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The Keto Craze: Is the Ketogenic Diet for Everyone?

By Jannell Baez, MS, RDN, LD/N

keto diet

The Ketogenic Diet: Is it for Everyone?

Ketogenic diets have become very popular over the past several years. I am sure you have heard the phrase “I’m doing keto” from others and may be curious as to what a ketogenic diet is beneficial for. People who choose to eat this way do so for various reasons such as weight loss, metabolic regulation of blood sugar, improved brain function and for enhanced athletic performance. Others regard the diet as “healthy” and decide to follow the ketogenic lifestyle because it is a popular trend among dietary therapies touting many health benefits including increased energy without feeling hungry or unsatisfied. You may be thinking “So what is the deal with this keto diet I have been hearing about?”. In this article I will review ketogenic diet basics as well as the therapeutic uses for this diet based on current research so you and your healthcare provider can decide if it will be helpful in achieving your health goals.

What is a ketogenic diet?

            A ketogenic diet is a very low carbohydrate way of eating that provides moderate amounts of high-quality protein and large amounts of healthy dietary fat. A reduction in carbohydrates allows the body to shift to burning fat as the primary source of fuel. The fat that is burned for energy is provided by the diet and from your body.  Breaking down fats for energy produces ketone bodies.  Ketone bodies are then used as an alternative energy source. When the body is able to switch to using fats as its primary fuel, we enter a metabolic state known as ketosis.

            When following a ketogenic diet, your brain as well as other organs will depend on ketones as an energy source. Once you have achieved a state of ketosis, we can measure the level of ketones in the blood and/or urine to ensure you stay in ketosis and reap the metabolic benefits of this therapeutic diet.

            The very low carbohydrate or ketogenic diet is not a new concept and was originally thought of in the 1800s. One of the first proponents of this eating style was John Anthelme Brillat-Savarin who is considered the “father of low carbohydrate diets” and was the first to connect obesity to carbohydrates in his 1825 book The Physiology of Taste. In the 1920s, the ketogenic diet was established as therapy to control epileptic seizures and has since been used as a therapy for epilepsy. Since then, the ketogenic diet has been studied, rebranded at times (i.e. Atkins Diet) and used to help treat multiple chronic illnesses.

Therapeutic Uses for Ketogenic Diets

Ketogenic diets have been studied for decades and although we may not always understand the mechanism by which it helps with certain conditions, the scientific evidence is clear that this style of eating can help with many illnesses. The ketogenic diet has been found to be a helpful tool managing the following health conditions.

  • Helps with weight loss

The keto diet helps people lose weight. Although the exact mechanism is not known it may have to do with a combination of factors such as reduced fat production in the body, increased metabolic rate from the energy cost of using fats and protein for energy, and a reduction in appetite due to higher satiety of a high fat diet and ketosis.

  • Cardiovascular Disease

When done in a healthy way, a ketogenic diet has proven to be helpful in regulating cholesterol and triglyceride levels. This is likely enhanced by the effects on lowering insulin response by eating a low amount of carbohydrates.

  • Type 2 Diabetes

Ketogenic diets have been found to help regulate insulin and carbohydrate metabolism in Type 2 diabetics. High rates of dietary compliance were found among diabetics compared to other diets. Significant improvements in weight and metabolic parameters were also observed when diabetics followed a ketogenic diet.

  • Epilepsy

The ketogenic diet has been recognized as an effective therapy for the treatment of severe childhood epilepsy since 1920. The mechanism by which it works is still not completely understood.

  • Acne

Some foods have been found to stimulate acne. Strong links have been found with foods high in sugar and milk. The stimulation of insulin seems to increase the effect of a substance called insulin-like growth factor (IGF-1). IGF-1 has effects on the cell turnover and sebaceous production in the skin.

  • Cancer

A connection between carbohydrates and cancer has been known since the 1920s. Carbohydrate intake stimulates the insulin/IGF-1 pathway which is involved in cancer development. A ketogenic diet is very low in carbohydrate which may inhibit the proliferation of cancerous cells in the body and has been used as an adjunctive therapy for patients with cancer.

  • Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine disorder thought to affect 6-10% of women. The condition is usually associated with insulin resistance, hyperinsulinemia, obesity and type 2 diabetes. There is some evidence of very low carbohydrate diet or a ketogenic diet being a helpful therapy since it controls insulin levels which can impact a metabolic cascade of symptoms that promote hormone dysregulation in PCOS.

  • Alzheimer’s Disease

Evidence supporting use of a Ketogenic diet with patients suffering from Alzheimer’s disease is growing. Improvements in cognitive function and mitochondrial function have been observed in animal and human studies. It is believed to help improve glucose and energy metabolism as well as providing protection to neurons via the ketones produced as the byproducts of a high fat low carbohydrate eating pattern.

  • Parkinson’s Disease

The beneficial effect of a ketogenic diet on mitochondrial function (the mitochondria is where energy is produced inside your cells) is proposed to be the mechanism by which this diet can help with the symptoms of Parkinson’s disease. The mitochondria is where energy is produced in the cells. When the mitochondria function improperly, it affects all body systems negatively. More research is needed on the therapeutic effects of diet for Parkinson’s disease.

  • Brain Trauma

The Ketogenic diet can be used as a therapy to reduce the risk of epilepsy/seizure activity after a traumatic brain injury. Some evidence in animal models shows reduction in post-traumatic cognitive and motor-function impairment when the animals were fed a ketogenic diet. The therapeutic effect of the keto diet in brain injuries is still controversial. More research is needed in this area.

Full Disclosure: Health and Social Impact of Following a Ketogenic Diet

The ketogenic diet can have therapeutic effects on various conditions but can also have drawbacks that limit who is a good candidate for this diet therapy. This diet is very restrictive and difficult to maintain long term when going about your daily life

Keto Flu

The body must metabolically adjust to burning fat as its primary source of fuel and while it does people often have symptoms such as fatigue, body aches, headaches and cravings known as “keto flu”. This can be treated with replacement of electrolytes which are lost as the body burns through glycogen stores and loses fluid. Electrolytes that need to be replaced include Sodium, Magnesium, Potassium and Calcium.

Impact on the Gut Microbial Balance

Some evidence suggests a change in gut microbial diversity when consuming a ketogenic diet. Given the restriction of carbohydrates, there is less intake of pre-biotic fiber as well as pro-biotic foods. People who follow this diet need be aware of their fiber intake and may benefit from consuming fermented foods and other probiotic supplements to ensure proper amounts of the health promoting byproducts of microbial metabolism in our gut.

Impact on Immune Function

If someone has an active infection, a ketogenic diet may not be the best choice because the immune system relies on carbohydrates in the diet to function optimally.

Possible Nutrient Deficiencies

When an entire food group is removed from the diet, we risk not getting the vitamins and minerals that food group has to offer. Common nutrient deficiencies associated with a ketogenic diet include Thiamin, Folate, Vitamin C, Magnesium, Iron, Vitamin D, Vitamin E and Calcium. If following a ketogenic diet it is beneficial to be aware of your intake of those nutrients and supplement if you are on this diet long term.

Social Implications

Following a special diet can be difficult when living in a culture where food and alcohol is used in social gatherings and celebrations. Going to dinner at a friend or family member’s home may not offer a healthy ketogenic option. Going on vacation may also be challenging and require you to bring your own cooler with foods you can eat on the road. Educating yourself on how to navigate social situations and dinner outings is a must when following a ketogenic diet. Certain types of alcohol and cocktails are to be avoided because of sugar content. Spirits such as whiskey, vodka and dry red wines are allowed but beer, liqueurs, and cocktails mixed with sugary ingredients must be avoided. Eating on the run can also be a challenge as most drive through restaurants offering a quick meal have limited options that are low carbohydrate.

Not Everyone is a Candidate for a Ketogenic Diet

Ketogenic diets done correctly provide 70% of your daily energy from fats. There several conditions for which a ketogenic diet would not be appropriate. Pregnant and breastfeeding women, children (unless needed for seizure control), and diabetics with history of ketoacidosis. People with a history of pancreatitis, liver failure, or a kidney disorder should not try a ketogenic diet. People with problems digesting, absorbing and metabolizing dietary fats should not follow a ketogenic diet unless they are able to correct the digestive issues first. If you have familial hypercholesterolemia, a ketogenic diet may increase cholesterol and lipid levels. People who are underweight may lose too much weight on the ketogenic diet and may need to include some carbohydrate in their diet to maintain a healthy weight.

