Let’s take a look at why the ketogenic diet probably isn’t an awesome choice for most people.
To start, we’ll do a quick review of what the keto diet is: The keto diet is the most extreme version of low carb dieting.
Usually, people’s progression from less extreme to more extreme dieting goes like this:
- Cut out dessert
- Cut out anything with sugar
- Cut out processed carbohydrates
- Cut out gluten
- Go low carbohydrate (this is where Atkins would be)
- Cut out all carbohydrates (this is where the ketogenic diet is)
What people do is start with a rigid rule set and use that rule set until it fails. When it fails, they “fall off the wagon,” eat a bunch of stuff, gain all of the weight back, and resolve to be “better” next time.
Then, next time, they find a rigid rule set that cuts out more things than last time.
If they “fell off the wagon” after cutting out gluten, then they’ll cut out all carbohydrates on their next try. The assumption is that if the last rigid rule set didn’t work, they need a rule set that’s more extreme.
Basically, if one rigid rule set was too hard for them to follow, they find an even harder one to follow for the next time. They don’t realize that they were set up to fail from the beginning, and that they’re set up to fail even faster with each more restrictive attempt.
Some people take it a step further, and after they crash and burn with keto, they go to the Carnivore Diet. Because if cutting out carbs wasn’t enough, they cut out vegetables also. Seriously, they just eat meat and salt. It never ends. You can’t just keep cutting out more things.
That is what we call “The Diet Cycle of Failure.” 👇
At a meta-level, we actually see this with any diet that has rigid rules about cutting out certain foods.
The Five Things Wrong With Keto
- Cutting out more and more foods is not the answer
- Rigid diet rules set you up to fail
- Moralization of food is bad your your relationship with food
- Super keto water weight fluctuations suuuuuck
- Keto is weird at social events
To be clear, if you love keto and it makes it super easy for you and fits into your life well, awesome.
But there are just as many folks who had a terrible experience with one (or more) of the five things above, and were totally crushed. They’d been led to believe that cutting carbs was the only way, and just couldn’t do it. If you’re in that camp, no worries, we got you.
For the folks who just couldn’t sustain doing keto for any length of time, let’s dig in on why that’s so common.
A big problem with the ketogenic diet is dichotomous thinking. That means having a black and white relationship to how you view certain foods. Dichotomous thinking is created by adopting rigid diet rules.
Examples of this would be labeling a food or food group (or all carbohydrates) as:
- Good or bad
- Clean or dirty
- Right or wrong
You’re assigning rigid rules to something that isn’t rigid. Food does not fall into perfect boxes. Which is unfortunate, because people LOVE the control this represents. There’s nothing more attractive and seductive than to have nice, neat little boxes to put things in, where you know exactly what is “good” and exactly what is “bad,” and there’s never any thinking required.
Look, we’re all tired. We all have way too many decisions in our lives and lots of important things to think about. It would actually be really nice if nutrition was that simple. That we could just have a list of good and bad foods, and never eat the bad ones, and live happily and magically ever after.
And yet, if you’ve graduated from elementary school, you know that few things in life are that simple.
Don’t get me wrong, things are marketed to you as being overly simple. People selling diets know how attractive it is to think that you could buy the perfect list of rules and be done forever.
Simple always sounds sexy, because people want to buy simple. So, we get marketed to, over and over again, that there’s a magic list of rules (like intermittent fasting) we can buy into that will solve all of our nutrition problems.
Most all of us have gotten sucked into that at some point. And really, it’s not our fault. We’ve been conned into believing that it’s simple and magical, so many times, and for so long, that we start to believe it. But now it’s time to move past it. We have to, nutritionally, grow up.
The ketogenic diet is sort of the ultimate in rigid diet rules — you’re either in ketosis or you aren’t. Being in ketosis is a win, being out of ketosis is a loss, absolute dichotomy. There’s no room for mistakes, intentional flexibility, of situationally aware choices.
