Layne Norton, PhD Nutritional Sciences, wrote in his book:

“My father lost 30 pounds on a ketogenic diet, then added back 60 pounds because he couldn’t sustain the diet for more than four months. Once he went back to eating “normally,” he rapidly packed the pounds back on.”

That is why I think the keto diet is just wrong in any conceivable way. Probably even in ways, I haven’t even thought about (I’m talking extreme keto diet where you cannot eat more than 50 grams of carbs per day or else you will ruin the magic (meaning, made-up) benefits of ketosis).

Sustainability is the most critical factor in losing weight — any diet you cannot permanently adhere to is a shit diet. For most people, the keto diet is that kind of diet.

A 2021 study looked at adherence to ketogenic and Mediterranean diets and here is what they did:

Food delivery phase - Participants were provided with all meals and snacks for the first 4 weeks; Self-provided phase - Participants were responsible for buying and preparing their own meals; Follow-up phase - Participants were free to choose which diet (keto vs. Mediterranean) they wanted to follow

As might be expected, average adherence was best during the first four weeks when all meals were provided by a food delivery service but the whole thing went tits up during the self-provided phase and even more so during the follow up:

There was considerable variability in adherence scores among the subjects — it actually increased for a few oddballs. But for most, keto was hard to sustain long-term and so the researchers concluded:

A challenge during the ketogenic diet phase was the extreme carbohydrate restriction, which meant the exclusion of many commonly consumed foods, making it harder to follow in the long-term. This exclusion of foods made it more challenging for participants that shared meals with their families, with many participants finding that they often had to make separate meals for themselves and their families while on the ketogenic diet.”

The famous A to Z weight loss study (famous among the fitness geeks who have no detectable social lives, like me) also investigated the level of dietary adherence to popular weight loss diets including the Atkins diet which is similar to the keto diet. The main difference between the two is that you gradually increase carb intake on Atkins while it remains lower than 50 g/day on the keto diet.

Check out the difference between the recommended daily carbohydrate intake and the reported:

The recommended daily carbohydrate intake was ≤20 g carbohydrate per day at 2 months but the actual intake was 55 g and ≤50 g carbohydrate per day for the ongoing weight loss phase of the subsequent 10 months but the actual intake was 135 g.

The same thing happened in the study by van Wyk and colleagues — carbohydrate intake on the keto diet started at 50 g/day but crept up to 132-162 g at the 12-month mark. The researchers concluded that:

“Very low-carbohydrate diets may not be sustainable over a medium to longer-term as carbohydrate intake in diets within studies often converged toward a more moderate level.”

Adherence to the keto diet has been a problem in this study as well:

We observed beneficial effects of ketogenic diets compared to non-ketogenic diets on BM and body fat in individuals performing resistance training. However, adherence to ketogenic diets may have a negative effect on fat-free mass, which is not ameliorated by the addition of resistance training.

The keto diet is a straightforward, easy-to-understand diet — limit carbs to almost, er… nothing and pretend you are happy about it. Simplicity is a good thing. But is the keto diet special or superior to higher-carb diets? No. Is it easy to sustain? For most people, no.

The keto diet is for you only if you are making progress and you are enjoying it. If either of those two is not true, then forget it and focus on these two to improve adherence:

  • Individualize macronutrient distribution — if you want to lose weight, create a calorie deficit, increase protein intake, and then base the proportion of fat and carbohydrate on your personal preference and training goal.
  • Individualize food choice within a healthy framework — choose foods that you prefer and can consistently access. A sustainable diet should consist of foods you like [insert ‘duh’ sound here].

File the above advice under things that make you say fuck it I’ll do it my way and you will be cutting perfectly healthy and nutritious foods out of your diet for no reason other than my friend read something about ketosis on the BBC website so the information must be legit.

Further reading: 3 Reasons Why Flexible Dieting May Be Your Last Diet

I will leave you with the excerpt from that among-the-geeks-famous A to Z weight loss study:

“Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.”

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Originally published by me on Medium on May 22, 2022

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