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My Take on the Ketogenic Diet—from both a Dietitian and Personal Perspective

My Take on the Ketogenic Diet

Now that I have ‘come out’ regarding my advocacy of low carbohydrate diets, I have become increasingly aware that, in doing so, I have been shunned by professional colleagues who I (wrongly) assumed would be more supportive—or at least open minded—about taking a less conventional approach to eating for long-term health. I am not a young hen by a long shot, so, trust me, I have been around long enough to witness, firsthand, the full pendulum swing of dietary recommendations promoted by medical and professional organizations.

Sadly, Nutritional Research is Not Always Right

For decades, my own profession aligned their dietary guidelines on the research studies that they claimed to to be ‘evidenced based’. I don’t think I have to convince anyone of the flaws of the studies originating circa early 1960’s. These studies placed lard, beef tallow, and butter on the ‘artery-clogging’ food list – this only led to Crisco and Fleischmann margarine becoming household staples (face-palm). During this same time period, eggs also became demonized due to their relatively high cholesterol content (additional face-palm).

It wasn’t until the turn of the century—i.e. early 2000’s—that trans-fats, derived mostly from the hydrogenation (solidification) of liquid fats—i.e. the very same fats that replaced the ‘dangerous’ animal fats—were found to play a much more harmful role in heart disease. The American Heart Association admits that ‘eating trans fats increases your risk of developing heart disease and stroke, and is also associated with a higher risk of developing type 2 diabetes’. Fast-forward to 2015, when our nation’s top nutrition advisory panel decided to drop its warning about foods high in cholesterol, stating that cholesterol in the diet need no longer be a ‘nutrient of concern’.

While dietary cholesterol has been redeemed of its ‘bad guy’ image, there remains a major research-driven disconnect regarding which type of fat is optimal for health. Although this same dietary advisory panel has deemed saturated fats—and especially trans fats— as new ‘public enemy #1’, there seems to be a growing seismic shift between researchers, medical professionals, and the like about this over-generalized conclusion that ‘saturated fats in the diet should be limited or even avoided.

Remember the “Low Fat” Craze?

Another transformation taking place throughout the world is our overall perception of the ideal macronutrient distribution for optimal health, driven by the skyrocketing dual epidemics of diabetes and obesity (i.e. ‘diabesity’) – there are more theories than you can count regarding what is causing these epidemics!

Beginning in the mid 1980’s, we turned our attention to dietary fat as the primary reason our nation’s population as a whole was getting fatter. Everything low fat and fat-free was flying off the supermarket shelves and food manufacturers quickly responded with low fat/fat-free versions of foods such as cookies (the green Snackwell boxes come to mind), salad dressing, and even Pop Tarts. What macro replaced the fat in these products? I’ll give you a hint—it wasn’t protein. The end result from a few decades worth of vilifying fats—read ‘fat phobia’—has revealed not only a worsening trend in rates of obesity and diabetes, but has also added more confusion and skepticism, among both health professionals and consumers alike.

So now, a short story about my own personal experience from a wellness visit with a physician several years ago…

After receiving the results of my lab work that indicated a slightly elevated LDL-cholesterol, their medical assistant called me to inform me of this result and advised me to stop eating beef and fatty foods. It wasn’t the fact that she was unaware that I was a dietitian that made me smirk at this remark. It had everything to do with the fact that I was already following a strict low fat diet (ever since I can remember) and hadn’t touched beef in several decades. Needless to say, it was my last ‘wellness’ visit at that office.

So the question remains: what is the ideal macronutrient balance?

The ultimate verdict on the ‘ideal diet’ remains a hotly contested issue, but my age and 35+ years of experience in the ‘trenches’ of translating ‘science’ into practical nutrition and dietary advice, tell me that there will likely never be a clear-cut answer. I truly believe that ‘no single diet fits all’. I have no intention of taking the ‘easy way out’ by not committing to a specific recommendation. What I am convinced of, however, is that you, and only you, can truly make this determination.

So now, for my personal experience going Keto

As far as my personal experience, I can say that, for several years, I firmly believed that a low-carbohydrate diet was in no way more advantageous to your health than a high carbohydrate diet (which I loosely define as > 50% of total calories from carbs, just as a ‘low fat’ diet is defined as < 30% of one’s total calorie intake from fat). I am slightly consoled by the fact that I made sure to preface my opinion with the specification of ‘healthy carbs’, indicating a less processed, higher fiber type of carbohydrate. It was my (type 2) diabetic and/or overweight patients and clients—not the health organizations or medical colleagues—that provided me with the initial ‘wake up call’. I was able to observe, first-hand, the impressive health outcomes from their transition to a lower carbohydrate eating style. No extreme, ‘cold turkey’ approach to carbohydrate reduction, but a more gradual modification, based on what they felt was doable for the long term.

I witnessed my Type 2 diabetic patients coming off of large insulin doses (100+ units/day) through a combination of switching out carb-dense foods for high fat options. Additionally, as they felt more ‘energized’ from their more stabilized blood sugar levels and their weight loss, they embarked on regular exercise regimens. The smiles on their faces and their enthusiasm for having achieved this transformation was the initial ‘spark’ that compelled me to begin my own transformative journey.

