Three Thoughts on the Keto Diet

First, a big picture meta thought about diets in general. Try to step back and make sure that whatever eating plan you are embarking on doesn't feel overly restrictive and like a temporary fix. If any way of eating requires white knuckle willpower and you can't see yourself doing it long-term, consider if there's any way to adjust it so that it feels more sustainable for you. This suggestion probably seems stale and boring, but I can't tell you how many times I've seen short-term restrictive diets lead to all sorts of long-term eating and health problems for people.  

Second, there are aspects of keto eating that are definitely an improvement over the 'standard American diet'. Most notably, keto diets usually contain less highly processed food (e.g., pop tarts, donuts, etc) and more nutrient dense 'real' foods (e.g., nuts, seeds, eggs, certain veggies, avocado, etc). With that said, there are also aspects of keto eating that I'm not too excited about. Most notably, really high amounts of fat, a lot of animal products, no beans, no whole grains, limited vegetable/fruit variety, and sometimes low amounts of fiber (depending on what the person is eating). 

Third, while humans can survive and thrive on a wide variety of diets, when I try to imagine an optimal way of eating for humans in 2019, a strict keto diet doesn't fit the criteria.*

*I don’t discount the idea that in rare circumstances a ketogenic diet might offer benefits to someone (or for a specific medical condition). But from a public health perspective, it doesn’t check enough boxes. 

Don't Worry About Finding 'Complete' Proteins

Note from Ryan: This was originally published on Furthermore, it’s worth revisiting here.

As a registered dietitian, nearly every week I hear clients, colleagues, journalists, coaches, students, friends, bus drivers, and barbers use the terms ‘complete’ and ‘incomplete’ proteins. We’ve become obsessive in our quest to consume more and more of the former. And this has led to a diet that overemphasizes animal products at the expense of plants. The ripple effect of a diet focused on animal food extends far and wide, influencing not only our personal health, but environmental sustainability and humane livestock production (and whether we like it or not, these last two influence all of us).

The idea: ‘Complete’ proteins supply the necessary proportions of all of the essential amino acids (nitrogen-rich compounds that our body cannot produce). If someone only ate a single ‘complete’ protein food for the day, and nothing else, they would meet 100 percent of their daily protein needs. Chicken, beef, eggs, fish, and soy are often referred to as ‘complete’ proteins.

‘Incomplete’ protein food sources, on the other hand, are often plant foods. The terminology suggests that if someone was to subsist exclusively on an ‘incomplete’ protein food, they wouldn’t meet 100 percent of their daily protein needs; they’d likely fall short of least one amino acid. Foods like rice, carrots, and beans are referred to as ‘incomplete’ proteins.

For years, health professionals thought that if one food contained a smaller amount of one essential amino acid, we’d need to pair it up with another food at the same meal in order for it to be useful to the body. Rice falls a bit short in lysine, for example, but black beans have plenty of lysine, which gives us black beans and rice.

After all, we need each amino acid in different amounts to build a protein—kind of like how you need different supplies (bricks, nails, wood) to build a house. Without enough of one supply, the house suffers.

Today, though, our knowledge and perspective has evolved. And classifying a food as a ‘complete’ or ‘incomplete’ protein (for the well-fed person in a developed nation with protein in their nutritional bullseye each day) is flawed and antiquated.

There’s no doubt that certain foods have more amino acids than others. But in my opinion, with a little thought and effort, it’s nearly impossible to fall short on getting enough essential amino acids in your diet, even if it’s plant-based.

Furthermore, continuing to use terminology that steers people away from having foods like legumes as a protein source is irresponsible and misguided, especially when you account for added benefits of eating more plant foods, such as decreased likelihood of chronic disease, a smaller environmental footprint, and improved animal welfare.

Nutrition science is a recent science, and it’s very complex. Food is made up of countless compounds that we are continuing to learn more about. And beyond nutrients, we all have unique differences in how we digest and process foods. This can make attaining certain nutrients from certain foods more difficult or easy depending on our genetic makeup, health history, gut microbiome, and medication use—things that cannot be captured in the ‘complete’ or ‘incomplete’ label.

So instead of focusing on whether your protein source is ‘complete’ or ‘incomplete,’ follow these three guidelines.

1. Eat enough food to support a healthy body size.

If we don’t meet our energy and calorie needs (if we crash diet, fast for extended periods of time, or don’t eat enough during high volume periods of training), both dietary protein and proteins stored in the body might be diverted to other functions that protein is not ideal for, like producing energy. Eating enough calories allows protein to do what it’s meant to do in the body: aid in growth, repair, development, and in the synthesis of hormones, enzymes, and neurotransmitters.

