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2 simple rules for the ketogenic diet that a Harvard cardiologist, a Cleveland Clinic diet expert, and a scientist who’s been keto for 6 years all agree on

2 simple rules for the ketogenic diet that a Harvard cardiologist, a Cleveland Clinic diet expert, and a scientist who’s been keto for 6 years all agree on

The keto diet has to be followed diligently in order for it to work.

The keto diet has to be followed diligently in order for it to work.
  • The ketogenic diet is a popular weight-loss strategy, but you don’t have to stick to it forever to see benefits.
  • Even nutrition researchers who may not endorse the keto diet say there’s a right and wrong way to go about it.
  • If you try out the diet, make sure to get enough fat, and don’t cycle in and out of the plan.
  • Consuming too much protein can be bad for your kidneys, so keto-ers should also incorporate fresh foods like veggies and drink plenty of water.

If you’re thinking of going keto, you can forget bread, beans, bananas, and nearly every other sweet treat.

The ketogenic diet is an exacting, tough-to-follow formula for rapid weight loss. The regimen essentially tricks your body into thinking it’s starving by depriving it of nearly all carbohydrates. The goal is to trigger a metabolic state called ketosis, in which the body burns fat for energy instead of storing it up in reserve.

Typically, people on the keto diet rely on fat for 70-80% of their caloric needs. They consume no more than 20-50 grams of carbohydrates a day, which means they’re limited to about an apple’s worth of sugars and starches, if that. Avoiding carbs is essential for maintaining ketosis – if you mess up the ratio, you’ll quickly kick yourself out of the fat-burning state and your body will start burning carbohydrates again, and storing more of the fat you eat as reserves.

The diet has gained popularity from Hollywood to Silicon Valley, with celebrities and venture capitalists alike marveling at how going keto controls their appetite, seems to sharpen mental focus, and trims waistlines.

But keto has its critics. Some doctors say they’re seeing more patients dealing with painful kidney stones, and they worry that some dieters may not drink enough water or are consuming too much protein, which acidifies urine.

Still, even nutritionists who are cautious about extreme low-carb diets are starting to agree that going keto can be a winning formula for managing Type 2 diabetes and controlling epileptic seizures. New evidence also suggests that the high-fat plan may improve certain cancer treatments and could help keep our brains healthy, though more research on those topics is needed.

[Read More: Silicon Valley’s favorite high-fat diet is beloved by everyone from venture capitalists to LeBron James – here’s how it works]

We’ve rounded up some of the clearest advice on keto from a skeptical Harvard cardiologist, a keto evangelist who’s been on the diet for six years, and a physician from the Cleveland Clinic.

Here’s what to know if you’re considering this high-fat regimen.

Keto dieters can eat lots of butter.

Keto dieters can eat lots of butter.

The keto diet is not for everyone

Many people should never consider going on a ketogenic diet.

David Harper, a cancer researcher and physiology professor, has been on the plan for six years. But he tells anyone who wants to try it to talk to a doctor first.

“Should we put everybody on a ketogenic diet? I don’t think so,” Harper said. “Because about a quarter of the people probably don’t need it.”

People who should be especially cautious about keto include those with a history of kidney or liver issues, as well as pregnant women. Others that should never follow the eating regimen have rare disorders that make it difficult to metabolize ketones, which are the chemicals your liver makes when it burns fat for fuel.

People’s magnesium levels can also plummet on the keto diet, and the plan can mess up the diverse garden of gut microbes that help us stay healthy if dieters aren’t careful.

So if you do go keto, make sure to get enough fiber from leafy greens and low-starch veggies to keep things running smoothly. And drink lots of water.

“You can’t do this halfway. You have to be all in,” Harper said. For himself, that means sticking to limited quantities of meat, making most of his meals at home, and enjoying plenty of butter and cheese.

[Read More: A cancer researcher who’s been on the keto diet for 6 years explains how he does it]

Some doctors – even those who might may prescribe the diet to some of their patients – acknowledge it isn’t the right plan for everyone, including themselves.

“If I eat no carbs, I will lose too much weight, and it won’t be good for me,” Cleveland Clinic doctor Mark Hyman said during a recent question and answer session. “I need a little bit, that’s my metabolism.”

But Hyman maintains that many of his patients thrive on the plan.

Ketosis can act like a miracle drug for certain conditions

The most surefire benefits of the keto diet have to do with reducing epileptic seizures, inflammation, and “hyper-excitability” of nerve cells, as Harper put it.

Children with tough-to-control seizures can see great improvements by going on a keto regimen for several months to two or three years. After that, they may go back to a more traditional diet and still see fewer seizures thanks to their keto stint.

“It’s changing something fundamental at the cellular level, which is pretty cool,” as Harper said.

The diet can also help people with obesity in a similar way, serving as a re-set button for those who are severely overweight.

“If you’re 300 pounds, if you’re diabetic, it can be very effective to get your systems unstuck from the metabolic crises it’s in, and put it in healthier state,” Hyman said.

He added, “there’s great evidence that you can reverse up to 60% of Type 2 diabetes in a year.”

