Sure, you can use the keto diet as a quick fix to lose weight. Alternatively, you can approach the keto diet from a long-term health standpoint and make it a lifestyle rather than just another fad diet. Dr. Will Cole, functional medical expert and author of "Ketotarian," is an advocate of a (mostly) plant-based keto diet to boost energy, improve brain function, aid in weight loss and more.
On this week's episode of LIVESTRONG.COM's Stronger podcast, Dr. Cole explains that "just because something is high-fat and low-carb [aka keto] doesn't mean it's optimal for long-term wellness." For example, a vat of cheese topped with bacon may contain tons of fat and not all that many carbs — and you may come across a picture of it under the #keto hashtag on Instagram — but that doesn't necessarily mean it's healthy or will make you lose weight sustainably.
In our conversation with Dr. Cole, he explains how to successfully follow the ketotarian diet and answers such questions as: "How long should you stay in ketosis," "How do you even know if you're in ketosis" and "Are all fats made equal?"
You can also read some of the highlights from our interview with Dr. Cole about what fats do to our brains, below.
What Are Some of the Pitfalls of the Keto Diet?
One of the reasons I wrote "Ketotarian" is I saw all of the potential pitfalls regarding the way that people were doing the ketogenic diet and seeing it done on social media. You look at #keto pictures, and you'll see a certain kind of meal, and it normally centers around lots of cheeses, and vats of dairy and bacon (really anything in the name of being high-fat, low-carb, or keto).
One of the main problems I have with this approach, and what I would say many people are seeing long term with it, is that just because something's high-fat, low-carb and keto, doesn't inherently mean its healthy — or that it's going to make you lose weight sustainably. And I find that many people have this early honeymoon period with the ketogenic diet. They are off of a lot of refined foods, and carbs and sugar, so they'll see the initial benefits of weight loss maybe, and they're maybe tapping into ketosis, and they're seeing the extra fat burning pathway mechanisms that are increased then too.
But from a long-term health standpoint, and a long-term weight standpoint, I find that people have to find a solution of what they're going to do past this plateau period. And I think the way that the conventional ketogenic diet is done leads many people to avoid plant foods, avoid non-starchy vegetables, or any vegetable because of their carb content. And vegetables have varying amounts of carbohydrates. And this is one of the reasons why I wanted to promote a plant-based, clean, ketogenic way of eating. Anyone who is trying to lose weight is ultimately going to have to make this a lifestyle, and not just another fad diet to add to your pile of quick-fix diets.
What I'm talking about is a clean, fresh approach of what ketotarian is meant to be. It's filled with very filling foods, and you still get the benefits of ketosis — including anti inflammation and fat burning — but you're do it in a clean way that is sustainable for your health.
I find that a lot of these conventional keto foods can be problematic for certain people because they don't do well with eating lots of red meat, and this can create weight loss resistance because it's impacting their hormone levels, inflammation levels or their gut. And if the inflammation levels or your gut are impacted, that can slow down weight loss for sure.
And then some people do not do well with dairy. They have dairy-sensitivities or other problems with dairy, or they're intolerant to dairy. And this is problematic too because dairy is the main keto staple food that you see on social media, but it doesn't have to be like that. So ketotarian is entirely dairy-free, it is plant-based, so people tend to tolerate it a lot better because it has that clean approach to it.
How Do You Know If You Are In Ketosis?
You can go off of how you feel. In "Ketotarian" I wanted to have a lot of keeping it simple options because some people are just doing this for wellness. Because they want to test it out, and try it out and use food as medicine in this way. And I like doing it this way too where I just go off of how I feel. And do I have increased energy? Is my brain clearer? If someone needs to lose weight are they losing weight? All these benefits of being a fat burner, being keto-adaptive, they can just see the natural signs of that.
But then there are definitely many people that want to know for sure, and the only way you know for sure is to test ketones. So you can measure it through blood, like a finger prick like you would for a blood sugar meter. It's very similar to a blood sugar meter and actually many glucometers, or blood sugar meters, will measure ketones and glucose.
Or you can get a ketone meter, and it will measure ketones, and it's the gold standard because it's measuring Beta-hydroxybutyrate, or BHB, which is the main ketone that all the cool medical literature is being done on and these health benefits of ketosis, they're looking at Beta-hydroxybutyrate.
But the technology around this is really developing, so we're getting a lot of other options too. Like the breath meter. So it's a ketone breath meter, and you breathe into it, and it's measuring breath acetone. And breath acetone is shown to be directly related or closely related to Beta-hydroxybutyrate. So basically, if breath acetone is higher, we are assuming that Beta-hydroxybutyrate is higher too. And people like this because you don't have to prick your finger, and it's simple, you just breathe into this tube, and it measures breath acetone.
What is the Biggest Misunderstanding About Keto?
I think the misconception with keto is centered around two things: It's the fear of healthy fats and the love of carbohydrates. And I feel like when you talk about eating healthy fats and then limiting carbohydrates, that can be quite a trigger sentence for many people in the West. We've been kind of ingrained — no pun intended — to love carbohydrates, but also to fear fats. So this is counter-cultural in many ways.
So-called healthy fats really are healthy, they are good for our body. Our brain is 60-percent fat, and 25-percent of all of our body's cholesterol is in our brain. So things like olives, and olive oil, and nuts and seeds and avocados shouldn't be feared. They shouldn't be avoided. And even wild-caught fish or pasture-raised eggs, these are all clean, fresh foods when used in appropriate amounts, and used until satiety, in the context of a real, healthy diet.
Our body will not produce essential fatty acids; we have to get it through foods. There's no such thing as an essential carbohydrate. This means our body will produce its own carbohydrates and convert them through gluconeogenesis naturally. But there are things that our body needs to get from foods — and in the context of the clean, real-food ketogenic diet, that means lots of fat, moderate protein, and a small amount of carbohydrates from real foods.
But I feel like the other side of that coin is the carbohydrate side. People think, look, it can't be healthy to not have carbohydrates, but what they don't realize is that the ketogenic diet is not a no-carb diet. It's a low-carb diet. You are still having carbohydrates, and how much depends on your carbohydrate sensitivity — some people definitely are more sensitive to carbs than others. You can have a pretty decent amount of carbohydrates and be fine and still be in ketosis.
The ketogenic diet is not about fearing real food. It's a fiber-rich diet when it's done in a healthy way, which is another reason why I wrote "Ketotarian" — to let people know that they don't have to fear plant foods.
In some way I agree with the people that are critical of the conventional ketogenic diet, but that doesn't mean you should just abolish everything and say there's nothing to this way of eating. I'm trying to make the keto diet into a sustainable lifestyle.