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A Nutritionist’s Beat on Keto

By: Jesse Haas
keto diet

The ketogenic diet is really hip and happening right now. Is it right for you?

I’ve been studying nutrition for more than 10 years and have yet to discover the one way of eating that is right for everyone. As a functional nutritionist, it’s important to me to meet my clients where they’re at. I approach my work with people eating vegan, Paleo and keto the same: asking questions and working to understand if what and how they’re eating is helping them find balance in their bodies and meet their health goals. And if it’s not, I advocate for change. 

Like most Americans, I grew up believing that eating fat would make me fat and clog my arteries. In my dietetic undergraduate program, this belief was further reinforced. As a dietitian-in-training, I was fed the information supporting the high-carbohydrate, low-fat diet recommended by the USDA. In a nutritional biochemistry class, I learned class that meals containing high-carb ingredients like pasta and potatoes dramatically increase the triglycerides (fat) content of our blood. On the same day I was taught in another class to treat cardiovascular disease with a low-fat, high-carb diet. It just didn’t add up! 

Fast forward 10 years or so and now the diet that’s hip and happening eliminates all those grains and encourages people to eat 75% or more of their calories from fat instead. Did you get whiplash? 

The ketogenic diet is a very low-carbohydrate, moderate-protein and high-fat diet that enforces a metabolic shift in our bodies away from using sugar (glucose) for energy. Whenever it’s available, the body uses glucose to produce energy. When glucose is not available, the body transitions to metabolizing ketone bodies produced from fat. This metabolic flexibility is what made our ancestors able to survive periods of scarcity or famine. Ideally, our metabolic “engines” are switching back and forth from glucose to ketones for fuel between meals. 

The ketogenic diet was originally designed as a medical intervention for children with untreatable epilepsy. Physicians found that when they fasted their patients – forcing their bodies into ketosis – the dysfunction in their brains that caused the seizures righted itself. As soon as the children went back to eating their normal, carbohydrate-containing diet their seizures returned. It is still not well understood what is happening in the brain that’s correcting this dysfunction, but the diet is still recommended to children with epilepsy when medications fail to stabilize them. 

Take a pause here to just let that sink in. 

The ketogenic diet is such a powerful intervention that it can correct an imbalance that our best medical knowledge cannot fix. 

There are two things that I take away from that: 

  1. Holy moly batman! Food is such powerful medicine – that’s so exciting! If a ketogenic diet can do that, what else can it do?! And,
  2. Wowzah, maybe we shouldn’t just willy nilly be going keto. I mean, this diet changes brain chemistry! That’s powerful stuff – what else is happening in the body when we eat keto? Is it all good? Or is there some bad too? 

Earlier this year, I completed an advanced training in the ketogenic diet to dive deeper into this topic and understand more fully what it is, what it can do, when to recommend it to my clients and, just as importantly, when not to. To go into detail on all that I learned is beyond the purview of this article. What I want to share is an insider’s perspective of this diet and help you (the reader) determine if this is a dietary approach you want to pursue.

Being in ketosis full-time is not our body’s natural state. Historically, humans were hunters and gatherers. What our ancestors hunted and gathered was largely dependent on the environment they lived in. Humans living in the rainforest had ready access to fruits (carbohydrates), while humans living on the Canadian tundra did not. The Inuit are talked about frequently in historical ketogenic context because their ancestral diet is very high in fat and nearly devoid of plant matter. The growing season that far north is VERY short and trade to that part of the world was very limited for a very long time. 

We know that humans can survive – and thrive – on a ketogenic diet. Even without intending to, we’re flowing in and out of ketosis as a part of our daily cycle. When we go periods of time without eating (i.e. sleeping), our bodies still need energy. When glucose stores are used up, the body looks to fat to fill the energetic void. As soon as a source of glucose has been secured, though, that fuel source is used preferentially. 

We can look around the globe and find so many different ways of eating that support health and longevity, including high-carb, low-fat diets. There’s no one best way of eating that works for everyone.

A ketogenic diet must be well-planned and formulated to include essential nutrients. It’s relatively easy to eat a diet that puts and keeps your body in ketosis. If, however, attaining wellness is your ultimate goal (which I’m going to guess it is since you’ve found your way to the Well Connected community) a bit more thought must go into planning your keto meals. 

