Thinking About Keto? What I See in My Practice May Surprise You

I'm often asked about popular diets, so I'm starting a short review series to share clinical observations and considerations. First up: the keto diet.

Keto Diet Angle:

The Keto diet is extremely popular for quick weight loss. It also has a place medically, as it has been shown to be therapeutic in cases of drug-resistant epilepsy. The dietary approach is similar to the Atkins diet and other extremely low carbohydrate diets that keep total daily carbohydrate intake around roughly 20-50 grams.

In practice, this translates to a diet heavy in fats and animal protein, with smaller amounts of non-starchy vegetables.

The name Keto comes from the word ketosis, or the metabolic state the diet puts your body in when carbohydrates are no longer available to burn for energy and the body shifts to burning fat for fuel.

Keto Diet Reality:

The Keto diet gets filed under an extreme diet, as it virtually eliminates a whole macronutrient group of food, in this case carbohydrates. The reality of eating a fat and protein based diet is that it can be difficult to stomach for more than a short period of time, not to mention the limited diet can really interfere with your social life.

The very low carbohydrate way of eating is typically reserved for those living in extreme temperatures like the Arctic where lush, carbohydrate-rich vegetation is not possible. Dramatic changes in diet such as this can leave your body really confused. It can't tell the extreme diet of carbohydrate restriction from actual starvation or harsh environmental conditions. The body's interpretation of these drastic dietary changes lands somewhere between intense stress and the possibility of death, which often first manifests with the absence of normal digestive function and an obvious lack of energy.

Not exactly the ideal scenario for someone seeking health. Think abundance rather than restriction.

Perhaps the most troubling to me about the Keto diet is that it forces you to ignore your cravings for simple carbohydrates as many fruits and carbohydrate-rich foods are significantly limited. From my experience working with hundreds of women, when internal cues like hunger, energy, and digestion are repeatedly overridden, symptoms often emerge. As the body moves out of homeostatic balance, the body sends signals that the forced regimen is not working. Imagine these like the warning lights on the dash of your car. But instead of low tire pressure or low gasoline, they show up as things like: constant cravings, poor sleep, anxiety, restlessness, fatigue, digestive bloating or discomfort, infertility, and sometimes even depression.

My biggest issues with the keto diet is its impact on metabolic health, energy levels and digestion. But I'm going to focus on the digestive impact because it's so important. Keto and very low-carbohydrate diets can reduce fiber intake and are often associated with slower bowel transit and constipation in practice. Over time, I frequently see bloating and symptoms consistent with bacterial overgrowth in clients following prolonged very low-carb approaches, particularly when fiber intake is low, starving your good gut bacteria.

Keto Diet Positives:

Don't get me wrong, there are some great aspects to the keto diet:

Encourages attention to protein quality and sourcing
Promotes nutrient-dense foods such as bone broth, gelatin, and collagen
Emphasizes fats such as butter, coconut oil, avocado, and animal fats
Eliminates most processed foods and common food sensitivities
Weight loss (typically short-term)
Helps lower blood sugar levels
Can support appetite regulation and glycemic control in some individuals

Keto Diet Negatives:

Here's a few negatives of the Keto diet to keep in mind, many of which I see in my post-keto clients:

Causes you to tune out your body, while tuning into diet rules that may not work for you
Very low in carbohydrates which can cause a drop in energy levels, constipation, and hormonal issues
Is very restrictive and not a sustainable way to eat long-term
Can change your digestive system over time and induce bloating, constipation and digestive sensitivity to carbohydrates (when you try to reintroduce them)
May negatively impact thyroid function
Some individuals report thyroid-related symptoms during prolonged very low-carbohydrate intake
Some people report sleep disruption or elevated stress symptoms
Could lead to vitamin and mineral overdose, specifically vitamin A and copper

A review from Harvard Health Publishing notes that keto is not appropriate for everyone and should ideally be followed under medical guidance.

Better Options And Things to Consider Before Going On The Keto Diet:

My philosophy as a nutritional therapist is never to tell anyone what to do. Instead, I prefer to help provide information and an opinion based on my work with clients and what I see every day in my practice. That way, you can feel empowered to make the best decision for you.

Here's a few suggestions of things to explore before going on the Keto diet:

Make sure you're addressing underlying reasons for weight gain before taking a diet approach that tricks and manipulates your body into temporarily losing weight at the expense of your long-term health.
Instead of cutting out a macronutrient group, learn about what foods work for and against your body. If this sounds too difficult for you, stool testing may be helpful.
Consider testing to discover your nutrient excesses and deficiencies to see if they may be influencing your weight. Hair Analysis and nutrient blood labs are my favorite tool for this.

I hope you enjoyed this review of the Keto diet, the first of many in the diet review series.

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