That daily pass/fail relationship to food creates a huge issue with workability. Rigid diet rules create dichotomous thinking, and dichotomous thinking creates the Diet Cycle of Failure.
Dichotomous thinking is the #1 psychological predictor of weight loss failure [2,3].
As in, if you wanted to make sure that someone failed, the most important thing to do to insure failure is to make sure that they had rigid thinking about certain foods. Having rigid thinking about an entire macronutrient group, like carbohydrates, is the farthest extreme of this.
Moralization of Food
Here’s where things get really bad. Like, it’s one thing to mess up your results (with dichotomous thinking), but if you wanted to make sure that you messed up your relationship with food and with your body also, you’d want to moralize your food choices.
Let’s revisit those three parts of dichotomous thinking again:
- Good or bad
- Clean or dirty
- Right or wrong
Those sound kinda moral, right? Like, a good person eats good food. A good person eats clean food. A good person eats the right food.
Labeling food dichotomously starts to lead to moral judgements about ourselves if we eat those things. Essentially we have these black/white thoughts about ourselves, being good or bad, successful or a failure, or good looking or ugly[2, 3, 4]
These labels turn food into a moral judgment really fast. Which feels fun and self-righteous when you’re eating perfectly, but no human ever eats perfectly for very long. Heck, no human ever does anything perfectly forever.
So, as soon as you eat something “bad” or “dirty,” that means that you are “bad” or “weak,” and maybe you “lack motivation” or have “low willpower.”
If your food choices have a moral component, then that means when you make bad choices, you actually have a character flaw. This is pretty hard to take. It feels super bad. Ironically, people usually soothe this bad feeling by eating more of the food that was “bad.”
Everyone, at some point, wants to eat something that’s off of their rule set. If you feel like a bad person, or like you “cheated on your diet” when you do that, you’re going to beat yourself up and feel worse. Usually, this leads to borderline binge eating, often with the promise to “start again next week/month/year.”
So, the Diet Cycle of Failure starts to become a cycle of feeling ashamed and weak. Your relationship with food and your body can become adversarial.
You lose all connection to normal hunger and fullness cues. You eat based on morality, instead of your body. Worse, when you do eat something off-plan, you feel morally bad, and eat way beyond feeling full because you’re already “bad.”
The keto diet is a fragile mindset
The thing that’s most bonkers about the keto diet is how unbelievably fragile it portrays the human body as being. As if having one serving of carbohydrates will destroy you.
The human body is remarkably flexible. There are people eating completely different diets all over the globe. People who eat locally, their diet changes remarkably from season to season. Humans are flexible, adaptable and strong.
The idea that the human body is incapable of processing a single serving of carbohydrates is a weird superstition that many have come to believe.
Repeat after me: Nutrition isn’t fragile.
You can have a pretty wide range of foods, in reasonable quantities, and do well. You can have some carbohydrates and not die. If you have a sandwich, you haven’t “destroyed all of your results.” You won’t get diabetes the next minute after having a doughnut.
It’s kind of like how people used to think that you had to get a certain amount of protein right after your workout, and now we’re finding that it doesn’t matter, as long as you hit your protein requirement throughout the day. It just isn’t so fragile that the timing is super important. That’s just one example of something that we had thought mattered a lot, and it turns out to matter very little.
Let’s look at the most tightly controlled trial we can find: An extremely robust and controlled study compared the ketogenic diet against balanced meals for weight loss was conducted in a locked ward.
A ward study is where people are literally locked in and fed perfectly controlled food. They matched calories and protein, and just changed the carbohydrate and fat content. What they found was, in perfectly controlled conditions, there was no difference in weight loss between a ketogenic diet and having balanced meals.
If your diet guru thinks that your body is going to be broken if you have an apple or a banana, your diet guru is an idiot.
Super Keto Water Weight Fluctuations
People will say:
“If I eat any carbs, I gain 20 pounds!”
Part of what drives the magical thinking about keto is how big and how fast it has an impact on water weight. Often, folks can drop like 8 pounds the first week they do the ketogenic diet.
