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Answers to 15 Burning Questions About the Keto Diet
From navigating the keto flu to stocking up on ketogenic diet foods, here are science-backed answers to some of the most common keto questions.
By Jessica Migala
Medically Reviewed by Kelly Kennedy, RD
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When it seems like everyone — not just celebrities — is on the ketogenic diet, you want to know if it’ll work for you. The so-called keto diet is a high-fat, moderate-protein, very low carb plan. But while people say that you can eat all the butter and bacon you want, is that really true (or healthy, for that matter)? And is the keto diet actually the best way to lose weight? Can it cause more problems than it solves? Here are your top questions, answered.
1. Is the Keto Diet Healthy?
In reality, you don’t have to go on the keto diet in orderto behealthy. The keto diet is a therapeutic diet used to control seizures in people who have epilepsy, according to the Epilepsy Foundation. For these people, a keto diet may be necessary for their health.
But today, the diet has become trendy, and many people are using it to lose weight. Eating high levels of saturated fat may pose a risk for long-term heart health; and in the short term, severely low carb diets may come with unpleasant side effects, like constipation and headaches, notes the Mayo Clinic. Given the restrictive nature of keto (it eliminates most fruit and dairy, whole grains, many vegetables, and legumes), you may also fall short of certain nutrients, like fiber.
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2. Is the Keto Diet Safe to Follow?
Even though following an extremely high fat diet can feel like a radical way to eat, “the research looking at ketosis via diet has not shown any real negative consequences when done in the short term,” says Scott Keatley, RDN, of Keatley Medical Nutrition Therapy in New York City. (Ketosis is the natural metabolic state that makes keto lead to weight loss.)
But there have been few long-term studies, adds Kendra Whitmire, a nutritionist and dietitian in Laguna Beach, California, who practices functional and therapeutic nutrition. It’s difficult to definitively say that it’s safe, and it also largely depends on the types of foods you’re eating on a keto diet. (For instance, olive oil is a healthier choice than butter; salmon is healthier than bacon.) That said, following the keto diet properly, and particularly with help from a medical professional, should reduce negative health effects, says Whitmire.
3. Is Ketosis Bad?
Typically, your body breaks down carbohydrates as its preferred fuel source. Ketosis is when your body has switched into a fat-burning state and breaks down fat into ketone bodies that are used as energy. Beyond the keto flu, “many studies have shown that entering ketosis via diet does not have any real negative consequence in the short term,” says Keatley.
But long-term studies are needed to truly assess the impact, he adds. Bottom line: Putting your body into ketosis for a limited time is likely not harmful.
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4. How Many Carbs Do You Actually Eat on a Keto Diet?
A keto diet is generally made up of 70 to 75 percent fat, 20 to 25 percent protein, and 5 to 10 percent carbohydrates, says Jill Keene, a registered dietitian nutritionist in private practice in White Plains, New York. The exact number of grams (g) of carbohydrates will be different for everyone, but is generally around 20 to 50 g per day. Many people on a keto diet count “net carbs,” which is total carbs minus fiber. Fiber isn’t “counted” in the carbohydrate total, because it’s not digested. Either way, this number of carbs is very low and requires careful planning. Eating a little fruit, starchy vegetables, sugary foods, or whole grains can easily kick you out of ketosis.
5. CanYou Drink Alcohol on the Keto Diet?
Yes. “Even though there are [often] carbs in alcohol, you can still drink it in limited amounts,” says Keatley. Realize that on days when you do choose to consume alcohol, depending on what you choose, you may have to adjust your carbs from other sources. This may mean making tough decisions, like having a drink but skipping a small amount of fruit or Greek yogurt.
In general, the simpler the better: Spirits are the best choice (avoid mixers that have calories), followed by wine. Your best bet is to stick with a half drink, says Keatley. Because of their lower alcohol percentage and other ingredients, beer and wine “can eat up a lot of your carbs, and they don't give back in terms of vitamins and minerals. It’s a waste of your carbs,” he says.
