Fort Berthold Diabetes Program

Keto (Ketogenic) Diet Q & A

By Shelby Stein, RDN, LRD – Community Dietitian


Q. I heard the keto diet can help me lose weight, control my blood sugars, and improve my health. What exactly is the keto diet? 

A.  A keto diet is high in fat, moderate in protein, and very low in carbohydrates. Ketogenic diets were originally developed to help treat severe epilepsy in children and have been used in this application since the 1920s. This diet is designed to put the body in a state of ketosis, where it is forced to use a different type of fuel for energy. Normally, our bodies prefer to use glucose (sugar) for energy but when the body is in ketosis it relies on ketones for energy. Ketones are produced by the liver from stored fat and are what supply the brain, muscles, and organs with fuel when in ketosis. Burning fat for energy seems like a great way to lose weight however getting the liver to make ketone bodies is difficult – it requires that you consume very little carbohydrates, eating too much protein will inhibit ketosis (if needed, the body can make glucose from protein to be used for energy), and it typically takes a few days up to a week for the body to get into ketosis. 

Q. What do you eat on the keto diet?

A. As the keto diet is now mainstream and remains popular as a method of weight loss in 2021, there are a variety of “keto diets” out there, all with varying guidelines. However, in order to actually be in ketosis, a strict diet must be followed. For a true ketogenic diet, approximately 75-85% of calories come from fat, 10-15% from protein, and 5-10% from carbohydrates. If the plan contains more protein or carbohydrates than this, it is not a keto diet rather it is a low carbohydrate diet. For a 1,800 calorie diet, this looks like 150-170 grams fat, 45-68 grams protein, and 23-45 grams of net carbohydrates per day. Net carbohydrates are the carbohydrates contained in a food when you subtract the grams of fiber from the grams of carbohydrates i.e. ½ cup of black beans contains 20 grams of carbs and 8 grams of fiber, therefore has 12 grams net carbohydrates. For reference, if you ate 2 eggs and 2 slices of bacon for breakfast and then had a ¼ pound burger with 1 slice of cheese, you would consume 47 grams of protein. So, protein intake on a keto diet is actually much lower than what most people think. The keto diet restricts what you can eat – below are some examples (not an inclusive list) of what foods would be included on a keto diet: 

FAT: the largest portion of a keto diet. Butter*, heavy cream*, lard*, coconut oil*, olive oil, canola oil, avocados, avocado oil, flax seed oil, nuts (almonds, walnuts, etc.), seeds (flax, chia, hemp). 

PROTEIN: eggs, chicken, fish, beef, pork, cheese, tofu. Smaller portions of black soybeans and lupini beans. 

CARBOHYDRATES: generally limited to 20 to 50 grams of net carbohydrates* per day (for comparison, one medium apple contains 25 grams of carbohydrates). All carbohydrate sources (bread, cereal, rice, pasta, beans, candy, sweets, chips, crackers, etc.) are restricted. Fruit is often limited to small portions of berries and vegetables are limited to leafy greens, broccoli, bell peppers, onions, mushrooms, celery, cucumbers, zucchini, Brussels sprouts, and cauliflower. 

*Contain high amounts of saturated fats, which are not health promoting for the heart when consumed in excess. 

Q. What are the benefits of the keto diet?

A. Ketogenic diets can help control seizures in individuals with severe epilepsy. Keto diets have been shown to be effective for short-term weight loss however at this time there is limited research on the long-term benefits. 

Q. What are the risks of the keto diet?

A. When used for a short period of time (less than a few months) the keto diet is probably safe but at this time the effects of following a keto diet for an indefinite period of time are not known. The keto diet may put you at risk for nutrient deficiencies – fiber, calcium, B vitamins, selenium, magnesium, and potassium. As the diet can limit high fiber foods, the keto diet increases risk of constipation. Some of the common foods consumed on a keto diet, butter, full fat dairy, and high fat meats are associated with increased cardiovascular disease risk. If you have a liver condition, a keto diet could make it worse. Lastly, because the keto diet is restrictive, it can easily become obsessive and lead to disordered eating – it limits healthy foods and doesn’t promote a healthy relationship with food. A restrictive diet is hard to stick to and often times once you resume a “normal” diet, the weight lost is regained. 

Q. Should I try the keto diet?

A. The keto diet can be an effective weight loss strategy when done appropriately and for a limited period of time. To increase the nutrient content on a keto diet, aim to consume many plant foods, such as avocados and olive oil instead of high quantities of butter and lard as part of your keto diet plan. Generally, if used, the keto diet is recommended for a few weeks to a few months and then to transition to a healthy, less restrictive diet, such as the Mediterranean diet or DASH Diet (both of which focus on lots of fruits and vegetables, lean proteins, and healthy carbohydrate sources) combined with regular exercise to promote continued weight loss. The best diet or way of eating is what you will stick to long-term and will enjoy! If you have diabetes or any other health conditions, please consult your doctor and a registered dietitian before trying the keto diet. If you decide to try the keto diet, please work closely with a registered dietitian who can help you utilize the keto diet in a healthful way. 

If you’d like to set up an appointment with a registered dietitian for support in your nutrition and health goals, for assistance in planning a healthy diet, or for additional questions or assistance on the keto diet, please give the Diabetes Program a call at 701-627-7931!