If you’re on social media, then you’ve probably heard of the keto diet. I know all my news feeds are filled with videos of how to make keto brownies, how to eat keto at fast food restaurants, and the list goes on. I also frequently see friends sharing stories of weight loss in a short amount of time. But what is the ketogenic diet? Is it healthy? What are the long term effects? These questions are specifically for the keto diet for weight loss alone, not for medical conditions.
I invited Joel Forman, MD
, from The Christ Hospital Physicians - Heart & Vascular, to be a guest on my podcast and have a discussion on the keto diet. Dr. Forman, a cardiologist who focuses on preventative care, says, “The ketogenic diet tends to be high-fat, moderate protein, and very low carbohydrate. The science behind the diet is that when your body gets very minimal carbohydrates and there aren’t enough to meet its metabolic needs, there’s a back-up fuel system, and when you take in carbohydrates you release insulin. Insulin prevents resorption of fat and promotes storage of sugar. If you don’t have sugar to stimulate the release of insulin, you break down fat, and as part of the breakdown of fat you form ketones. You are basically putting your body into a very, very low carbohydrate state where you stop producing insulin and thus, burn fat.”
After learning how the diet helps the body lose weight, I asked Dr. Forman about the long-term impact of the keto lifestyle. He said, “I don’t think we know long-term studies on health outcomes with the keto diet. You certainly do lose weight on an appropriate keto diet, and probably lose weight at a higher rate than a low-fat diet.” He mentioned that diets are also hard to study in the long term since people’s circumstances change. Also, a great point was made that weight loss doesn’t necessarily mean healthy. You can be gravely ill and lose weight, so health should always be considered first with any diet.
I’ve heard of “dirty” keto, but what is that? In my own layman’s terms, dirty keto relies on macronutrient sources that are not the healthiest, meaning processed foods, low in vegetables and fibers. I asked Dr. Forman his thoughts.
“The data that I know really says that plant based fat, plant-based protein, is only better for you than animal based fat, animal-based protein. And whole foods and real foods are better than processed foods. And with any diet, the quality of the food you’re eating and how natural the foods are, I think, naturally leads to your health outcomes. With any diet people can learn the rules and work around the rules sometimes still achieving the goals of weight loss, whether that’s good, solid nutrition. I would argue there’s a big difference with the keto diet eating a bunch of vegetable products and vegetable fat and lean chicken breast and grass fed beef than going to a fast food restaurant and taking a bacon cheeseburger, taking the bread off and eating that.”
So with all that being said, what’s Dr. Forman’s best advice? “What I encourage my patients to do is not worry as much about your weight. If you want to monitor it, sure, it’s a barometer and I’m going to look at it when you come in to see me every six months, but that’s going to make you unhappy. And if you focus on your weight, that raises your cortisol, that raises your stress hormones, it makes you hungry, it makes you binge eat, it makes you not sleep, and all those things are associated with weight gain. Weight is not necessarily my primary goal, my primary goals as a physician is health. If you focus on health and you focus on immediately actionable things, you can control what you’re putting in your mouth, you can control how you sleep, you can control how you manage your stress, and you can control that you exercise, and I’ve had patients that lose a couple pounds a visit and they’re happy. And they’re not feeling bad about themselves if they have a bad meal.”
For a deeper dive on this topic and more, listen to the full Pound This Podcast: Keto Diet for Weight Loss, the Good and Bad with Dr. Joel Forman
! You can also find Dr. Forman at the Preventative Cardiology Program at The Christ Hospital Health Network, helping people prevent heart events.