Here’s what each alcoholic drink contains, carb-wise:
, 1.5 fluid ounce (fl oz), 0 g carbs (1 serving)
, 5 fl oz, 4 g carbs (1 serving)
, 5 fl oz, 4 g carbs (1 serving)
, 12 fl oz, 6 g carbs (Stick to half of a beer if this is your choice.)
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6. How Much Weight Can You Lose on the Keto Diet?
There’s no doubt that a ketogenic diet may help spur weight loss — and anecdotal reports of drastic transformations are easy to find. “I have clients who have lost a significant amount of weight on a keto diet, but they were obese when starting and had quite a bit of fat to lose. These individuals have fairly drastic body transformations,” says Keatley.
In a study published in February 2019 in theJournal of Clinical Endocrinology, 20 people with obesity who followed a very low calorie keto diet for four months lost an average of 44 pounds (lb), mainly from body and visceral fat. (It’s important to note that there was no placebo group and this was a small sample source, so the findings are limited.) In another study published in February 2019, inNutrition Metabolism, normal-weight adults who followed a non-energy (calorie) restricted keto diet for six weeks lost about 4 lb in both fat and lean body mass.
But long-term studies show that there’s not much of a difference in weight loss between keto and other diets. One meta-analysis published in October 2013 in theBMJcompared adults on a ketogenic diet (eating less than 50 g of carbs) with those on a conventional low-fat diet. After at least a year, those on the keto diet lost an additional two pounds compared with the group who slashed fat. The bottom line is that diets, including keto, may help you lose the same amount of weight in the long run. With that news, know that there may be a better option out there for you, says Keatley.
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7. What Fruits Can I Eat on the Ketogenic Diet?
Fruit is generally not a mainstay of the keto diet. With so much natural sugar, fruit generally has too many carbs to be included. But you can have small amounts of lower-carb fruits, like berries, says Whitmire. And if you’re really getting technical, avocado and coconut, two higher-fat foods, are, in fact, fruits. Based on U.S. Department of Agriculture carb counts, here’s what can fit on keto:
Raspberries: 3 g net carbs per ½ cup
Strawberries: 2 g net carbs per ¼ cup slices
Blueberries: 4 g net carbs per ¼ cup
Blackberries: 3 g net carbs per ½ cup
Coconut: 2.5 g net carbs per ½ cup, shredded, raw (unsweetened)
Avocado: 3 g net carbs per 1 cup, cubes
*All carb values are net carbs, which is total carbs minus fiber. Fiber is often not counted in net carb totals, as the nutrient isn’t digested.
8. Can I Eat Snacks Like Popcorn, Oatmeal, and Yogurt on Keto?
Unfortunately, high-carb foods like popcorn or oatmeal probably won’t fit in the keto diet. contains 5 g of net carbs, which may be ¼ of your carb allotment for the entire day. It’s also worth mentioning that one cup of popcorn is not a large serving; it contains just 30 calories and no fat, so it won’t be filling. Oatmeal likely doesn’t fit, either. About ¼ cup of plain dried oats (about ½ cup cooked) has 12 grams of net carbohydrates for 77 calories and just one gram of fat.
As for yogurt, it depends on what type you choose and whether it’s keto-compliant. , for instance, contains 3 g of carbohydrates. Remember to choose plain versions, as flavored will add more sugar (and, therefore, carbs).
Better keto-compliant snacks include nuts (1 oz almonds has 3 g net carbs), seeds (½ cup of sunflower seed kernels has 3 g of net carbs), and small amounts of low-carb fruits like berries, says Whitmire. Beef jerky and nonstarchy veggies such as broccoli and cucumbers are other good snack options on keto.
RELATED:10 Quick and Easy Keto Snacks Probably Already in Your Fridge or Pantry
9. Should I Be Concerned About the Keto Flu?
If you’re interested in the keto diet, you have probably read about the keto flu, one not-so-fun side effect. “The keto flu is definitely real,” says Keatley. “Your body functions really well on carbohydrates — that’s what it was designed for. When it switches to fat burning, it becomes less efficient at making energy,” he says. On keto, you have less energy available and you may feel sick and sluggish, kind of as if you have the flu. As your body naturally adjusts to this new way of drawing energy, you will come out of it. This may take a couple of weeks, says Keatley.
