Photo by: Brooke Lark

A medical school student’s perspective

Keto Diet: The Good, The Bad, And The Ugly

The deal with internet’s most popular diet.

Jonathan Adrian, MD
7 min readJun 14, 2019

It is everywhere — someone in your family has probably attempted it, a fair few of your friends are perhaps on it right now, and they permeate the air of your occasional house parties and hangouts. It’s the unmistakable K-word, short for the infamous keto diet, which is one of the most internet-popular diets of recent times.

The keto diet, like many other fad diets, are spreading across the cyberspace landscape like wildfire, latching onto millennials (aka instant gratification monkeys… jk) who then go on to exploit their massive social influence to inadvertently mislead millions into blind-sidedly involve themselves into this whimsical trend.

This article intends to clear up some of that misconception and provide foundational insight for everyone who is thinking about boarding the keto train. Written from the semi-scientific perspective of a third year medical school student, here’s a neutral, crude take on the good, the bad, and the ugly faces of the keto diet world.

What the hell is it?

The term ketogenic diet (or keto diet for short) was coined in 1921 by a medical researcher by the name of Dr. Russell Morse Wilder. His studies on diet and diabetes found that ketone bodies were produced by the liver of healthy people when they were starved on a low-carb, high-fat diet. Curious, he then trialed this diet on several epileptic patients that year, which to his excitement, relieved many of them off their symptoms. It has since then been medically used as a dietary treatment for patients with epilepsy, especially for children with the hard-to-treat, refractory subtypes.

Recent dietitians have altered that model slightly, adding another element to the fundamental concept of a ketogenic diet: moderate amounts of protein, which by the way, adds zero clarity to the already vague concept, but in summary:

  1. A ketogenic diet involves consuming: high fats, moderate proteins, and low carbs.
  2. The diet was initially intended (and still used today) for treating epilepsies.

What’s the actual science behind it?

I am going to make this part as simple and casual as possible, so don’t worry if you’re not the most well-versed in terms of science — I’ll be gentle.

Let me start with the brain, which is the big mushy organ inside your head that controls every single aspect of your life — from obvious things such as enabling you to understand what I’m currently writing, to minute, less obvious things such as controlling your breathing and appetite. Therefore, it is only natural for your brain to be the number one gas-guzzling organ in your entire body.

If your 2010 Honda Accord runs on unleaded petrol, your brain runs on glucose, which is a simple sugar that is formed by breaking the carbohydrates you eat. Now, there’s plenty of glucose stored in your body, but when that thing runs out, your brain switches its fuel to, guess what? Ketones. Ketones are, as I mentioned in the beginning, formed by the breakdown of fats in the liver — and we all know just how much we have that stored within our body.

The entire ketone-forming process is conveniently called ketosis, and herein lies the core appeal in ketogenic diets. Ketosis, as it so happens, promotes a lot of fat burn. But not only do they promote fat burn, they are the byproduct of fat burn. So the entire thing is basically a crazy, intense, diabolical loop of fat burn, which leads to? Quick, appealing, new-years-resolution-friendly weight loss.

Alright, so now that we’ve established a basic understanding of ketogenic diets, let’s get on with the good and bad sides of this diet, plus a bonus on its ugly rear.

The Good

1) Weight loss

This one should be obvious from my previous salvo, but it’s by far the number one reason and motivation for keto diet adopters. The high-fat low-carb system has also been found to be more effective in weight loss than low-fat diets, which used to be the classic go-to diet for weight watchers. Because this diet is very effective in making its devotees quickly lose weight, it creates a validation loop system that feeds your brain with internal senses of accomplishment, and in return encourages you to do more of it.

2) Lowers your blood sugar and insulin levels

Remember how blood sugar aka glucose is formed as a result of carbohydrate breakdown? Ketogenic diet’s restriction of carb intake simply means that there will be less of its breakdown, leading to lowered blood sugar levels. Insulin is produced by the pancreas to ensure your blood glucose levels stay nice and low, so if that’s already low to begin with, there’s no need to produce insulin! This is believed to decrease your risk of acquiring diabetes.

