Keto, Paleo, and More! A Seattle Dietitian Debunks Some Of The Most Popular Diets
By: Katherine Metzelaar, MSN, RDN, CD & Lindsay Hodgson, MS
Diets are alluring and enticing.
They offer promises that often feel hard to turn down, like better health and weight loss. And, considering the culture that you exist in, the desire to have both is completely understandable. To exist in this (diet) culture means that you are constantly being exposed to one diet after another, each one offering promises of hope. While there are countless diets and “lifestyle changes” that circulate, there are a few that are particularly popular right now. But, how do you make sense of all of them? How do you decide what is rooted in fact and which might actually cause harm and be problematic?
The Keto Diet
The ketogenic diet aka the “keto diet” is a high-fat, moderate protein and low carb diet designed to force your metabolism into a state of ketosis. Carb intake is extremely low (think no fruits, very little veggies, no beans/legumes, bread, etc.) with followers unable to eat more than the equivalent of one piece of bread per day. This diet is similar to an Atkins-style diet, but is even more restrictive.
Unfortunately, the keto diet has been co-opted for weight loss and proponents of the diet promote the value of going into “ketosis” as a means to reduce one’s number on the scale.
Ketosis is a way human bodies have evolved for survival during long periods of time when they didn’t have access to carbohydrates as a way to provide energy to the brain and body. More specifically, ketosis happens when your body doesn't have enough glucose (broken down from carbohydrates) for energy, so the liver processes the fatty acids (from the body’s fat tissue and/or from the consumption of high fat foods) to make molecules called ketone bodies as a fuel source. Confusing, I know. In other words, it’s not how human bodies are meant to function under normal conditions.
What’s most important is that the keto diet has only been scientifically proven as effective only for reducing seizures in children with epilepsy and is not recommended by the medical community. In fact, even for children with epilepsy the keto diet is only recommended for kids that are resistant to drugs that control seizures because of how restrictive this diet is.
As a Dietitian, here’s why The Keto Diet is problematic:
Restricting carbs means there is little glucose (aka cell food) for your cells, particularly your brain cells. You may be able to maintain a low-carb keto regimen in the short-term, but your body needs carbohydrates in the long-term. Additionally, cutting out carbs increases the release of something called Neuropeptide Y which tells the body that you need carbs. Then, when you don’t get the carbs that your body needs, this chemical builds up and can intensify cravings which can increase the risk of developing disordered eating patterns like binge eating. “Control” or “will power” cannot reverse your body’s physiology and basic human need for energy (carbs). This is your body’s biological response to deprivation and has nothing to do with how much will power you have.
The keto diet was never meant to be adopted by otherwise healthy individuals without medical supervision. Despite the diet providing the body with calories from fat, the keto diet puts the body in starvation mode. It has risks including constipation, nutrient deficiencies, and can stress the liver and kidneys.
Common side effects and considerations about this diet that are important for you to know:
Followers of the diet get something commonly called the “The keto flu” where individuals experience dizziness, headaches, nausea, vomiting, insomnia, lowered tolerance for exercise and constipation.
There has been evidence to support that individuals who follow this diet lost more muscle mass than other diets comparatively. This may be related to the fact that protein alone is not very effective in building muscle compared to having enough protein and carbohydrates together.
This diet has been linked to significant liver, kidney and gallbladder problems. All three of these organs processes macronutritients in the body and can be significantly impacted by radically changing your diet to be high fat. Here’s why:
That amount of fat added to the diet to metabolize can add extra strain on those that have fatty liver and cirrhosis. And even for those that don’t, it can increase your risk for future liver issues.
Kidneys metabolize protein so when you don’t get the protein balance right, it can cause kidney issues and kidney stones.
The gallbladder is responsible for producing bile to break down fat, and eating that much fat (especially abruptly) can overwhelm its functioning.
Keto diet is VERY low in fiber. This can cause either constipation or diarrhea and usually severely messes with the digestion of those that are following this diet.
It can lead to mood instability and reduced cognitive function because your brain needs carbs to function. Yes that brain fog is indeed from not having enough carbs, not you “detoxing.”
We don’t have a full understanding of the long-term impacts of this diet on human health. There is no long-term research at this point to show its efficacy.