Fearless Keto Holiday Menu Guide
My daughter, Lauren, and I

Coincidentally, my daughter Lauren, who had struggled with weight since adolescence (which for a dietitian mom is another story in itself), was the final ‘wake up’ call that maybe it was time for me to dedicate the necessary time to researching the impact of low carbohydrate diets on blood sugar, weight, and other health-related issues. Lauren began her keto journey close to a year ago, after being low carb for several years. She has not only reaped the benefits of weight loss and an end to her perpetual sugar cravings (even during ‘that’ time of the month), but has actually gained both greater self-esteem and confidence—the latter being just as important to her overall health as any physical benefits. So this became the defining moment that both my professional and personal life began to change.

Within a few days of nonstop internet research, I felt as if I was back in college, taking a crash course on diet and human metabolism. I was learning the intricacies and complexities of an area of science that I was either unfamiliar with or that I had long forgotten about over the past ~35 years. Perhaps even more challenging was sorting through the large amount of scientific literature on very low carbohydrate (ketogenic) diets that had not been updated for over a decade, coupled with the need to re-learn a lot of what I thought was scientific fact and finding coherent research articles that could substantiate the information. A glaring example of the vast number of misconceptions and misinformation surrounding the ketogenic diet is the myth that our brain only functions on glucose. This dogma was beaten into my brain for decades. It apparently is still the mainstream response for why very low-carbohydrate diets, such at the ketogenic diet, are either dangerous and/or unhealthy.

Within a few weeks of beginning my research I realized more than ever before that a good amount of my professional experience, especially in the realm of educating diabetic patients on healthy diets, was undermined by inaccurate and flawed data. I can’t say what I preached in terms of healthy eating was all wrong, but I personally feel that I could certainly have helped more of my patients and clients if I were willing to go against the conventional and standardized guidelines. I admit that, many of my pre-diabetic and Type 2 diabetic patients/clients could have benefited from a more stringent low carbohydrate eating style and I could have been the person advocating attempting such a change—along with supervision and guidance. Unfortunately, I can not go back and undo what was said or done over the span of my career, but what I can do is try to open the minds of whomever has any doubts or concerns about going ‘keto’.

After embarking on my own ‘keto’ journey, I feel even more convinced that, if you choose a much ‘cleaner’, more plant-based, and minimally processed version of ‘keto’, this not only can become a safe eating style, but one that has amazing and unexpected health benefits beyond weight loss. Since the age of 17, I have never been ‘overweight’, so weight loss wasn’t a reason for testing this diet on myself. I did it simply to experience what I read about and to be better able to offer personal advice to whoever needed it. For the past six-plus months since eating a ‘keto-style’ diet, I have been sleeping better (a top priority for me!), my ability to focus has improved, and whatever intermittent joint pain I might have experienced before starting this very low-carb diet, has completely disappeared. I am amazed that, in spite of my age, I am experiencing more energy. My two year-old Aussie is loving this part. Even though I was considered slim before I even heard of the ‘keto’ diet, I inadvertently have lost over five pounds and have not managed to gain it back—yet! Best of all, the slight post-menopausal abdominal ‘paunch’ is gone, which I thought was impossible without cosmetic surgery!

After taking this ‘guinea pig’ approach to personally testing out the ketogenic diet, I want to emphasize that this diet is not for everyone. However, unless you have a medical condition for which this type of eating style is contraindicated, I simply ask that, if you are interested in trying this out for yourself, you do as much research as you can on what this diet entails (the pros and cons, etc.), and invest the necessary time to learn what is involved in making this commitment. It truly is a commitment. It very well might work for you but it also could be that your body and ‘keto’ are not a good fit. While your strategy should be to achieve your health goals over the long term, the ketogenic diet can be used as a springboard to jump-start your goals.

Whatever the outcome, if you make the necessary preparations, including fortifying your mindset, at least you can say that you are willing to give it your best shot. I have no agenda for promoting the ketogenic eating style other than learning more about its effects on the body and mind over the long term. So far, I am hopeful that as I continue to age (as we all do), the beneficial impact of a very low carb diet will extend to the preservation of neurological (brain) health, as so many neurology specialists have alluded to in recent medical journals and research articles.

What this new ketogenic eating style has taught me—beyond learning about and experiencing its many health benefits—is just how important it is to have an open mind. What gives me hope that I am on the right track are the growing numbers of people from all walks of life—including health professionals—that are either strong proponents of low-carb diets, or are in a contemplative stage and reveal a willingness to accept what was once deemed preposterous. Maybe it takes giving it a try yourself to truly know the answer to the million dollar question re: what diet works best—and most importantly, the one that works best for you.

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Mary Paley

Fearless Dietitian; 30+ years as a professional dietitian; Master’s Degree in Nutrition and Dietetics at the MGH Institute of Health Professions; Lead research dietitian for several major pharmaceutical companies; Currently focused on health and wellness and the benefits of ketogenic diets for both obesity and diabetes management. MS, RDN, CDE, LD/N

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