Is Keto a No-No?

You may have heard of a ketogenic diet. Perhaps you’ve noticed keto products popping up in stores. Maybe you or someone you know is on a ketogenic diet, but is a ketogenic diet right for kids?

What is a ketogenic diet?

A ketogenic diet is a very high-fat, very low-carbohydrate diet with adequate but not excessive protein. A ketogenic diet allows a person to switch from burning glucose as their primary energy source to burning ketones. This process is called “ketosis,” and it happens to be effective at improving insulin resistance, which is the root cause of metabolic syndrome.[1],[2],[3],[4]

The ketogenic diet offers neurologic and metabolic benefits. It has been used since the 1920s to prevent epileptic seizures,[5] and is currently being explored as treatment for mood and psychiatric conditions.[6],[7],[8] For the broader population, its popularity is increasing for weight loss, reversing type 2 diabetes or prediabetes, and improving various elements of metabolic health.

Truth be told, I’m a huge proponent of a ketogenic diet done correctly for adults interested in reversing metabolic disease, but I’m not likely to recommend a strict ketogenic diet for a child with metabolic syndrome. Here’s why.

A truly ketogenic diet is quite extreme. It involves:

Eating very very very very very little carbohydrate, like fewer than 50 grams per day,[9] ideally from high-fiber sources like vegetables. One cannot consume free sugar, starches, beans, lentils, or many whole fruits on the diet.
Eating loads and loads of healthy fats. Think coconut oil by the spoonful and grass-fed butter atop everything.
Eating enough whole food protein, but not too much! Think meat, fish, eggs, nuts, nut butters, and cheese.

It’s restrictive.

Copious amounts of butter may sound enticing–and indeed it would be smeared across some sourdough bread—but eating a predominantly fat-based diet is challenging. And eating so little carbohydrate is very challenging. Since it’s hard to do, it’s unlikely that a child is going to be successful with it. It’s hard enough for a child to avoid free sugar let alone most fruits and all starches.

It’s unforgiving.

Nearly every parent tells me it’s nearly impossible to control what their child eats. I always encourage them to focus on what they can control: the foods they buy and bring into their child’s food environment. They can also speak to other caregivers like family, sitters, teachers, and coaches about suitable foods to offer their child, but that’s about it. Think about all the instances in which your child is offered foods you haven’t approved and what those foods might be. Spoiler alert—it’s refined carbohydrate!

The ketogenic diet is unforgiving. One must stick with it for it to work. Even if you ensure your child only has access to a ketogenic diet at home, the second they accept a piece of candy in the classroom, eat school lunch, or trade foods with friends, all is lost. The diet will no longer be ketogenic. It will then be high-fat and high-carbohydrate, which will NOT help your child reverse metabolic syndrome.

Misinformation

Many people confuse a ketogenic diet with a high-protein diet. They think they can eat all the steak they want, but that’s not truly ketogenic. If protein intake is excessive, the body converts protein to glucose, which disrupts ketosis.

People also think protein is benign—that there is no harm to eating more, and that isn’t true either. Excessive protein is harmful to both the kidneys[10] and the liver,[11] so that isn’t a safe mindset. Many people with metabolic syndrome already have an injured and impaired liver, a condition called non-alcoholic fatty liver disease (NAFLD). What few people know is that excessive protein can harm the liver just like free fructose does.[11]

The other mistake I see people make with ketogenic diets is relying on “keto” products. Most keto products are not truly ketogenic. They contain refined carbohydrate of some sort; it’s simply reduced in comparison to a more traditional form of that product. If you believe that a product is suitable for a ketogenic diet, you won’t pay attention to how much you eat, and if you have more than one serving or multiple “keto” products, you might exceed the carbohydrate limit, disrupt ketosis, and not be successful.

Those same “keto” products usually contain Frankenfood ingredients too, like diet sweeteners, protein isolates, emulsifiers, and gums, which, for various reasons, I do not recommend.

Resilience

Lastly, extreme measures like a ketogenic diet aren’t typically necessary for children and teens. Kids are so metabolically resilient that often a few simple changes can produce major results. The changes we focus on are:

Eating whole foods
Limiting free sugar to special occasions
Reducing starches
Filling up on quality proteins, high-fiber foods, and healthy fats.

When it comes to children, the more extreme the diet changes, the more likely they are to fail. Subtle shifts toward a lower-carbohydrate, higher-fiber diet can achieve powerful results. The one non-negotiable is that you must eat real food. There is no hacking that!

[1] Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018 Sep;7(3):97-106. doi: 10.1007/s13668-018-0235-0. PMID: 30128963; PMCID: PMC6472268.

[2] Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J Transl Med. 2020 Feb 27;18(1):104. doi: 10.1186/s12967-020-02277-0. PMID: 32103756; PMCID: PMC7045520.

[3] O’Neill BJ. Effect of low-carbohydrate diets on cardiometabolic risk, insulin resistance, and metabolic syndrome. Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):301-307. doi: 10.1097/MED.0000000000000569. PMID: 32773574.

[4] Li J, Bai WP, Jiang B, Bai LR, Gu B, Yan SX, Li FY, Huang B. Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: A randomized, open-label, parallel-group, controlled pilot trial. J Obstet Gynaecol Res. 2021 Mar;47(3):1145-1152. doi: 10.1111/jog.14650. Epub 2021 Jan 18. PMID: 33462940.

[5] Wheless JW. History of the ketogenic diet. Epilepsia. 2008 Nov;49 Suppl 8:3-5. doi: 10.1111/j.1528-1167.2008.01821.x. PMID: 19049574.

[6] Arab A, Mehrabani S, Moradi S, Amani R. The association between diet and mood: A systematic review of current literature. Psychiatry Res. 2019 Jan;271:428-437. doi: 10.1016/j.psychres.2018.12.014. Epub 2018 Dec 4. PMID: 30537665.

[7] Sarnyai Z, Kraeuter AK, Palmer CM. Ketogenic diet for schizophrenia: clinical implication. Curr Opin Psychiatry. 2019 Sep;32(5):394-401. doi: 10.1097/YCO.0000000000000535. PMID: 31192814.

[8] Norwitz NG, Dalai SS, Palmer CM. Ketogenic diet as a metabolic treatment for mental illness. Curr Opin Endocrinol Diabetes Obes. 2020 Oct;27(5):269-274. doi: 10.1097/MED.0000000000000564. PMID: 32773571.

[9] Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI, Nielsen JV, Krarup T, Saslow L, Roth KS, Vernon MC, Volek JS, Wilshire GB, Dahlqvist A, Sundberg R, Childers A, Morrison K, Manninen AH, Dashti HM, Wood RJ, Wortman J, Worm N. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015 Jan;31(1):1-13. doi: 10.1016/j.nut.2014.06.011. Epub 2014 Jul 16. Erratum in: Nutrition. 2019 Jun;62:213. PMID: 25287761.

[10] Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S. The Effects of High-Protein Diets on Kidney Health and Longevity. J Am Soc Nephrol. 2020 Aug;31(8):1667-1679. doi: 10.1681/ASN.2020010028. Epub 2020 Jul 15. PMID: 32669325; PMCID: PMC7460905.

[11] Bremer AA, Mietus-Snyder M, Lustig RH. Toward a unifying hypothesis of metabolic syndrome. Pediatrics. 2012 Mar;129(3):557-70. doi: 10.1542/peds.2011-2912. Epub 2012 Feb 20. PMID: 22351884; PMCID: PMC3289531.