A dietitian's Blunt Truth: The Ketogenic Diet & Weight Loss

Updated: Nov 26, 2019

Ketogenic diet and weight loss

The ketogenic diet is low carbohydrate, moderate protein, and high fat diet and currently the latest weight loss diet craze. Protein is kept moderate (1.0 g/ kg body weight), includes 10-15 g total carbohydrates/day and the rest of the calories come from fat (Roehl & Sewak, 2017). The idea behind it is to be better for weight loss because it puts the body into ketosis to be able to maintain muscle mass better and burn fat for weight loss by mimicking a state of starvation. In a state of starvation, fat is broken down for energy instead of glucose stored in the muscle as its energy source. The ketogenic diet has to be calculated and followed exactly to ensure enough nutrient intake to prevent malnutrition caused by starvation. Ketosis is also supposed to help keep hunger at a minimal. Sounds too good to be true, right?


The ketogenic diet was developed for children and adults who have epilepsy who have not been responding to anti-seizure medications. Even then, the ketogenic diet as a medical nutrition therapy is not intended to be followed long term because it is considered a last resort treatment effort. This special diet was conceptualized in 1921 at the Rush Medical College in Chicago along with Mayo Clinic for the treatment of seizures in efforts to achieve ketosis without causing malnutrition that happens with long-term starvation (Roehl & Sewak, 2017).

Example menu for Classic Ketogenic Diet

Breakfast: Egg Scramble. Prepared with melted butter in frying pan, scrambled together on medium heat

Lunch: Cobb Salad. Prepared by tossing all salad ingredients together in a bowl, top with olive oil and red wine vinegar

Dinner: Chicken and Zucchini "pasta"

Snack: Celery and Cream Cheese

(Diet modified from Roehl & Sewak, 2017).

The risks of following the ketogenic diet are vitamin and mineral deficiencies and increased grogginess to start. Because the ketogenic diet is also high in saturated fats, it is possible that following that nutrition plan will increase your LDL (low-density lipoprotein aka "lethal") cholesterol levels and decrease your HDL (high density lipoprotein aka "healthy") cholesterol levels. Researchers report improvements in heart risk factors and management of type 2 diabetes when following low-carbohydrate diets; however, insufficiency quality research has been done on the effects of a low-carbohydrate, high-fat diet on cardiovascular health (Roehl & Sewak, 2017)

Vitamin and mineral deficiencies at risk in the ketogenic diet include folic acid, vitamin C, calcium, thiamine, *** A multivitamin is a must when following the ketogenic diet. Keep in mind that some supplements have carbohydrates added to them to make the tablet/ capsule form.

Another problem with diets that cut out food groups- like the ketogenic diet- is that they are often difficult to follow long term. In order for weight loss to be successful and lasting, the nutrition plan that you begin to follow for weight loss is the one that you'll have to continue.

"In order to keep what you have, you have to keep doing what you're doing."

Be honest with yourself, are you really never going to have another potato, corn on the cob nor piece of birthday cake ever again? Probably not. Stricter diets like these are harder to follow because they have unreasonable expectations. When we do poorly on a weight loss attempt, there's a sense of "cheating" and "failure." We believe what we are doing is wrong. We feel like we are wrong. We feel defeated and just want to give up the whole thing. We revert to poorer eating habits we might have had before and weight regain ensues. It's a vicious cycle of high hopes for success, even higher expectations of ourselves, slip ups and feeling like failures.

Set yourself up for success. Be real and be honest with yourself of what you can and are willing to do. Harsh honesty says "you are not perfect." Being kind with yourself says "I do not need to be perfect. I just want to be better." A successful diet is one that you can stick to for life. As a registered dietitian, I recommend a well-balanced diet that includes a variety of foods- lean protein, fruits, vegetables, whole grains, starchy vegetables, low-fat dairy, and heart-healthy fats. I also encourage planning for a little wiggle room for special occasion foods and drinks. The best diets for weight loss are lower calorie plans that you can stick to for life.


Roehl, K., & Sewak, S. L. (2017, Aug). Practice Paper of the Academy of Nutrition and Dietetics: Classic and Modified Ketogenic Diets for Treatment of Epilepsy. Journal of the Academy of Nutrition and Dietetics, 117(8), 1279-1292.

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