February 2021

Keto or Not Keto... This Is the Question!

"I'm going keto" is the phrase on everyone's lips these days. But what does it actually mean, and is it the right choice for you? Is it a passing fad, or here to stay? Let's take a clear-eyed look.

What Is Keto, Really?

Ketogenesis is the process where the body produces energy from ketone bodies rather than glucose. Normally, glucose (made from carbohydrates) is the body's preferred fuel, but in the absence of carbs, the body switches to burning fat for energy instead.

Getting into ketosis can take several days, and it's not always an easy journey.

In practical terms, a ketogenic diet means:

  • No more than around 50g of carbohydrates per day, that's less than a cup of rice, or two slices of bread
  • Up to 70% of intake from fat, and only around 25% from protein

Here's the catch that surprises many people: it's not as simple as "swap carbs for protein." If protein is too high, the body can convert it into glucose, and just like that, ketosis is gone. You could eat all that fat and still have your body reaching for glucose. It's genuinely tricky to get right, which is why many people who think they're in ketosis actually aren't.

Is Keto Good for You?

There's a lot to say here. Keto is sometimes used for short-term weight management, and it's also used therapeutically under strict medical supervision for certain specific health conditions, but that's very different from adopting it as a general lifestyle.

The important question isn't really "is keto good?", it's "is keto right for me?" And that comes down to a few honest questions.

Questions Worth Asking Yourself

  • Do I actually enjoy eating a lot of fat?
  • Is my digestion, particularly my ability to process fats, up to it? This is especially worth discussing with your healthcare team after WLS, as fat digestion and gallbladder health are common considerations.
  • Can I genuinely stick to it consistently? Keto only works if it's followed closely.

Here's the thing: keto goes well while you're eating high-fat, low-carb, but if the weekend rolls around and you "relax a little" with some carbs, the balance tips quickly, and much of that dietary fat is more likely to be stored rather than burned. It's an all-or-nothing approach, which is part of what makes it hard to sustain.

If You Do Try It

If you've answered a genuine "yes" to those questions and want to give keto a go, the general guidance is:

  • Use it in short blocks of no more than around six weeks
  • Follow it closely and correctly
  • Then transition to a healthy eating plan rich in fibre, complex carbs and healthy fats
  • If you want to cycle back into keto after that, do so with a solid break in between

Over the longer term, keto isn't generally considered a sustainable way to eat, so it's best approached as a short-term tool, not a permanent lifestyle. It's also worth speaking with your healthcare team before starting, particularly after WLS.

The Bigger Picture

Here's the reality after WLS: because you're already eating smaller amounts, you'll be supporting your goals regardless, so building a balanced, sustainable relationship with food matters far more than chasing the latest trend.

Following the newest craze can easily become another form of yo-yo dieting, precisely because it isn't something most people can maintain for life.

So when you're weighing up any eating approach, keto, paleo, Mediterranean, gluten-free, vegetarian, vegan, or any other, ask yourself one simple question:

Can I do this for the rest of my life?

If the answer is no, there's a good chance it'll unravel the moment you stop.

What we suggest instead is finding a structure around food that's a lifestyle, not a diet. The word "diet" so often leads to short-term commitment followed by a blowout, because you feel deprived. A sustainable lifestyle, where everything is in moderation, life stays enjoyable, and you can leave the house without it all falling apart, is what leads to lasting success.

Always consult your healthcare team before making significant dietary changes, especially after Weight Loss Surgery.

Jacqui Lewis
BHSc Nutritional and Dietetic Medicine