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February 7, 2023

The Keto Diet: Its History and What You Need to Know

by Karen Buynak, MS, RDN, LDN

You’ve heard of the Keto Diet, you’ve seen it on Instagram, or you’ve seen Keto-friendly recipes on Pinterest. But, what is it, and does it work? Karen Buynak, Avance Care Registered Dietitian, is breaking down what the keto diet is, its surprising history, and what you need to know about it.

What is a Keto Diet?

To put it simply, the keto diet is a diet plan that emphasizes consuming high amounts of dietary fats, low-to-moderate amounts of protein, and low to no amounts of carbohydrates.

The standard ketogenic diet allows for only 10% of the diet to come from carbohydrate sources. For the average American diet, this would mean having no more than 200 calories come from carbohydrate sources, and yes- this does include fruits and vegetables.

The current recommendations from USDA’s Dietary Guidelines for Americans suggest that for optimal nutrition, our meals should consist of 45-65% of carbohydrates. Eating a diet that is made of only 10% carbohydrate sources is a significant restriction.

The idea behind the keto diet is to get your body into a state of ketosis, mimicking a fasted state. Ketosis is when the body is using mostly fat as its energy source in the form of ketones. Since our body’s preferred source of energy is carbohydrates (glucose), when we limit or severely restrict our body’s access to dietary carbohydrates, we start to use other sources of stored energy. Instead of using carbohydrates and sugar as our main fuel source, we switch to using bodily stores of fat as energy since there is no longer a source of glucose coming in the body.

Because the brain requires glucose as its energy source, we must convert ketones into glucose without dietary sources of carbohydrate coming into the body; a process which takes a lot of metabolic energy, thus resulting in weight loss.

Why is it so popular?

The keto diet has been around for years- but you may have heard of it by another name. It’s basically a rebranded version of the Atkins diet which was popularized in the 1970s-1990s. If you’ve ever heard of a low-carb diet, a high-fat diet, or even a carnivore diet, they all have similar characteristics; so the keto diet is in no way a new trend.

Many celebrities and social media fitness influencers have endorsed the keto diet and its claims of quick weight loss recently, which is why there has been a surge in its popularity in the last 5 years.

Its Surprising Origin Story

The idea that fasting could be used to remedy health issues is something that has long been observed in history; dating back to Ancient Greek and Ancient Indian doctors using fasting as a solution to cure illness. Throughout history, there has been a curiosity about the health implications of remaining in a fasted state. In the early 1900s, the idea of fasting to promote health outcomes was again widely popularized, and then published into the scientific and medical fields. Researchers grew curious to learn more about any potential health benefits of remaining in a state of starvation.

It may surprise you to know that the keto diet was originally created with the intention of treating epilepsy in children, with the goal of reducing seizures and other symptoms of the disease.

In 1921, the Mayo Clinic ran the first clinical trial on the keto diet; studying the effects it had on epileptic children. The results of their research suggest promising results for reducing seizures and easing other symptoms of the disease when entering a state of ketosis.

Once pharmacologic advances in epilepsy management started showing success, the keto diet slowly disappeared from the therapeutic scene; as it was much harder for patients to stick to the diet lifestyle than it was to take medication.

Researchers continued to focus on the role of ketones as a long-term energy source in the 1960s and 1970s, and this is when the Atkins diet was created by cardiologist Robert Atkins. With the intention of burning fat as a preferred fuel source for the body, the Atkins diet took off as a solution for weight loss.

Does it Work?

Similar to any diet or lifestyle change, there are always pros and cons to weigh. Researchers have found that people can lose weight by following the keto diet for 2-6 months, but after this, weight loss will likely plateau.

Keto dieters have enjoyed various aspects of the diet, largely feeling unrestricted by calories- which is unique to many diet plans. There is also a higher satisfaction with available food choices, as there is no push to eat low-fat or fat-free diet branded products. Dieters can enjoy the full range of dairy and meat products without feeling like they have to compromise taste for calories.

Athletes have also found that following a strict keto diet is helpful for quick weight loss and fat burning. This may be helpful to body builders or athletes who participate in sports based on weight classes.

There are some important items to consider when we look beyond weight loss, however. Sudden and drastic changes to our diet patterns and body weight can be detrimental to our metabolism overtime.

By following keto and eating outside of the “normal” distribution of macronutrients, we are changing the way our body is sourcing and using energy. We are manipulating our diet to make our metabolic pathways work in a manner that they are not intended to. The ketogenic change in our natural and default energy source creates undo stress on our metabolism and hormones. This explains why researchers have linked the ketogenic diet to increased risk for developing disease.

Researchers have found that staying within the strict guidelines of the keto diet can be linked to liver, kidney, and gallbladder problems- as these organs play a vital role in digestion and absorption of different macronutrients. Eating a diet very high in fat can cause undo stress on our digestive system and hormones. Additionally, people who have followed the keto diet have a greater chance of developing high cholesterol and other cardiovascular diseases. Another risk to consider is the lack of dietary fiber within the keto diet,  since fiber is uniquely found in carbohydrates. Without proper supplementation, this could lead to constipation and GI discomfort.

Any type of diet plan where we are restricting intake of major nutrients and food groups can lead to disordered eating behaviors and episodes of binge eating. When dieters feel limited and restrained by the tough confinements of the keto diet, this can lead to feeling a loss of control, anxiety, and a lowered self-esteem. Since the diet is almost impossible to sustain for a lifetime, people often gain the weight back and view themselves as a failure, rather than viewing the diet as a failure.

What’s the Bottom Line?

Many people try keto and find success with the program as a fast-paced way to drop weight. However, it is also important to weigh the associated health risks and sustainability of the diet. Every person’s journey with keto is unique and individualized, but we need to consider eating patterns long-term in order to achieve long-term and lasting weight loss. If significantly restricting carbohydrates is not something you believe you can do long-term, the keto diet may not be your best answer.

You should work with a registered dietitian for best results on achieving your health and nutrition goals, where together, you will create a plan that is individualized to meet your lifestyle. Avance Care has a handful of dietitians- all with diverse backgrounds and interests- who are ready to help you achieve your goals.

Call 919.237.1337 (option 4) or visit our nutrition page on our website to find nutrition resources and schedule an appointment in-office or virtually.


The Pros and Cons of a Keto Diet

History of the Ketogenic Diet

Podcast: The Maintenance Phase- The Keto Diet

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