Just Say No to Keto, Especially in Midlife

If you’ve been dieting for even just a few years, chances are you’ve tried or been super curious about if a Keto diet could help you lose the weight that are feeling desperate to shed. While may women have experienced success with being able to achieve weight-loss goals quickly with Keto, I would argue that there are far more significant risks than there are benefits to this diet. And they are the risks that are almost never talked about.  

For one, keto is problematic for the same reason any diet is problematic-it’s restrictive. Our bodies need a wide variety of nutrients and eliminating any one of them can have huge effects on our bodies. When it comes to keto, reducing carbs poses two key problems. For one, a low-carb diet leads to a reduced fiber intake, which in turn can affect gut health and lead to constipation. Perhaps more overlooked is the fact that the metabolic state of ketosis can actually increase cortisol levels (stress hormone) and CRP (an inflammatory marker) which can absolutely exacerbate hormone balances women in midlife are already experiencing. And let’s not forget how incredibly grumpy we feel without carbs. 

Even more dangerous is the impact that this extreme approach to food has on our relationship with food. In order for it to really yield results, a keto diet requires you to adopt the all-or-nothing approach. When we normalize this type of thinking, the natural consequence is that we develop a fear of food because of how it limits our definition of “success”. It makes it close to impossible to associate a positive self-image with anything except a number on a scale. 

While it’s not sexy, and a heck of a lot more investment in terms of your mind and emotions, gentle nutrition is still the only option I see that supports every element of your health. When we make room for everything on our plates, we enjoy and embrace all foods because we understand how they make us feel and how they fuel our bodies. We can approach food in a way that serves us now and in the decades to come.

In this episode, you'll learn: 

• Why the keto diet lacks sufficient scientific evidence for its long-term effectiveness 
• How keto actually fuels a strong fear of food
• Why restricting carbs is so dangerous in the long-run
• The science behind how the state of ketosis impacts our brain and emotions
• How embracing intuitive eating can foster a positive relationship with food and overall well-being

