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breaking down the trend “diets”

I find nutrition so intriguing. While pursuing my Bachelor’s degree in dietetics, I loved learning about the interaction of macro and micronutrients with the physiology of the human body. It was incredible how these little molecules could fuel so many reactions to allow us to perform day to day functions. That is why I find all of these new diets out on the market so interesting to research. I often hear people say “I’m Paleo” or “I’m Keto”, like it’s a defining characteristic. While everyone has their own reasons why they choose certain eating regimens (I hate the word diet), whether it be weight loss, performance, building muscle, or even just cultural beliefs, I think it is important to understand how you are affecting the bodies physiology. Let me briefly break down some of the new “diets” on the market today. This is not an in depth science course, but a simplistic way to better understand what these diets entail and my opinion on them based on my experience as a physician with a strong background in nutrition. There have been trials looking at how these diets may impact health and certain conditions such as cancer, heart disease, hypertension, and diabetes. I am not going to review these here but will discuss those in later posts. 


atkins diet

Let’s start out with the one that started it all out. The Atkins Diet is focused on low carbohydrate intake in phases. The goal is to deplete your bodies glucose and glycogen stores so that your body will turn to fat to fuel the body. I describe this in more detail below when I talk about the ketogenic diet, which is similar to Atkins but a little more intense. The Atkins diet is set up in phases. Phase 1 is the induction phase where carbohydrate consumption is limited to under 20 grams a day. In contrast, the average American consumes about 300 grams of carbohydrates a day. The foods recommended therefore are high in fat and protein. Phase 2 is the balancing phase where some low carb vegetables, and small amounts of fruit and nuts are added back into the diet as additional carbohydrate sources. In phase 2,  5 grams of carbohydrates a day are added each week until the dieter stops losing weight. At that point the individual is supposed to reduce the daily carb intake back down by 5 g until they start to lose weight again, thus “balancing” one’s carbohydrate intake. This does allow for more nutrient and fiber sources, but is still restricting many healthy food options. The average amount of carbohydrates in this phase is around 25-50 grams of carbs a day, still very low.  In phase 3, also called the fine-tuning or pre-maintenance phase, the dieter once again increases their carb intake by 10 grams a week until their weight loss again slows. Carb intake typically ranges from 50-80 grams a day here.  Phase 4, the lifetime maintenance phase allows the person to add a wider range of carbohydrate sources while monitoring their weight to ensure that they are not gaining weight. Carbohydrate intake is still low, usually no more than 100 grams a day. Whole grains and starchy vegetables are allowed, however still only in small amounts.

Just reading what I typed out above bothers me so much. This diet is basically saying to trick your body into thinking it is starving and then slowly add back more carbs…but not too much. Give me a break. First off, people cannot stick to this diet. Studies have shown that most dieters that start the Atkins Diet are no longer following it a year or so out and most stop a lot sooner than this do to low energy levels. I know there are people that will argue and say it works great and they have lost a ton of weight on it and that’s fine. I am happy this has worked for them. For most people, it is just not sustainable. In the induction period, yes, you will see the numbers on the scale drop. A gram of carbs holds four grams of water, (carbo-HYDRATE-get it?) so you will lose water weight for sure. But isn’t the goal to increase lean body mass, decrease body fat percentage,  and improve overall health?  Once you start adding carbs back into the diet, this water weight will come back, and that is why I suppose the diet incorporates that balancing phase. Also, yes your body will use fat for energy, but at the expense of your own energy levels, fluctuating hormone levels, and poor sleep. People often complain of constipation, headaches, fatigue and dizziness. I will discuss controlled trials on these diets in a separate post, but suffice it to say that while studies have shown increased weight loss in the first 3-6 months, there are no controlled studies showing long term benefits of this diet. 

ketogenic diet

The Ketogenic Diet was originally utilized to treat patients with epilepsy and seizures. Once the low carb craze started becoming widespread, the ketogenic diet, or keto, moved in as a sort of “low carb on steroids” diet. It involves eating an extremely low amount of carbohydrates and high proportion of fats. The breakdown of calories for most keto diets is 70% fats, 25% protein, and 5% from carbohydrates. As you can see, this is not even close to what the average human would eat with a normal balanced diet. If you are following this way of eating, you are basically taking the calories you would get from carbohydrates and swapping those out for fat, similar to the first phase of the Atkins Diet. 

