Keto is Not a 'Lifestyle Change.' FYI: It's Still a Diet

I have to be honest - I hate the term "lifestyle change."  

This is because the dieting industry has co-opted it as a way to insidiously not use the word "diet" in their marketing.  In my professional opinion, the only true "lifestyle changes" occur when someone is authentically living in their truth; nourishing their body, their mind and spirit....in whatever way feels best for them.  Not surprising, my issue with diets is they're advertised as a "one-size-fits-all" model to achieve "health and wellness" for everyone....which we know from the plethora of research and data out there: diets are not sustainable, and they rarely result in weight loss long-term (<5% of people who try them keep weight off longer than 1-5 years).  Hence the irony that diet companies continue to create and advertise their newest and latest plans...because they ultimately have a 95% failure rate.

It's probably obvious why the ketogenic diet (keto for short) is also on my shit list as a general eating plan/recommendation...but this one gets under my skin specifically because the ways people rate their "success" can actually be dangerous (more on that later).  Of course this diet has medical research & positive outcomes in a small portion of the population (i.e. children with epilepsy, but it's not focusing on weight loss).  I want to be clear: I'm not dragging this diet through the mud if it's medically monitored by a healthcare physician to reduce the risk of seizures.  Rather, my inspiration to write this post was actually sparked by a recent article in a grocery store magazine advertising 'how great keto is' for just about anyone.  I was also disappointed in how the Registered Dietitian provided the information, because the "education" was very inconsistent and honestly left a bad taste in my mouth...so I wanted to take a little bit of time to do my own research and educate my friends and family who might read this.

So what IS the overall definition of the keto diet?  Generally, it's main focus is restricting carbohydrate intake (limiting to <50 grams/day; the equivalent of under 3 1/2 slices of bread, OR less than 3 pieces of fresh fruit per day), consuming a diet higher in fat (sometimes up to 75-90% of calories from this macronutrient), and moderate protein.  During ketosis, the body essentially learns to use fat, rather than glucose (i.e. blood sugar) as fuel. When you are in this state, your energy supply comes from ketone bodies circulating in the blood; (1) hence the name "keto," and people desiring to "be in ketosis." 

Basically, the 'goal' of this high fat/low carbohydrate ratio is to interfere with our body's natural & desired energetic pathways, in hopes that using fat as energy will result in weight loss.  With our society's rampant fat-phobia, it makes sense why this diet plan would peak interest: "Breaking down fat stores AND quick weight loss?! Sounds too good to be true!"  Well....

I already said it above...this diet is literally tricking our body into creating ketone bodies for energy by breaking down fat molecules instead of it's desired route of breaking down carbohydrates and using glucose. Now, there is a separate process called gluconeogenesis that our bodies utilize at varying times to create glucose from amino acids and fat molecules.  This can happen during intense exercise, when consuming high protein diets, as well as fasting/starvation (2).  But ketosis differs from gluconeogenesis as the body is using ketones for energy, vs. converting fat to glucose for energy.

Here is one of the reasons why this diet makes my skin crawl.  The following quote is straight from my Advanced Nutrition and Human Metabolism textbook, from a course I took at Iowa State in 2011:

"This shift to fat catabolism, coupled with reduced oxaloacetate availability, results in accumulation of acetyl CoA.  As would be expected, a sharp increase in ketone body formation follows, resulting in the condition known as ketosis.  Ketosis can be dangerous because it can disturb the body's acid-base balance.  However, the liver's ability to deliver ketone bodies to peripheral tissues such as the brain and muscle is an important mechanism for providing fuel in periods of starvation.  In short, it is the lesser of two evils." (3)

Long story short, in a healthy human, the concentration of ketone bodies in the blood or urine is very low....but when you are in a fasted/starvation state, have impaired carbohydrate use (aka Diabetes Mellitus) or simply consuming a low-carbohydrate diet, your body can decide to choose the "lesser of two evils" in hopes to prolong your life.  Just the fact that the way to rank your "success" on a keto diet is by measuring your urine for ketone bodies is insane to me.  NEWSFLASH: If you can measure ketone bodies in your urine, your blood pH level is already too acidic...which is dangerous.  High levels of blood or urine ketones can lead to ketoacidosis, a life-threatening condition that can result in seizures, coma, or even death (particularly in those with Type 1 Diabetes).  While it might be a lower chance that someone without diabetes puts themselves into ketoacidosis (mainly because a ketogenic diet is extremely difficult to follow 'perfectly,' and consuming just a small amount of carbohydrates can prevent this risk)...it is not impossible.  Check out THIS LINK where the dangers of ketoacidosis occurred in a non-diabetic & lactating woman.  You can also read this link from Science Direct on the negative impacts of starvation ketosis.  My point is....why as a population are we so fixated on weight loss, that we will literally risk our internal health for the sake of external "beauty?"  Will the ketogenic diet cause weight loss?  Probably short term...but it's also extremely likely that weight gain will return if you are below your set point.  There are also no long-term studies to determine how safe or risky this diet can be for us greater than a few years. Like I mentioned above: diets prescribing weight loss don't work long-term, and it is highly improbable that you will be able to maintain a ketogenic diet for long periods because of how restrictive the intake needs to be (most people who do keto claim they go "in and out" of ketosis for this very reason....it's not sustainable).  I don't know about you - but I've never heard of a lifestyle change that you have to modify every few months....but that's just me :)  

