editor’s note: a piece we published in early august, about a study that highlighted the risks of the ketogenic diet, was wildly popular but also wildly controversial. we received a ton of mail from readers rebuking the study and letting us know about their positive experiences with the diet. so we called in andy de santis, a registered dietitian, to give us his informed opinion on the keto diet.
i want to say, first of all, that i do not generally support the ketogenic diet. for the vast majority of people, it isn’t a truly sustainable approach to eating.but i do understand that there are a number of people — including those who vigorously responded to the previous piece, apparently — who benefitted from the rigid parameters of this style of eating. if you fall into this category, i respect your positive experiences and don’t necessarily intend to dissuade you from that path.i’ll also admit that there’s a growing body of evidence that supports the use of the keto diet to improve health outcomes in some specific contexts, not dissimilar to claims we might make about a vegan or vegetarian diet — which is also restrictive and omits a number of foods, although for different reasons.essentially, when we’re being honest about it, there are both good things and bad things about keto. the internet is full of contradictory information about how to eat healthily, and that can lead to a lot of confusion. like a lot of nutritional information, the truth is nuanced.here are some of the things about keto that are often misunderstood, but important to keep in mind:
keto can look very different for different people
like veganism, keto is an umbrella term that encompasses drastically different styles of eating. i could theoretically eat avocado, sardines and spinach all day and be doing keto. that would be a healthy choice: i’d be eating large amounts of potassium, monounsaturated fat, omega-3 fatty acids and tons of fibre and antioxidants, which we all know to improve health outcomes.
on the other hand, i could be doing keto by eating nothing but cheese and ground meat. there’s nothing wrong with either of these foods, but if they were all i ate, i’d be exposed to a good amount of saturated fat and sodium but not much else.most people probably fall somewhere between these two extremes, but there’s a ton of variation within this one diet.
keto might mean cutting out some unhealthy foods, but eating more of other ones
foods made with refined flour like baked goods, desserts and certain kinds of breads are untenable on a ketogenic diet due to their carbohydrate content. (there are low-carb or card-free alternative that would be allowed, though.) i won’t argue that eating fewer foods made from refined flour is probably a healthy choice. but on the other side of things, foods like processed meats could become more prominent on a ketogenic diet. salami, sausage, and hot dogs, which are are associated with an increased risk of colorectal cancer, may seem more appealing on a diet where many other foods are unavailable. when so many kinds of foods are forbidden, the unhealthy ones that
are allowed might be consumed in excess.
restriction is hard to maintain
if you’re a person who finds keto enjoyable and sustainable, great. but you have to understand that that’s not the case for everyone: the broader population will probably struggle to omit half of the foods available to them, many of which they truly enjoy.strict diets can take the joy out of eating, and are often very hard to maintain on a permanent basis. there are potential ethical, environmental and mental health issues that arise if we buy into the notion that health necessarily means cutting out a good 50 per cent of the food we have access to.some of my clients, for example, are burdened mentally by the lingering notion that the ketogenic diet is the best path forward for their health. they might feel guilty or ashamed if they can’t stick to it, but the reality is it’s very difficult for most people to stick to. just because they read online or heard from their friends that keto is the best diet doesn’t mean it will work for them.
keto is a bargain that may not be the best long-term choice
i see the keto diet is as a bargain.essentially, when you go keto, you’re at least partially betting on the fact that perpetual ketosis is better for your health than eating any meaningful amount of the wide array of healthful carbohydrate-containing foods and enjoying their benefits. the sustainability aspect aside, the idea that ketosis is more beneficial to our bodies in the long-term than getting nutrition from those restricted foods is my biggest area of concern.the keto diet, if strictly adhered, forbids foods that are really high in desirable components such as antioxidants and fibre, including all kind of fruit, legumes (lentils, chickpeas), whole grains (oatmeal, brown rice, quinoa) and starchy vegetables, especially squash and sweet potatoes. (did you know, for example, the purple sweet potato is a dietary staple in the region of the world — okinawa, japan — where people live the longest?) there’s a high degree of scientific evidence that these foods have positive health outcomes when it comes to reducing the risk of cancer, heart disease and type 2
diabetes.those are my general thoughts on keto: it can work for some people, but it’s definitely not a diet i advocate for on a broad basis.i hope you feel more informed now — i’m sure the emails to my editor that follow will let me know whether or not i’ve succeeded.
andy is a registered dietitian and author who has operated a private practice in toronto since 2015. he spends his free time eating, writing and talking about kale @andytherd. he can be reached at andytherd.com
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