How to nutritionally guide clients to ketogenic diet

The concept of the ketogenic diet began primarily in the early 20th century, as a variation of prolonged fasting for the treatment of epilepsy, where a study found that seizures in these patients were less critical when following this diet.

Nowadays, this diet is getting attention as a potential weight-loss strategy due to the low-carb diet approach. As a nutrition professional, it is important to closely monitor any biochemical changes after starting the regimen, and to create a meal plan that is tailored to one’s existing health conditions and to prevent nutritional deficiencies or other health complications. You also need to provide guidance on reintroducing carbohydrates once weight loss is achieved.

We know this can be a big challenge, but we bring everything you need to give the best nutritional support to your client. In this article, you can find all the scientific evidence you need and even templates for meal plans, specially designed for this diet. 

First of all, let's understand what it is and then, how Nutrium's software can help you give the best nutritional advice possible with this diet.

What is the ketogenic diet?

The ketogenic diet is a dietary pattern in which macronutrients are distributed in such a way that the amount of fat consumed is high, the amount of protein consumed is moderate and the amount of carbohydrates very low. 

When a patient’s diet does not include a sufficient amount of carbs, the body converts them into glucose – the brain's main source of energy. On the other hand, when the amount of carbohydrates is very low or zero, the stores of glycogen are reduced and the body starts using fat as a source of energy, which is converted into ketone bodies by the liver. This process puts your body into a metabolic state called ketosis. 

Types of ketogenic diets

• Standard ketogenic diet (SKD): This is a very low carb, moderate protein, and high-fat diet. It typically contains 70% fat, 20% protein, and only 10% carbs 
• Cyclical ketogenic diet (CKD): This diet involves periods of higher-carb refeeds, such as 5 ketogenic days followed by 2 high carb days.
• Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
• High protein ketogenic diet: This is similar to a standard ketogenic diet, but includes more protein. The ratio is often 60% fat, 35% protein, and 5% carbs.

How are ketogenic diets used in a medical setting?

Since the 20th century, several studies have shown that when ketone bodies are elevated, there is a very significant reduction in epileptic seizures in children. However, this diet has been shown to be quite difficult to maintain, due to dietary restrictions. 

Ketogenic diet may be an option for people who have difficulty losing weight with other methods. It can provide short-term benefits in some people including weight loss and improvements in total cholesterol, blood sugar, and blood pressure. Yet, the available research on the ketogenic diet for weight loss is still limited.

The ketogenic diet can be used in specific situations. For example, endurance athletes and bodybuilders use it to scrap fat in short timeframes. Also, this diet is being studied in patients with progressive neurological disorders like Parkinson’s disease, but scientific research has not confirmed its benefits for these populations. In general, this diet should not be carried out without a medical prescription or without the follow-up of a nutritionist.

Nowadays, the current main reason that leads many people to follow this diet is weight loss. Several studies have been carried out in order to understand if there is any advantage in following diets low in carbohydrates, and it has been shown that this type of diet promotes faster initial weight loss. 

However, this is not due to the cost of fat loss, but to water loss and, although the state of ketosis promotes loss of appetite, it is generally a diet quite rich in saturated fats and low in vitamins, minerals, and fiber. In addition, this is not a diet to follow in the long term because it is too restricted and rigid.

What foods are allowed on the ketogenic diet?

Although the maximum amount of carbohydrates for inducing ketosis can be different from person to person, this diet involves the consumption of foods that are low in carbohydrates.

• Fish and seafood
• Low-carb veggies - celery, cucumber, broccoli, bell peppers, spinach
• Cheese
• Avocados
• Poultry
• Eggs
• Nuts, seeds
• Plain Greek yogurt and cottage cheese
• Berries
• Unsweetened coffee and tea
• Dark chocolate and cocoa powder
• Healthy oils - olive oil, coconut oil, avocado oil

That is, foods rich in carbohydrates are not allowed, such as:

• Grains
• Starchy vegetables and high-sugar fruits
• Sweetened yogurt
• Juices
• Honey, syrup, or sugar in any form
• Chips and crackers
• Baked goods including gluten-free baked goods

Risks of keto diet

Calorie Depletion and Nutrient Deficiency

Because the keto diet is so restricted, patients may not be receiving the nutrients — vitamins, minerals, fibers — that you get from fresh fruits, legumes, vegetables, and whole grains.

Due to these deficiencies, people also report feeling foggy and tired. Obstipation is also common in the keto diet due to the lack of fiber. 

Bad Fats in Practice

The high-fat nature of the diet could also have negative impacts on heart health. The American Heart Association recommends limiting saturated fat intake to 5 to 6 percent. Many people eat high amounts of saturated fats, which could increase cardiovascular disease risk. There is an increase in lipids, or fats, in the blood of patients on the keto diet within six to eight weeks.