So what kinds of foods are on the keto diet? The same recommendations as the Atkins diet, without the reintroduction of higher carbohydrate foods.  That includes plenty of high fat foods like red meat, eggs, dairy products, avocados, nuts, and oils. You are told to avoid carbohydrates like pasta, rice, oats, beans, root vegetables, and starchy vegetables. 

The reasoning for this is to put your body into ketosis, hence the name. This is basically a starvation state for the body. This is what is happening in the first phase of the Atkins Diet, however since you are not adding back some higher carbohydrate foods to this diet, the body is continuously in a starvation state. The preferred fuel for the body and brain is glucose, however when there are not enough glycogen stores around due to lack of carb intake, one is forced to use ketones, the by-product of fat breakdown, for energy instead. You may think “Great! I want to burn fat! This is perfect!” Except it’s not. The brain needs glucose to function, which is why you may have also heard people on keto diets talk about “brain fog” or “keto flu”. It’s not a fun thing and along with brain fog includes headache, chills, sore throat, digestive issues, dizziness, insomnia, irritability, and more. Also, in my medical career I have seen too many people in the hospital suffering from diabetic or starvation ketoacidosis to know that you cannot really maintain living off only ketones for energy for a sustained period of time without causing other metabolic issues. Additionally, there are no controlled studies showing long term benefit. In the short term, sure you may lose some weight. If you read my blog post title “Foods to Avoid to Lose Weight” you will note that I even dabbled in this diet for a short period of time. But I do not recommend this pattern of eating.  Don’t get me wrong, I think that the foods included in the keto diet- eggs, dairy, avocados, nuts, are all great foods. However I recommend them as part of a balanced diet along with fruits, vegetables and whole grains. 


paleo diet

The Paleo Diet comes from the word paleolithic, or the caveman era, and looks at what our ancestors ate before processed foods. Basically, anything a person would have been able to hunt or gather. The breakdown for a Paleo diet is about 30% of calories from protein, 35% from fats, and 35% from carbohydrates, so you can see the carbohydrate ratio is much more liberal than the above diets. Carbs are allowed, but really only in the form of fruits and vegetables. 

The Paleo diet includes fresh fruits and veggies, lean meats, fish, nuts, seeds, eggs, and healthy oils. There are also “foods to avoid” or “off limits foods” that include anything processed along with dairy, grains, vegetable oils, refined sugar, and legumes. While I do agree that processed foods and refined sugars should be limited in a healthy lifestyle, I do not feel that there should ever be “banned” foods. Also, this diet restricts you from extremely healthy options. The thought is that humans need to go back to the basics and what our ancestors ate is how our body was meant to process foods. In theory this sounds legitimate and I do feel there are some good components of this diet. I don’t think that this is something that has to be followed strictly however. There are plenty of healthy dairy products out there and by completely cutting this out of your diet you are limiting high calcium and vitamin D sources. Sure you can supplement or eat a truck load of leafy greens to try to compensate, but unless you have a real health condition such as lactose intolerance or Celiac disease, I do not see a reason to completely cut out dairy or whole grains. Banning whole grains and legumes also removes key fiber sources from the diet. It is just really hard for me to get on board with something that actually cuts out complete food groups.


The vegan diet is both a lifestyle and a prescribed diet, and I know a lot of people that follow this not just for the claimed dietary benefits but also because of other social, ethical, and environmental reasons. The vegan diet excludes all meat and animal products. This includes dairy, eggs, fish, and seafood. The diet allows fruits, vegetables, whole grains, legumes, nuts and seeds. There are different variations on the vegan diet however I am not going to go into detail on each of these here. Obviously the biggest things to worry about following a strictly vegan diet are nutrient deficiencies. Iron and B12 deficiencies are prevalent due to the lack of meat intake. By restricting dairy there are also issues with calcium and vitamin D sources.  This diet is another one that restricts whole groups of foods, and for that reason I don’t recommend to strictly follow a vegan diet as I do think there is a role for incorporating lean meats, fish, and dairy into healthy eating habits. However, if a vegan diet is being followed for ethical beliefs there are ways to supplement and combine protein sources to avoid dietary deficiencies. Another issue I have with the vegan label is that  I sometimes think people fall into the trap of seeing something labeled as vegan and assume that means it is healthy. I often see recipes posted online for things like “vegan” cookies or stores selling “vegan” chips. If you look at the ingredient list and nutrition facts for many of these foods they are not what you would consider healthy. Many contain high amounts of sugar and saturated fats, so it is important to always look at what products contain and not assume that if you are shopping at Whole Foods everything is automatically good for you. 