You don’t have to stay keto for life, but waffling back and forth isn’t good for your health

Other doctors maintain a cautious approach to extreme diets like keto, largely because they’re so hard to maintain.

One 2017 study published in the New England Journal of Medicine suggested yo-yo dieting has deadly consequences, and it can lead to serious health problems, including more deaths, heart attacks, and strokes.

Sara Seidelmann, a cardiologist and nutrition researcher at Harvard Medical School, recently co-authored a somewhat controversial roundup of studies examining people’s diet patterns and death rates around the world. She found that people who ate a moderate amount of carbohydrates, especially those who consumed more whole grains and vegetables, tended to live the longest. People who stuck to low-carb diets (which are often meat-heavy) or high-carb diets (those who consume little more than white rice) had shorter average lifespans.

Her big takeaway was that the quality of a diet mattered much more than how many carbs people ate.

“Try to make choices that fill your plate with plants,” she said.

That includes “whole foods and whole grains, things that you can recognize,” she added.

But Seidelmann also recognizes that a keto stint can be a successful weight-loss strategy as long as people don’t eat too much low-quality processed food or red meat. Once the desired goal is achieved, though, she believes healthy, plant-based carbohydrates like whole grains and beans should be incorporated into meals again.

“Once that phase of dieting is over, it may be really worth taking a long pause and thinking about, what are the healthy choices that you can make for your whole life?” she said.

All three experts agree it’s more important to stick to a diet that’s healthy, rather than one that’ll cause energy crashes.

“The first thing you want to do, and I think we’re all agreeing now, is get sugar out of your diet,” Harper said. He also doesn’t endorse shifting back and forth between high- and low-carb plans. In fact, he thinks it’s dangerous and puts unneeded stress on the body.

“There’s a metabolic conversion that happens each time you do that,” he said. “When you start adding high-carb calories onto that again, it’s already biasing your body to store fat, because it thinks you’ve been in a fasting state.”

Whether you decide keto’s a good plan for you or not, experts maintain any healthy plan should include plenty of fresh produce, limited doses of meat, and whatever fat-to-carb ratio you can maintain in good health.

We’re learning more about which carbs you should never cut from your diet

We’re learning more about which carbs you should never cut from your diet

Milled bread flour isn't as good for your body as unrefined whole grains.

Milled bread flour isn’t as good for your body as unrefined whole grains.
Justin Sullivan/Getty Images
  • Several new studies suggest that people who eat a moderate amount of carbohydrates live longer than people on both low-carb and high-carb diets.
  • That doesn’t mean you should gorge on white bread and cake. Instead, researchers are discovering that people who eat more plant-based foods of all kinds, including carbs, have some of the best health outcomes.
  • Some of the healthiest carbs for your body and brain are whole grains, starchy vegetables, peas and squash – which are high in fiber.

Limiting carbs might be an effective short-term weight loss strategy, but science is discovering that it’s perhaps not the best meal plan for a long life.

That’s because not all carbs are created equal, and often people who forgo carbs replace them with more animal proteins. Too much of those can lead to kidney trouble and increase inflammation levels in the body.

Carbohydrates are our bodies preferred fuel source, and although eating one type of carb – sugar – can expand your waistline, that’s not true of other sources of carbohydrates like starches and fiber. Our bodies actually can’t absorb dietary fiber at all, so those carbohydrates help us better digest food, keeping bellies satisfied while protecting the body from disease.

Rigorous scientific studies are increasingly showing us that people who eat more fruits, vegetables, beans, and peas and avoid processed foods are more likely to live longer, cancer-free lives. A diet rich in whole foods such as plants can never be low-carb, but it can be filled with good carbs.

“There’s absolutely nothing more important for our health than what we eat each and every day,” Sara Seidelmann, a cardiologist and nutrition researcher at Brigham and Women’s Hospital in Boston, told Business Insider. Seidelmann’s study of more than 447,000 people around the world revealed that people who eat a moderate amount of carbohydrates, and stick mainly to plant-based meals live longer than others who fuel up on animal proteins or white bread and white rice.

If you’re wondering which carbohydrates are the best for your body, here are a few dietitian-approved choices:

Whole grains

Unlike processed grains, whole grains have outer shells of bran and germ that provide protein and fiber, which help keep you full.

Eating whole grains also lowers your chances of suffering a stroke, helps regulate blood pressure, and reduces your risk of developing diabetes, according to the Cleveland Clinic. To incorporate more whole grains into your diet, look for breads and pastas that are “100% whole wheat” or “100% whole grain.” Remember, wheat flour is only about 25% whole wheat.

Also remember that whole grains aren’t limited to wheat, oats, and brown rice. Try some high-fiber barley, crunchy quinoa, Ethiopian teff, or wild rice.

Pulses, including peas, lentils, and beans

lentils egg


“Pulses are excellent sources of healthy, slow-digesting carbs packed with fiber, vitamins, minerals, protein and phytochemicals,” registered dietitian Sharon Palmer, author of “The Plant-Powered Diet,” told Business Insider in an email.

