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Written by Mikel Bryant, MS, RDN, CSOWM, LDN. Mikel is a registered dietitian at Mayo Clinic's campus in Jacksonville, Florida. She works in weight management and bariatric surgery.
Chances are, if you have followed anyone on social media, gone to a gym, or seen any “health” magazine at a grocery store, you have probably heard about the keto diet. You may have heard family members, friends, or even strangers who have tried it and touted the benefits of weight loss, increased satiety, and decreased hunger between meals. But what exactly does this diet entail? Is it truly as good as it sounds?
“Keto” is short for ketogenic, which is a process during which your body uses fat as its primary source of fuel, instead of carbohydrates. Calories on this diet primarily comes from sources of dietary fat, such as butter, oil, some nuts, and moderate amounts of protein-rich foods, such as meat, full-fat cheese, fish, and eggs. Aptly, the keto diet is a form of low-carb diet, which the Academy of Nutrition and Dietetics defines as consumption of less than 20-50 grams of carbohydrates per day. Given this extreme restriction, many find this diet hard to sustain, as it often requires omission of multiple foods including not only grains and legumes, but also most fruit, milk, yogurt, and many types of vegetables. As a result, there is expressed concern for deficiencies of certain micronutrients, including vitamin A, vitamin C, vitamin K, and folate, as well as dietary fiber.
Most research suggests notable outcomes in the first 2-3 weeks of starting the keto diet, with some studies suggesting benefit for as long as 6-12 months. Most people who have tried this diet report initial symptoms of bad breath, headaches, muscle cramps, nausea, and constipation, which can be collectively known as the “keto flu”. Long-term health risks remain unknown at this time. Some specialists recommend restricting the diet to 3-6 months, with a gradual progression to a Mediterranean or plant-based diet. Others recommend avoidance of any overly-restrictive diet or lifestyle change that may be unsustainable long-term.
If you are wondering whether or not to try this diet, it is highly recommended to first discuss this option with a registered dietitian and/or physician with a clinical specialty in nutrition. Populations for which this diet is contraindicated include persons with eating disorders, pancreatic disease, liver conditions, kidney disease, thyroid problems, gallbladder disease or those who have had their gallbladder removed, and any person with a fat-malabsorption disorder. Some initial studies suggest possible short-term benefit for individuals with neurological disorders, overweight, obesity, metabolic disorders, and diabetes; however, additional research is needed before a general recommendation can be made.
Pros:
- Possible short-term weight loss
- Increased awareness of food and nutrient intake
- Possible increased satiety and decreased hunger between meals
- Restrictive nature of diet usually encourages more home-cooked meals
Cons:
- Rapid weight loss might initially come from “water losses” and may not be indicative of true weight loss
- “Keto flu”
- Increased risk of kidney stones, liver disease, and micronutrient deficiencies
- Lack of fiber may lead to constipation
- Concern for long term outcomes of high-fat diets on cardiovascular health
- Lack of research suggesting long term health benefit
- Difficult to sustain restrictive diet, which may lead to weight regain
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@lagiaconda
Thank you for sharing. I don’t have PD and I don’t have any expertise. I am a stage 4 cancer survivor who has always had a lay person’s interest in diet and in the conflicting expert opinions around what diet is best for different people.
I have never tried being a vegetarian let alone a strict vegan.
I have used the keto diet a few times but find it socially isolating, difficult and limiting to remain in ketosis and I simply don’t feel good on it. (I did lose a lot of weight on it but weight loss for me was not enough).
After trying various promoted nutrition options I have personally landed on the Mediterranean diet - but my interest remains.
Thanks to you I looked up on the internet last night Dr Mischley’s recommended diet for PD and was particularly interested in a strong debate between health experts and people with PD. A variety of opinions.
Thank you for the information - albeit not for me.
thanks for saying what I was about to say. I am waiting for a response to come from the Mayo Clinic because I too know that Keto is not a NEW FAD or a Johnny Come Lately diet craze. I've only been doing it for nearly 3 months and I'm close to my lowest weight now in decades. The only thing I'm wondering about is how much of my almost 10 lb weight loss is water and how much is actual fat? I don't know my stats from when I started (i.e. fat to lean body mass) so I'm not sure I'll ever know. My clothes DO fit a little looser but not as much as I'd think with 10 lbs of weight loss if it had all been fat or even mostly fat. BUT I am tracking METICULOUSLY my macros and while I haven't bought a breath or blood test kit I feel that I MUST be in ketosis because of the strict way that I am meeting my macro goals daily for the past 84 days. Caveat: I'm 5'3 1/4 - an inch and a quarter less than I used to be. So perhaps my current weight of 127 (starting weight on keto was a136.7) isn't showing much change in how my clothes fit because of the water weight lost? IDK. I didn't have much weight to lose but what I DID have and still do to some degree is a lot of GUT weight which I never had before. It's shrunk a lot. BUT there's still a good layer of fat that hasn't disolved yet.
But I do feel like I have more energy and more brain clarity. I'll be 75 in a few days and I'm a member of a djembe drumming group (and in the elite portion of that 50 member orchestra of drummers after only 3 years). I also created our facebook group and I create all of our marketing content including flyers, posters, and recently (like the past 2 months) I'm teaching myself 3 different software progams that allow me to download our videos from our director's youtube channel, then extract the audio track and attach that to a flat image that then becomes a "video" lasting as long as the audio track and I'm using another program to add effects to that and posting them as REELS on Facebook Instagram and TikTok. So my brain is working like it did 30 years ago!
What I wonder, though, is how it's affecting my kidneys and liver. I'm unconcerned about my lipid panel because I've never had any issue with high cholesterol and the things I'm reading lately about the fallacy of high cholesterol being villainized are making me wish that there was a lot more transparency in our medical system. I fear that given the stronghold of BIG PHARMA on our healthcare, we may never know the truth about so many things.
I highly recommend the book A STATIN NATION by UK doctor Malcomlm Kendrick. He discusses low carb high fat and all the fallacies around cholesterol and how studies are skewed and how their not even correctly peer reviewed any longer because the reviewers aren't given the raw data to analyze...but simply a SUMMARY of the results.
It is hard to know, as you stated what is water weight and what is actual fat mass without bioelectric impedance measurements before and after the weight loss. I am happy to hear you are having more energy and brain clarity. As stated before, with any diet pattern for weight loss, the best option is what is going to be sustainable for you in the long-term. Regarding your kidney and liver health, your primary care doctor can order labs to evaluate the function of these organs. Proper hydration of at least 64 fluid ounces per day and monounsaturated fats such as olive oil, nuts/seeds and avocado are best for liver and kidney health.