There are several nutrients that I worry about when talking a client through eating keto. Fiber, vitamin C and phytochemicals all come to mind. The quality of the fats being eaten is also critically important. 

Fiber has many physiological benefits, including maintaining bowel regularity and fueling the microbiome. Lack of fiber is why one of the most common side effects of the ketogenic diet is constipation. Ketogenic researchers are trying to understand what the impact of a ketogenic, low-fiber diet has on colonic health but we know from other research that fiber is protective against many common health conditions, including colon cancer, type 2 diabetes and even heart disease. When recommending keto to a client, I make sure to include instructions for supplementing fiber intake at or above 25 grams per day. 

Vitamin C needs are not hard to meet…if you’re eating plants. Remember the Inuit? Traditionally, their diets were comprised of meat and fat, predominately coming from seals. They may have gone months without vegetables and seldom had access to fruits. How did they not get scurvy (severe vitamin C deficiency)? They didn’t let anything go to waste! Organ meat is very nutrient-dense and kidneys provided sufficient vitamin C to meet their basic needs.

Many ketogenic recipes gloss over vegetables and fruits because they contain carbohydrates. Eating too many will pull you out of ketosis. You never thought you could eat too many Brussels sprouts, did you?! Since Americans seldom eat kidneys or other organ meat, vitamin C deficiency on a ketogenic diet is a concern and one that requires attention and planning. Creating meals around non-starchy vegetables like leafy greens, bell peppers and broccoli keep essential nutrients like vitamin C in the diet without adding too many carbs to maintain ketosis. 

The absence of plants in a ketogenic diet also creates a need for phytochemicals that impart important health benefits. The pigments that give our food color is evidence of powerful magic. Phytochemicals are compounds that we’re just tapping the surface in our understanding of. Keto-supportive ingredients like spices, nuts, coconut, avocado, olive and olive oil have beneficial phytonutrients to offer. I worry, however, that cutting out carbohydrate-containing vegetables and fruits will leave a deficit in this category. Once again, careful meal planning is key to maintaining balance.

To maintain ketosis, one must be very diligent and prescriptive, which means this diet is not for anyone with a history of restricted eating. This really can’t be emphasized enough! There is a long list of foods that are keto-friendly…and an equally long list of foods that are not. For those of us with history of anorexia or other disordered eating, this can be really triggering. If you have a medical condition that warrants exploration of the ketogenic diet, gather of team of nutrition and mental health professionals to support you through the process.  

As a nutrition nerd, I’m excited by what we might accomplish with the ketogenic diet. I marvel at the therapeutic potential a low-carb, high-fat diet has for people with metabolic and neurodegenerative diseases, as well as cancer. As a functional nutritionist, I look at wellness from a holistic perspective, taking into consideration all aspects of my client while working up a treatment plan. And while a medical history might point me in the direction of keto, there are so many other aspects to put into consideration: mental burden, emotional wellbeing, financial wellness, and community support to name a few. If any one of these areas is lacking, a recommendation from me to adopt a ketogenic lifestyle may exacerbate – instead of improve -my client’s wellness. 

If you take nothing but this away from reading this article, I’ll be content: the ketogenic diet is harder to do well than most other diets on your radar. 

Before endeavoring this on your own, talk with someone who can provide an objective and informed perspective. 

Ask two questions:

  1. Given my unique health and life needs, is keto right for me? If the answer is yes:
  2. How do I adopt a ketogenic lifestyle that will optimize my healing and long-term wellbeing?

If you need help answering these questions, I recommend scheduling an appointment with a nutritionist or health professional who is trained in applying the ketogenic diet therapeutically. I’d be happy to support your in your health goals – whether with keto or with other tools in my skillset, whatever is appropriate. Please schedule a complimentary phone consultation with me at Wellness Minneapolis to see if we’re a good match.

Jesse Haas is a functional nutritionist and co-founder of Wellness Minneapolis, a holistic wellness clinic in south Minneapolis. You can learn more about her on her website, and follow her on Instagram here.

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