ketogenic diet

5 Things to Consider Before Jumping into a Ketogenic Diet

The ketogenic diet (KD), while having been around for close to 100 years, has gained some

traction in the last few years as an amazing diet that everyone should follow.  Or should you? In this blog, I’ll break down what it is, how it works, conditions, and cautions surrounding the KD.  Let’s dive in, shall we? 

What is the KD? 

It’s a high fat, moderate protein, low carb diet.  The fats should come from healthy sources such as olives, avocados, flax, nuts/seeds, etc.  Moderate protein should come from clean sources.  And the limited carbs should be good carbs like veggies. 

What is it not?  

It’s not a high protein, low carb diet.  It’s not a pass to consume a fast food burger with no bun or a steak for breakfast, lunch, and dinner. 

The KD takes time to balance out and you should be using an online calculator or information from a health professional on getting an accurate balance of your macronutrients and a list of foods that you should be consuming.  Before you jump into doing the KD, keep reading to determine if you should follow a KD.

So, how does the KD work? 

We take in carbohydrates, which are ultimately broken down to glucose…the primary source of fuel for our bodies and the only source of fuel for our brain. When we take in too much than is needed in the moment, we store excess in the liver and muscles to be used later when we need more energy (i.e. in times of fasting or working out).  Sometimes, we store excess as fat, which are triglycerides…buts that’s a different story for another time. 

Ketosis is the process that those following the keto diet are looking for.  When the body is low on carbs being taken in and the carb stores are low or depleted, the body switches to burning fat as fuel.  The byproduct of this process is a series of acids called ketone bodies.  When the body is producing ketones, you’re known to be in ketosis. 


In the 1920s, it was found that drastically reducing carbohydrate intake, limiting protein, and subsisting mostly on fat could eliminate or reduce seizures in children with epilepsy. 

A study was completed in which children were placed on and followed a diet consisting of 1 gram of protein per kilogram of body weight, allowed to consume between 10 and 15 grams of carbohydrates daily, and the remaining caloric intake came from fats.  What the study found was 52% completely stopped their seizures and 27% had improved control over their seizures (6).  This is a great use for the KD that most people aren’t actually aware of today. 

When anti-seizure medications gained traction, the KD medication became a first run option over the KD in patients.  In the mid-1990s, the diet resurfaced when a young child’s parents employed the KD to help their child eradicate his seizures.  A television show picked up the success and the KD became a popular treatment option again for kids with epilepsy.   

Aside from epilepsy, there are a variety of other conditions the KD can be used to help treat therapeutically.  The KD is widely used in conjunction with cancer treatments, particularly those cancers that involve tumors.  There are theories that the KD can help reduce the size of tumors in the body.  However, there have been no clinical trials backing these theories up (1, 5).  On the flip side, there are studies showing that ketones actually promote tumor growth (3).  Since there’s no clinical trials showing the KD is good or bad for cancer, it’s a toss of the dice. 


Now, there are studies that show the KD can be used to treat obesity, reverse cardiovascular disease, and place Type 2 Diabetes in remission.  There are also a ton of other studies showing the Paleo diet, a Plant-Based diet, and a Mediterranean diet can do this as well…and all of those are not nearly as restrictive as the KD.  So, you can become “well” again and lose weight without going to such extreme measures. 

Some things that need to be considered before taking the leap…the KD has been linked with a down spiral in thyroid function. 

A recent study following 120 kids with drug resistant epilepsy following the KD diet for treatment showed that almost 20% of these kids eventually developed hypothyroidism (4).  

Another study followed varying levels of carbohydrate intake in men over a period of time.  They found that very low carbohydrate intake was associated to changes in various thyroid hormones…and not for the better (2).

A quick Google search yielded several message board postings of individuals discussing changes to their thyroid after following a KD…not for the better. 

Now, if it came down to continued seizures in my kids and hypothyroid, I’m going for quality of life here and taking my chances.  But if I don’t have epilepsy and my thyroid is in tip top shape, I won’t be rolling those dice…I’ll be following another weight loss method.

Opinion Time

Here are my thoughts on the KD.  I don’t share the popular opinion that the KD is the best thing since sliced bread.  Rather, I share in the opinion that the KD should be used for a short period of time in a therapeutic setting.  Here’s why. 

