Revisiting The Keto Diet in 2020 – My Thoughts

Several years after enjoying a significant surge in popularity, the ketogenic diet remains a salient if not divisive topic in the world of nutrition.

Having written articles on the topic on three previous occasions over the last several years, I’ve since come to the realization that it was probably time to revisit the state of the evidence and to clarify my evolving opinion.

If you’ve followed my recent fascination with intermittent fasting, you might erroneously assume that I’m also a huge fan of the ketogenic diet.

You’d be wrong if you made that assumption, not least because intermittent fasting does not restrict one from interacting with 75% of the food system.

I’m writing this article today because I believe that this is an important topic to be discussing on the heels of the recent pandemic, when no doubt droves of the public will be seeking expedient dietary solutions and “quick fixes” following an extended period of time where nutrition was understandably not always going to be the number one priority.

For better or worse, It seems to me that the ketogenic diet does often finds itself in this sort of “silver bullet solution” category.

I say this based on my own personal & professional perceptions, and not to detract from anyone who has found a home within the ketogenic style of eating.

I have zero beef with you guys, no pun intended. (it was definitely intended).

I also can’t deny that my clients tend to carry a general curiosity on the topic, which I can hardly blame them for given the keto diet’s pervasiveness in modern popular nutrition discourse.

With that being said, let’s get to the good stuff.

My Views On The Keto Diet In 2020?

Great question.

Am I a staunch advocate of this explicitly restrictive style of eating?

Nah.

But I also won’t just blow it off without an honest discussion.

Certainly my views on this topic have evolved over the last several years and I’m increasingly inclined to avoid bashing anyone for pursuing a style of eating they think resonates with them or is in their best interests.

Yet I’m equally concerned about members of the public who are bending over backwards to try to pull it off because they’ve been led to believe it is their holy grail.

Like any other dietary pattern, there are actually a number of drastically different ways one can carry out a ketogenic diet and as a result it can be a challenge to land on a broad general assessment of its nutritional suitability.

If, for example, I knew someone’s diet consisted largely of avocado, salmon and kale, I would certainly not default to thinking that was a terrible way to eat.

Conversely,  if I knew someone ate mostly sausages and mayo, I might be a bit concerned.

In both cases, these theoretical individuals could be following a ketogenic diet.

Such a diet would, by definition, largely exclude most selections within important food groups like fruit, legumes, starchy vegetables, whole grains and certain types of nuts/seeds.

Among a number of other foods.

The big issue here is that, beyond being widely enjoyed items, these omitted groups all tend to be associated with good health and longevity.

It’s also true that in the region of the world where people live longer than most others, it is indeed purple sweet potatoes that are a primary dietary staple.

So you can see where my reservations lie from a public health perspective.

And so this conundrum leaves me asking a sort of impossible question.

All else equal, is the potential/theoretical benefit of being in a perpetual state of ketosis actually a superior choice for human health as compared to freely including the important food groups mentioned above?

AND the mental ease that accompanies the freedom of being able to select liberally from these groups.

This is the question you really have to ask and I certainly don’t believe we have the evidence to suggest this is the case for the average healthy person.

Nor we do have the evidence to assert that the keto diet confers some sort of guaranteed ergogenic benefit across the board.

Now the keto diet does obviously have medical origins (epilepsy management) and continues to draw some interest from the medical community for potential therapeutic effects in the disciplines of oncology and neurology.

I do not refute it’s potential in this regard and I’m always happy to concede its utility wherever that happens to be.

Yet I also don’t doubt there are likely at least as many people out there pursuing the ketogenic diet for the wrong reasons and to their detriment as there are individuals who truly enjoy and thrive with this style of eating.

Even so, I cannot just sweep the latter group under the rug just because the diet’s principles don’t resonate with me.

I also can’t act like there is NO evidence to support its efficacy.

Evidence For The Keto Diet In 2020

I think by now enough keto-centric studies have accumulated to suggest that a well planned ketogenic diet has the potential to improve the traditional biochemical markers of good health including A1C, LDL cholesterol and so on.

But hey, I can say the exact same thing with as much or more confidence about a vegan or vegetarian diet too.

Certainly when it comes to these biomarkers there is some evidence to suggest that a very low carbohydrate ketogenic diet may be superior to an extreme diet in the opposite direction ( ie: low fat).

A recent 12-month trial found that a ketogenic diet was superior to a moderate carbohydrate low fat diet when it came to A1C reductions and reducing medication needs.

(Not than any professional worth there salt is really even recommending “low fat” diets, at least I hope not!)

These types of findings have popped up on more than one occasion.

Yet they don’t compel me to believe that a well planned ketogenic diet is in any way superior to a well planned , well balanced more liberal style of eating for most people.

In saying this, I once again take nothing away from anyone who has found true health and happiness in pursuing this style of eating.

I’m also obligated to provide words of support to those of you out there who may be pursuing the ketogenic diet against your better judgement (and your happiness) because you have been led to believe it’s the best way for you become “healthier”.

It probably isn’t.

If you are currently following a ketogenic diet and are concerned about whether or not it’s truly right for you, know that a dietitian like myself can help expand your horizons.

Equally so, if you are intent on following the keto diet at all costs, it could be worth your time to speak to a dietitian to ensure you carry it out in the healthiest way possible.

Final Thoughts

I’ve tried my best to capture the most salient points of the keto diet debate for the average person in 1250 words.

While my stance on keto has certainly softened since I wrote my first article on it several years ago, you still won’t find me promoting or advocating for it.

Even though I cannot refute it’s potential utility for those with whom it resonates, it still does not feel quite right that such a restrictive dietary pattern should be championed in the mainstream.

Certainly not based on the current state of the evidence.

Until such a time when that changes,

Andy De Santis RD MPH