If you’re just looking at the scale, that feels like a really big deal!
“I lost 8 pounds in a week, this must be magic!”
But, if you consider that everyone has big drops in water weight when they cut out carbs [6,7], you realize it’s fake. Like, you probably started keto to lose fat, not water.
Then, you spend the next week or two dreaming of all of the carbohydrates you can’t eat. Until you snap, and eat some, probably too much… and get super bloated. You gain back the 8 pounds of water weight, sometimes plus some extra bloat. You feel gross (everyone feels gross when they’re bloated) and it reinforces the superstition about carbohydrates.
People think that they lost 8 pounds of fat when cutting out carbohydrates, and they think that they gained 8 pounds of fat when they started eating carbohydrates again.
So, it really does feel like carbohydrates are magical both ways. I mean, how else could you lose and gain that much fat that quickly? Of course, you can’t lose or gain fat that quickly, ever. It’s always a fluctuation in water.
The big scale weight drop is just water. And the big scale weight gain is just water.
The rush of scale weight changes in either direction feel dramatic, emotional, and important… but it’s just water.
This is where it’s all just going in circles. It doesn’t feel good in your body, it doesn’t feel good in your relationship to your body. It’s the worst rollercoaster ever.
“But It Worked For Me!”
People will say, “I did keto and lost weight for three months!” But, if you ask, you find out that they used to have five servings of carbohydrates per meal, they never had vegetables, and they inconsistently ate protein. It wasn’t that carbohydrates were magically bad for them, it was that they never had any kind of plate balance or any reasonable portioning at all.
They were simply eating too much.
Here are some reasons that keto can work:
- You ate vegetables. Vegetables are filling.
- You ate protein. Protein is filling.
- You ate fat. Fat can help you stay full between meals.
- You stopped eating five servings of carbohydrates at every meal.
Those are smart things. Though, it might be noted that none of those require eating zero carbohydrates.
The fact that it worked for you is great. Just keep in mind that other people have gotten the same results while still eating carbohydrates. They probably just also added vegetables, protein, and fat.
In the short term, you may get a quick drop in water weight from keto. In the long term, though, numerous studies show people end up with the same weight loss that they would get from a diet that included carbohydrates.
You have to recognize that there are people who are getting the exact same results as people on the Keto Diet, but they are eating moderate carbohydrate diets.
They could be eating heavily researched moderate carbohydrate diets like the Mediterranean Diet or the DASH Diet, Or they’re eating based on Harvard School of Public Health’s Healthy Eating Plate, or the American Cancer Research Institute’s New American Plate, both of which are also moderate carbohydrate. Or they’re just eating what everyone would generally assume is a “balanced meal,” with no name attached to it at all.
In a 12-month study comparing high and low carbohydrate diets, researchers found no difference in weight loss.
A two-year randomized controlled trial also showed no difference in weight loss between high carb and low carb diets. One randomized controlled trial noted that weight loss was faster for low carbohydrate diets at the beginning, but that there was no difference at one year.
Yet another study compared named diets, Atkins (low carb), Ornish (high carb), Weight Watchers (no carb recommendation), and Zone (moderate carb), and found no difference in weight loss or cardiovascular health.
Finally, a meta-analysis looking at 96 randomized controlled trials, comparing low carb and high carb, found no difference in weight loss.
The research is overwhelmingly consistent.
Most of the research that people lean on for low carb has been done with rodents (not humans), or has no comparison group (so, not an actual experiment), or does not match calories and protein (not comparing apples to apples), or does not look at actual weight loss (they just guess what would happen).
Keto can totally work. It just doesn’t work any better than anything else.
You Can Have One Serving of Carbohydrates
I can’t believe that I have to tell people they can eat fruit. Or that they can have a slice of whole grain bread. This is seriously bonkers.
Harvard’s School of Public Health breaks down the research on how fruits and vegetables are associated with nearly every kind of positive health outcome. They state that no fruit or vegetable has all of the micronutrients we need, so it’s important to eat a variety of fruits and vegetables. It’s hard to get a variety of fruits if you skip fruit completely. Similarly, folks who eat more whole grains are less likely to die.
