The Ketogenic Diet - Benefits & Pitfalls

The principles of the ketogenic diet are very appealing to me as a holistic Nutritionist. This diet was originally developed 100 years ago to treat childhood epilepsy. In recent years, a few modified versions have cropped up on the health and wellness scene. 

So is keto worth a try for the average person who wants to lose weight? Or should it be left to specialists addressing serious health concerns? 

What is a keto diet and do I recommend it? 

On the whole, I think we should be reacquainting ourselves with healthy fats, ensuring adequate protein intake and minimising refined or processed carbohydrates. Where people come unstuck with the label ‘keto’ I believe, is the inherent restrictiveness that goes in hand with its implementation. 

As soon as I read any ‘eat-this-but-certainly-not-this’ descriptor, I immediately want a closer look. And then I have questions. What are the merits? What are the concerns? Where would I apply this in clinical practice? 

I will say that I have used a modified version of a keto diet with varying degrees of success. A guided keto diet can be helpful, but with consideration for long term and potentially unforeseen health risks. 

So let’s break it down and get an understanding of the background and modern applications of a ketogenic diet. 

Classic Keto Diet

A true ketogenic diet can be described as a high fat, moderate protein and low carbohydrate diet. Its primary use is in the medical treatment of paediatric epilepsy. In fact a ketogenic diet was used as a dietary intervention for this condition in the 1920’s, well before anticonvulsant drugs were on the market. 

This approach uses foods or food derivatives high in fat as the main energy source, rather than carbohydrates. This causes a metabolic switch that triggers the liver to break down fats into fatty acids and ketones. These ketones are then used by the brain and body cells as energy. In this setting, it is a closely monitored intervention, performed under the care of a doctor usually in a hospital environment and with expected outcomes. This diet is a true ketogenic diet and is very different to what’s been popularised in the last decade or so. 

Ketogenic diet ingredients on a white background

Modern Keto or Varied Keto Diet

Recent Ketogenic diet trends gained popularity within the last 10 years. In fact I remember distinctly how prevalent it was around 4 years ago. It was all the rage in health conscious groups for weight-loss, athletic enhancement, optimising brain health and for rebooting a carb-heavy diet. I’ve had colleagues who’ve implemented modern keto diets well with clients, and others with less success. 

On the whole, most people tend to feel better, when they clean up their diet and make a conscious effort to introduce healthy fats. However the removal of some other main food groups can cause a metabolic boomerang effect, as the body adjusts from one macronutrient energy source to another. It puts stress on the liver, the intestines and honestly we don’t know enough about the long-term effects of such a dramatic change in diet on an individual. 

“A healthy keto diet is built on whole, nutritious foods, including meat, fish, eggs, some nuts and non-starchy vegetables, along with natural fats like butter, coconut or olive oil.”

What are the benefits?

In my experience, patients who have received the greatest benefit from implementing a modified ketogenic diet are those who are overweight or diabetic. A diet that re-organises your body’s main energy inputs can be a dramatic improvement, especially if the extra weight is life threatening or is causing other metabolic problems, such as fatty liver and diabetes mellitus. 

Ketogenic lunch plate

This is, in my view, where a keto diet shines. If your diet is terribly nutrient-poor, or your liver, digestive tract and energy is overburdened, sometimes a complete overhaul is needed. I still think it should be done carefully with regular check-ins. Overall, there’s some health benefits to be had, as people the world over will agree. 

Reported benefits include:

  • Weight loss
  • Improved appetite regulation 
  • Balanced blood glucose and insulin levels
  • Increased energy
  • Improved alertness & clear thinking
  • Enhanced athletic performance

What are the pitfalls?

There's an argument amongst us health providers as to whether a keto diet may contribute to nutritional deficiencies. However if there’s adequate protein intake and enough fibre from easily digestible and lower carb foods, it shouldn’t be a concern. As always, it’s important to consider your individual situation and whether going through some temporary side effects is worth a greater metabolic benefit. Some potential short-term side effects include:

Common side effects include:

  • Constipation
  • Digestive issues
  • Menstrual or reproductive alterations
  • Kidney stones
  • Headaches
  • Fatigue

The exact link between keto-style diets and reproductive or digestive disturbances is unclear, yet there seems to be some rumblings amongst us natural therapists that it relates to changes in the microbiome.

We know that any significant dietary changes affect the gut and affect microbiome diversity. Gut bacteria depend on a certain amount of insoluble fibre and a low pH in the intestines to thrive and proliferate. If the diet has minimal or low carbohydrates, which includes grains, lentils, fibrous fruits and vegetables, then the microbiome, immune system and digestive function could change accordingly. 

Ketogenic diet ingredients

Is A Keto Diet Right For Me?

I stand firm in my belief that no one diet suits everyone. It’s a matter of discovery, discernment and guidance with the help of a qualified professional. More than that, however, is the very important point of listening to your instincts, understanding your body and learning what works and doesn’t as far as food and nutrition. 

If you’re trying for a baby, pregnant or breastfeeding, I would not recommend this dietary approach. If you have hypertension, diabetes or metabolic conditions, there could be a place for a keto-style diet as an intervention. 

In all instances, I strongly advise that you work with a degree-qualified health provider who’s savvy with the protocols, risks and benefits of this approach to ensure it’s the right fit for you. At the end of the day, my view with implementing dietary changes for anyone, is that the practitioner should treat the person and not just the condition or symptom. 


