The Problem With Keto

Last year I posted an excerpt from our Muscle and Strength Nutrition Pyramid book describing how to assess whether a ketogenic diet might be suitable for you. This is a nuanced, fully-referenced look at the claims behind keto diets and how to decide whether to try it.

While this a solid article, when you’re down the pub, it just doesn’t have the bite needed to silence stupidity. This is where today’s rant comes in, which is less about the keto diet itself and more a complaint about a few advocates making exaggerated claims about it.

Keto is trendy right now, in a way that the paleo diet was a few years ago, and many other diets before it.

The problem is that when something trends, the algorithm’s reward extreme claims. The loudest voices rise to the top, muddying the waters for all. Now, a diet that was once used almost exclusively to control epileptic seizures (the 1920s onwards), and then used by a niche crowd of bodybuilders (in the 1990s), is being touted by the media as THE cure for rising levels of obesity in the masses.

This is the sad state of the diet industry we’re in right now — everyone moving off into factions (keto, vegan, carnivore, paleo, intermittent fasting), staying in their un-fact-checked echo chambers, playing a game of he who shouts the loudest wins — like kindergarteners.

Nuance has gone out of the window. Extreme options are touted as the only solutions, and the losers are those who desperately need help but don’t know where to turn. Ultimately, this only disempowers people when they try something, find they can’t stick to it, and then lose all hope as they’ve been brainwashed into believing this is their only option.

Let me back up a moment.

Keto diets are extremely low in carbs (often defined as 50g or lower) and necessitate a very high fat intake (60% or higher). It’s no surprise that when you give someone a ruleset like this, they tend to lose weight. — You’ve just told them that they can’t eat most of their favorite foods. It is fucking crazy hard to stick to.

People say that keto is superior for fat loss. It’s not. Studies consistently show that when calorie intake is equated, fat loss is the same.

Keto diets give the illusion that they work like magic because people lose a lot of weight in the first week or two. This is mostly water and muscle glycogen (1 g of carbohydrate intake brings with it 3–4 g of water when it is stored), and gut content losses (there’s less food in the gut because carbohydrate, especially fiber intake, is lower).

The additional problem is that whenever people go off the diet, they gain a large amount of weight back and don’t realize this is mostly the water/glycogen/gut content regain. So they feel trapped.

I want to love something as much as people love to talk about their keto diet.

People have even started asking me if it cures cancer! (I’ll come back to this in a moment.)

AN ALL TOO Typical Comment Exchange

“Diets aren’t the issue, it’s the self-discipline that is usually the problem. These are people who typically have a very bad habit built into them since childhood. Everyone, if followed correctly would lose weight on keto. You can’t be in a state of ketosis and not burn fat, it has to go somewhere and it’s very, very difficult to overeat the fat burning process, especially if you are obese.”

My response:

1. Presenting someone with an overly restrictive ruleset and then telling them self discipline is the problem is like telling someone they have to drive at 100 mph down a country road and blaming them if they crash.

2. A calorie excess sustained over time will be stored as fat. Fat is the easiest to store. So yes, you can be in ketosis and still gain fat.

3. There are mild appetite blunting effects with a keto diet, but it is still perfectly possible to overeat.

(Actually, I should correct myself here: There is also an initial drop in hunger and an increase in satiety which lasts 1–4 weeks in most people and often results in a spontaneous reduction in calories and initial fat loss. But this does not mean that people can’t overeat, especially past this point.)

The commenter follows up with a seemingly reasonable reply:

“My point was, there’s no issue with the diet. Any diet will likely be an improvement over their current eating structure and habits. If an obese actually followed the keto diet, they would see a drop in weight. Is the diet the most ideal? No, is it the most healthy? Probably not. Can it be an effective way to lose weight? Obviously and definitely.

“I’d like to see an obese person eat enough fat to sustain their current size. It would likely be extremely difficult to overeat in order to store additional fat. Again the meal plan likely isn’t the problem, it’s the person and their ability and desire to stick to it.”