10. Will the Keto Diet Give Me Kidney Stones?
The development of kidney stones is certainly a concern if you’re switching to a diet in which you’re eating more protein. (Though, again, the keto diet is more of a moderate-protein diet.) “Consuming high levels of red meat and not drinking a lot of water may make stones more likely,” says Whitmire. She adds that on a keto diet, you need to stay hydrated and replenish electrolytes (minerals like sodium, potassium, magnesium, and calcium). “If not, this can increase your risk of side effects like stones,” she says. Past research gives a small glimpse into how likely stones may be. A study published in theJournal of Child Neurology on children using the keto diet to control epilepsy found that about 1 in 15 developed kidney stones, though supplements of oral potassium citrate reduced this risk. Talk to your doctor if you have risk factors, like a family or personal history of stones, about any precautions you should take when on the keto diet.
RELATED:The Short- and Long-Term Effects to Expect on the Keto Diet
11. How Might the Keto Diet Affect My Period?
There’s a possibility you may see a change in menstruation. “Studies on younger women who eat severely low-carb for an extended period of time end up with irregular periods or missed periods,” explains Whitmire. Severely limiting carbohydrates may be taxing on the adrenal system, leading to hormonal imbalances that disrupt a woman’s cycle. Similarly, rapid weight loss can also have this effect. The takeaway? “Women may need more carbs on a keto diet compared to men, especially if a woman is noticing a change in her [cycle],” she adds.
On the other side of the spectrum, there is limited evidence that for women with polycystic ovary syndrome (PCOS), a ketogenic diet may improve their hormonal balance. The small study, published inNutrition &Metabolism,foundthatasmallgroupofwomenwithPCOSwhofollowedaketodietfor24weekslost12percentoftheirbodyweightandreducedtestosteroneandinsulinlevels.Again,talktoyourdoctor,especiallyifyou’reusingthedietaspartofyourtreatment.
Whileaketodietmayfocusonfat,thatdoesn’tmeanyouhavetoeatbaconandsausagesallday.Thereisroomforleanerproteins,likechickenorcod; just remember to add fat (for example, roast the chicken with olive oil) to these lower-in-fat sources, she says. Many cuts of beef are also considered lean or extra lean, as they contain 10 g or less of total fat, as well as a modest amount of saturated fat (4.5 or 2 g or less, respectively). These include eye of round roast and steak, sirloin tip side steak, top round roast and steak, bottom round roast and steak, and top sirloin steak, notes the Mayo Clinic.
RELATED:What Is Keto Cycling and Can It Help You Stick With the Keto Diet?
15. Can the Keto Diet Reverse Type 2 Diabetes?
“Though this isn’t the first tool I’d use to help someone control their insulin — carb counting, evenly distributing carbs throughout the day, may be easier to commit to — it’s not off the table, especially with stronger emerging research,” says Keene.
It’s true: Some preliminary research suggests keto may be a good approach for some people with type 2 diabetes. For example, one small February 2019 study in theJournal of Medical Internet Researchrandomized overweight adults with type 2 diabetes into two groups: one that consumed a keto diet, and a control group that ate a low-fat diet recommended by the American Diabetes Association. After 32 weeks, the keto group saw their A1C (a measure of average blood sugar over a three-month span) fall more compared with the control group, and half lowered their A1C to less than 6.5 percent (less than 5.7 percent is considered normal). The keto group also lost 28 lb compared with about 7 lb for the control group.
But long-term studies are needed, and keto can pose health risks to people with diabetes, especially if you’re following it without supervision from a medical professional. Importantly, anyone who is on medication to lower blood sugar or who is using insulin should be aware that drastically cutting carbs, as you must do on keto, can lead to dangerously low blood sugar, research shows. Unaddressed, this condition, called hypoglycemia, may lead to seizures, loss of consciousness, and blurred vision, according to the Mayo Clinic. (People with type 1 diabetes should not try the keto diet, experts warn.)
The takeaway? Be sure to work with your doctor if you have type 2 diabetes, and manage your expectations.
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