Just think of that - why are we forcing our bodies to restrict a required macronutrient for survival in hopes to obtain a specific look (but let's not care about our internal organ health)??  That's why I was so angry at this article, because one of the quotes (which of course is for shock factor) states: 

"At its core, carbs are not essential - our bodies can produce the exact amount of glucose they need through other sources, converting nonsugar molecules into sugar." **

**just so we're clear, I don't agree with the statement 'carbs are not essential.'

This is such a twisted statement because its hopes are to continue the fear mongering around carbohydrates, and promote "clean eating" which just so happens to be in bold yellow font above.  Riddle me this:  If carbohydrates are not essential, then why would our body then find a solution to still create the glucose it needs?  The article's statement is so annoying because it's skewing the truth....sure, our body doesn't "require" carbohydrates in the macro form, but it DOES require glucose in it's simplest form.  The RD in this magazine knows exactly what he is doing....he does not actually mean our body doesn't need sugar, but that our body is actually VERY smart, and that even in survival mode it will keep us alive by burning other sources for fuel.    *eyeroll*  Friends, I give you the next generation of diet culture...health professionals trying to use science to trick us into believing the messages, because to the lay person, it sounds good and fulfills all the other diet messages we hear day-in and day-out.  

It gets even more infuriating because in the same breath, he goes on to explain that he experienced the keto flu his first week of trying it; he still recommends "high quality" fruits and vegetable intake; and he doesn't recommend keto to high performance athletes......ummmmmm, okay.....so who DO you recommend this diet to?  There are obviously very functional side effects of this "lifestyle change," and it again just goes to show you that desiring "health" is obviously more complex than by just the amount of carbohydrates you consume in a day.  And by making the fruit and vegetable statement (which you can only eat a few of on this diet, by the way) he is insinuating that there are "better" ways to consume carbohydrates, which is a very orthorexic proclamation. I work firsthand with eating disorder clients who I know will be harmed by reading his personal story, let alone the entire article.  Bottom line: it's just plain frustrating!!

Health.com also put out an article listing some of the negative side effects that could result when restricting carbohydrates for long periods of time (again, this diet hasn't been mainstream long enough for us to know all the ins and outs).  But here are a few potential side effects that could arise just based on food/food groups eliminated: vitamin and mineral deficiencies, lower fiber intake/gut issues, weight cycling [which we DO have research showing yo-yo dieting is more harmful on health than weight itself], potential blood vessel damage, and chronic disease risk.  People who've done keto also complain of brain fog, crankiness, low energy, mood shifts, and memory issues. AGAIN please explain to me how any of those are not concerning?  But I guess that doesn't matter if you have a good-looking bod...? [sarcasm]

I want to make it clear - I am not anti- DIETER....I am anti -SYSTEMIC DIET CULTURE that forces people to believe weight loss is the answer to all of life's problems.  I'm also anti-HEALTHISM, which had allowed people to believe trolling others online for their "health risks," is somehow acceptable.  To be frank, if people truly cared about someone's health, they wouldn't risk damaging that person's mental health by bullying comments online.  (Also in all honesty, can we all just agree that shaming tactics are not successful at creating behavior change long-term...)?  

I just wish people who truly valued health would take a hard look at the many outlined problems with dieting effects long-term, as well as the very real health consequences diets create in an otherwise healthy individual.  We have to de-construct our internalized weight biases that make us believe weight loss at any cost is a benefit.  We have to hold companies, healthcare professionals and nutrition educators accountable for monetarily profiting off of worsening people's health. PLEASE, PLEASE, PLEASE if you are considering any type of diet for whatever reason, please talk with an eating disorder or intuitive eating professional...whether diagnosed or not, diets ARE disordered eating behaviors. Diets take away from your natural intuition and wisdom to nourish your body fully.  And let's keep remembering the high failure rate of diets - because if weight-loss companies really had your best interests at heart, they wouldn't be making billions of dollars (and exponentially growing) off of the likelihood of you "failing."

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I hope this topic useful, and if you have any questions, please feel free to contact me in the comments or on social media!

(1); (2)  Gluconeogenesis in Low Carb Diet

(3)  Advanced Nutrition and Human Metabolism (Fifth Edition)