The do’s and don’ts of the high-fat, low-carb keto diet: Best of Molly Kimball

Best of Molly Kimball: Nutrition columnist Molly Kimball will be on leave until Aug. 6. While she is away, we are revisiting some of her best-read and most popular columns published by | The Times-Picayune. Kimball, a registered dietitian, can be reached at Follow her (@MollyKimballRD) on Facebook, Instagram and Twitter and you can check out her weekly podcast; just search ‘Molly Kimball’ on Apple Podcasts, Spotify, or your favorite podcast app.

I’m often asked about popular diets, so this week and next I’m covering two popular diets – the keto diet this week, and Whole30 next week – including the pros, cons and my take for each.

To be clear, I am not advocating or recommending that we all follow these programs.

While these diets – or components of these diets – may be beneficial to some, my recommendation for the majority of the population is to keep it simple, streamlined, wholesome – less about hard rules with lists of do’s and don’t’s, and more about the key fundamentals: limit added sugars and white carbs. Emphasize lean proteins. Tons of vegetables, some fruits (mostly berries), and more of an emphasis on plant based fats when possible. Find what works for your individual lifestyle, taste preferences, budget and schedule.

If you do choose to try one or some of these popular diets, use it as an opportunity to help break and replace not-so-good habits, and to educate yourself and learn more about how you may respond to certain foods and ingredients so that you can make lasting behavioral changes that can stick around long after you’re “off” of a particular diet plan.

“I’m going keto.” I’m hearing this more and more often. And odds are you’ve heard someone talk about “going keto,” you’ve considered it yourself, or at the very least, you’ve seen “keto-friendly” products and recipes in stores, magazines, and social media.

The Keto Diet: What is it?

“Keto” is short for “ketogenic” and is a type of diet that has been used for 100-plus years for children with uncontrolled seizures. Approximately half of those following a classic ketogenic diet experience at least a 50 percent reduction in seizures, and an estimated 15 percent become seizure-free.

This classic ketogenic therapeutic diet is a very-high-fat, extremely low-carbohydrate, low-protein diet, calling for a 4:1 ratio of fat to combined protein plus carbohydrate.

By comparison, the keto diet that some of your friends are doing may be anywhere from a ratio of 2:1 to 4:1, depending on which book, website or protocol they’re using as a guide.

Although carbohydrate and protein limits can vary, the general rule of thumb for a is a maximum of 50 grams of carbohydrate daily, or about 10 percent of total calories, though many keto advocates recommend about half this amount.

Protein goals are generally around 0.8 grams of protein per pound of lean body weight, with the rest of the calories coming from fat, which varies with appetite and calorie needs.

The science behind the Keto Diet

Carbohydrates are usually our body’s main source of energy, but because the ketogenic diet is so low in carbohydrates, fats become the primary fuel for the body. When we burn fat for energy we produce compounds called ketone bodies – which is why it’s called the “ketogenic diet.”

Ketones can be detected in the urine, blood and breath, so people following a ketogenic diet will often use test strips to check urine for ketones to confirm that they are in fact in ketosis.

Ketones aren’t harmful for most people; they’re simply a result of the body burning fat for energy or fuel. It should be emphasized that for people with diabetes, however, ketones can build up and lead to diabetic ketoacidosis, a serious medical condition. Symptoms include excessive thirst, frequent urination, fruity-scented breath, confusion, and consistently high blood sugar (over 300). If you suspect diabetic ketoacidosis, it is suggested to seek medical treatment immediately.

Research is mixed when it comes to effectiveness of a ketogenic diet for fat loss, with several studies showing no significant difference in fat loss for ketogenic diets when researchers controlled for protein and calorie intake.

In my own experience as a registered dietitian, however, I have seen many clients and friends experience positive results with a ketogenic diet.

One of the main advantages of following a keto diet is appetite control; we feel less hungry on the lower-carb keto plan, which generally results in a natural reduction in our calorie intake. Some of the research shows a daily reduction of 300 calories per day – or more – without really trying.