  • Keto can be useful when done with guidance, monitoring and with a measurable outcome.
  • Both positive and negative long-term keto diet effects are yet to be elucidated.
  • Changes to the microbiome are likely and may have upstream impacts on brain health and immune health. 
  • Certain demographics may not suit this approach, including pregnancy, if breastfeeding or among healthy children.

Top 3 Keto Nuts 

If you’re following a keto or low-carb diet, and you want to know which nuts fit the bill, here you go. The highest in healthy fat and lowest in carb with a moderate to low protein content. Pecans, macadamias and Brazil nuts are your three. 


Looking for a healthy nut that’s high in fat and keto-friendly? Stop here, you’ve arrived. In fact they’re at the top, boasting the highest fat and lowest protein and carb content. These macronutrient ratios are what define something as ‘keto’, which means pecans qualify. Pecans, followed by macadamias and brazil nuts, for those following a keto-style diet would no doubt be on regular rotation. For more on pecans, check out this article. 

Pecan Macros

  • 75% fat 
  • 9% protein 
  • 14% carbohydrates 

As the reported benefits of keto-style diets go, many of them include the enhanced brain and cognitive function as well as the ability to manage diabetic symptoms. While this claim for keto diets could be difficult to substantiate, the evidence for pecans in this regard is solid. A recent systematic review from 2021 cited pecans, along with all nuts as having a positive association with brain health. Another study confirmed 2 tablespoons of pecans per day resulted in better pancreatic cell function and insulin production. This is a compelling finding in support of pecans consumption. 

Close up shot of macadamias


A perennial favourite, keto or not, macadamias are one of the healthiest and most moreish nuts around. One big reason I love macadamias is that the majority of the fat content is monounsaturated, which makes them a heart-healthy and anti-inflammatory snack choice. 

Macadamia Macros

  • 75% fat
  • 8% protein
  • 14% carbohydrates

One crossover trial from 2020 examined the cholesterol levels of a small group of participants consuming macadamias compared with a control group consuming a standard diet. The results showed the macadamia-enriched diet high in monounsaturated fat had beneficial effects on cholesterol and low-density lipoprotein cholesterol levels when compared with a typical modern diet.

Close up of Brazil nuts

Brazil nuts 

The high fat and mineral content make Brazil nuts a naturally good choice amongst keto followers. Brazil nuts make for a balanced and low-carb snack, full of other helpful nutrients as well. Brazil nuts are famous for their selenium content which is neuroprotective and anti-inflammatory. These two elements combined give the body a boost of antioxidant defense and can improve cognitive performance. 

Brazil Nut Macros

  • 66% fat
  • 14% protein
  • 12% carbohydrates 

Even a single Brazil nut per day can benefit your brain, as was revealed in a study published in the European journal of nutrition. Here, participants showed improved verbal and motor function after a 6 month study period. Read more about Brazil nuts here.

Article References

Bolling, B. W., Chen, C. Y., McKay, D. L., & Blumberg, J. B. (2011). Tree nut phytochemicals: composition, antioxidant capacity, bioactivity, impact factors. A systematic review of almonds, Brazils, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts. Nutrition research reviews, 24(2), 244–275.

Curb, J. D., Wergowske, G., Dobbs, J. C., Abbott, R. D., & Huang, B. (2000). Serum lipid effects of a high-monounsaturated fat diet based on macadamia nuts. Archives of internal medicine, 160(8), 1154–1158.

Kornsteiner-Krenn, M., Wagner, K. H., & Elmadfa, I. (2013). Phytosterol content and fatty acid pattern of ten different nut types. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition, 83(5), 263–270.

Li Z, Heber D. Ketogenic Diets. JAMA. 2020;323(4):386. doi:10.1001/jama.2019.18408,, viewed 5 October 2021

Maranhão, P. A., Kraemer-Aguiar, L. G., de Oliveira, C. L., Kuschnir, M. C., Vieira, Y. R., Souza, M. G., Koury, J. C., & Bouskela, E. (2011). Brazil nuts intake improves lipid profile, oxidative stress and microvascular function in obese adolescents: a randomized controlled trial. Nutrition & metabolism, 8(1), 32.

Naghshi, S., Sadeghian, M., Nasiri, M., Mobarak, S., Asadi, M., & Sadeghi, O. (2021). Association of Total Nut, Tree Nut, Peanut, and Peanut Butter Consumption with Cancer Incidence and Mortality: A Comprehensive Systematic Review and Dose-Response Meta-Analysis of Observational Studies. Advances in nutrition (Bethesda, Md.), 12(3), 793–808.

Rajaram, S., Burke, K., Connell, B., Myint, T., & Sabaté, J. (2001). A monounsaturated fatty acid-rich pecan-enriched diet favorably alters the serum lipid profile of healthy men and women. The Journal of nutrition, 131(9), 2275–2279.

Rita Cardoso, B., Apolinário, D., da Silva Bandeira, V., Busse, A. L., Magaldi, R. M., Jacob-Filho, W., & Cozzolino, S. M. (2016). Effects of Brazil nut consumption on selenium status and cognitive performance in older adults with mild cognitive impairment: a randomized controlled pilot trial. European journal of nutrition, 55(1), 107–116.

Wikipedia Contributors. (2021, October 5). Ketogenic diet. Retrieved from Wikipedia website:, viewed October 5 2021.