The phytochemicals in plants that give them color and flavor are great cancer-fighters too, since they decrease inflammation in the body and help repair our DNA.

Green peas, for example, are filled with bone-protecting potassium and belly-satisfying protein. They are also sweet and rich in folate, which is critical for cells to grow and function properly. Aside from the green kind, there are also chickpeas, which are used to make hummus.

Potatoes and sweet potatoes

Sweet potatoes are a great source of vitamins A, B6, and C. It’s best not to overdo it on the sweet orange roots because they have a high glycemic index, which will temporarily spike blood sugar. But a bit of cooked sweet potato mixed into a salad or roasted as a side dish is a good dinner choice. Instead of baking or frying, boil potatoes with the skins on and boil for about 20 mins to retain the most nutrients, according to Harvard Health.


Squash, which can be added to soups, roasted, or blended into casseroles, is a rich wonder-food. Many types contain some natural sugar, but they’re also high in eye-protecting lutein. Squash also packs enough protein and fiber to keep you full for a while, while providing magnesium and potassium for bone health.

Limited amounts of fruit

Fruits like bananas and apples are often banned on low-carb diets since they’re carb-heavy and contain natural sugars. But eating a bit of fruit isn’t bad for you, especially when you consume it whole instead of blending it into a smoothie or juice. Eating an apple with its fibrous skin on instead of peeling it will deliver about double the fiber, 25% more potassium, and 40% more vitamin A, according to the Washington Post.

Cheese isn’t bad for you. A group of health experts says dietary guidelines should change accordingly.

Cheese isn’t bad for you. A group of health experts says dietary guidelines should change accordingly.

Cheese won't necessarily clog your arteries.

Cheese won’t necessarily clog your arteries.
  • Studies of more than 660,000 people suggest that not all dairy is created equal when it comes to effects on our health.
  • People who eat cheese tend to live longer, but drinking a lot of milk can lead to slightly higher rates of coronary heart disease and death.
  • Other new studies suggest there might be something about the way fat and protein is arranged in products like cheese and yogurt that makes them better for our hearts than milk or butter.

Eating cheese and yogurt may be linked to a longer life, researchers at the European Society of Cardiology Congress 2018 reported on Tuesday.

The team, led by cholesterol expert Maciej Banach of the Medical University of Lodz in Poland, compiled data from studies of 636,726 people on a long-term scale of 15 years. Their results suggested that not all dairy is created equal when it comes to your heart.

Drinking milk appears to up risk of coronary heart disease by 4%, according to the study, but consuming yogurt and cheese does not seem linked with negative health outcomes.

The finding aligns with what other researchers around the world are discovering about dairy: Some types may not be bad for us after all. In fact, we’ve known for a while that people who eat more fermented dairy products like cheese and yogurt are at a lower risk for developing heart disease and Type-2 diabetes.

“Public health officials should revise the guidelines on dairy consumption,” Banach said in a release.

Changing the rules about dairy

cow at new york dairy farm

Getty Images/David Silverman

Many heart and health experts are increasingly suggesting that overall, the fat in dairy may not be as bad for us as once thought, even though much of it is saturated fat, which is considered one of the heart-clogging kinds.

A roundup of 29 different studies published last year showed no connection between dairy intake and heart disease or death of any kind. Another study published in July followed more than 2,900 American adults for more than two decades and found that people who consumed full-fat dairy had no greater risk of dying from any cause than anyone else.

Banach and his colleagues have now gone even further, and found that dairy isn’t just harmless, it might even be helpful. When the researchers dove into six years of data on 24,474 middle-aged Americans, they determined that eating dairy was associated with a 2% reduced risk of death overall. Consumption of cheese was associated with the best outcome: an 8% lower total mortality risk.

Why milk may be dangerous

But a big implication of the new finding is that it may not be ideal to lump all types of dairy into one dietary category, since milk seems to have a different impact on our hearts than yogurt or cheese.

Milk “appears to increase the risk of coronary heart disease,” the researchers said in their release, while cheese (and yogurt, to a lesser extent) does the opposite.

The difference between dairy products that are more and less healthy may have to do with the way protein and fat molecules are arranged in cheeses and unprocessed cream. The protective shield for fat molecules – the milk-fat globule membrane – is better preserved in foods like cheese and buttermilk. The same can’t be said of butter, which drains off that membrane. And in the homogenized milk we buy in the grocery store, the globules have been shrunk.

Still, a word of caution is in order: Banach said it’s hard to tease out exactly which kind of dairy is the best for our bodies based on the observational studies he looked at.

“It is indeed very difficult to confirm the causality, because it is almost impossible that some participants might intake only the given dairy product without the other ones,” he told Business Insider in an email. He added that a “well-designed, randomized, controlled study” is needed.

Other researchers are already taking up that charge. One such study conducted recently in Ireland found that overweight adults who ate full-fat cheddar cheese reduced their cholesterol more than peers eating reduced-fat cheese or butter.

So while cheese and yogurt can be a beneficial part of your diet, it may be best to keep milk and butter intake in check, at least until we know more.

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