TRANSCRIPT

Jenn Salib Huber 0:02
Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Celine Huber. Come to my table, listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Okay, welcome to the season finale of season two of the midlife feast. And I decided to end this season with a bit of a bang, because I am giving you the by far most requested podcast topic ever, whenever I put a call out for topic requests or guest requests, this is always at the top of the list. And I'm really excited to finally be getting this out to you. But I really do feel a need to go over a few disclaimers. So I'm a dietitian and a naturopathic doctor, but I'm not your doctor, and I'm not your dietician, please view this and any other information as just that information. It's not medical advice, and it's not advice for you. I always welcome discussion. And I think that if you you know me or follow me, you know that I don't shy away from controversy. But I'm also not interested in debating my opinions, but I do like discussion. So if you feel the need to send me a note, please don't make it a nasty gram. And keep it civil and ideally referenced. And on the topic of references, I'm not going to include references, meaning, you know, links to journal articles or other peer reviewed research, because I don't think that that's what most of my audience wants. But I am happy to share that information. If you want any, to have questions about any particular topic or something that I say, please do feel free to reach out, I'm always happy to discuss research. So last thing is I'm going to mainly be focusing on why I don't think the keto diet or ketosis is good for women and in particular women in midlife, I am not going to touch on all of the other reasons why someone may, you know, explore a keto diet or choose to try that because it would just be too, too much too much for my little podcast. All right, are you ready? Settle in. So first, let's kind of set the stage and talk about what exactly is keto. So the ketosis diet was originally developed, believe it or not in the 1920s for as a treatment for epilepsy. So as a treatment for treatment resistant epilepsy in kids who weren't responding to the conventional standard treatment of medication. And in this original form, it was described as being about 90% of the calories coming from fat and with the goal of kind of keeping carbohydrates to less than 50 grams a day. And there actually is, you know, a fair amount of research that is effective with people in this population in particular. But you know, that's a really specific indication and use, and keto as a weight loss diet actually didn't start to come into the conversations around weight loss, I would estimate until the early to kind of mid 2000s. So certainly, we had high protein and Atkins, and all of those other things, but kind of discussion around ketosis in particular, I didn't encounter in my practice until probably more like 2008 2009, there was kind of some, you know, talk around that and then it got really popular, I would say after 2013 2014. Now, as I mentioned, the strict definition of keto is where 90% of your calories are coming from fat. This definition has been adapted a little bit and sometimes people will do what's called Dirty keto, where they're choosing to, you know, either add more protein or maybe not be as strict with carbohydrates, but strictly speaking, that is not keto. So how is keto different? Why is it so popular? Why does it have almost a cult following of people who who really believe that it is the way that we should be eating? So unlike low carb or high protein, a keto diet is really high fat, like I mentioned, strictly speaking, 90% of calories coming from fat. This is what is required in order to trigger the production of ketones. So that metabolic shift that happens where we go from burning primarily glucose as fuel to producing ketones and attacks takes about three days to get into full ketosis and it's very much all or nothing. You're either in ketosis, or you're not one slice of bread, and you're kicked in, and you kind of have to start all over again. And it's these ketones that can be used by our body as fuel for energy. So yes, it can help you survive if you don't have regular access to the body's preferred fuel source, meaning glucose. But I like to call ketones, our bodies brake in case of emergency system. It is designed to help you survive, but it is not going to help you thrive. And we'll talk a little bit more about some of the side effects that happen when you're in ketosis. When it comes to any diet, the thing that we're all drawn to at some point is they appeal to us because they present us with a set of rules on how to make decisions about food. And I don't know about you, but I have a lot of decision fatigue, when it comes to deciding what and when and how much to eat. Just think of that, you know, conversation that happens in so many households on a regular basis? What's for dinner? What am I going to have for breakfast? What am I going to have for lunch? What do we have for a snack. So I think that one of the big appeals of any diet, but in particular, the keto diet has that for most people, it actually allows them to eat foods that most diets don't. So there's a novelty built into it, right. So most diets, if you're counting calories, or fat, don't allow you to have bacon and cheese and unlimited amounts. But the keto diet says that you can have that whenever you want. So there's there's a novelty there, and it feels exciting. And I totally, totally get that. And as I'll share at the end, when I share a little bit about my own personal experience with keto many years ago, that was 100%, one of the appeals was being able to eat having permission to eat all the foods that are often restricted. But after the honeymoon phase wears off, and it always does, you'll probably find yourself in a really familiar dilemma, craving the foods that you're restricting. But this time, you're craving an apple, or more than 10 Blueberries, or you just can't imagine anything tasting better than having a ban on your burger instead of lettuce. Because as we know, and as I've talked about before on this podcast, it is the control that creates the craving, not the food itself. So we're gonna go down my little list here of reasons why I don't recommend the keto diet for anyone really, but for women in particular, and why I think that it actually does more harm than good, even if it produces weight loss. So the first and I think most important reason is that the science doesn't support it. So I'm going to kind of give a big overview of some of the problems of studying weight loss as an intervention. So in order to determine whether or not any particular way of eating any particular set of rules, is effective in air quotes, by producing weight loss, we have to be able to apply that to a group, which is going to be the test group. And compare them to a control group, which is the group that we don't change anything with. So when it comes to studying weight loss as an intervention, we need to have two groups of people who are similar in many ways, age, socioeconomic status, education, access to food, cooking skills, all those kinds of things. And then apply the intervention, meaning teach them the food rules, and also monitor how well they're able to follow those food rules and measure them at you know, regular intervals, which could be you know, weeks or months, and then see if there's enough of a difference in the test group compared to the control group.