My response:

To say a meal plan isn’t the problem and to blame the person’s desire is just silly. The fact that it is so damn hard to stick to is the issue with the diet. Anything that can’t be sustained is not going to lead to long-term weight loss.

I disagree with you when you say that it is difficult to overeat on a keto diet. The majority of people who start a keto diet will lose fat as they’ve just had a large portion of their favorite foods banned from them, which is going to create a caloric deficit.

However, as weight is lost and diets progress, hunger will ramp up and the mind will start to get exceptionally creative with meals to try to combat it.

If someone is educated about caloric intake determining weight loss, it manifests itself in more and more elaborate food planning as they try to find less calorically dense, more satiating options, while keeping to their calorie budget. Weight is still lost in this case.

But if someone isn’t educated about caloric balance and they believe they will continue to lose fat (or can’t gain fat) if they follow the ‘no-carb rule,’ hunger is, more often than not, going to pull them to overeat the foods they are ‘allowed,’ eventually. This may bring them to caloric maintenance, or this may pull them beyond and cause them to regain weight.

The problem is that because they don’t know why their weight loss has stalled (or they are gaining it), they quit and rebound. They feel hopeless because they were told that keto was ‘the’ cure and it didn’t work for them.

Now, it’s at this point that people typically say, “But a keto diet is better than sticking to the diet that’s making them fat!”

🤦🏻‍♂️ Nobody is advocating the standard shitty western diet. The choice people face is not just between keto and what they are currently doing. This is a false dichotomy.

This is what I Suggest People Do

• Eat fewer processed, packaged foods. So, less sugary foods, less stuff in boxes, more fresh produce.
• Eat more vegetables and fruit — real fruit, not juices that are calorie-dense and lack the filling effect of fiber.
• Stop drinking calories. Just stop it. Water, coffee, tea, and diet sodas if you have to. And those coffees and teas should be plain, perhaps with a splash of milk. Watch out for those bottled drinks with a lot of sugar. 
• Make sure you eat enough protein. This will keep you feeling fuller and help with recovery from workouts, muscle growth, and maintenance. (Aim to eat a gram of protein per pound of body weight, or for obese people, your height in cm.)
• Strength train regularly. Here’s my guide to choosing a training program.
• Understand that calorie balance is the key determinant of whether weight is gained or lost over the long term. You can’t trick the system though I really wish you could.
• Learn how to make meals that they enjoy out of their calorie and macro targets. I have a guide for that here.

Moderation is fine, and there is absolutely no need to cut out entire food groups! Education is how people will set themselves free of dietary dogma.

And back to that comment on keto curing cancer

I occasionally get asked whether keto helps cure cancer. This seems to be an increasingly common claim being made.

Such questions make me exceptionally uncomfortable. On the one hand, it’s not my place to wade in on anything medical, let alone, life-threatening like this for someone. But morally, I feel the need to say a couple of things.

Extraordinary claims require extraordinary levels of evidence.

Cancer is not one disease, it refers to over 100. I have read that there is some evidence that it may be helpful for specific types of cancer as an adjuvant therapy (in conjunction with other therapies, after that have been administered). But this is a very different thing to saying a ketogenic diet can cure cancer.

To anyone who is going through a battle with cancer, my advice is to consult with their oncologist. These specialists live this day to day, they spent 8 years of their lives working their asses off to be qualified and then killed themselves through residency and beyond because they want to help people.

If there is a dietary intervention that may help a person’s specific case, I’m sure they’ll be aware of the research and be open to telling mentioning it.

–

Although it is not very typical among recreational and competitive bodybuilders and strength athletes to do better with higher fat-to-carbohydrate ratios, here’s my guide showing you how to systematically test if it may be something for you. I also have all the pros and cons listed, with references. So if that interests you, please see that article.

Anyway, please excuse the rant. This is something close to the bone for me and I hope it was helpful. 🙏🏻