We, as humans, tend to live in extremes.  We went from high carb, low fat in the 1980s to high protein low carb in the late 1990s to fat isn’t the devil in the 2000s to now with the KD. 

The KD is an extreme diet by cutting out an almost an entire macronutrient.  In individuals that do not have epilepsy, do we really need to do that to be healthy?  No, we don’t.  To me, this is extreme dieting.  I’m aware that I am going to catch hell for this but I’ll also share that I’m not the only nutritionist that feels this way. 

When you cut out carbohydrates, you’re missing out on whole grains, which help increase your fiber, bind to excess cholesterol in the body, and flush it out in the feces.  You also miss out on tons of wonderful nutrients from fruits and veggies.  Realistically, we should be consuming between 7 and 9 servings of veggies per day (a serving of veg is ½ cup cooked or 1 cup raw).  When you limit your carbs to 10 to 15 grams daily, you’re limiting your nutrient intake.  Yes, I'm aware that some promote net carbs vs actual carbs.  This is a bit better but 20ish grams of net carbs is still too low in my book.

Now, before you say I should try it before knocking it…I did.  I wanted to see if I truly felt better and check out what the hype was all about.  I’ve done low carb previously so I am aware of the feeling that occurs when your body switches from carbs to ketones for fuel…you know that feeling like you’ve been hit by a truck…that one (they call it "keto flu").

Typically, I eat small, frequent meals throughout the day.  I don’t overly worry about food or whether I am hungry or not.  I eat when I feel like it and I don’t eat when I’m not hungry.  If I wanted a snack, I would have one.  My meals typically consist of a small amount of protein, a portion of fat, and a heaping pile of veggies, fruits, and whole grains. 

When I tried the KD, my mind shifted.  I went from not really thinking about food to focusing on it non-stop.  I didn’t starve myself and I ate if I was hungry but I was constantly fixated on the foods I couldn’t have.  I was craving veggies and salads and apples!  It was a complete mind F%^*!  I didn’t like it and I didn’t want to live like that.  So, I stopped.

If you do follow the KD and love it…more power to you.  I’d encourage you to put less constraints on the carb amounts and add some more veg in your life so you can benefit from a wide range of nutrients.  If you haven’t tried it but have been dying to, have a crack at it.  I only ask that you spend some time researching, do it correctly, and for a short period of time (60 days or less).  

Listen to your body, it won't lie to you 🙂 

Feel free to share or post your comments below.

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Allen, B. G., Bhatia, S. K., Anderson, C. M., Eichenberger-Gilmore, J. M., Sibenaller, Z. A., Mapuskar, K. A., … Fath, M. A. (2014). Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biology, 2, 963–970. (1)

Bisschop, P. H., Sauerwein, H. P., Endert, E., & Romijn, J. A. (2001). Isocaloric carbohydrate deprivation induces protein catabolism despite a low T3-syndrome in healthy men. Clinical Endocrinology,54(1), 75-80. doi:10.1046/j.1365-2265.2001.01158.x (2)

Bonuccelli, G., Tsirigos, A., Whitaker-Menezes, D., Pavlides, S., Pestell, R. G., Chiavarina, B., … Lisanti, M. P. (2010). Ketones and lactate “fuel” tumor growth and metastasis: Evidence that epithelial cancer cells use oxidative mitochondrial metabolism. Cell Cycle, 9(17), 3506–3514. (3)

Kose, E., Guzel, O., Demir, K., & Arslan, N. (2017). Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. Journal of Pediatric Endocrinology and Metabolism,30(4). doi:10.1515/jpem-2016-0281 (4)

Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789–796. (5)

Wheless, J. W. (2008). History of the ketogenic diet. Epilepsia,49, 3-5. doi:10.1111/j.1528-1167.2008.01821.x (6)

Sunny Brigham, MS, CNS

I'm Sunny! I'm a board-certified clinical nutritionist with an MS in Clinical Nutrition. I help individuals reduce fatigue, eliminate bloat, and lose weight by healing the digestive tract and balancing hormones. I provide individual and group nutrition consultations nationwide. Grab my metabolism boosting guide!

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