As a result, following a keto diet can help to reduce cravings as well as drop body fat. Other benefits include improved blood sugar control, cholesterol, blood pressure, and inflammation, all of which are likely due to the extra weight lost as well as following the lower-carb diet.

All about the keto diet

  • Very limited carbs: 50 grams per day or less, though most advocates recommend 20 grams or less. This includes carbohydrates from even lower-carb foods like vegetables, avocado, nuts and plain Greek yogurt.
  • Somewhat limited protein: The keto diet is not a “high protein” low carb diet; the protein recommendation is generally 0.8 grams protein per pound of fat-free body weight. You’ll need to know your percent of body fat for this – or you can use your lowest healthful weight. If a very lean weight for you is 150 pounds, for example, then use 150 x 0.8 for a total of approximately 120 grams of protein daily.
  • Fats make up the rest: The keto diet is mostly fats, with fat being the “wild card” that varies by amount, depending on calorie needs as well as appetite. This can include animal fats like butter, ghee, heavy cream, mayonnaise and bacon, as well as plant-based saturated fats like coconut oil, olive oil and vegan mayo.

Keto calculators are available online to help figure out your macronutrient goals (carb, protein, fat) for a keto diet. Keto blogger and cookbook author Maria Emmerich has an easy-to-use version on her website, – just search “keto calculator.”

Although the keto diet can be challenging, it’s easier now than it was just 10 years ago. There are so many more “keto-friendly” recipes and products available, including low-carbohydrate wraps, noodles and potato alternatives, nut flours for baking, and snack foods like chips and bars that make it easier to incorporate a wider range of ketogenic meals and snacks.

What’s out

  • Starchy and/or refined carbs are pretty much off-limits entirely, including bread, rice, pasta, cereal, potatoes, pasta, rice or legumes.
  • Sugar of any type is also out, including table sugar, brown sugar, honey, molasses, agave and coconut sugar.
  • Fruits: Only a small amount of fruit is allowed; mostly berries, because of their lower carb content.

What’s in:

  • Fats of all types.
  • Meat, fish, poultry and eggs.
  • Nonstarchy vegetables and leafy greens, fresh or frozen; carbs from these vegetables need be factored into daily carbohydrate allotment.
  • Dairy, organic, full-fat is recommended for keto diets; carbs need to be accounted for in daily total.
  • No-calorie plant-based sweeteners like monkfruit, erythritol, stevia, including brands like Swerve and Truvia.
  • Beverages with zero sugar or artificial sweeteners, including water, sparkling water, tea and coffee.

A typical day on the keto diet:

  • Coffee with coconut oil, butter, MCT oil or ghee (clarified butter).
  • Breakfast consists of some combo of fat plus protein: eggs, cheese, bacon, sausage, butter, etc.
  • Lunch: Burger (or burgers) with cheese, no bun. Salad with protein, avocado, nuts, oil and vinegar.
  • Dinner: Fish, chicken, beef or pork with vegetables cooked with olive oil, served with avocado, guacamole or mayo-based sauce.
  • Snacks: Hardboiled eggs, cheese, avocado, nuts, nut butter, berries, and DIY fat bombs. (“Fat bombs” are any type of little snack bite centered on high-fat ingredients like butter, bacon, and/or coconut oil. See our recipe below for a plant-based version of chocolate fudge fat bomb).

Molly’s take:

I don’t love a strict keto diet for most people. The reality is that we don’t need to be in a perpetual state of ketosis to drop extra body fat – countless people have lost significant amounts of body fat by cutting calories with a low-fat, carb-rich diet.

I’m generally an advocate of lower-carb, protein diets, however, since even if we exercise on a regular basis, most people – especially those of us with sedentary jobs or hobbies – still spend a large portion of our day sitting at our desk, in our car, or on our sofa.

So I don’t mind the low-carb approach of the keto diet, it just takes “low-carb” even further.

A few things that I don’t love about the keto diet:

It can make eating feel more like science than pleasure. Counting our “macros” – our carbs, protein and fat – for each meal and snack can feel burdensome. Many people simply get into an automated routine and end up eating the same combinations of foods for most meals and snacks.

