Every day in my clinic, I have at least one patient come in asking if they should try the ketogenic diet. It is usually a woman who is so desperate to lose weight, and is looking for that magic bullet. I totally get it ladies! But please, do not try a Keto diet util you have read this! I usually do not see people do well on a Keto diet, especially women.

It is not that a Keto diet does not have it’s place. It is very helpful for neurological conditions and cancer. The problem is that most people are doing it as a last ditch effort to lose weight, and usually they are doing it wrong! Here are the top things to consider before starting a Keto diet.

1). It is not a long term sustainable diet for most people. Do you know how many times I have people tell me they are Keto, but they occasionally have beer, or bread, or fruit. When I question them how often, it is usually a few times per week. Sorry folks but that is not Keto! They are spending more time out of ketosis than in ketosis. If you are going to say you are in ketosis then you need to measure this to make sure you truly are.

2). You MUST track your food! A true Keto diet is 60% fat, 20% protein and 20% carb. Many people make the mistake of eating a lot of fatty meat and think they are ketosis. Too much protein in your diet will take you out of ketosis. How? Excess protein can convert into glucose. To truly know if you are in this range you must weigh and measure all of your food and track it on an App like My Fitness Pal.

3). You MUST track your food! I know, I just said this, right? I can not emphasize this enough! It is easy to become micronutrient deficient if you are not eating nutritionally dense carbohydrates. A diet that only allows for 20% carbs does not leave a lot of room for error. If you are not eating a lot of green leafy vegetables and get your carbs from a potato, you will end up with problems. It is also easy to not get enough fiber. Fiber is needed to feed your good gut bacteria and a Keto diet tends to be lower in fiber which can starve the good guys. Again, use an App such as My Fitness Pal to give you an idea where you are at. There a lot of other great Apps out there for food tracking. It really does not matter what you use as long as you use something.

4). Hire a nutritionist or health coach! You need to have someone that you can check in with weekly that is familiar with the Keto diet. This person can help you monitor your micronutrients and also make sure you are sticking to the correct balance of 60% fat, 20% carb, and 20% protein.

5). Women usually don’t do as well on a Keto diet. Why is this? I believe it has to do with the hormonal shifts that women go through. Too low of a carbohydrate diet can sometimes cause more stress which up regulates cortisol. This can cause more hot flashes and insomnia. It also leads to thyroid issues. I have seen women’s thyroid labs look worse on a Keto diet. This may be because the diet was not done correctly, but I can say I consistently see this on blood work.

6). Test yourself! Is the Keto diet helping you or hindering you? Do the blood work to find out. How does your thyroid look before and after the diet? What does your cholesterol look like? How about your cortisol levels? Ultimately, how do you feel? You should not continue any diet that you don’t feel well on.

7). Do you have thyroid issues? If you are hypothyroid, you may pause before doing the Keto diet. I have seen multiple patients whose hypothyroidism became worse once they did a Keto diet. When you decrease your carbohydrates, it can cause an elevation in cortisol. This elevated cortisol will then affect your thyroid. Elevated cortisol will increase hypothyroidism and affect your thyroids ability to convert to the active form T3.