A lot of conflicting information has been circulated about the consumption of fat. People are sometimes concerned that adding fat to their diet will cause them to gain weight. This is not necessarily the case. Fat a neutral food. It is also satisfying. If you eat a low-fat meal, whether you have carbs or not, you will stay hungry. Fat allows you to feel full for longer. Furthermore, fat does not spike insulin and adding some healthy fat at meals will help you go longer between meals and really dip down into your fat stores to burn that fat off the body. Burning all that fat off the body is much healthier than holding onto it—which will lead to insulin resistance, diabetes, and all the dominoes that fall after that—cardiovascular disease, cancer, the list goes on and on.
One area where food tracking can be especially helpful, though, is ensuring that you're hitting the right ratios of macronutrients—protein, carbs, and fat. "The most researched version of the ketogenic diet derives 70 percent of calories from healthy fats, 20 percent from protein, and only 10 percent from carbs," explains Charles Passler, D.C., nutritionist, and founder of Pure Change. "In the ideal world, each keto meal and snack should have that same (70/20/10) ratio of macronutrients, but studies have shown that you'll still achieve great results even if each meal varies slightly from that ratio, just as long as you don't exceed 50 grams per day of carbs, or eat those carbs in one sitting," says Passler. In order to achieve these ratios without a preset meal plan from a dietitian or doctor, some food tracking is probably going to be necessary. But once you get the hang of things, you may not need it anymore.
Contrary to what social media hashtags would have you believe, there's not much to suggest that it will improve athletic performance. Keto also ranked dead-last (down with another joy-stealer, the Whole 30 Diet) on the U.S. News and World Report's Best Diets list. The lack of research on long-term outcomes, hard-to-follow regimen, and potential health hazards all alarmed the panel of experts.
That's because my intro to this seemingly new plan was when I worked in a hospital, where ketogenic diets were specifically used as a medical nutrition therapy for pediatric patients with seizure disorders, for whom medication was no longer effective. In other words: It was used as an absolute last resort for families who felt otherwise hopeless in the face of a neurological disease, and under strict medical supervision.
The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more calories than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein and carbohydrate is then evenly divided across the meals.
Eggs have gotten some bad press in the past, but according to Franziska Spritzler, R.D., a certified diabetes educator in Huntington Beach, California, "eating whole eggs has been shown to modify blood cholesterol in a way that actually reduces risk of heart disease and stroke." She adds that eggs are also a great source of choline, which is necessary for brain and liver health.
Meat is fair game when you’re following the keto diet, which is why Griffin is a fan of putting together a plate of charcuterie when you’re in the mood for a snack. This doesn’t need to be one of those fancy displays you’d find at a restaurant — you can keep it simple and arrange whatever cured meats you have on hand. (Psst: This one makes a great party appetizer, too!)
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet (MAD) or the low-glycaemic index treatment (LGIT) diet, because they find the difficulties too great.
Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer. A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.
Net carbs is simply total carbs minus fiber and non-digestible sugar alcohols, like erythritol. (This doesn’t apply to high glycemic sugar alcohols, like maltitol.) We don’t have to count fiber and certain sugar alcohols in net carbs, because they either don’t get broken down by our bodies, are not absorbed, or are absorbed but not metabolized. (Read more about sugar alcohols here.)
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.
When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common but disappear within two weeks. The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar and handling illness. The level of parental education and commitment required is higher than with medication.
Before starting, ask yourself what is really realistic for you, Mattinson suggests. Then get your doctor’s okay. You may also work with a local registered dietitian nutritionist to limit potential nutrient deficiencies and talk about vitamin supplementation, as you won’t be eating whole grains, dairy, or fruit, and will eliminate many veggies. “A diet that eliminates entire food groups is a red flag to me. This isn’t something to take lightly or dive into headfirst with no medical supervision,” she says.
Following the ketogenic diet can be safe in the short term but it does come with health concerns. 'It's not something that I recommend for the general population for the long-term,' says Dr Barclay. 'By drastically cutting out carbohydrate-containing foods, you'll miss out on the nutritional benefits of healthy choices like whole grains, fruit, starchy vegetables, and legumes such as beans, chickpeas and lentils.'
Bulk buy and cook. If you’re someone who doesn’t like to spend a lot of time in the kitchen, this is the best of both worlds. Buying your food at bulk (specifically from wholesalers) can reduce the cost per pound tremendously. Plus, you can make ahead food (bulk cook chicken thighs for pre-made meat, or cook entire meals) that are used as leftovers, so you spend less time cooking.