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To Carb or Not to Carb

“Oh, you’re a dietetics major? Tell me more about the keto diet!” This is a common conversation starter when people find out I am studying dietetics. In this article, I am presenting the pros and cons of the keto diet.

The ketogenic (keto) diet is a low-carbohydrate, moderate-protein and high-fat diet that is becoming very popular for people looking to lose weight. The keto diet trains the body to use ketones as fuel. When you lack insulin in the blood, the body produces toxic acid chemicals called ketones.

Ketones build up in the blood when you dos not have enough insulin in the body to use glucose as energy. The liver starts to break down fat in the body to be used as an energy source instead of glucose, which originates mainly from carbohydrates. The body is in a state of ketosis when it uses fat stores instead of glucose to generate energy.

Because the goal of the keto diet is to put the body in a state of ketosis, carbohydrates are extremely restricted in the diet. The keto diet seeks to limit the amount of carbohydrates to roughly 50 grams or less.

However, carbohydrates are an essential nutrient and should be the main source of energy. Carbohydrates should make up 45% to 65% of calories based on a 2,000-calorie diet.

To reach that percentage, one should have an intake of 225 to 325 grams of carbs, according to the recommended dietary allowance. However, not all carbs are created equally, so be cautious when choosing carbohydrates. Fruits, vegetables and whole grains are great nutrient-dense sources of carbohydrates.

A few short-term health benefits can be seen with the keto diet, according to the article “Nutritional ketosis for weight management and reversal of metabolic syndrome.” A low-carbohydrate keto diet possibly could lower fasting blood glucose levels, raise HDL cholesterol, reduce hypertension and increase weight loss short term. The keto diet also could help with diabetes (Gershuni, V., Yan, S., and Medici, V., 2018).

“So, you’re saying I should hop right on this diet because it could help me lose weight quickly and raise my good cholesterol?” I get asked. No, along with the pros are some cons related to health we need to consider.

Many nutrients are being limited in the keto diet. Fiber is a major nutrient missing in the keto diet, and a lack of fiber could decrease satiety and cause constipation. A higher fiber intake can decrease the risk of colon cancer.

The high-fat intake seen with the keto diet is another concern. According to Mayo Clinic, “... the high fat content - and especially the high level of unhealthy saturated fat - combined with limits on nutrient-rich fruits, veggies and grains, is a concern for long-term heart health.”

All three macronutrients (carbohydrates, proteins and fats) are essential for the body to function properly. Carbohydrates are the body’s main energy source and are important for proper functioning of the brain, kidneys and central nervous system.

Proteins are not only important for muscles, but they’re also needed for producing enzymes and hormones, as well as repairing damaged tissues. The body needs fats to help absorb certain vitamins, make cell membranes and protect the organs.

According to the article “Timeline of changes in appetite during weight loss with a ketogenic diet,” studies have shown how the diet helps people lose weight, but the article also notes that once individuals go off the diet, they more than likely will gain all the weight back and put on even more. Some people may have this thought in mind, so they go on the keto diet for the long term (Nymo et al., 2017).

Putting the body in a state of ketosis usually causes no harm, but if done for an extended amount of time, it can put the body in a state of ketoacidosis. Ketoacidosis occurs when ketone bodies rise to dangerous levels that lower the pH of the blood. Low blood pH could lead to acidosis, which is linked to kidney failure, kidney stones and bone disease.

Ketoacidosis is especially dangerous for people with diabetes who already have problems secreting insulin. Ketoacidosis is uncommon for people who do not have diabetes, but it still is possible when the body has been put in a starvation state for so long.

Ketones have an important function when the body has an energy deficit. However, when the number of ketones gets too high, they can affect the body adversely, causing low blood pressure, dehydration, coma and death.

Before deciding if a low-carbohydrate diet is for you, you must weigh the pros and cons. Visit for more information about a balanced diet.


By Kaylee Lybeck, Community Nutrition Intern, NDSU Extension

Reviewed by: Julie Garden-Robinson, Food and Nutrition Specialist

Sponsored in part by the Sanford Health Foundation.

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