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“Keto diet” was the most-searched diet term on Google in 2018.1 If it has not
happened already, your patients will soon start asking, “Should I do keto?”
Author:
Diane Vizthum, MS, RD, CSSD, LDN
Johns Hopkins Institute for Clinical and Translational Research
Citation:
Vizthum D. Keto: fad diet or health benefit? [published online March 13, 2019]. Cardiology
Consultant.
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“Keto diet” was the most-searched diet term on Google in 2018.1 If it has not happened
already, your patients will soon start asking, “Should I do keto?” Although the specifics can
vary, ketogenic eating patterns generally recommend consuming a diet that is high fat,
moderate protein, and very low carbohydrate. Carbohydrate intake is often less than 20 g of
net carbohydrate (total carbohydrate minus fiber) or 5% of calories per day. The goal of this
strict restriction is to get the body into a state of ketosis.
Patients tend to be interested in ketogenic diets for weight loss, and studies that typically last
1 to 2 years show that patients randomly assigned to low-carbohydrate or ketogenic diets
tend to lose slightly more weight than those randomly assigned to other diets.2,3,4,5 It is
theorized that being in ketosis helps with appetite regulation and improves fat burning, and
that high dietary fat intake increases satiety. However, research also shows that weight loss is
highly variable and tends to be greatest among people who are most adherent to dietary
changes, regardless of what eating pattern they are following.6,7
In addition to potential weight loss, ketogenic diets also typically result in decreased blood
sugar, triglycerides, and blood pressure and increased high-density lipoprotein cholesterol.
Total cholesterol and low-density lipoprotein cholesterol tend to decrease or remain stable,
especially among patients who have lost weight, although individual differences
exist.8,9,10,11
Low-carbohydrate, high-fat diets are well-established in the treatment of epilepsy and are
currently being researched in the treatment of other neurological conditions, including
Alzheimer disease and brain tumors.12,13,14,15
Ketogenic diets are not recommended for women who are pregnant or nursing and patients
with kidney, liver, or heart disease or eating disorders. Side effects could include dehydration,
constipation, vomiting, or, in rare cases, kidney stones. Bone health should be monitored over
time. Research into the impact of these diets on long-term cardiovascular health, advanced
cardiovascular markers, and the microbiome is ongoing.
Ketogenic diets are extremely strict and require diligence in planning meals and tracking
nutrients. Patients should work with their doctor and dietitian to determine if their potential
benefits are worth the costs. Patients can certainly experiment with the diet if they would like
to see how it makes them feel and how it impacts their health. However, this (or any) diet
should not be viewed as a “quick fix.”
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A doctor should closely monitor all patients who decide to start a ketogenic diet. If the
patient is taking medication to lower blood glucose or blood pressure, the dose will likely
have to be adjusted. Labs and bone health should be monitored.
A registered dietitian should also help patients ensure they are meeting their nutritional
needs. There is a wide range of foods that people can eat and still be technically following
the diet and producing ketones. Individuals could be eating a diet of quality foods that
includes vegetables, nuts, healthy oils, avocados, meat, fish, eggs, and cheese. Or the diet
could be highly processed and deficient in many micronutrients. A multivitamin is always
recommended, and additional supplementation or diet adjustments may be needed. Any
time multiple food groups are restricted, it is possible for deficiencies to develop without
careful planning.
Clinical Takeaway
Ketogenic diets can be presented as an option to individuals who could benefit and in whom
it is not contraindicated. Some patients do very well on the diet, but it is not for everyone and
it is not always necessary. Practitioners should work with patients’ goals and preferences to
help them find a long-term sustainable eating pattern that will maximize health and quality
of life.
Diane Vizthum, MS, RD, CSSD, LDN, is a research nutritionist and dietitian at The Johns
Hopkins Institute for Clinical and Translational Research in Baltimore, Maryland. She was also
voted Young Dietitian of the Year in 2015 by the Maryland Academy of Nutrition and Dietetics.
References:
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