As I mentioned a few weeks back, I am slowly resuming my blog presence. Addressing the ketogenic diet hype seemed like a good place to jump back in. What are we talking about? A calorie controlled meal plan that is 5% carbohydrate (20-40gm/day), 25-30% protein and 65-70% fat.The ketogenic diet has become recognized as a standard of care when seizures in children cannot be controlled by medication. In these situations the meal plan is calculated to include 4gm of protein and fat for each gram of carbohydrate, often referred to as 4:1 diet. Fewer children require such drastic dietary changes with the availability of medical marijuana in many states, including Florida.

More recently, the ketogenic diet has gotten attention for weight management, cancer prevention and diabetes control. There is no shortage of research and new studies are being published daily. I reviewed 20 from the past 2 years. However…..

• The published studies are largely observational. Double-blinded randomized control trials (RCT) are considered the gold standard in human research, and it is hard to “blind” a subject when they know if they can eat bread or not.
• While the diet appears safe in the short term, dietary changes for health affects should be long term. None of the studies were longer than 6 months in duration. It may take 2 years or more before adverse effects show up.
• Small numbers of subjects. Like any “diet”, the drop-out rate can be significant and ultimately impacts the power of a study.
• Almost every paper concluded with the statement “more research is needed”.

So where does that leave us? Surprisingly I get few (no) requests for a keto plan from clients in my office. But I have also evolved to an appreciation that 50-60% of calories coming from carbohydrates is too much for most people: they get hungry and give up the plan. Cholesterol levels, blood pressure and glycemic control all improve with as little as 7-10% wt. loss, and high circulating levels of insulin can stimulate the growth of tissue cells, including cancer.

Don’t allow yourself to become a guinea pig; if traditional plans have not worked for you in the past and a lower carbohydrate intake is appealing, seek out the services of a Registered Dietitian Nutritionist who can personalize a more moderate carb level plan for you.