Healthy Foods to Include in a Ketogenic Diet

  • Non starchy vegetables

Many vegetables are low in carbohydrates and provide the only source of fiber in a ketogenic diet. They provide important vitamins, minerals and phytonutrients. Vegetables such as cauliflower, zucchini and spaghetti squash can substitute for high carbohydrate foods like potatoes and pasta.

  • Meat, Poultry and Fatty Fish

Organic chicken, turkey, beef and pork provide a high quality source of protein and fats. Wild caught salmon, mackerel and sardines are excellent sources of omega 3 fatty acids. Most seafood contains no carbohydrates but some shellfish contain small amounts to be aware of

  • Avocados

These fruits are high in vitamins, minerals, healthy fats and fiber. Please not avocados do contain some carbohydrates (12g per 1 cup) so you may have to watch the amount you consume to stay within the appropriate carbohydrate allowance that your healthcare provider will recommend to you based on your personal needs.

  • Organic Eggs

Egg yolks are the richest source of choline in a typical diet and the egg whites provide a complete protein.

  • Nuts and Seeds

Nuts and seeds provide essential fatty acids, zinc, selenium and other minerals. They are a convenient snack when on the go and can be used creatively for recipes such as chia seed pudding or grain free sugar free granola. Nuts and seeds may contain small amounts of carbohydrate you must be aware of

  • Organic Greek yogurt, Cheese, Butter and Cream

If you are able to tolerate dairy, pasture-raised, full fat dairy products with no added sugars are good choices to incorporate into a ketogenic diet.

  • Coconut Oil

This oil is high in Medium Chain Triglycerides (MCT) which promotes beta-oxidation of fats into energy and ketosis

  • Olive Oil and Olives

Olive oil and olives provide a source of healthy fats that contain polyphenols to help quell inflammation

  • Coffee and Tea

These beverages are carbohydrate free as long you don’t add sweeteners.  Heavy cream can be added to coffee. A popular beverage for people on a ketogenic diet is coffee with grass-fed butter and MCT oil blended into a latte-like beverage

Foods to Avoid While on a Ketogenic Diet

  • Processed sugary foods and sauces like soda, fruit juice, smoothies, ice cream, candy and other sweets
  • Grains or starches and wheat-based products such as rice, pasta, and cereal
  • Most fruits except for limited amounts of berries
  • Root vegetables and tubers like potatoes, carrots, and parsnips
  • Low fat or diet products
  • Unhealthy fats such as processed vegetable oils
  • Sugary alcoholic drinks (sweet wines and cocktails) Always consider carbohydrate ingredients in cocktails that provide such as fruit juices. Beer also can provide carbohydrates
  • Sugar-free diet foods that are often high in sugar alcohol or artificial sweeteners like aspartame (i.e. Equal), acesulfame K, and sucralose (i.e. Splenda). Avoid diet sodas.
  • Fast food (pizza, burgers, pasta etc.)

The ketogenic diet can be a useful therapy for many health conditions, but it is not for everyone.  Ketogenic diets can be done in an unhealthy way that may promote nutritional deficiencies and inflammation. Long-term use of this diet may not be optimally healthy due to the restriction of an entire food group which affects the microbial composition of the gut as well as immune function. If you would like to explore this style of eating, you can read about this diet in more detail in the books listed below. You should always speak with your doctor or Registered Dietitian beforehand to make sure this diet is right for you and to ensure you do it right.

Keto Friendly Broccoli Salad

INGREDIENTS

For the salad:

  • kosher salt
  • 3 heads broccoli, cut into bite-size pieces
  • 1/2 c. shredded Cheddar (optional if you need dairy free)
  • 1/4 red onion, thinly sliced
  • 1/4 c. toasted sliced almonds
  • 3 slices bacon, cooked and crumbled
  • 2 tbsp. freshly chopped chives 

For the dressing:

  • 2/3 c. mayonnaise
  • 3 tbsp. apple cider vinegar
  • 1 tbsp. dijon mustard
  • Kosher salt
  • Freshly ground black pepper

DIRECTIONS

  1. In a medium pot or saucepan, bring 6 cups of salted water to a boil. While waiting for the water to boil, prepare a large bowl with ice water.
  2. Add broccoli florets to the boiling water and cook until tender, 1 to 2 minutes. Remove with a slotted spoon and place in the prepared bowl of ice water. When cool, drain florets in a colander.
  3. In a medium bowl, whisk to combine dressing ingredients. Season to taste with salt and pepper.
  4. Combine all salad ingredients in a large bowl and pour over dressing. Toss until ingredients are combined and fully coated in dressing. Refrigerate until ready to serve.

