The aim is to find the level best suited for you. There are two ways to count carbs - you can either count total carbs or net carbs (net carbs are total carbs minus fibre). According to Volek and Phinney, you should not eat more than 50 grams of total carbs (25-30 grams of net carbs) on a ketogenic diet. If your aim is to lose weight or maintain a healthy weight, eating 20-30 grams of net carbs (up to 50 grams of total carbs) is a great way to start. If you want to learn more about total vs net carbs, read this post.
I’m a Registered Dietitian, and I greatly appreciate your overview. I will admit, I felt the exact same as yourself, but I decided to research it further, and then go on it to test it, and I have to admit, it has changed my view of it completely. I believe as dietitians, instead of telling our clients it’s a fad, educate them on how to do it successfully as a lifestyle and not as a fad. I believe that is the key. I highly recommend “What the Fat” book written by both a Registered Dietitian and professor. Great job going into the science and research. https://whatthefatbook.com/product/what-the-fat/
People claiming huge benefits of these supplements – despite the lack of solid scientific support – may sometimes have a financial reason to believe in the supplements. Some of these products are sold under a multi-level marketing arrangement, where sales people are paid based on commission. For example, the company Prüvit sells drinkable ketones, called KETO//OS with a multi-level marketing structure.
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Thank you SO much for your blog post. My niece went into Ketoacidosis recently and I compared it to what a former RN in my neighborhood has been doing & recommending to everyone (& they believe her because she used to be a nurse, but definitely NOT a Dietitian). Anyway, after reading, I learned they are completely different, however if a healthy person does test for ketones in their blood, what are acceptable levels? (This same nurse tests for ketone levels). I appreciate how much work you put into this write-up and honest feedback! (I work with 2 RDs who agree with you!)
First off, I will say the ketogenic diet is not for everyone for their individual health reasons. However, reading through many of the posts where it didn’t work for people I would be willing to bet 90% of the time there is an obvious reason and no offense to that person but maybe a little more research would have helped. Something as simple as consciously increasing salt intake, or taking a multi-vitamin to get the minerals you need could help. Everyone’s body is different and some people can’t eat as much cheese for example (like my wife), as others can. If you feel off, or just don’t feel right before abandoning the diet please look up your symptoms and see if there’s a simple fix. It can really be worth it.
My biggest beef with this diet is that it focuses on how much and what you can eat and less about the quality of the food you eat. A recent 2018 study found that people who focused on eating plenty of vegetables and whole foods and less on counting calories and limiting food groups, lost a significant amount of weight over the course of a year. This continues to echo the notion that the key to successful weight loss is diet QUALITY and not QUANTITY. And now, there’s research that actually supports that!
There is not one “standard” ketogenic diet with a specific ratio of macronutrients (carbohydrates, protein, fat). The ketogenic diet typically reduces total carbohydrate intake to less than 50 grams a day—less than the amount found in a medium plain bagel—and can be as low as 20 grams a day. Generally, popular ketogenic resources suggest an average of 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. For a 2000-calorie diet, this translates to about 165 grams fat, 40 grams carbohydrate, and 75 grams protein. The protein amount on the ketogenic diet is kept moderate in comparison with other low-carb high-protein diets, because eating too much protein can prevent ketosis. The amino acids in protein can be converted to glucose, so a ketogenic diet specifies enough protein to preserve lean body mass including muscle, but that will still cause ketosis.
Thanks for the great article! As a fellow dietitian I think its challenging to stay on top of the fads and weight loss trends. The way I see it is that there are two types of ketogenic diets – lifestyle (for weight loss) and therapeutic for some of the medical conditions you mentioned above. Bottom line, the ketogenic diet is not a “natural” diet and there are serious associated side effects. I believe that people following the diet need to be supported by a team of medical professionals to ensure adequate monitoring.
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While I admittedly struggled after going off the diet (they have some high protein, low carb,good tasting premade foods that I no longer had access to) with what to eat, I at least had better knowledges of HOW to eat and have been able to maintain my weight loss since. For the first time ever, I realized that I couldn’t eat the “food pyramid” suggested amount of carbs if I wanted to maintain a healthy weight. I even began running because I was thin enough to do so. What people who have never been fat before don’t understand is how much being fat holds us back from trying new things. If only there was a way to get people to quickly and easily lose the weight so they could be successful at dieting and discover such things (tongue in cheek).
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There have been many attempts at studying the link between type 2 diabetes and the keto diet. In one study, a strict low-carbohydrate diet was administered in obese patients with type 2 diabetes. After 14 days of being on the diet, the glucose levels of participants normalized, their hemoglobin A1C decreased from 7.3% to 6.8% and insulin sensitivity improved by 75%. Some of this study’s limitations include the short duration, the small sample size and the weak control group. In another study, 84 obese patients with type 2 diabetes were randomized to either a low-carbohydrate keto diet or a low-glycemic reduced calorie diet. At the end of the study, both groups experienced improvements in glycemic control however the low carb keto group had greater improvements in hemoglobin A1c and higher HDL levels compared to the low-glycemic group. A more recent 2017 study in the journal of Nutrition and Diabetes found that a low carbohydrate ketogenic diet for 12 months led to greater reductions in HbA1c and body weight. These results suggest that low carbohydrate interventions may be effective at improving glucose control.
I recently went to a walk in lab and found that I have high cholesterol and I am pre-diabetic. However, I am well on my way to healing my body with nutrition and supplements. I was able to reverse all my pre-diabetic symptoms in a few days (brain fog, blurry vision, thirst, frequent urination) and I have amazing energy and mental clarity now. I’m losing weight without hunger or counting calories. I eat low carb produce, poultry, fish, nuts and dairy. I believe that the key to avoid diabetes is to drastically reduce or eliminate grains, sugar and any type of processed food or cured meat from your diet. For cholesterol, I take plant sterols/stanols before meals and tumeric & black pepper, fish and flax oil. I believe that everyone who eats meat should take plant sterols (Try Minute Maid Heart Smart OJ!). It is the ultimate preventative, because it is not usually not possible to reduce your cholesterol enough with diet and exercise alone.