Keto Krazy

by Holley Nash, RDN, LD

Is this new Low Carb Craze all it’s cracked up to be?

So often we learn about the newest diet craze from our friends, family members, and coworkers. People talk about how the latest diet fad improves metabolism and burns fat without effort, and recount a few people they know who have lost tons of weight thanks to this magic bullet. We listen patiently knowing that, as with any restrictive diet, the backlash will eventually hit. So it seems to have come to pass with this latest diet craze, the Ketogenic Diet, also known as the Keto Diet.

The “Keto diet” is the newest addition to the low carbohydrate diet fad, (think Atkin’s diet 2.0). This time, followers are required to severely limit their carbohydrate intake and to replace carbs with high fat foods like butter, coconut oil, avocado and cheese. People also get to eat high fat red meat, bacon, sausage, and fried food without guilt, and of course tons of veggies and fruit, all with the promise of losing weight. Well, we only need to look into the recent past (Atkins, South Beach, low-carb diets) to see that that many people did lose considerable amounts of weight, albeit in the short term, to have only gained it back and then some. So the question is, is this diet sustainable?

How about some History?

The ketogenic diet was originally designed as a medically assisted therapy to help patients control their epileptic seizures. In the 1920s, researchers noticed that fasting lowered the occurrences of seizures, so they began using a high-fat, protein/calorie restricted diet as the medical treatment for epilepsy. This medical diet was used almost exclusively until the late 1930s, when anti-seizure medications became available. The ketogenic diet continues to be used as medical nutrition therapy for children who do not respond well to anti-seizure medications, but because of the high potential for vitamin and mineral deficiencies, patients must be closely followed by a registered dietitian nutritionist throughout the course of their treatment. Furthermore, they are not permitted to remain on the diet indefinitely, due to the inherent health risks associated with severe carbohydrate restriction.

To clarify, a healthful diet requires a balanced daily intake of macronutrients (carbs, protein, fat), in a ratio that resembles 10-20% lean protein, 25-35% healthy fats and 55-65% carbohydrates, depending on the individual and their specific lifestyle needs. Hence the importance of meeting with a registered dietitian nutritionist to help determine your individual needs. The ketogenic diet, on the other hand, restricts carbohydrate intake to a mere 5%, thereby starving the body of its main source of energy and fuel. Inevitably, this tricks the body into losing weight short-term - and, voila! The newest weight loss craze is born. Unfortunately, as with any highly restrictive diet, there are unpleasant consequences that need to be considered.

And Then There’s Reality:

Last month, two well-reputed long-term studies were published, each linking low carbohydrate diets to higher rates of death from all causes. The first study was published in the Lancet, which is one of the world’s oldest and most prestigious peer reviewed medical journals. Dr. Sara Seidelmann, a cardiologist and nutrition researcher at Brigham and Women’s Hospital in Boston, led the study. For this study, Dr. Seidelmann and her team analyzed the diets of 15,400 adults in the US, and an additional 432,000 people in over 20 countries worldwide. The researchers compared the amount of carbohydrates each of these subjects typically consumed to how long the individual lived. They found an increased death rate in the groups that typically consumed either a high carbohydrate (+70% kcal) or low carbohydrate diet (-40% kcal). Those who lived the longest were the ones who consumed right at 55% of their calories from carbohydrates. Further, and not surprisingly, the individuals who followed a low carbohydrate diet, but increased consumption of animal protein and fat, (can you say, “Keto”?) were associated with higher mortality. So, what’s the answer? According to Seidelmann and her colleagues, the answer is the same as what your registered dietitian nutritionist tells you: 55-65% of calories from carbohydrates; favor plant-derived proteins and fats; and be sure to include sources such as vegetables, nuts, peanut butter, low-fat dairy, and whole-grain breads.

The second study, led by Professor Maciej Banach, of the Medical University of Lodz, Poland was presented at the European Society of Cardiology Congress 2018 in Munich, Germany. In this study, researchers examined the self-reported diets of 24,825 participants of the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. The research scientists were looking for the relationship between low carbohydrate diets and deaths from all causes. They further explored the relationship between low carbohydrate intake and deaths from specific causes like coronary heart disease, cerebrovascular disease (including stroke), and cancer. What they found was that people who followed carbohydrate restricted diets had a 32% increased risk of death from any cause than those who consumed a high carb diet. In addition, low-carb diets resulted in a 51% increased risk of death from coronary heart disease and a 35% increased risk of dying from cancer, when compared to those who ate a higher carbohydrate diet.

In an interview following the presentation of his study, Professor Banach was quoted as saying, “Low carbohydrate diets might be useful in the short term to lose weight, lower blood pressure, and improve blood glucose control, but our study suggests that in the long-term they are linked with an increased risk of death from any cause, and deaths due to cardiovascular disease, cerebrovascular disease, and cancer.” He further concluded that, based upon their study’s findingsthere is an unfavorable association between low carbohydrate diets and all cause death; therefore, low carbohydrate diets are unsafe and should be avoided.

The reality is that any restrictive diet will help take weight off short term, which is why there are so many fad diets out there. But, if successful weight loss and long-term weight maintenance is your goal, working with a registered dietitian nutritionist is always the best and safest option. Call us for an appointment at 678-568-4717, or click here to make an appointment directly on our website, and let’s work together to find a healthier relationship with food for your wellness.


Banach, M. (2018, August 28). Low carbohydrate diets are unsafe and should be avoided[Press release]. Retrieved from

Breuck, H. (2018, August 17). Amount of carbs to eat for a long life. Retrieved September 5, 2018, from Business Insider website:

Brueck, H. (2018, August 29). Low carb diets linked to higher risk of death. Retrieved September 5, 2018, from Business Insider website:

Seidelmann, S. B., Claggett, B., Cheng, S., Henglin, M., Shah, A., Steffen, L. M., . . . Solomon, S. D. (2018). Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health, 1-10.