Keto Stuffed Peppers

Ingredients

  • 3 bell peppers, any color
  • 1 lb grass-fed ground beef (Italian sausage or turkey work well too, Organic if available)
  • 1/2 cup yellow onion, chopped
  • 3 tsp minced garlic cloves
  • 2 cups riced cauliflower
  • 1 1/4 cup chunky marinara sauce (sugar free)
  • 1 tsp dried basil
  • 1/2 tsp sea salt
  • 1/4 ground pepper
  • 1/2 cup 3 cheese blend (omit for dairy free or use low carb vegan cheese)
  • 1 tsp chives, optional

Instructions

  1. Preheat oven to 350 degrees.
  2. Wash bell peppers, cut them in half and remove the membrane and seeds
  3. Place peppers in a baking dish, cut side up and sprinkle with a little salt and pepper
  4. Cook ground meat in a pan for 6-7 minutes until cooked through. Drain the grease and set the meat aside in a bowl
  5. Sautee chopped onion, garlic, and riced cauliflower for 4-5 minutes, until softened
  6. Add marinara sauce, dried basil, 1/2 tsp sea salt and 1/4 tsp ground black pepper to the same pan, mix together and simmer on medium-low for 2 minutes until heated through
  7. Stir in ground meat and cook until heated through
  8. Stir in 1/2 cup of shredded cheese

Spoon the meat and sauce mixture into the peppers, add a small spoonful of marinara on the top and a sprinkle of cheese to each pepper half. Cover with foil and bake for 30 minutes. Garnish with chives if desired, optional.

Is the KETO diet right for you and your health journey? To make an appointment with Jannell or for more information, please email us at therezilirway@rezilirhealth.com or call the office at 1-866-REZILIR

Suggested Reading to Learn More

Keto Clarity , by Jimmy Moore and Eric C. Westman

The Ketogenic Cookbook: Nutritious Low Carb, High Fat Paleo Meals to Heal Your Body: By Jimmy Moore and Maria Emmerich

The Keto Diet: By Leanne Vogel

The Ketogenic Bible The Authoritative Guide to Ketosis : By Dr. Jacob Wilson & Ryan Lowery, PhD (c)

References

Rusek M, Pluta R, Ułamek-Kozioł M, Czuczwar SJ. Ketogenic Diet in Alzheimer’s Disease. Int J Mol Sci. 2019 Aug 9;20(16):3892. doi: 10.3390/ijms20163892. PMID: 31405021; PMCID: PMC6720297.

Prins ML, Matsumoto JH. The collective therapeutic potential of cerebral ketone metabolism in traumatic brain injury. J Lipid Res. 2014 Dec;55(12):2450-7. doi: 10.1194/jlr.R046706. Epub 2014 Apr 10. PMID: 24721741; PMCID: PMC4242438.

Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789-96. doi: 10.1038/ejcn.2013.116. Epub 2013 Jun 26. Erratum in: Eur J Clin Nutr. 2014 May;68(5):641. PMID: 23801097; PMCID: PMC3826507.

Wilson J, Lowery R. (2017) The Ketogenic Bible: The Authoritative Guide to Ketosis. Victory Belt Publishing.

Hahn TJ, Halstead LR, DeVivo DC. Disordered mineral metabolism produced by ketogenic diet therapy. Calcif Tissue Int. 1979 Aug 24;28(1):17-22. doi: 10.1007/BF02441213. PMID: 115548.

Churuangsuk C, Griffiths D, Lean MEJ, Combet E. Impacts of carbohydrate-restricted diets on micronutrient intakes and status: A systematic review. Obes Rev. 2019 Aug;20(8):1132-1147. doi: 10.1111/obr.12857. Epub 2019 Apr 22. PMID: 31006978.

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