3) Reduces appetite

Low carb diets have been found to not only cause an increased rate of fat burn, but also significantly lower your appetite. This is believed to be due to its beneficial effects on appetite regulating hormones such as leptin and ghrelin — which leads to additional reduction in caloric intake, and subsequent weight loss.

4) Lowers your triglyceride levels

Triglycerides make up the majority of fat molecules that circulate in your bloodstream. However, weirdly enough, the main driver of elevated triglycerides isn’t fat consumption, it’s carb consumption. To add to this peculiarity, incorporating plenty of healthy fats in your diet causes a reduction in blood triglycerides, which lowers your risk of acquiring heart diseases. The keto diet fits the puzzle — it’s all about that high-fat-low-carb system.

The Bad

1) It’s hard to follow

Most people who start their keto diet adventures usually fall through after a short period of time, and that’s just because proper keto diets are physically and mentally very demanding.

A low carbohydrate intake may actually make someone very lethargic and weak, not to mention overall feelings of indisposition that goes with starting any kind of intense diet regime as your body undergoes a temporary ‘shock’ phase. Many starters also report bouts of nausea, vomiting, and gastrointestinal distress. These symptoms are so common that the keto diet community came up with a term for them — they call it the ‘keto flu’.

2) Nasty diarrhoea

Normally, the fats that you eat are broken up by tiny lipid-destroying molecules called bile, which is stored in a conveniently named structure called the bile duct.

When you eat a lot of fats, your bile duct may become overwhelmed and go into overdrive, causing not just diarrhoea, but a nastier, greasier version called steatorrhea, and trust me, you do not want to google that, let alone have that.

3) Constipation

What the hell man? You just told me it causes diarrhoea and now you’re telling me I’m not gonna be able to poop what is going on? I’ll explain.

These two events do not occur simultaneously. The initial fat flood in your system causes bile duct “shock syndrome”, hence the early-onset diarrhoea. After some time, however, your body becomes accustomed to that change and the diarrhoea stops. It’s then that the subsequent shortage of fibres from your low-carb diet sets in, and the wrath of constipation begins.

Now here is where things start to get real ugly, and the reasons may not sound terrifyingly unpleasant straight off the bat, but that is exactly why they’re ugly — they’re subtle. The nasty changes only start to take effect when it’s too late to reverse your gears, and you’re left wondering where exactly it went wrong. So let’s cut to the chase.

The Ugly: Weight Regain

The keto diet is notorious for having one of the strictest and hardest to follow regimens in the dietary landscape. If anything, for the average Joe like you and me, this diet is probably going to last us 3 months tops. And when we eventually give up and revert to our normal diet routine, sh*t starts to hit the fan.

A majority of people will regain a lot of the weight back as soon as they go back on carbs. And that only makes sense — retaliation, from a nature’s evolutionary standpoint, was a trait human beings were favoured to possess. A savage attack on one of our tribe-members warranted a gruesome retaliation in the form of killing. After all, it reduces the chances for such an event to occur to our next of kin, our genetic successors. And so we essentially return to our roots with our unwise decisions after the torment of arduous diets — we become savages.

“It’s a common issue with any fad diet, but it seems to be extra common with ketosis.

When people tell me they want to try it because their friends lost weight, I always tell them, ‘Just watch, I almost guarantee that they’ll gain it all back’ ”

(Kristen Kizer, Registered Dietitian)

Kizer adds that these kinds of yo-yo weight fluctuations can contribute to disordered eating, and can even lead to serious behavioural eating disorders. Moreover, studies have shown that practicing such behaviours may increase your risk of diabetes and cause an overall increase in mortality. Yikes.

However, let us all remind ourselves that there is no single diet that works for everybody. Your body’s uniquely specific mechanic is different from your mother’s, your friend’s, or mine. It is especially crucial for you to approach adolescent trends like these with more than just a pinch of salt, involving adequate research and prior consultation with experts into your planning so you don’t fall into untested treacherous pits.



Jonathan Adrian, MD

Doctor, writer, photographer, and part-time social media strategist.