The Paleo Diet
The paleo diet aka the “caveman diet” encourages followers to “eat foods that were available to ancestors in the days of hunting and gathering”. The main foods emphasized are (limited) fruits, vegetables, lean meats, fish, nuts and seeds. Processed foods containing sugars, refined grains, vegetable oils, trans fats, and chemicals are encouraged to be avoided. Other common dietary restrictions part of the paleo diet include gluten-free and dairy free, as well as no legumes (beans, peanuts, peas, lentils) or nightshades (potatoes, peppers, eggplant, tomatoes). Advocates of the paleo diet argue that it’s “not really a diet” because it is “created by nature” and is how the human diet was “supposed to be” before the developments of the modern western diet.
While there is nothing inherently wrong with wanting to eat more fruits and vegetables or be more connected to the food you’re eating, the paleo diet is extreme.
Here’s why the Paleo Diet is problematic:
The paleo diet is restrictive because it eliminates multiple foods and food groups. Paleo is a low-carbohydrate diet (not as low as Keto) and as discussed above, your body has powerful mechanisms in place to ensure you’re getting enough carbs. For this reason, carb binges, cravings, or stress around carbohydrate-rich foods are common. Binging also becomes a common occurrence on this diet due to the restrictive food rules.
Beyond the carbohydrate restriction, paleo eliminates a lot of other foods which drastically reduces variety in the diet. This not only causes cravings for other energy-dense foods that are not permitted, but this also reduces the nutrient variety consumed. Long-term research shows that humans benefit best from getting a variety of foods in their diet.
By demonizing foods and limiting food options, food will inevitably take up lots lots of headspace and time, which is a common outcome of this diet. Processed foods, or any food for that matter, all serve different purposes and should not be demonized. Processed and packaged foods provide nourishment and make food and meeting nutrition needs more accessible.
This diet is elitist. It asks followers to follow a restrictive diet that requires a lot of money to buy the products, produce, etc. This leads to food shaming and blaming of individuals for “ill health” because they cannot follow this diet.
There is no long-term data to support the efficacy of this diet. Not only this, it promotes disordered eating behaviors like cutting out foods and food groups.
Intermittent Fasting
Intermittent fasting (IF) is a diet in which followers are encouraged to not eat for certain extended periods of time and can entail a daily or weekly schedule of fasts. The amount of time varies based on the “kind” of intermittent fasting someone chooses to follow. The scientific rationale for IF is attributed to “metabolic switching” where the body can “more easily burn fat” . Intermittent fasting has been celebrated as a “weight loss strategy and as a path to longevity and clearer mind .”
Here’s why the Intermittent Fasting diet is problematic:
Intermittent fasting means sporadic eating throughout the day. This means it makes it harder to meet your nutritional and energy needs when eating for a shorter window of meal times, and it’s also harder to feel satisfied and at peace with food. Not getting consistent access to food is also a threat to your body and brain which can lead to increased anxiety around food, food binges, and other disordered eating behaviors.
Even if you are eating typical meals outside of the fasts, it is still a restriction-style diet and makes it very hard to meet your body’s energy needs during the window of time allotted. For many, this can wreak havoc on eating patterns and relationships with food. For example, a common disordered eating behavior that results of IF is bingeing episodes. These happen as a completely natural response to the anticipated deprivation during the next fast.
Common side effects are extreme fatigue, low blood sugar, or brain fog (the exact opposite of IF’s purported benefits) after doing intermittent fasting for a period of time. These are all symptoms of inconsistent nourishment and a sign that the body is not getting enough food consistently through the day.
Not eating consistently can disrupt hunger signals. This means that overtime you become increasingly disconnected from your body’s hunger and fullness cues, which can lead to confusion around hunger and fullness.
There is no long-term data to support the efficacy of this diet. Not only this, it promotes disordered behaviors that are in alignment with anorexia-type eating disorder behaviors.
NOOM
Noom is a weight-loss app program with goals to instill “behavior change” among users to “improve food choices, exercise habits, and overall health”. To start, users provide answers to a few health questions and then an algorithm generates a weight loss plan. As part of following the Noom diet plan, users have to log daily food and steps for which they receive feedback from a Noom “coach” for diet advice. Foods are color-coded as red, yellow, or green depending on their nutrient density and calorie content to serve as a guide to encourage restricted calorie intake.
Noom is a perfect example of a modern diet in that it claims that “it’s not a diet”. And like all diets, critically examining how it promotes disordered eating is important.
