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Clinical Dietitian’s Two Cents: Ketogenic Diet (Part I)

Is the Ketogenic or Keto Diet Recommended for Weight Loss?

Many people claim to have lost weight following the ketogenic diet. What is the ketogenic diet? Is it advisable for weight loss and improving health?

What is the Ketogenic Diet?

The ketogenic or keto diet is a high-fat, moderate-protein, low-carb diet not to be mistaken for high protein diet.

Carbohydrate is drastically reduced and replaced with fats. In 2 to 4 days, when the body runs out of fuel(glucose), protein and fats are broken down. This produces waste products called ketones, which accumulates in the body causing ketosis.


Food Allowed in the Ketogenic Diet:

  • Meat 

  • Fish & seafood

  • Eggs

  • Fats & oils

  • High-fat dairy (except milk)

  • Non-starchy vegetables

  • Nuts (lower carbs varieties)

  • Berries (limited amounts)

To put things into perspective, 5-10% of carbs based on 2000kcal is 25-50 grams per day.

1 avocado = 17g carbs

1 cup broccoli = 6g carbs

100ml coconut milk= 6g carbs

2 slices cheese = 4g carbs


How Does the Keto Diet Work for Weight Loss?

During the first few days with minimal carbohydrate intake, the body runs out of glucose.

Glycogen stored in muscles are then broken down. For every gram of glycogen, the muscles hold 3 grams of water!

Therefore, in the first week quite a bit of weight can be lost but, more likely water weight.

For this reason, the lost weight can also be quickly regained with the intake of carbohydrates. Glycogen (and water) restored.


Research on the Keto Diet & Weight Loss

Short term studies on ketogenic diet, very-low-calorie-ketogenic diet (VLCKD) and low-carb diet found more reduction in body weight compared to low-fat diet or conventional therapy.

However, the differences seem to disappear over time!

It is also worth mentioning, that in a meta-analysis of randomized controlled trails on VLCKD, all but one study had a mean carbohydrate intake of less than 50g at the end of the 12 to 24 months follow ups.


Keto for Weight Loss; Yay or Nay?

As research has shown…

In a short period of time, the ketogenic diet is more effective than other diets for weight loss.

At 12 months and above, there is no clinical significance in weight loss on a ketogenic diet compared to other diets.

The ketogenic diet was not sustained for even a year in most studies.

Long term studies on the efficacy of the ketogenic diet is limited, at most 12 to 24 months (where participants fall out of the ketogenic category).

Some other aspects to be considered:

  1. Limited food allowed

  2. Palatability of the diet

  3. Cost

  4. Side effects; both acute and long term

  5. Safety; current health condition & medications

  6. Your ultimate goal for weight loss


Dietitian's Notes: 

I believe that for most, the eventual goal for weight loss is HEALTH in a long run. There is not enough evidence yet for me to advocate the ketogenic diet for weight loss and ultimately improved health.


Written by, 

Dietitian Ivy Cheah


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