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As a dietitian, my patients ask about a wide variety of diets. One plan has dominated the inquiries lately: the ketogenic diet. Since I’ve never put a patient on a diet I haven’t tried myself, I knew I needed to experience it personally. I dove in for 30 days with two carb-loving feet — and a combination of trepidation and motivation.
Since I began the experiment in October 2017, interest in keto has grown. At the same time, recent studies have questioned the health benefits of very low, as well as very high, carbohydrate diets. I've learned a lot from my experiment.
Here’s how it went:
Saying goodbye to carbs and making fat a way of life
The ketogenic diet allows about 70 to 80 percent fat, about 5 percent carbohydrates (which equates to about 25 digestible, or net carbs, which are calculated by subtracting fiber from total carbohydrates), and moderate amounts of protein.
I recently wrote about a cancer specialist who not only adheres to the diet himself, but also feels it’s the right plan for the prevention, and perhaps even treatment of disease. I detailed his keto dietary practices in an earlier article.
What can you eat on the keto diet?
During week one, it was the drastic cut of carbohydrates that left me really hungry.
I soon realized keeping carbohydrates under 25 net carbs meant eating no “traditional” carbs at all. My tiny amount was being filled from non-carbohydrate sources, like:
- tree nuts — 2 grams for ½ cup of macadamia nuts
- vegetables —4 grams for a cup of broccoli
- my daily snack of pure coconut chips, 5 grams for a 1-ounce serving
Breakfast consisted of eggs, but not too many egg whites since that would increase my protein too much. I snacked a lot on dried cheese — particularly useful when traveling — and nuts. Lunch comprised of salads with lots of dressing and avocado.
Dinner was often wild salmon with broccoli, kale, or spinach — usually roasted to factor in any missing fat I needed for the day. As for dessert, forget about it, unless I was up for a tablespoon of olive oil as a midnight snack. I did find a few no-added-sugar coconut bars I liked, but in general, it was best to skip any after-dinner eats.
Keto diet side effects: The ‘Keto Flu’
Consistent with the books I read, the keto “flu” hit as my body got adjusted to the lack of a constant glucose supply, and transitioned into burning fat instead. During this time, I was tired, had crazy sugar cravings and was generally mean to my poor husband. At one point, during a heated discussion about dog food, he suggested, in a very loving and compassionate manner, that perhaps I eat a piece of bread.
It was a rough start. And then, it wasn’t.
The cloud lifted.
I went from irritable and “hangry” to feeling great. A quick check of my urine using my ketone at-home stick kit revealed I was on my way down the ketosis highway and I was euphoric.
Before I started the diet, I thought my greatest challenge would be getting the recommended amount of fat, while taking in so little carbs. I was wrong. Those two macronutrients became the easiest to manage.
Instead, keeping my protein under control proved to be the greatest threat to knocking me out of ketosis. I soon realized why every keto book I read had multiple uses and recipes for coconut oil, egg yolks, and bacon. These foods were high in fat, but relatively moderate in protein.
This continues to be a challenge for me and most likely would have taken more than 30 days to figure out. I also had a nasty bout of constipation as my body transitioned away from the whole grain and bean-based fiber that kept me regular. I had to really up the ante with the non-starchy vegetables to get what I needed.
Perhaps my greatest challenge was eating while traveling. On a business trip, I found myself at an event with a plated dinner that I could not eat due to its mound of quinoa sitting under a protein source I was allergic to. I left starving and binged on pecans and tofu jerky back at my hotel room. I realized success in sticking to this diet would always be made easier the more control I had of my environment.
Just as the holidays can derail even the healthiest diets, a lack of planning in a ketogenic diet could be the kiss of death. Finally, I read about the bad breath often accompanied with ketosis. I didn’t feel this impacted me. If it did, no one told me!
My diet officially started just before Halloween — a holiday that's traditionally free reign for me to steal candy from my own children’s loot. Four candy-laden parties led up to the actual trick-or-treating, each of them abundant with carbohydrate sources. I had none of it. It felt both amazing and empowering. Even during the tough few days, I realized I could give up all sugar and be just fine. Perhaps this was one of the greatest results of trying the diet.
The other surprising impact was my complete lack of hunger. I knew fat fills you up. However, I was surprised after the initial shock subsided that my hunger went along with it. What I had been preaching to my patients for the past two decades was, in fact, the truth: It’s not the calories that matter, it’s the type. My daily calorie consumption during my 30 days was at an all-time high. It makes sense, since gram for gram, calories from fat are more than double that of carbohydrates or protein. Despite this, I lost weight. I felt better in my clothing. I also felt that my belly, which I struggle with, had deflated. (Some experts advise against the ketogenic diet for weight loss.)
How to start the keto diet
If the ketogenic diet is one you feel you are a good candidate for, then don’t wait, start today! Start by planning out meals that follow the macronutrient breakdown detailed in this article. You can use an app that tracks your snacks and meals. I also found ketogenic recipe books to be very helpful.
Breakfast: a protein smoothie or eggs with a side of avocado
Lunch: a big salad, or zucchini noodles with pesto and grilled salmon
Dinner: hearty mushroom soup made with veggies and cream, butter, or bone broth to satisfy and fill you up. Or grass fed beef or an abundance of roasted vegetables
Snacks: nuts, jerky, or coconut chips with no added sugar
A year later
Towards the end of my 30 days, I realized I had felt the best I had in years. It’s hard to stop a diet that makes you feel so good. While restrictive and not for everyone, I came to the conclusion the ketogenic diet could be the perfect plan for the right person.
But a year after starting the ketogenic diet, I found that my body does not need to be in a constant state of ketosis for better health.
The question for me however, has always landed on the science, and to date, aside from the astonishing benefit seen in seizure disorders, we still need more studies to determine if keto will keep us on this earth longer. An August study in the Journal Lancet questioned the health benefits of very low, as well as very high, carbohydrate diets, citing an increase in mortality for both. The sweet spot, the study concluded, was somewhere in the middle.
This also happened to be where I landed as well.
I kept my grain consumption low after I completed the diet and I can for sure credit keto for that insight but I did reintroduce carbohydrate rich berries and starchy vegetables. I also gave myself permission to increase my protein content but now avoid very high-protein diets. Studies show that high protein diets (especially when rich in red and processed meats) have also been linked to increased mortality.
As for fat, I still see a huge benefit in maintaining healthy fats in the diet. It was the high fat that helped to suppress insulin and ultimately contribute to weight loss and it was the high fat that worked to keep me satisfied, and hunger free for hours on end.
The benefits of ketosis — seen mostly in studies on fasting — may include a decrease in the risk of certain metabolic diseases, inflammation and obesity. I still will do a week or two of the ketogenic diet, or I may do a prolonged fast a few times a year, but, in general, my overall diet is now more varied.
The ketogenic diet can still be a great option for many people, and studies do show that it can be done safely.
My experiment was a great example of something I say to my patients every single day — there is no “one size fits all” diet out there. You can indeed, go off and on the diet. You simply need to try things out, and determine what your body likes best.
Perhaps this is the secret to living longer, and better.
Kristin Kirkpatrick, MS, R.D., is the manager of wellness nutrition services at the Cleveland Clinic Wellness Institute in Cleveland, Ohio. Follow her on Twitter @KristinKirkpat.