I often get questions about how to lose or maintain weight and am surprised that people still talk about the keto diet. Any fad diet comes with big promises, but the risks are rarely highlighted.

The ketogenic diet was first introduced in the 1920s to manage epilepsy or seizures in children. However, in the last few years it has gained popularity because many who follow the regimen experience significant weight loss. Unfortunately, in many of those cases it has proven to be unsustainable, resulting in aggravating relapse and much of the lost weight returning.

So how does the ketogenic diet work? Our body has adapted to survive in periods of famine by breaking down fat and forming ketones, a by-product of fat, instead of the normal process which breaks down sugar or glucose from carbohydrates. So, to achieve the true ketosis state, a person needs to have at least 75% of calories coming from fat (normal diet is around 30%), less than 5% from carbohydrates (less than 25g carbs a day) and 15% from protein for at least 3 days.

Because this diet is “all or nothing,” it is extremely difficult to maintain. It is considered to be a quick fix to control blood sugars and to drop weight, but most people regain all the weight plus more. One problem is that it is so easy to rationalize the choice of unhealthy fat over healthier fat. Because this diet is also low in fruits, vegetables, and whole grains, it can increase the risk for heart disease. Some other deleterious effects of the keto diet are bad breath, headache, dehydration, constipation, abdominal pain, vomiting, kidney stones, hypoglycemia, lethargy, high cholesterol and high LDL (“bad cholesterol”), bad body odor, and nutrient deficiencies. It is not considered safe for people who have pancreas, liver, thyroid, or gallbladder issues, so it is important to consult with your doctor before starting the keto diet.

In conclusion, there is no quick fix for weight management. There is no universal diet that is appropriate in all situations. Everyone presents a unique set of dietary needs based upon a variety of factors, including overall health and medical condition. If you want to further explore the keto diet, talk with your dietitian, and try a “modified keto diet” that will encourage eating healthy fats, nuts and seeds, some fruits such as berries, vegetables, whole grains, beans, and lean protein. This approach will be easier to sustain without causing negative side effects and, in the long run, help you control blood sugars and better manage your weight. And of course, don’t forget to include regular exercise, which in addition to a diet that fits your lifestyle, is key to overall good health.