Here’s why the NOOM diet is problematic:
The traffic light system reinforces the idea of “good” and “bad” foods, which disconnects you from eating intuitively and enjoying all foods. It also instills a deep sense of fear about foods, quantity of foods and types of foods. Additionally, this stop light system moralizes food which can quickly contribute to food guilt and shame. For example, eating a “green” food can very quickly turn into “I’m a good person for eating this food” and eating a “red” food can do the opposite.
The behavior change is not “healthy eating” despite the creators wanting to push it as such and spending lots of marketing to do so. The advertising is compelling: “A “not diet” (diet) is “back by trained psychologists” to create behavior change that wires your brain to only eat foods low in calories.” Except that your body is smarter than that. This diet only serves to reinforce the idea that you can control what your body size is if only you have enough “will power” and “determination.” No amount of weight-loss psychology can prevent an underfed body from getting its needs met.
There is no long-term research to support the effectiveness of this diet. By looking at the efficacy of other very similar diets like WW we know that low-calorie diets are not sustainable in the long-term. Not only this, diets like Noom are a significant risk factor for the development of eating disorders.
Whole30
Whole30 is a 30-day diet challenge for the sake of “health” to eat “whole food” where added sugars, alcohol, grains, legumes, dairy, baked goods, “junk food,” or food additives are not allowed. Whole30 considers itself an elimination diet “reset” that emphasizes making “good” food choices and boasts the fact that participants “don’t need to weigh themselves or count calories,” but that “strict adherence for 30 days is absolutely necessary.” Any “slip-up” of eating food on the off-limits list requires the person to start over again at day one of the diet.
Here’s why the Whole 30 diet is problematic:
Like the paleo diet and others, Whole30 is extremely restrictive. Eliminating so many foods and food groups makes you susceptible to a scarcity mentality, restrict-binge pendulum, and takes a toll on your relationship with food.
The elimination of grain-based carbohydrates is particularly impactful because the body and brain need carbohydrates. As mentioned above, restricting carbohydrates is unsustainable and will likely make you feel even more out of control in the long-term around those kinds of foods.
Whole30 perpetuates problematic food language and beliefs. As a dietitian, I disapprove of the terms “whole food,” “real food,” or “clean food” because they reinforce orthorexic-type behaviors and promote classist attitudes about “good versus bad foods”.
Orthorexia is a type of eating disorder often described as an “unhealthy obsession with healthy eating”. Cutting out foods and food groups, checking ingredient labels, and prioritizing the cleanliness or purity of foods is common in this eating disorder.
Diet culture has fueled orthorexic thinking about food because of the way it elevates certain foods and demonizes others for the sake of “health.” This kind of thinking also neglects all the other ways food nourishes you: culture, connection, pleasure, and more. Like the Noom traffic light system, the food language and meanings you use can translate to unhealthy judgement of ourselves and others.
Diets are not harmless despite diet culture’s messaging around them. They come with series side effects, some with long-term damage to metal and physical health. Not only this, diets are a significant risk-factor for the development of eating disorders. It’s important that individuals understand the risks involved in intentionally depriving the body of consistent, adequate nourishment from food like nutrient deficiencies, intense-carbohydrate cravings, binge-eating, weight-rebounding/weight cycling, bone degradation, blood sugar dysregulation, increased risk for diabetes, constipation/digestive disruption, and more.
Diets promote disordered behaviors as “health and wellness” and lead many feeling even more confused about how to feed themselves. As a Dietitian, I don’t recommend that anyone follow any of these diets due to the risk factors involved. Instead I encourage individuals to embrace intuitive eating, a non-diet approach to nourishing the body, as well as Health At Every Size (HAES).
References:
Should you try the keto diet? Harvard Health Publishing. August 31, 2020. Accessed July 9, 2021. https://www.health.harvard.edu/staying-healthy/should-you-try-the-keto-diet
Defining the Paleo Diet. The Paleo Diet. Accessed July 9, 2021. https://thepaleodiet.com/paleo-101/what-is-paleo
Intermittent Fasting: What is it, and how does it work? John Hopkins Medicine. Accessed July 9, 2021. https://www.hopkinsmedicine.org/health/wellness-and-prevention/intermittent-fasting-what-is-it-and-how-does-it-work
Everything you need to know about the Noom Diet. Medical News Today. Accessed July 8, 2021. https://www.medicalnewstoday.com/articles/327114#foods-to-eat
The Whole30 Program Rules. Thirty & Co, LLC. Accessed July 12, 2021. https://whole30.com/whole30-program-rules/
Orthorexia. The National Eating Disorders Association. Accessed July 12, 2021. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia
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