• Derrick W. Spell, MD FACP

Veto the "Keto" Diet

Carbohydrates, or carbs, have been ridiculed for decades. Recent trendy diets that advocate “low-carb” eating include the Atkins Diet, the South Beach Diet, and The Paleo Diet. The newest craze is the ketogenic, or “keto” diet. Recently, I have had several people ask about my thoughts on the “keto” diet. We discover in The Bite-Sized Guide to Getting Right-Sized that nothing in the realm of good nutrition resembles a fad. We also learn that there are carbs that you should enjoy (fiber and complex carbs) and those that you should avoid (refined sugars). Since I did not specifically discuss the “keto” diet, let’s learn more about it and why I do not recommend it for weight loss.


Ketosis is a normal physiologic state that occurs when the body does not have enough carbs to burn for energy. All of the aforementioned “low-carb” diets cause ketosis. During ketosis, your liver makes ketone bodies from your fat stores. Your body then uses these ketones instead of carbs as its primary fuel. When you are in good health, your body controls your fat stores so that you don’t make ketones. However, when you decrease your consumption of either carbs or calories, your body will burn fat stores and utilize ketones for energy. This typically happens after a few days. Ketosis happens after you exercise for an extended period of time, such as after 45 to 60 minutes of vigorous activity. Ketosis also happens after periods of fasting, like sleeping overnight.


The main difference between these “low-carb” diets is that the “keto” diet emphasizes fats as the main calorie source, whereas the other “low-carb” diets promote high-protein eating. You are not allowed to eat certain carb-rich, yet nutritious foods on the “keto” diet, including beans, legumes and most fruits. You must also eat high-fat foods with every meal. Unfortunately, the diet does not discriminate between unsaturated fats and saturated fats. There are many nutritious foods that are naturally high in unsaturated fats, such as nuts, seeds, avocados, and olives. I have no concern with consumption of unsaturated fats in moderation. However, saturated fats from oils and butters are promoted on the “keto” diet. Other foods that are high in saturated fats (like beef and pork) are also encouraged.




As noted in my last blog, long-term consumption of foods high in saturated fats increases risk of heart disease and stroke. There are other health risks with the “keto” diet including micronutrient deficiencies, liver problems, and bowel issues, fluctuating between diarrhea from the fatty foods and constipation from the overall lack of fiber. The diet can also impair brain function due to the lack of available sugar. There is insufficient data at this time concerning cancer risks from the “keto” diet, but I’m sure you can imagine my opinion!


There are literally thousands of dietary strategies that one can use to lose weight. The biggest obstacle for most people is the long-term commitment to any plan, especially for the rest of your life! We have all seen friends or family members lose weight successfully for a short while but then gain the weight back (often with more!) over time. This “yo-yo” effect is the main reason I don’t recommend any rigid eating plan. Most people prefer flexibility with their meals, otherwise a diet is just not sustainable over time! In addition, you can’t follow any “low-carb” plan long-term without potential serious health risks.


You will only learn to develop your own willpower if you can make your own food choices. If you want to learn more about willpower as well as beneficial food choices, please check out The Bite-Sized Guide to Getting Right-Sized!


P.S. Did you notice what I said about ketosis in the second paragraph? When you decrease your consumption of either carbs or calories, your body will burn fat stores and utilize ketones for energy. Basically, any time you eat less and lose weight by burning fat, your body is in ketosis! Since ketosis naturally happens any time you are burning fat, why not choose to make a lifestyle change that will be healthier long-term?

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© 2019 by Derrick W. Spell, MD, FACP

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