I think your comments are reasonably accurate generally, but I’d like to offer some context.

I have T2D (diabetes). You did mention I’m a special category in your comment. I’ve never been obese or consumed too much sugar, I just lost the genetic lottery. Eventually I will die from one or more of the myriad of complications caused by T2D. However between now and then keto will be a main stay of my management of T2D.

I agree that most people, including myself, just can’t maintain a strict keto diet for more than several months.

As you alluded to, the way to lose weight is to run a calorie deficit. Either consume less or burn more.

In my opinion, keto inspires weight loss in several ways. Firstly you shed a heap of water weight in the first few weeks, instant results, you feel different, it inspires you to continue your weight loss journey. Secondly you’re intently observing what you’re eating, if it’s your first time on a strict diet, might be your first time with a rigid meal plan, of course you’re going to lose weight. Thirdly fat does make you feel satiated for longer - that is to say, it’s easier to consume fewer calories because you feel less hungry.

That said, there are some real dangers - like consuming too much saturated fat. If keto requires you to consume ~100g of fat per day, then the only way to stay under the heart foundation’s recommended maximal intake of saturated fat is to acquire every last gram of that fat from good quality olive oil (EVOO). In my own experience, after being on keto for several months you start to consume far too much saturated fat. If you’re getting your calories from cream, cheese, and pork or beef, you’re going to be consuming 4x or 5x the recommended maximums. Additionally, this can instil bad habits even once you discontinue keto, by promoting an attitude of “fat is actually good for you” which is not the whole story.

Finally, and this is just a personal opinion rather than fact, the “healthy food pyramid” with all that grain at the bottom is bullshit. Its borne of the fact that grain can be mass produced in most places and can be used to manufacture shelf stable products that don’t require refrigeration. Legumes are a far superior source of carbohydrates.

My advice to a non-T2D person thinking about starting keto would be… it’s a great way to challenge the way you think about food, but only attempt it for 3 months or so at a time.

https://nutritionsource.hsph.harvard.edu/healthy-weight/diet-reviews/ketogenic-diet/

It’s a pretty good over-view of a ketogenic diet actually. Though its written from a very skeptical perspective and uses weasel language like

Some negative side effects of a long-term ketogenic diet have been suggested…

Thanks for sharing the resource!

My doctor said something similar.

But after years of me being on keto, losing 167lbs, having an “absolutely fantastic health record” and the “healthiest bloodwork” he’s ever seen (his words), plus significant improvement in mood, memory, and mobility, and a significant reduction/elimination of pain and inflammation, he changed his mind.

He even admitted that most of the content he had heard or read when saying it was “a bad diet” all those years ago was “completely biased” and “worded very slyly” (also his words). After revisiting those sources, he realized they “weren’t actually describing real keto, just people eating a ton of fat” (which is not what keto is), “and crying about how bad fat is” (again, his words… which made me LOL). Also, mega bonus points for him - he actually checked into the sources and found that most of them were funded by the sugar industry.

It takes nothing to realize you’re wrong; for some people, it takes a lot to admit it. He had no problem doing so, and even recommends the diet to other patients now.

Hmm…

The ketogenic diet is not considered a benign, holistic, or all-natural treatment. As with any serious medical therapy, it may result in complications, although these are generally less severe and less frequent than with anticonvulsant medication or surgery. […] Supplements are necessary to counter the dietary deficiency of many micronutrients. […] Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. […] In adolescents and adults, common side effects reported include weight loss, constipation, dyslipidemia, and in women, dysmenorrhea.

Sounds like you’re right, this diet is something that should be done for specific medical reasons, with professional guidance and with specific goals in mind:

The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate dietary therapy that in conventional medicine is used mainly to treat hard-to-control (refractory) epilepsy in children.

https://en.wikipedia.org/wiki/Ketogenic_diet

Some nits to pick:

Ketosis is a metabolic state where the body burns fat for fuel (lots of handwaving, but more or less)

ANY diet where weight is lost MUST have states of ketosis to metabolize fat (by definition). This includes the old classic ‘eat less, move more’, ‘count calories CICO’, ‘low fat diet’ etc.

A ketogenic diet, keto for short as people use it, is a diet that keeps people in the metabolic state of ketosis for extended periods of time. There are food groups that do not introduce glycemic load (fat and protein), and therefore keep the metabolic state of ketosis.

I must respectfully disagree with the statement that keto isn’t safe - if that statement were true, then losing any weight ever, would not be safe - including sleeping (you run out of glucose and burn fat while you sleep… break-fast is called that for a reason). The flip side of the ‘keto isn’t safe’ statement is the implicit statement that carbohydrates are a essential macronutrient - which is an difficult position to defend.

If we modify the statement to be prolonged periods of ketosis are not healthy, then we need to answer how long, and what levels of carbohydrates are essential. We would also need to account for the metabolic success of cultures that do not consume carbohydrates (historic Inuit for example - who lived in cold regions where no grains grow).

Keto seems less dangerous than the old Atkins diet. I had a coworker who rapidly shed about 30 lbs on Atkins and then had a stroke - he was 32.

Thanks for the advice.

For the time being, we’re trying to transition very gently into keto. It’ll probably be multiple months before we’re trying to maintain a “real” keto diet, so hopefully that will help the side effects or at last provide time to intervene before they become too serious. Worst case, we can stop at whatever point is healthy for us, but we’ll still need recipies to maintain even that compared to our current “rice or potatoes with every meal” diet.

With respect to electrolyte options:

I use LITE SALT (low salt salt, like a 50/50 sodium/potassium mix), but any brand works. Super cheap per serving, I just mix with hot water and drink it like a shot. Some people use bullion cubes too!

example: https://www.mortonsalt.com/home-product/morton-lite-salt-mixture-2/

I already do that for pastas and stews, but haven’t found any good keto recipies using it (yet).