The issue is when people have five servings of carbohydrates each meal, not when they have one serving.
But, But, But
“But it works for me!”
That’s cool! Totally keep doing it. Just be aware that you don’t have to.
“But nothing else worked for me!”
That’s cool! Totally keep doing it. A thing can work for you, and you can also be completely wrong about why it works.
“But my friend has epilepsy, and was ordered by his doctor to eat the ketogenic diet.”
Ok, I get that. That has nothing to do with most people.
“But I can’t eat bread, because I have celiac disease.”
Ok, I get that. That has nothing to do with most people.
“But I feel really bloated after I eat a whole pizza in one sitting.”
I mean sure, everyone does.
“But I used to snack on carbs three times a day, and I gained weight.”
It sounds like mindless snacking was the issue. Maybe you needed to learn how to distinguish between hunger and cravings, or how to deal with stress without food, or how to pause before eating something.
“But I always over-eat carbs.”
Then maybe slow down your meals, eat without screens, add vegetables and protein, plate reasonable portions, pause ten minutes before getting seconds. This is a deficit of eating skills, not anything to do with carbohydrates.
Carbohydrates are Delicious
Look, carbohydrates are delicious. Most people need to learn some eating skills to be able to moderate their carbohydrate intake.
Then, when they do learn how to moderate their carbohydrate intake, they find that they can have carbohydrates and hit their goals.
Many folks, when they start having carbs again, find that they’re stronger in their workouts and they sleep better.
Also, they don’t have to eat like a weirdo.
Like, when the family is having a pancake breakfast, they can actually have a pancake. On Taco Tuesday, they can eat their taco with a tortilla, instead of eating it with a lettuce wrap, like a monster. You can actually have a chicken sandwich for lunch, because it’s easy and it works.
People bond over food. Our cultures are often connected to food. Community and group events are often tied to food. We often have family traditions based around certain foods. There’s a reason we talk about “breaking bread” together. And there’s nothing less keto than breaking bread. I mean, I guess you could break it and put it back? Also weird.
The family meals that our parents or grandparents made, our favorite place to eat when we go back home, the things we eat on holidays… That’s a lot to give up over a superstition about carbohydrates having magical properties.
We had a client who hit all of her goals after she started actually eating the pizza at pizza night with her kids.
She found out that she could have two-slices of pizza, and a salad, and it was ok. She realized that the connection with her family really mattered to her.
On the flip-side, most of the time she ate really balanced meals, with ¼ of the plate protein, ¼ of the plate carbohydrates, a tablespoon-ish of fat, and ½ the plate vegetables. It was fine, and she got to actually do a thing with her family.
We’ve had tons of clients who thought that their problems losing weight were carbohydrates but found that they had no problem at all with one serving of carbohydrates at each meal. In fact, all of sudden, their constant cravings for dessert and snacks went away, and they stopped “falling off of their diet” every weekend.
Clients often find that when they aren’t scared of and don’t moralize the birthday cake at their grandma’s house, they’re able to eat the birthday cake, enjoy it, and then just go back to balanced meals like normal. Taking away the moralization and the rigidity allowed them to actually have a normal life and eat balanced meals most of the time.
For all of those clients, taking away the dichotomous thinking and moralization of food was what allowed them to be able to have a conscious choice. It made it possible for them to start practicing eating skills that put them in the driver’s seat with food. It allowed them to create some awareness of their body and get in touch with their own hunger and fullness cues.
You get all of that by learning guidelines and skills for checking in with your body.
You lose all of that with rules for cutting things out. Cutting out specific foods is a bad path. Cutting out an entire macronutrient is actually just silly.
Review: The Five Things Wrong with Keto
- Cutting out more and more foods is not the answer.
- Rigid diet rules set you up to fail.
- Moralization of food is bad for your relationship with food.
- Super keto water weight fluctuations suuuuuck.