Jenn Salib Huber 9:38
And in order for us to be able to say that the results of that particular intervention are something that we can apply to everyone. We need to study a really large group of people in order to be able to generalize the results. So I think that anybody who's thinking a little bit critically here can see Either there's a lot of inherent problems or confounding variables that come up when we're studying weight loss as an intervention. So one is, how long can we ask people to do this? How closely can they adhere to the rules? And how much confidence do we have that they're actually able to do that, because unless they're living with us, and we're preparing the food for them, we kind of have to trust what they're telling us. And so most of the time, all of these problems mean that weight loss studies are short, weeks, months, at best, very rarely years. And it's very difficult to be able to generalize the results. So when it comes to studying weight loss, what we find is that there really isn't any particular way of eating that outperforms another after about three to six months. And again, this is a sweeping generalization. And yes, you will find studies that are longer and shorter, that have differing opinions on this. But in general, if you look at low carb, high carb, you know, high protein, whatever it is, they will all, quote unquote, work for three to six months, but then stop working, meaning that at six months or 12 months, or maybe two years, if we're lucky, there isn't a whole lot of difference between the groups. And the same is true for keto, there really isn't any long term data that is generalizable to say that it's any better or any different than any other way of eating. And so when it comes to the science of keto, I just have always felt like it's missing. It is it is shiny, and it is exciting. And it is novel. And it has a cult like following, but it doesn't have science to back it up. The next reason, which is a little bit more in line with my work as an intuitive eating counselor, is that it is so on sustainable, it is either on or off, there is no room for life, there is no room for what do you do if your house catches on fire, and you don't have a kitchen or a fridge? That was actually from a conversation that I had with someone just last month who said that it was literally their house burning down that made them realize that keto was completely unsustainable for them, because when they didn't have access to being able to have all this food prepared and ready to go. They they couldn't do it. But you know, like I talked about earlier to ketosis, the state of ketosis is on or off, it's all or nothing, you're either in or you're out. And that is never going to be sustainable. And I'm not the first person to say that that's a big problem with the keto diet. But I think that most people who go into it, know that, but they're willing to try, they're willing to say, I'm gonna do it until I get what I want, meaning weight loss, and then I'll figure it out. But it's not that easy, because there really is no room for life. But it also cuts out entire food groups. So one of the big criticisms about keto is that by cutting out carbohydrates, essentially, you're committing to a low fiber diet. And, you know, fiber is one of the interventions, we'll call it that, you know, across the board seems to support better health, whether it's a reduction in cancer risk, reduced risk of diabetes, whether it's lowering cholesterol, whether it's managing IBS, whatever it is, you can find research that supports the benefits of a high fiber diet. Possibly because fiber is what feeds our microbiome, it you know, the gut bacteria that live in the lower part of our bowel require and thrive on fiber. And if you're cutting out carbs, you're cutting out fiber. Yes, you can absolutely get fiber from leafy greens. But I don't know anybody who wants to try and get 25 grams of fiber from kale. I know that I don't, it is not enjoyable. I don't think it's achievable. And it's not necessary. We don't have to limit our fiber to the vegetables that grow above ground. We can and should get fiber from a variety of sources, which includes a lot of foods that just aren't allowed, like carrots and potatoes, and even things like sweet potatoes and beets are not allowed when you're following a keto diet because they're high in carbs. So cutting out entire food groups is, you know something, again, it adds to that sustainability argument. But it's also about enjoyability, it is not enjoyable to get 90% of your daily energy needs from fat. And it makes people fear food. And so much of the work that I do is around changing the default programming that we have around food and our beliefs. And when it comes to carbohydrates, the Keto culture and discussion around keto, have really made people afraid of good carbs and bad carbs. There's a hierarchy of what's good and what's bad, and what's allowed sometimes and what's not. But it really, you know, I think, calls into question our own intuition about foods that we enjoy foods that help our body to feel good, and reduces it to just a molecular structure and what its impact on insulin is. And that's never a way I don't think it's a way to live. But it's also not intuitive to be afraid of food. Food should be enjoyable, it should be pleasurable, it should be relatively easy, because we have to make decisions about food, every single day of our life. And if you're afraid of always making the wrong choice, if you're afraid that your lunch or supper meal is going to have an effect on the scale the next day. It's it's really, really uncomfortable. And it has no room for life. Like the person whose house burned down. You know, there is no, there's no living and having to bring your own food to every restaurant or birthday party or vacation. There's no room for life when you have to, you know, go for sushi and only eat the sashimi. There's no room for life when you can't have an ice cream at the beach with your kids. And because going back to that all or nothing on or off status with keto, it feels like such a big decision when you're in ketosis. And let's say you're at the beach and you want an ice cream with your kids. To say yes means undoing all of that. But to say no feels like you're missing out. And that's not what I want. For women. It's not what I wanted for myself. And it's not what I want for women who are just looking to have a more peaceful relationship with food. I don't want you to ever feel like a decision about food is make or break anything. But probably most relevantly I believe that there's enough evidence to say that sustained ketosis can have a negative impact on hormones. And for women in midlife, and especially for women in perimenopause, who are already on an up and down hormone roller coaster that they did not sign up for. I think that this makes most people feel worse. I know that that was how I felt. And I and I see that all the time in the women that I work with. So some of the the major kind of hormone shifts that can happen and that we have evidence for is that cortisol levels can increase. Cortisol is our stress hormone. It is the hormone that tells our body that we're in danger and our brain that we have to be on the lookout for a threat. And so if you think about that kind of in a meta kind of way, if being in ketosis is our breaking case of emergency system, and we also have evidence that it is stressful enough to mount a cortisol response.

