Forget the fat-free diet. One of the latest trending diets involves eating lots of high-fat foods and curbing carbs. Would you like to regularly eat bacon, butter, eggs and lamb shanks? Enter the ketogenic diet, or keto, for short.

This low-carb regimen has a reputation for being effective for weight loss, but registered dietitians like Kimberly Spatola at Novant Health Heart and Vascular Institute said it’s not a long-term, sustainable option for everyone.

What is the keto diet?

The keto diet is a high-fat diet built around meals that are 55% to 60% fat, around 30% to 35% protein and 10% carbohydrates from total daily calories.

To give you a benchmark, for those on a 2,000-calorie-per-day limit, Spatola said this would mean consuming around 123-133 grams of fat, 50 grams of carbohydrates and 150-175 grams protein.

Spatola mug
Kimberly Spatola, registered dietitian

For example, here’s a typical daily routine on a keto diet: Eggs cooked with coconut oil for breakfast, salmon and spinach cooked with olive oil for lunch, and grass-feed beef and asparagus cooked with avocado oil for dinner.

While this low-carb plan (some say it’s similar to the popular Atkins diet) can help people lose weight quickly, Spatola said it’s also an overly restrictive diet that can be hard to follow long-term.

How does it work?

The keto diet is built around severely curtailing consumption of carbs, which deprives the body of glucose, a main source of energy for all cells. The goal, Spatola said, is to achieve a metabolic state in the body known as “ketosis.”

When this happens, the body produces an alternative fuel called ketones that’s made from stored fat. As the body burns that fat, you start losing weight, assuming that you’re also watching your calorie intake. The time it takes for individuals to reach ketosis varies by person, Spatola said, but in general, it takes around two to four days or sometimes even a week.

Originally, the keto diet was developed in the 1920s by doctors who wanted to treat epilepsy in children to help prevent seizures. This method is still used today and is considered an option for some children with uncontrolled epilepsy.

There’s ongoing research on whether keto diets can also help patients with Type 2 diabetes manage their symptoms. Some early studies have shown that the keto diet could be an effective alternative that helps patients rely less on drugs.

The keto diet has been shown to create metabolic changes in the body that are helpful for those who are overweight, such as rapid weight loss, reduction in insulin resistance and reduction of blood triglyceride levels (a type of fat found in your blood).

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Is it right for you?

The best way to make a sustainable transformation is to make a lifestyle change rather than a short-term change of diet, Spatola said.

“There are a lot of factors behind weight gain, which include not just what we eat, but how we think and how active we are, so I always advise my clients that you can lose weight short-term on a diet but it’s really a lifestyle change that’s going to help prevent you from gaining that weight back,” she said.

Losing weight is a complex process for the body and goes much further than the simple “calorie in-calories out” model. If someone wants to lose weight, Spatola said that evaluating their stress, sleep, and activity level is just as important as their food choices. And if long-term weight loss is what you are seeking, making progressive small lifestyle changes overtime will be more effective than a short-term diet change.

The hard part about keto

Like any eating regimen, consider the pitfalls before jumping on the keto diet bandwagon. As Spatola pointed out, the diet is rigid and can be hard to stick with. For example, drastically reducing carb-intake can be challenging and can lead to discomfort, irritability, loss of libido, nausea and even vomiting.

Spatola also added that women who are pregnant, plan to become pregnant or plan on breastfeeding should avoid the diet. Those with gallbladder problems, kidney, live or heart diseases should also definitely consult with their provider before starting the diet.


Moderation is key

Radically restricting the kinds of food you eat over the long run is difficult to sustain. Moderation and consistent exercise have a far better chance of helping you achieve your goal, dietitians say.

“A lot of folks come to me and say that they want to get started on a keto diet after reading stuff online, but I always recommend that you get educated by a professional to see if it’s right for you or try a more balanced approach first ,” Spatola said. “I joke that the first few days on the keto diet you turn into a gremlin because it’s such a drastic change for your body.”

However, for the majority of people, cutting out major food groups is not sustainable long term. Spatola recommends working with a registered dietitian to find a more balanced approach.

"Do your research and don’t be afraid to consult a professional before delving into a plan that may not work for you," Spatola said. "Look at the big picture and set realistic goals that involve a lifestyle change, rather than a short-term diet alone."