2. Build a diet around a variety of foods.

When a diet is built around a single food group, there’s a much better chance that the person will run into a nutrient deficiency problem. If you were only eating steak, for example, you might meet your protein requirements but you’d fall short on fiber, vitamins A, C, E, K, D, some B vitamins, calcium, magnesium, potassium, copper, and manganese. For people who love numbers, an active adult should aim for between 1.2 to 1.7 grams of protein per kilogram of body weight, or 82 to 116 grams of protein each day for a 150-pound adult. This protein can come from a variety of vegetables, fruits, whole grains, legumes, nuts, seeds, and animal foods.

3. Include at least one cup of cooked legumes each day.

Or closer to one and a half cups if you’re over 160 pounds. Legumes are a rich source of the essential amino acid lysine. If someone eating a highly plant-based diet is going to fall short in one of the essential amino acids, lysine is probably the one. That’s because it’s found in lower amounts in most plant foods—other than legumes, quinoa, pumpkin seeds, pistachios, and amaranth, that is.

All Plant-Based Diets Are Not Created Equal

I was recently interviewed about the hierarchy of plant-based diets. I wanted to post my full response here…

*All plant-based diets are not created equal. What is the healthiest of plant-based diets? I know above you state Most healthful dietary patterns a) get people thinking about daily food choices; b) emphasize the consumption of more minimally processed foods; and c) ensure a greater nutrient intake. Together, this often leads to a healthier body size, more energy, improved sleep, a better mood, and so forth. What do healthy plant-based diets have in common? Or would you still stick by that quote?

Healthy plant-based diets fall under those same general criteria. 

The interesting thing right now with plant-based diets (and this is happening with paleo diets too) is that the food industry has started to get involved. This has been positive and negative. It's now possible to get lentil pasta, sprouted spelt bread, and almond butter at most grocery stores. This is probably a positive thing for our collective health in the U.S.! 

At the same time, it's also much easier to get vegan mac & cheese, vegan ice cream, and vegan chips. If someone switches from eating "regular" mac & cheese, ice cream, and chips to the vegan versions, and that's the only change they make in their diet, I wouldn't anticipate any noticeable health improvements. Now, if someone is eating mostly minimally processed vegetables, fruits, legumes, whole grains, nuts/seeds, and then they include vegan mac & cheese, vegan ice cream, and vegan chips about 10% of the time (give or take), it would still be very health promoting diet! There's no need to completely eliminate all highly processed foods. 

Another important point here is that not everyone makes dietary changes for personal health reasons. Some people want to eat a diet that doesn't support over-reliance on livestock, has a lighter environmental footprint, and promotes more tolerable working conditions for farm laborers. So, while eating vegan mac & cheese, vegan ice cream, and vegan chips might not support personal health goals, in some cases, it could still be supporting these other "bigger-than-self" goals.

(Practical personal example: I buy Fair Trade chocolate bars and non-dairy ice cream. I don't do this because I think it's going to improve my personal health. But I do believe it's a step in the right direction for farm laborers and animal welfare) :) 

When personal health is your main focus, the big question to ask when making any type of dietary switch is: What would I be eating instead? This can clue you in to whether or not it's a positive or negative decision for your health. 

*Do you ever find that people who eat plant-based diets have unhealthier behaviors or sort of hide behind their plant-based diet and eat other stuff that is seemingly healthy but really isn’t? Please explain.

Sure. This is possible under any dietary label. Some people might be craving strict rules and regulations around their eating. This can often happen when they are disconnected from body cues and preferences. They use a dietary label to grant themselves permission to overeat certain foods, while overly restricting others. This would be disordered eating territory, and can lead to all sorts of physical, emotional, and social problems. If someone suspects they have some disordered eating going on, I would encourage them to get this sorted out first, before trying to abide by any dietary labels. 

*What are some signs that your plant-based diet isn't working for you?

Well, it's hard to say for certain, as so many factors influence our overall health. No matter if someone is feeling crummy or fantastic, it might have a lot to do with their diet, or it might have very little to do with their diet.

Generally speaking, I would suggest 2 things here:

1. Keep an eye on health markers during your annual physical exam. If anything seems out of whack (e.g., lab values, blood pressure, weight, etc) talk with a doc or dietitian about if it could be diet related.

2. Keep tuned into your body. Intuition is often underrated when it comes to personal health. If you've made some dietary changes, and coinciding with those dietary changes is a general feeling of crumminess, major weight fluctuations, digestive problems, and so forth, it might be a sign to make some adjustments to your food/beverage intake, preferably with professional assistance. 

*What should you look for / focus in on when sticking to a plant-based diet? Why is this so important

What you're eating, not on what you're avoiding. Great, so you avoid meat, fish, dairy, and/or eggs. What are you actually eating every day? Hopefully plenty of minimally processed vegetables, fruits, legumes, whole grains, and nuts/seeds!

And avoid the all-or-none trap. It's common in the U.S. to give ourselves 2 options when it comes to plant-based eating: Option 1) Vegan/vegetarian. Option 2) The status quo (which is often animal products at every meal, or at least every day). There's a lot of middle ground to explore here. And if the middle ground allows you to feel better and consistently eat more plant-based in the long run, it might be your best option.