Speaker 1 19:00
Why would we think that that's a good thing, even if it produces

Jenn Salib Huber 19:05
weight loss. There is also evidence that CRP which has C reactive protein, which is an inflammatory marker, increases in ketosis for reasons that they don't fully understand why. But again, I think if we know that it increases cortisol levels, it makes sense to me that the inflammatory response may also be activated. And what we know about hormones, especially reproductive hormones, is that the pathway that enables us to to grow and follicles and mature eggs and prepare for you know, potential pregnancy requires a degree of safety. Meaning if you are under a significant amount of stress, your body will shut that pathway down. Because as I've said, Thanks In times before your body will always prioritize survival over reproduction. So let's make this really relevant to somebody who is, let's say 38 or 39. Still having regular cycles, but has started to notice body changes, isn't sleeping well, is experiencing mood, mood swings and anxiety. And it's just feeling not themselves anymore. They're not sure if it's perimenopause, but they decide just to give this keto thing a try, because why not all their friends are doing it and it can't hurt, right? So they give it a good try. They're being really diligent and strict, and they're tracking and they're counting all the grams, and they're a master at calculating net carbs. And they have fat bombs in the freezer, and they know how to make keto pizza crust set up mozzarella cheese and coconut flour. But instead of feeling better, they start to notice that they're feeling more anxious, more stressed, maybe they've developed a bit of the Atkins attitude, which is you know that that mood change, or sometimes people call it the Keto flu that happens when you're in ketosis, where you're kind of irritable, but also a whole lot of blah, because you're eating pizza across it's made from mozzarella instead of fluffy, delicious dough. And maybe you started to notice that it's actually harder to stay asleep, or you're waking up feeling really wired. These are all really, really common symptoms and situations that happen. When women in perimenopause, try a keto diet. And yes, absolutely, in the first couple of weeks, maybe even in the first month or so the scale will look like it's going down. A lot of that is water weight. And because we know that water follows carbohydrates, so as you burn through your body's carbohydrate stores, and they are, you know, significant have have a lot of water that goes along with them, the scale will go down, and you may feel less bloated initially. But that stalls for most people. And again, going back to that all or nothing nature of keto one one ice cream, and you could find the scale up five pounds the next day, because your body will start storing carbohydrates as glycogen and taking water along for the ride. But there are other side effects that I think are more disruptive in day to day like constipation. You know, constipation is I think one of the top side effects of the keto diet, again, going back to that low fiber, but also just because it's less bulk, you know, you're not eating fruits and vegetables, and that provides bulk to your stool. And as a result, a lot of people are constantly trying to manage constipation, with magnesium or laxatives, or water or this or that. And that's uncomfortable, nobody wants that. But I also see changes with energy in particular. So because again, glucose is our body's, you know, preferred fuel source, our brain in particular, but also our red blood cells, which are transporting oxygen. You know, with iron around our body. It's you don't have a lot of stamina and endurance. And I think it's one of the reasons why, you know, the keto diet in especially in the sport community never really took hold, because yes, There absolutely are exceptions to the rule. And, and, you know, I know, I've read lots of stories, and I'm sure people will share them with me of like, you know, endurance runners who do keto, but believe me when I say that they're the exception, because anybody who has tried to go for a run, or you know, do more than 20 minutes of activity that you know, requires endurance while in ketosis will tell you that it's exhausting. The irritability and the mood changes are also really common. But at the end of the day, what I find the most, it kind of comes down to my own experience. At the end of the day, I wanted a diet to help me think about food less. And what I got was a diet that made me think about food more, and not just Am I following the plan, but am I following it exactly. To the letter because otherwise it's not working. So I realized that there you know, there are going to be people who succeed at maintaining a keto diet for their maybe their entire life. I've certainly met a handful of people who have had been doing it for years. Who actually feel like it's the best thing for them, they don't mind it, they feel good. They're not being limited in any way. But I can't stress enough how much of an exception those people are. And going back to my very first point, there is no evidence that we need or should do this. There is no evidence that this is any different than any other diet. So I want to end with a little bit of my own experience, because I think one of the reasons why I'm so passionate about coming up against the keto diet, is because it was my last diet in 2015, I was 38. And I was in perimenopause, because at 45, now I'm in menopause. So I was definitely in perimenopause. And like so many others, I was just feeling like, my body was on a roller coaster or train wreck, and maybe a better better way to describe it. I couldn't sleep, I was angry, I was irritable, I was tired, I was cranky, my clothes didn't fit. I felt like something had to give. And despite all of my nutrition, training, and knowledge and experience, and even though it felt wrong, I tried. And I was all in for nearly six months. And it almost killed me. Not literally, of course. But like everyone else, I you know, lost some weight in the first you know, two to four weeks, and absolutely became an advocate for keto, because, hey, look, it worked. Nothing else was working. And look at this. It's working now. But I felt awful. The only good thing about it was that I was seeing the scale move.

