The Stereotypical High Fat Keto Diet is Only ONE Type

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Introduction

There is a common but mistaken belief that there is such a thing as “THE keto diet” (singular)—which is high in fat of all types, including cream, butter, bacon, and fatty cuts of meat. In fact, there are a wide range of “keto diets” (plural), including several different therapeutic ones as well as those popularized for weight loss. This article explains the range of ketogenic diets available and the unintended consequences of believing that a “keto diet” must always be high in fat.

What is a Ketogenic Diet?

A ketogenic diet induces and sustains a state of ketosis, a natural metabolic state where the body burns fat as its primary fuel rather than carbohydrate. What makes any diet ketogenic is not how much fat it contains, but the low amount of carbohydrate it contains.

Ketogenic diets, often referred to as very low carbohydrate diets (VLCD), limit carbohydrate intake to 20-50 g per day or 10% of total energy intake [1]. This results in blood ketone levels (beta-hydroxybutyrate or BHB) increasing at or above 0.5 mmol/L. Nutritional ketosis for weight loss is usually set between 1.5–3.0 mmol/L [2].

Therapeutic Ketogenic Diets

A diet is therapeutic when used to treat a medical condition. When implemented by a Dietitian, this is called Medical Nutrition Therapy (MNT) [3]. Therapeutic ketogenic diets were first used in the 1920s for epilepsy, where a very high fat, low carb, and restricted protein approach proved as effective as fasting.

There are three main high-fat therapeutic versions used for clinical conditions like epilepsy, glioblastoma, or Alzheimer’s:

  • Classic Ketogenic Diet (KD): A 4:1 ratio of fat to protein/carbs (90% fat).
  • Modified Ketogenic Diet (MKD): A 3:1 ratio (80-90% fat).
  • Modified Atkins Diet (MAD): A 2:1 ratio (approx. 60% fat).

Weight-Loss “Keto” vs. Therapeutic Keto

Many people stall or even gain weight on popularized “keto” diets because they are essentially following a therapeutic protocol (75% fat) that was designed to maintain weight, not lose it. Unless these high-fat diets are combined with intermittent fasting, weight loss may not occur.

Clinical weight-loss approaches, such as the Protein Power approach or the Phinney and Volek approach, often utilize a higher protein-to-energy ratio. The goal in weight loss is to utilize your own stored body fat for energy, not to burn large amounts of added dietary fat like butter and fat bombs.

Final Thoughts

The idea that “THE keto diet” must be high in fat is a fallacy. A diet low in carbohydrate and rich in nutrient-dense lean protein and vegetables is just as much a “keto” diet because it maintains low carbohydrate levels—and it can be used successfully for weight loss without requiring extended fasting.

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If you would like more information about the type of low-carb or ketogenic diet that might be best suited to you, you can learn about me and the Comprehensive Dietary Package that I offer.

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Quick Clinical Summary

Q: What is the clinical definition of a ketogenic diet?

A: Clinically, a ketogenic diet is a Very Low Carbohydrate Diet that limits carbohydrate intake to 20-50 grams per day (roughly 10% of total energy). This restriction induces ketosis, where the body produces beta-hydroxybutyrate (BHB) at levels of 0.5 mmol/L or higher.

Q: What are the different types of therapeutic ketogenic diets?

A: The three primary therapeutic ratios are the Classic Ketogenic Diet (4:1 ratio, 90% fat), the Modified Ketogenic Diet (3:1 ratio, 80-90% fat), and the Modified Atkins Diet (2:1 ratio, approx. 60% fat). These are used for conditions like epilepsy and glioblastoma.

Q: Why do some people stop losing weight on a keto diet?

A: Weight loss often stalls when people follow high-fat therapeutic protocols designed for weight maintenance. For weight loss, the goal is to burn stored body fat; consuming excessive dietary fat (like ‘fat bombs’) can prevent the body from utilizing its own energy stores.

References

  1. Feinman RD, Pogozelski WK, Astrup A, et al. Dietary Carbohydrate Restriction as the First Approach in Diabetes Management. Nutrition. 2015. [https://pubmed.ncbi.nlm.nih.gov/25287761/]
  2. Bhanpuri NH, Hallberg SJ, Williams PT, et al. Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis. Cardiovasc Diabetol. 2018. [https://doi.org/10.1186/s12933-018-0698-8]
  3. U.S. Dept. of Health and Human Services. Final MNT regulations. Federal Register. 2001. [https://www.federalregister.gov/documents/2001/11/01/01-26210/medicare-program-medical-nutrition-therapy-services-for-beneficiaries-with-diabetes-or-renal-disease]
  4. Peterman MG. The Ketogenic Diet. JAMA. 1928. [https://doi.org/10.1001/jama.1928.02690450007003]
  5. Kossoff EH, Doward JL. The Modified Atkins Diet. Epilepsia. 2008. [https://doi.org/10.1111/j.1528-1167.2008.01844.x]
  6. Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes: A Consensus Report. Diabetes Care. 2019. [https://doi.org/10.2337/dci19-0014]
  7. Diabetes Canada. Position Statement on Low Carbohydrate Diets. Can J Diabetes. 2020. [https://doi.org/10.1016/j.jcjd.2020.04.001]
  8. Eades M, Eades MD. Protein Power. Bantam. 1997.
  9. Paddon-Jones D, Westman E, Mattes RD, et al. Protein, weight management, and satiety. Am J Clin Nutr. 2008. [https://doi.org/10.1093/ajcn/87.5.1558S]
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