Over the past several years, you’ve probably heard a lot about the keto diet. While so many fad diets fade over time, the keto diet has continued to grow more popular. Some companies and restaurants even now offer “keto-friendly” options.
But the keto diet, says registered dietitian Sharon Jaeger, RD, has more going on than a lot of other diets.
“It’s considered a medical, or therapeutic, diet,” she says. “This means that it’s extremely beneficial for people with certain conditions, but it’s not for everyone.”
Jaeger gives us a better idea about what the keto diet is, how it works and whether you should — or shouldn’t — consider giving it a try.
What Is the Keto Diet?
The ketogenic diet, or keto diet, is a very low‑carbohydrate, high‑fat, moderate‑protein eating plan designed to shift your body’s metabolism from using glucose (from carbs) to using fat as its primary fuel source. This metabolic state is known as ketosis.
The Metabolic Shift: Ketosis Explained
Normally, your body runs on glucose, which comes from carbohydrates (such as bread, rice, pasta, and sugar). When carbohydrates are restricted — typically to about 20–50 grams per day — and replaced largely with fats, the body exhausts its glucose supply and begins producing ketones from stored fat in the liver. These ketones become an alternative source of energy for muscles and the brain.
Ketosis is the hallmark of the keto diet, and entering it consistently is what differentiates true ketogenic diets from general low‑carbohydrate eating plans.
How the Keto Diet Works
The keto diet works through a combination of macronutrient redistribution and metabolic adaptation:
- Low Carbohydrates: Reducing carbs forces the body to shift fuel sources.
- High Fat: Dietary fat becomes the main energy source.
- Moderate Protein: Enough protein to preserve muscle without converting excess into sugar, which could interfere with ketosis.
Typical ratios on a standard ketogenic diet are roughly:
- 5–10% carbohydrates
- 70–75% fat
- 15–20% protein
By substituting fat for carbs, insulin levels fall, signaling the body to burn stored fat. This is why the keto diet is often referred to as a fat‑burning strategy rather than a calorie‑restricted diet.
What Keto Foods You Should Eat
To stay in ketosis and maintain nutrient balance, your diet should emphasize whole foods high in fat and low in carbs:
Keto‑Friendly Foods
- Healthy fats: avocados, olive oil, coconut oil
- Fatty fish: salmon, sardines, mackerel
- Meats: beef, pork, poultry
- Eggs and full‑fat dairy: cheese, Greek yogurt
- Low‑carb vegetables: leafy greens, broccoli, peppers
- Nuts and seeds: walnuts, almonds, chia seeds
- Other: olives, berries (in moderation)
Foods to Avoid on Keto
Since ketogenic diets depend on very low carbohydrate intake, you should limit or eliminate:
- Grains and starches (bread, pasta, rice)
- Sugars and sweets
- Most fruits
- Legumes and beans
- Potatoes, corn, and sweet root vegetables
- Sugary drinks and fruit juices
Potential Benefits of the Keto Diet
1. Weight Loss & Appetite Control
Because fats and proteins tend to be more satiating, keto can reduce hunger and help people lower calorie intake naturally. Many studies show greater initial weight loss on ketogenic diets compared with low‑fat diets.
2. Blood Sugar and Insulin Management
Ketogenic diets significantly lower blood glucose and insulin levels, which may improve insulin sensitivity — especially relevant for people with prediabetes or type 2 diabetes.
3. Improved Lipid Markers
Some research suggests beneficial changes in triglycerides and HDL (“good”) cholesterol levels with keto, although the long‑term effects on heart health remain under investigation.
4. Neurological and Therapeutic Uses
Originally developed as a medical therapy for epilepsy, keto can dramatically reduce seizures in children with treatment‑resistant epilepsy. Research is ongoing into potential effects on brain function, cognitive performance, and neurological conditions.
Risks and Side Effects of Keto
The keto diet isn’t without potential drawbacks, especially over the long term or without proper guidance:
Short‑Term Side Effects
- “Keto flu” — fatigue, headache, nausea, irritability
- Digestive changes (constipation or diarrhea)
- Electrolyte imbalance as the body adjusts to ketosis
Potential Long‑Term Concerns
Long‑term or unsupervised keto diets may increase risks of:
- Nutrient deficiencies due to limited food variety
- Elevated saturated fat intake and heart disease concerns
- Kidney stones and liver stress
- Low blood protein levels in rare cases
Because of these risks, many experts recommend monitoring nutrient balance and working with a healthcare professional if following keto long term.
Who Should Consider Trying Keto
Appropriate Candidates
- Individuals seeking short‑term weight loss support under medical supervision
- People with metabolic syndrome or insulin resistance, guided by clinicians
- Patients using therapeutic keto for specific medical conditions such as epilepsy
Caution or Avoidance Recommended
- People with liver, pancreatic, or gallbladder disease
- Those with a history of eating disorders
- Anyone on certain medications (especially SGLT2 inhibitors for diabetes) due to risk of ketoacidosis
It’s crucial to consult a qualified healthcare provider before beginning a ketogenic diet — this ensures personalized planning and monitoring of metabolic, cardiac, and nutritional parameters.
Is Keto Right for You? A Balanced Perspective
The keto diet can be a powerful tool for specific goals such as short‑term weight loss and metabolic regulation, especially when implemented thoughtfully and under supervision. However, because it restricts many nutrient‑rich foods and requires strict adherence to macronutrient ratios, it may not suit everyone or every lifestyle.
