The ketogenic (“keto”) diet is an extremely low carbohydrate and very high fat diet that has been gaining popularity as of late. The diet typically involves eliminating carbohydrate containing foods (like grains, starchy vegetables, legumes, fruit and some milk products), consuming moderate amounts of protein and very high amounts of fat. On this diet, typically 70-80% or more of calories consumed come from fat.
Historically, it has been used under doctor supervision to treat seizures in children with epilepsy. In this specific population, it has been well studied and applied. However, in recent years the keto diet has grown in popularity as a trendy weight loss diet.
With many claims surrounding this diet, it can be hard to discern myth from fact and weigh the pros and cons to decide if the keto diet is, in fact, a good idea. There are also specific considerations to be aware of for those who have undergone weight loss surgery.
Does It Work?
While there are testimonials of weight loss demonstrating that the keto diet may work for some individuals, there isn’t good evidence that this diet is superior to other diets in terms of long-term weight maintenance. Additionally, because the diet is so restrictive, very few individuals stay on the keto diet for the rest of their lives. It is well known that any way of eating that is not sustainable long-term often results in significant weight regain.
Are There Side Effects?
Unfortunately, the long-term impact of a keto diet on overall health and chronic disease is unknown. More research needs to be done on the long-term effects of this diet on weight as well as cardiovascular and metabolic health.
In the short-term, in addition to the potential for weight regain, other possible side effects include nutrient deficiencies, constipation, increased cholesterol levels and some documented cases of heart arrhythmias.
Furthermore, eliminating whole grains, most fruits, legumes and some vegetables while on the keto diet can result in limiting fibre and other nutrients from our diet that are important for health and prevention of chronic diseases. There is also emerging evidence that eating a variety of foods high in fibre can positively impact the gut microbiome (gut bacteria), which is related to other aspects of overall health.
Considerations after Bariatric Surgery
Following bariatric surgery, patients are not required to follow a low carb diet. Instead, we encourage patients to find a way of eating that is nutritionally balanced, enjoyable and sustainable. We recommend that patients consume foods that are high in protein and fibre and this can include good quality foods that contain carbohydrates.
Depending on the type of bariatric surgery that an individual has undergone, following a very high fat diet, like the keto diet, can increase the risk of experiencing dumping syndrome. Furthermore, due to the smaller portion sizes after surgery, it may also be difficult to meet one’s protein and fibre goals with such a high fat intake.
The Bottom Line:
Instead of continuing to follow unsustainable fad diets, we encourage patients to consider a new lifestyle which includes eating a variety of foods that are nutritious and satisfying.
The best pattern of eating is one that can be maintained and sustained long-term. When deciding what pattern of eating is right for you, be sure to speak with your doctor or a registered dietitian.
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