whole 30

 Whole30 is not a sustainable way of eating but rather  a 30-day program to determine which foods or food groups are causing intolerances in your body. Whole30 is complicated and comes with a lot of rules and off limits foods. Sugar, alcohol, grains, legumes, dairy, MSG, sulfites, pastries, or snacks are all on the “banned” list. You eat a lot of meat, fruits, and vegetables, but that’s pretty much it. I guess maybe you do it to see if you have food intolerances such as to gluten or dairy. However, I see no reason to go a month of your life being absolutely miserable to do this. I have seen people post about following Whole30 and feeling better than they have ever felt before. I will take their word for it, but I see no reason to follow this diet. If you think you may have a dietary intolerance you can slowly start cutting out foods that seem to cause your GI distress until you pinpoint the culprit. I see no reason to do it all at once since then you don’t know what was really causing your issues. You just cut everything out, how do you know what food was causing the problem?! Do I think its good to limit refined grains, sugars, and alcohol in one’s diet? Of course, but I don’t think it is healthy to feel guilty for having a glass of wine or a piece of bread. There again you’re losing that connection with emotional and mental well being as well. It is also a 30 day program and not a long term plan. But I guess this diet sells books and products so I’m sure we will continue to see it advertised. 


Bottom line

If you haven’t noticed already, I am not a fan of trend or fad diets. I do not believe that banning or restricting foods is going to allow anyone to lead a well balanced, healthy lifestyle. It seems that many have become caught up in the notion that less is more, and that the answer to weight loss and fitness is to completely cut out “bad foods.” But health is not just about food. It is about physical activity, fitness and performance, along with emotional and mental well being. If your diet is so restrictive that it is causing increased stress, limiting social interactions, or impairing your sleep and recovery, is this “diet” really benefiting you?

When patients ask me about what they should be eating, I always tell them that its not about dieting, but about a lifestyle change. That being said, I do feel that Mediterranean Diet is a good guideline to start with, more so because it outlines more of a lifestyle change than a restrictive way of eating. This includes whole grains, fruits, vegetables, legumes, along with healthy oils and fats. Fish and seafood are recommended a few times a week, and dairy, like cheese, are eaten in moderate portions. Red meats and sweets are also allowed just at lower portions. This eating pattern does not have foods that are “off-limits” or “banned.” It allows for discretion and enjoying food, but also being smart in dietary choices. Of course, these choices still need to be tailored to each individual based on one’s goals, and that is where meal planning comes into play. In addition, for elite athletes and those looking to improve performance, meal planning is going to be much different than those that are just starting on the path to fitness. There are tons of books out there with great recipes and cooking ideas to incorporate these eating habits into your life, such as The Complete Mediterranean Cookbook: 500 Vibrant, Kitchen-Tested Recipes for Living and Eating Well Every Day. 

So no matter where you are on the path to better health, don’t feel like you have to restrict yourself to achieve your goals. There are plenty of ways to incorporate great tasting foods without feeling guilty. I realize that we are living in the era of instant gratification, but if you are truly looking to improve your health, quick weight loss is not the answer. If you look at a diet and see that it is going to be a struggle to follow, chances are that you won’t be able to stick with it for the long term. Maybe you will see some weight loss in the short time you are able to adhere to it, but is that the goal? Health and fitness is something that is achieved and maintained over a lifetime, not a month.



30% protein, 35% carbs, 35% fat

 Okay: fresh fruits and veggies, lean meats, fish, nuts, seeds, eggs, and healthy oils.

 Off-Limits:dairy, grains, vegetable oils, refined sugar, and legumes



 70%fats, 25%protein, 5% fats

 Okay: high fat foods like red meat, eggs, dairy products, avocados, nuts, and oil

 Off-Limits:  carbohydrates like pasta, rice, oats, beans, root vegetables, and starchy vegetables


Atkins diet

 Similar to ketogenic diet, but in phases. 20 grams carbohydrate in phase 1 up to 100 grams a day in maintenance phase

 Okay: High fat foods such as red meat, eggs, dairy in phase 1

 Off-Limits: Carbohydrates like pasta, rice, oats, beans, root vegetables, and starchy vegetables. Gradually added back in later phases but at low levels



 No specific breakdown of calories into macronutrients

Okay: fruits, vegetables, whole grains, legumes, nuts and seeds

Off-Limits: meat and animal products. This includes dairy, eggs, fish, and seafood.



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