- Keto is weird at social events.
We’ve looked at the five things that are wrong with the Ketogenic Diet.
Again, it works great for some people. And for the people who love it and it makes their life easier, that’s awesome.
For people who have tried keto and had issues with any of the five things above, and were disheartened, it’s ok. Carbohydrates are not bad or evil and you don’t have to cut them out. We have an alternative.
Eating Skills Yo 🍕 🍔 🥑
If you want to be in the driver’s seat with your food — to create awareness around what your body needs, your own personal values about food, and to be able to make food choices based on that in any situation, you just need to practice a dozen or so eating skills.
What you learn about yourself, in your practice and in your facilitated reflection, will give you your own personal path forward.
You don’t need someone else’s magic list of what food groups to be superstitious about.
The “I’m-Trying-To-Add-Back-In-Carbs” Skill Pack
- Plating Balanced Meals 🍽
- Put your fork down between bites 🍴
- Fast 4-6 hours between meals ⏰
- Pause 10 minutes before getting seconds 🍜
Plating Balanced Meals
The first thing we’re going to do is have a balanced plate. You’ll notice that there is protein, vegetables, and fat (just like in keto!), but that we limit the fat to one serving and we also have just one serving of carbohydrates.
We’re looking at the plate really simply, in terms of which place balance has people self-regulate food intake the easiest. People self-regulate the easiest when they have a balance.
For during meals, it’s easiest to notice when you are full and stop, when you have:
For between meals, it’s easiest to not snack between meals when you have
So, we do the best of both worlds, and combine it all: Protein, carbohydrates, fat, and vegetables.
There’s nothing magic about having a balanced plate, it’s just that if we balance our plates it’s easier to self-regulate food intake. It doesn’t have to be perfect, but it’s something to shoot for when we want to make it easier on ourselves. If we can just get close to it, most of the time, we do pretty well.
🍴 Put Your Fork Down Between Bites
The next guideline is about eating slowly enough to be able to notice when you are full and stop. Everyone knows that if you eat slowly, you enjoy your food more, you can actually feel yourself getting full, and you can stop before you eat too much.
If people overeat carbohydrates at meals, it’s because they never slowed down enough to notice themselves getting full.
The thing is, mostly we aren’t given an action for eating slowly. The action of eating slowly is putting your fork down between bites. Or put your spoon down between bites, or put the taco down between bites, or the sandwich, or whatever. We don’t care what implement you are using to each, just put that down between bites.
And no, it doesn’t have to be between every bite. It can be every other bite, or whatever. Just putting the fork down between bites regularly can slow you down enough to be able to notice the food flavors, enjoy them, and check in with your stomach.
⏱ Fast 4-6 Hours Between Meals
One of the reasons that cutting out carbohydrates can work for people is that all of the things that they snacked on mindlessly, or stress-ate, or emotionally ate, were carbohydrates. Basically, they ate a lot of carbohydrates between meals, for non-hunger reasons.
All we are going to do is learn to check in with ourselves.
If you are truly hungry between meals, sure, have a snack. But that just means that your meal wasn’t balanced (see the Plating Balanced Meals guideline) or that the meal was too small, because your head is stuck in Diet World.
Fasting 4-6 hours between meals is a guideline. And if you want to have a snack between meals, you have to check in with yourself first.
If it’s been less than 4 hours, usually it’s just boredom or tiredness or stress or something else. If it’s been more than 6 hours, that’s usually too long and you’ll roll into the next meal way too hungry and overeat.
It’s not a rule. It’s a guideline for checking in with yourself. The whole program is about being mindful of how you are eating, and having a structure to practice checking in.
It works because you learn to trust yourself, instead of magical diet rules.
Pause 10 Minutes Before Snacking
So, if you are in that 4-6 hours between meals, and you feel a craving coming on, what do you do?
You pause 10 minutes before having a snack.
We need to put in a gap between the feeling of wanting or having a craving, and actually eating something. Mindless snacking happens because it’s mindless and automatic. We want and we eat, without any pause, and without checking in.