In many cases, more flexible low‑carb diets or balanced nutritional patterns (including Mediterranean‑style or “Keto 2.0” approaches) can deliver metabolic benefits with better sustainability and broader nutrient intake.
Conclusion: Practical Keto Insights
The ketogenic diet represents a unique metabolic approach that shifts fuel use from carbohydrates to fats, with potential benefits for weight loss, blood sugar control, and certain health conditions. Yet, its strict nature and potential risks mean it’s not ideal for every person or long‑term use without guidance.
Before starting keto, evaluate your health status, lifestyle preferences, and goals with a healthcare professional. A personalized, evidence‑based plan increases the likelihood of safety, adherence, and success.
How does it work?
The premise of the keto diet is pretty straightforward.
“The keto diet switches you from using glucose, which carbs provide, to using ketones, which fat produces, for energy,” explains Jaeger.
This switch — also called ketosis — can prompt these changes in your body:
- Your metabolism speeds up.
- Your hunger goes away.
- Your muscle mass increases.
- Your blood pressure and heart disease risk profile improve.
Over time, our bodies adapt to certain situations, like shifting from carbohydrate metabolism to fat metabolism when necessary, using fat as fuel for energy, also when necessary.
“Eating fat doesn’t make your insulin go up, as eating carbs or protein does,” Jaeger points out. “So, the keto diet doesn’t spike your insulin, and you don’t store fat. Instead, you burn it, creating the ketones that give you an effective and efficient metabolic jolt.”
What foods can you eat?
Remember, the focus is on fats with a mix of protein but little in the way of carbs. This includes:
- Meats, including high-quality red meat (steak and ham) turkey and chicken.
- Eggs.
- Avocados and avocado oil.
- Other healthy oils, including extra virgin olive oil and coconut oil.
- Fish like salmon, tuna and scallops.
- Butter and cream.
- Nuts like walnuts, flaxseed, pecans and chia seeds.
- Vegetables that are low in carbs like broccoli, spinach, kale, tomatoes and cucumbers.
- Unprocessed cheeses like cheddar, Gouda, Parmesan and goat cheese.
Alcohol, sugar and sugar drinks, beans and high-carb veggies like potatoes and carrots are out the window. You’ll even need to cut back on fruit due to the sugars they can carry.
But it’s essential you consult a healthcare provider first before trying this diet. Moving to a keto diet could mean big changes, and everyone’s needs are different. A doctor or a registered dietitian is best positioned to help you create the best diet plan to benefit you.
Is the keto diet healthy?
There’s still not enough long-term data to say that the keto diet is effective and safe over a long period of 20 to 30 years.
“But if you’re overweight or diabetic, this diet can help get your system out of metabolic crisis and put it in a healthier state,” Jaeger notes.
It’s important to eat real, whole, fresh foods when you’re on the keto diet.
“This includes nonstarchy vegetables,” Jaeger adds. “Frozen food is OK but shouldn’t be processed.”
So, whether you’re doing the keto diet, the Mediterranean diet or a low-fat diet, what matters most is the quality of the food you eat.
Who should try the keto diet?
The keto diet is the standard of care for treatment-resistant epilepsy.
While the exact science of what happens isn’t fully understood, the diet has been used for a century to help alleviate epileptic seizures, particularly in children. It’s believed that a combination of the high-fat and low-sugar content has an effect on how “excitable” the brain is and, thus, reduces seizures.
But doctors are also seeing its benefits in other neurological conditions. The keto diet can be a powerful intervention, particularly for people with the following conditions:
- Type 2 diabetes. One study found that being on the keto diet for one year reversed diabetes for up to 60% of participants. With an average weight loss of 30 pounds, they dramatically reduced or eliminated their need for insulin and no longer needed oral hypoglycemic drugs. The keto diet is also easier to sustain than other diets.
- Class III obesity. If your body mass index (BMI) is over 40 — or if you have insulin resistance without Type 2 diabetes — the keto diet can be very helpful as well. It can be used as a short-term strategy to reset your metabolism and you don’t have to be on it forever.
Research suggests the keto diet might also help those with Alzheimer’s disease and autism.
“Again, it’s vital to work with a doctor or healthcare professional who can treat and follow you while you’re on the keto diet,” stresses Jaeger.
Who shouldn’t try the keto diet?
“Our responses to the keto diet are individualized,” she says. “They’re based on our biology, our metabolism, our numbers and the way we feel.”
Some people can sustain the diet for decades while others don’t fare as well.
Those who shouldn’t try the keto diet include those who:
- Have an eating disorder.
- Are at risk for heart disease.
- Have kidney disease.
- Are pregnant or trying to become pregnant.
The keto diet is generally only explored in children with epilepsy, Type 2 diabetes or obesity, too.
How to get started on a keto diet plan
First and foremost, consult a healthcare provider. Not only can they help you outline a plan that works best for you, but they can also alert you to any unnecessary risks you might face with these changes to your diet.
If you’re given the all-clear to give keto a try, do plenty of research to see what foods fit and what foods don’t fit the plan. Then, consider meal-planning. This gives you an opportunity to make sure you’re getting a good variety of foods to get as many different nutrients as you can.
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