Renal Risk

Patients with kidney disease have an increased risk of requiring dialysis on the keto diet due to the additional ketones that their renal system has to process.

Some people also experience dehydration on the keto diet because they’re eradicating glycogen, which holds water, from their bloodstream.

Food Obsession

Micromanaging food intake by tracking how much is eaten can lead to disconnection from what the body is asking for. Clients can start using outside numbers to determine what to eat instead of listening to their body. 

Monitoring food so closely can lead to psychological distress, such as shame, and binge eating. Restriction can lead to binging, which often leads to guilt, which then leads back to restriction in a continuous cycle.

TIP: From food journals to mindful eating tactics, here’s how you can help your clients overcome food addiction.

Step by step guide to creating a meal plan to ketogenic diet

Step 1: Conduct a nutritional assessment

As a nutrition professional, it's important to speak with your client and see if this is the right approach for their situation. 

If it is, take note of your client's height, weight, BMI, and current nutritional intake before beginning the meal planning process. This will aid in determining their nutritional needs as well as supporting their health and wellbeing objectives. It’s important to work with clients on an individual basis to determine what works best for their goals and overall health.

Focus on the client’s specific needs, such as energy requirements, protein, carbohydrates, fat, and water intake.

Step 2: Customise the plan:

In order to make the meal plan more personal to the client and understand their lifestyle and goals, the plan needs to be personalized. Here are some potential questions that could be asked:

• Do you have any specific goals (physical, mental, or otherwise)
• Do you have any allergies?
• What foods do you like and dislike?

Step 3: Create a draft:

You can import the meal plan templates available in the software to a client's profile while leading a nutrition appointment. Then, you only need to make a few adjustments according to the client's energy, meal frequency, or even specific food preferences. This will both save you a lot of time and, when combined with Nutrium’s automatic nutrition analysis feature, will help you make sure every macro and micronutrient is added in the right amount.

Nutrium offers 7 meal plan templates that you can use to plan a ketogenic diet:

• 1200 kcal ketogenic meal plan;
• 1500 kcal ketogenic meal plan;
• 1500 kcal targeted ketogenic meal plan;
• 1500 kcal cyclical ketogenic meal plan;
• 1500 kcal high protein ketogenic meal plan;
• 1800 kcal ketogenic meal plan;
• 2000 kcal ketogenic meal plan.
  

Step 4: Check in.

By following up with your clients in between sessions, it gives you an opportunity to see if the plan is working for your client. This will encourage them to keep going with their diet and allow them to stay motivated. 

Summary

The ketogenic diet, like other diets, is a possible approach to weight loss. However, it can be associated with risks such as nutritional deficits and heart problems. Before prescribing this diet, you must correctly analyze whether it is suitable for the client. If so, it should be very well monitored over time.

If your clients have mentioned they want to try out a Keto approach or if this is your go-to method, make sure to follow up the recommendations and check the supporting evidence. 

We are always working toward bringing you the best nutrition content, so we welcome any suggestions or comments you might have! Feel free to write to us at info@nutrium.com.

Haven't tried Nutrium yet? Now is the time! You can try Nutrium for free for 14 days and test all its features, from appointments, to meal plans, nutritional analysis, videoconference, a website and blog, professional and patient mobile apps, and more! Try it now for free!

References

1. Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013 Oct;110(7):1178-87.
   
   
2. Wheless JW. History of the ketogenic diet. In: Epilepsia. 2008. p. 3–4
   
   
3. 2022. [online] Available at: <https://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2008.01821.x&gt; [Accessed 17 May 2022].
   
   
4. Sampaio LP. Ketogenic diet for epilepsy treatment. Arq Neuropsiquiatr. 2016 Oct;74(10):842-848. doi: 10.1590/0004-282X20160116. PMID: 27759811.
   
   
5. The Nutrition Source. 2022. Diet Review: Ketogenic Diet for Weight Loss. [online] Available at: <https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/&gt; [Accessed 11 May 2022].
   
   
6. eating, H., 2022. How to create a meal plan: the ultimate step-by-step guide - Nutrium Blog. [online] Nutrium Blog. Available at: <https://nutrium.com/blog/how-to-create-a-meal-plan-the-ultimate-step-by-step-guide/&gt; [Accessed 17 May 2022].
   
   
7. Nutrium Blog. 2022. Bone health and nutrition: meal plans for clients with osteoporosis. [online] Available at: <https://nutrium.com/blog/bone-health-and-nutrition-meal-plans-for-clients-with-osteoporosis/&gt; [Accessed 17 May 2022].