By: Nicole Recine, RN MSN APRN
Most who are familiar with my work know that I am a huge advocate of the ketogenic diet. I have found it to be beneficial in many of my patients, and I also personally follow a ketogenic way of eating. That being said, I do not think it is ever reasonable to suggest that one way of eating is appropriate for everyone. Despite my inherent bias, I do not agree that a ketogenic diet is necessary for every individual.
It’s the new year and, like many, you may be pondering a lifestyle or diet change. In the following article, I will discuss the rationale behind who should consider a ketogenic lifestyle, and offer suggestions for those who might benefit from a more moderate approach to carbohydrate reduction.
Who should adopt a ketogenic diet?
The primary reason most people are interested in a ketogenic diet is for weight loss. While the majority of individuals lose weight on a ketogenic diet, it is not a guaranteed weight loss strategy. Some people actually gain weight on a ketogenic diet, especially if they are over-consuming the various, new, “keto-friendly” food products that have overtaken the marketplace. That being said, weight loss is typically a desired side-effect of using a ketogenic to correct metabolic disease. A ketogenic diet has a profound effect on reversing insulin resistance, pre-diabetes, or type 2 diabetes. Correcting this metabolic state can make achieving a normal weight easier for folks who are overweight or obese. As such, if you have metabolic syndrome or have been formally diagnosed as prediabetic or type 2 diabetic, I would strongly recommend following ketogenic diet under the supervision of a medical professional. How do you know if you have metabolic syndrome?
According to the American Heart Association, an individual has metabolic syndrome if 3 of the following criteria are present:
- Elevated waist circumference:
Men – greater than 40 inches (102 cm)
Women – greater than 35 inches (88 cm)
- Elevated triglycerides: Equal to or greater than 150 mg/dL (1.7 mmol/L)
- Reduced HDL cholesterol:
Men – Less than 40 mg/dL (1.03 mmol/L)
Women – Less than 50 mg/dL (1.29 mmol/L)
- Elevated blood pressure: Equal to or greater than 130/85 mm Hg or use of medication for hypertension
- Elevated fasting glucose: Equal to or greater than 100 mg/dL or use of medication for hyperglycemia
If this is you, adopting a ketogenic diet would likely be beneficial. A strict ketogenic diet limits carbohydrate to less than 30g per day. This is typically achieved by limiting carbohydrate sources in the diet to non-starchy vegetables and the trace amounts found in foods like nuts and low-sugar dairy products. What about everyone else? Does someone without metabolic disease need to limit their carbs to less than 30g per day to avoid disease in the future?
The Benefits of Carbohydrate Reduction
It is my opinion that most people can benefit from adopting a lower carbohydrate/lower sugar way of eating. Simply reducing the amount of carbohydrate, especially from sugar and grains, can help aid in weight loss, and potentially prevent metabolic disease in the long-term. What does low carb look like in numbers? A standard, carb-heavy, 2000-calorie diet that is 45-60% carbohydrate would contain 225-300g of carbs per day. This would be what a low-fat, whole-grain-based diet might look like. Although it would vary widely depending on the individual, most people will see some benefit from reducing carbohydrate intake to less than 100g per day. This is a more moderate approach to a lower carb way of eating without being strictly ketogenic. A diet at this level of carbohydrate could include higher carb food items such as fruit, unflavored yogurt, whole milk, avocado, winter squash, corn, beans, hummus, potatoes, low-sugar chocolate, carb friendly baked goods, or more liberal consumption of nuts.
To achieve this, I recommend eliminating concentrated sources of sugar and grains such as:
- Juices (yes, even pure fruit juice) and soda
- Syrups, jelly, jams, honey and other sugary condiments
- Blended smoothies
- Hot and cold cereals
- Rice, pasta, and any grain meal bases
- Tortillas, biscuits, and bread
- Chips, fries, and other snack-type foods
- Candy, pastries, and desserts
- Energy bars
- Granola bars or breakfast bars
- Sugar sweetened beverages including coffee
If you’re looking to “clean-up“ your diet in the new year and ketogenic diet seems too restrictive, this may be a great approach. It may also be a good approach to reduce the amount of sugar in children’s diets. As always, be sure to discuss any health concerns with your doctor.