of healthy unsaturated fats. 3.5 ounces (100 grams) of avocado contains about 9g of carbs, but 7 are those are from fiber and will pass through the digestion, so its net carb count is only 2g.
Eggs are another fantastic food for keto diets. Eggs contain a very small amount of carbs and a moderate amount of protein. Eggs have been shown to trigger the production of a hormone that curbs your appetite and even though they are high in cholesterol, they do not seem to increase blood cholesterol levels in adults. Make sure you eat the entire egg, yolk and all. Egg yolks have lots of beneficial amino acids and antioxidants.
Olive oil has virtually 0 carbohydrates and is very high in oleic acid, a monounsaturated fat that has been shown to reduce the risk of heart disease. Olive oil also contains antioxidants known as phenols that promote heart health and reduce inflammation. Olive oil is a great choice for salad dressings and making healthy spreads.
Nuts are one of the best non-meat sources of protein for those on a keto diet. Nuts like peanuts, macadamia nuts, walnuts, hazelnuts, and almonds are extremely high in protein and very low in carbs. A single serving of nuts actually has a lot of carbs in it, but most of these are contained in fiber that will pass through your digestive system. Most recommended servings of nuts usually have about 3g of net carbs.
Meat and poultry are among the two highest protein foods that humans can eat. Fresh meat and poultry contain basically 0 carbs and are rich in B vitamins, potassium, protein, and zinc. If possible, try to buy grass-fed meat. Grass-fed meat has more omega-3 fatty acids and antioxidants than meat from grain-fed animals.
Be warned though, while red meat is a very rich source of protein, consuming too much red meat can lead to high blood cholesterol levels. Try to stick to poultry, and eat red meat sparingly. For instance, beef should not be the main staple of your keto diet; lighter meat such as chicken, turkey or fish would be better suited for that role.
Grains are probably the biggest source of carbs that you will have to avoid. Grains are present in a lot of different foods Common grains to avoid include:
It is also important to remember that bread, pasta, cookies, cakes, and anything else made from grains will have a high carb count, so these should be avoided too. This is probably one of the harder things to avoid as so many products are made from grains or have grain additives.
Surprisingly, fruits are not a good option for people on keto diets. While fruits are in general healthy, they tend to contain high levels of sugars and carbs, especially citrus fruits like oranges, apples, limes, and fruit juices. Sugars are a kind of carbohydrate o eating fruits should be avoided. Some low carb berries are good for keto diets, including blueberries, strawberries, and raspberries. Of course, this also means you should avoid smoothies and fruit juices like orange or apple juice.
Although lentils and beans have a moderately high protein count, they also have a lot of carbs and so are not good foods for keto diets. Things like chickpeas, lima beans, pinto beans, black beans, lentils, and kidney beans all have high carb/mass ratios and should be avoided if you’re on a keto diet.
You also need to watch what you drink. Sugary drinks like soda and energy drinks are packed full of sugars and carbs and even a single soda can put you over your carb limit for the day. Beer is another big offender as beer is most of the time made with barley which has a lot of carbohydrates. Straight alcoholic drinks, like whiskey, vodka, tequila, rum, and gin usually do not have any carbs, but they are often combined with mixers that do.
So if you are looking for keto weight loss they key thing to remember is: low carbs, adequate protein, and high fats. Like we said earlier, it may take some time for your body to acclimate to its new diets. Normally any symptoms of tiredness and lethargy should subside in about a week or two once your body gets used to instantly metabolizing fats.
Like any dietary change, make sure to consult with a physician before switching to a keto diet. You should also have periodic check-ups while following the diet to make sure that none of your body’s nutrients are out of whack.