Pausing separates us from that mindless “want —> eat” pattern.
It literally smashes that pattern.
In that 10 minutes, we can actually check in with ourselves:
- Do I feel a hollow feeling in my stomach?
- Do I feel hungry for a balanced meal?
- Do I only want one specific treat?
- Am I tired?
- Am I thirsty?
- Am I stressed out or feeling uncomfortable emotions?
- Am I procrastinating or avoiding something?
- Is this just a habit I do every day?
- Do I just need a quick break from work?
We can use that time to check in with ourselves and be mindful about what our needs are.
People are often shocked to find out that they just never took any time to check in. That, when they do check in with themselves, they can figure out if it’s true hunger or if it’s something else.
If it’s true hunger, eat.
Just use that as a note to adjust your meal to have better balance or more food next time.
If hunger is not the problem, then food is not the answer.
Ditch Made Up Diet Rules and Put Yourself in the Driver’s Seat with Eating Skills
Diet rules are totally external, and mostly made up. They work in some situations, and not in others. People “fail” on diets when they run into a normal situation where the diet rules don’t work.
This whole program is based on using guidelines to learn to check in with yourself. You develop the eating skills to check in with yourself, trust yourself, and be able to make smart, effective, conscious decisions about your eating in any situation.
It’s about putting you in the driver’s seat.
Build Skills that Last
Eating Skills is a coaching experience that will help you build sustainable skills around how you eat, giving you a healthy, non-dogmatic approach to food.
- Mann, T., Tomiyama, A. J., Westling, E., Lew, A. M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: diets are not the answer. American Psychologist, 62(3), 220.
- Wolpert, S. (2007). Dieting does not work, UCLA researchers report. UCLA Newsroom, 3.
- Byrne, S. M., Cooper, Z., & Fairburn, C. G. (2004). Psychological predictors of weight regain in obesity. Behaviour Research and Therapy, 42(11), 1341-1356.
- Palascha, A., Van Kleef, E., & van Trijp, H. C. (2015). How does thinking in Black and White terms relate to eating behavior and weight regain?. Journal of Health Psychology, 20(5), 638-648.
- Byrne, S. M., Allen, K. L., Dove, E. R., Watt, F. J., & Nathan, P. R. (2008). The reliability and validity of the dichotomous thinking in eating disorders scale. Eating Behaviors, 9(2), 154-162.
- Hall, K. D., Chen, K. Y., Guo, J., Lam, Y. Y., Leibel, R. L., Mayer, L. E., … & Ravussin, E. (2016). Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. The American journal of clinical nutrition, 104(2), 324-333.
- Yang, M. U., & Van Itallie, T. B. (1976). Composition of weight lost during short-term weight reduction. Metabolic responses of obese subjects to starvation and low-calorie ketogenic and nonketogenic diets. The Journal of clinical investigation, 58(3), 722-730.
- Astrup, A., Larsen, T. M., & Harper, A. (2004). Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?. The Lancet, 364(9437), 897-899.
- Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J. P., … & King, A. C. (2018). Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial. Jama, 319(7), 667-679.
- Sacks, F. M., Bray, G. A., Carey, V. J., Smith, S. R., Ryan, D. H., Anton, S. D., … & Williamson, D. A. (2009). Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New England Journal of Medicine, 360(9), 859-873.
- Foster, G. D., Wyatt, H. R., Hill, J. O., McGuckin, B. G., Brill, C., Mohammed, B. S., … & Klein, S. (2003). A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 348(21), 2082-2090.
- Dansinger, M. L., Gleason, J. A., Griffith, J. L., Selker, H. P., & Schaefer, E. J. (2005). Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. Jama, 293(1), 43-53.
- Hu, T., Mills, K. T., Yao, L., Demanelis, K., Eloustaz, M., Yancy Jr, W. S., … & Bazzano, L. A. (2012). Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: a meta-analysis of randomized controlled clinical trials. American Journal of Epidemiology, 176(suppl_7), S44-S54.