There is a huge keto diet following on the internet and on instagram, there are lots of people promoting this as the holy grail of diets with lots of very appealing before and after photos.  But is it really the best diet ever?

A true Ketogenic diet is really, really hard.  In reality many people who say they are on a ketogenic diet are not lowering carbohydrates enough to push their bodies into ketosis.  You need to reduce your carbohydrates to around 5% of your total energy intake per day for at least 3-4 days, so that you use up most of the body’s store of carbohydrate.  Only then will your body just be using fat for energy and create the ketones that give this diet its name.  When someone is in ketosis there can be a sweet pear drop like smell on their breath, it is ketones that we can smell.

A ketogenic diet will result in weight loss, and due to the high protein, fat is lost rather than protein (muscle mass).  Weight loss can be quite fast too.  Sounds great. But is it?

In reality, the weight is lost because eating this way is really restrictive, it is hard to eat enough calories and it automatically cuts out many of the high calorie, low nutrient snacks that make weight management difficult. Most restrictive diet plans will lose weight if you can stick to them.

There are downsides to the ketogenic diet:

• Many people struggle with tiredness, headaches, low mood and other side effects.
• It is impossible to eat the recommended amount of fibre on a ketogenic and lack of fibre is not good for the health of our friendly gut bacteria and can cause constipation.
• Eating whole grains and less refined carbohydrate foods also give us a range of micronutrients important to health.
• Generally, studies show that when the diet is stopped, weight regain can be pretty rapid.

Successful weight management is sustaining a steady weight and remaining healthy, it is not simply about how much or how quickly weight is lost.  The number on the scales is not always a reflection of good health, we should always put health at the centre of any weight management plan.  Changing our behaviours to be more healthy gives benefits even if the weight is being stubborn, slow steady improvements in weight will be more sustainable and more likely to give us health benefits.  Generally speaking, the more quickly the weight is lost or the more restrictive the diet, the more quickly weight is regained.

Of course there will be people out there who have never felt better and have maintained the weight loss.  It doesn’t automatically mean that it is right for you or that it is the best, healthiest option.  Every body is different.

A more gentle and balanced approach is to increase protein and lower carbs moderately (to around 40% rather than 5% of energy) and this can be helpful for many people.  Choose less refined carbohydrates that are higher in fibre.

Protein and fibre helps to make us feel fuller for longer, we feel satisfied sooner and are less likely to snack later.  It is much less restrictive so doesn’t have the downsides that a true ketogenic diet can have.

Weight loss will be slower but the diet is more balanced.  By maintaining a good intake of protein rich foods and continuing to choose wholegrains and less refined carbohydrate foods, it is easier to maintain weight afterwards.

It is really important to remember that anyone with diabetes  should not try a ketogenic diet without talking to a medical professional.

Ketosis occurs in diabetes when blood sugar falls too low, but can continue into ketoacidosis which can lead to coma and be fatal!  While some people with diabetes help to manage their condition by limiting carbohydrates, it should be done with the help of a qualified health professional.  Every person is different.

The ketogenic diet is used under careful supervision by dietitians to help children who have epilepsy and are not responding to treatment.

But the Ketogenic diet DOES NOT cure cancer!! Despite what you may have read.  And because it is such a restrictive diet can actually be much worse for a cancer patient’s outcomes and quality of life.  So please help stop that rumour.  Dietitians working with cancer patients will thank you.