It limits our vegetable intake. I’ve had countless keto followers tell me they’re avoiding non-starchy vegetables like asparagus, broccoli, eggplant, spinach and kale because they’re “too high in carbs.” Let’s be honest: who among us can blame our extra pounds on too much asparagus?

For clients who want to go the keto-style route, I usually recommend bumping up the carb limit enough to account for a variety of non-starchy vegetables.

It’s easy to go overboard with high-fat, processed meats. We know that processed meats like sausage and bacon aren’t exactly superfoods. So while they’re okay in small amounts, I recommend keeping these as “extras” to accompany a less-processed keto diet, not the focal point.

It can add more barriers. Many people already think of “healthful eating” as limited or restrictive, and this takes it to the next level. Dining out with friends, traveling or preparing meals for the entire family all pose extra challenges when following a strict protocol like the keto diet.

It can be heavy in animal fats. I encourage choosing plant-based foods when possible, and this applies to the keto diet as well. Instead of focusing mainly on butter, bacon and cream, try incorporating more coconut oil, olive oil, and nuts, seeds and avocado.

The bottom line:

As with any diet, if it’s centered on foods that we enjoy and it fits within our lifestyle and habits, then we’re more likely to stick with it and see positive results.

Experimenting with a keto diet can serve as a valuable educational tool as well, helping us to recognize just how much carb (or fat or protein or calories) we’ve actually been consuming in our everyday diets.

If you decide to try a keto diet, track your food intake in an online or app-based food log like My Fitness Pal – it will save you a ton of time, not to mention brain space, tallying up all those numbers in your head.

Consider adding a multivitamin and calcium supplement, since you may not get the full spectrum of micronutrients from your food choices on the Keto Diet. As always, check with your physician before beginning any new program, and consider consulting with a registered dietitian to help you design a Keto Diet that fits within your lifestyle.

You would never guess that this deliciously decadent recipe by Maria Emmerich has no sugar added and nearly zero carbs. Double up the cocoa for dark chocolate fudge, or mix things up by adding almond butter for “peanut butter cup” fudge, food-grade peppermint oil for peppermint chocolate fudge, or spices like cayenne, cinnamon and/or chipotle for a spicy cocoa fudge.

Keto Fudge

Makes 12 servings

1 cup coconut oil, soft yet still solid

1/4 cup full fat coconut milk

1/4 cup organic cocoa powder

1/4 cup Swerve confectioners

1 teaspoon vanilla extract

1/2 teaspoon almond extract

1/2 teaspoon Celtic sea salt

Place coconut oil and coconut milk a medium sized bowl and mix with a hand mixer on high for 6 minutes or until well combined and glossy.

Place the remaining ingredients in the bowl and stir on low speed until the cocoa is combined (so it doesn’t poof all over your kitchen). Increase speed and mix until everything is well combined. Taste the fudge and adjust to desired sweetness.

Pour into small molds, or to make fudge squares, place a sheet of parchment or wax paper along the inside of a loaf pan. Place the loaf pan in the freezer for at least 15 minutes, until just set. Use the edges of the parchment to pull the fudge out of the pan. Place on a cutting board and remove the parchment paper. Use a sharp knife to cut the fudge into squares.

Store in an airtight container in the freezer; it will liquefy if you leave it in a warm area.

Per serving: 170 calories, 19 grams fat, 16 grams plant-based saturated fat, 100 mg sodium, 5 grams carbs (1 gram net carbs), 1 gram fiber, 0 sugar, 1 gram protein.


Editor’s note: Registered dietitian Molly Kimball offers brand-name products as a consumer guide; she does not solicit product samples nor is she paid to recommend items.


Molly Kimball is a registered dietitian in New Orleans. She can be reached at Follow her (@MollyKimballRD) on Facebook, Instagram and Twitter and you can check out her weekly podcast; just search ‘Molly Kimball’ on Apple Podcasts, Spotify, or your favorite podcast app.

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