Speaker 1 26:53
But then the scale stopped moving. And I was missing out on life.

Jenn Salib Huber 26:59
I had three kids. And all I could do was think about food, all I could do was planning out my entire day. So that I would have something to eat. And I wasn't eating with them. I wasn't eating with my husband and my kids at the table. I was eating something else. I was asking for the bun. Without the burger without the bun. I was making that stupid pizza crust recipe. I was buying Parmesan chips from Costco and eating them like they weren't going out of style. Because they, you know, felt like something that resembled what I wanted, which was a potato chip. I was putting butter on everything, including my coffee, which I think I still need therapy for her for how awful that was. But I was obsessed, I was reading every label, I was counting, I was measuring I had a scale, I was doing everything. And then I just couldn't. And so it kind of broke me. But it broke me in the best possible way. Because it was shortly after that, that I remember very distinctly in a big old crying fest saying to my husband, I just can't do this anymore. And I have to do something different. And I don't exactly know how or why. But that's kind of how I you know, stumbled into intuitive eating and started training to become an intuitive eating counselor. And it was you know, just over a year after that, that I closed my practice to weight loss, because I no longer felt like it was ethical to prescribe something that was more likely to fail than succeed. And I also wanted to actually help help people feel healthy. I wanted them to feel good in their bodies, and I wanted them to feel good about their relationship with food. I don't want anyone to be afraid of food. I don't want anyone to feel guilty for eating anything. And I don't want to feel like anyone's life hinges in the balance of an ice cream. So I hope that sharing this sheds some light onto why so much of my Instagram content is about normalizing eating carbohydrates and normalizing enjoying all food. But also maybe gives you a bit of confidence that if you're stuck in this, should I or shouldn't tie or why can't keto work for me. I just want you to know that it doesn't work for most people. And most people feel better not doing keto, even if the scale isn't doing what they want it to. So thanks for listening to this season finale. I hope that you'll tune in in September when season three comes out. And along with it keep an eye out for some pretty exciting news that will be coming out Towards the end of the summer, early September, and I would love for you to be part of it. Have a great summer and as the saying goes, see you in September. Hey there. Thanks so much for tuning in to this episode of the midlife feast. You can find a link to my group program beyond the scale and anything else that I've got on the go in the show notes. You can also find a link to download my free menopause nutrition for underwriters Guide, which includes some of my favorite recipes to help you implement gentle nutrition. And as always, come hang out with me on Instagram at menopause dot nutritionist. It's where I love to connect with people who are in this stage of life and are looking to try different instead of harder