Keto Diet-Friend or Foe?

“Keto here, keto there, keto everywhere!” It is inevitable, whether attending social gatherings, visiting the grocery store or interacting on social media you have probably heard about the keto diet and been tempted by its promises. In fact, the keto diet was the most searched weight loss diet in 2018. But is this diet the weight loss solution we’ve all been waiting for?

The ketogenic diet (better known as ‘keto’) is a high fat (70-80% of total calories), low carbohydrate (less than 50 g of carbohydrates (5-10% of total calories), moderate protein (10-20% of total calories) diet that adjusts the way the body produces energy. On a normal healthy eating plan that typically has 25-35% of total calories from fat, 45-60% of total calories from carbohydrates and 20-35% of total calories from protein, the body relies on burning carbohydrates for energy. On the other hand, in the ketogenic approach the body becomes dependent on burning fat producing ketones bodies to fuel itself. This is where the theory of keto diet for weight loss came from. It is difficult to know when one enters ketosis, unless you check for ketones in the blood/urine. However, it is very easy to leave this state, since the slightest increases in carbohydrate intake may resume regular energy production, adding to the challenges faced on this restricted diet.

Like other weight loss diets with restricted intake, individuals may notice rapid weight loss in the first week (about 2-10 lbs), primarily related to water loss and glycogen stores depletion. Shortly afterwards, the rate of weight loss slows down, similar to other weight loss diets, to about 1-2 lbs/week. Whether this diet is sustainable and improves overall health outcomes is in doubt.

The ketogenic diet is not a new trend. In the 1800’s, scientists discovered its efficacy in treating epilepsy and other similar seizure disorders in kids. Therefore, most available research, especially long-term studies, is concentrated on that rather than weight loss. Long-term studies linked the keto diet with increased risk for kidney stones, osteoporosis, hyperlipidemia, possible nutrient deficiencies and risk for liver abnormalities. Short term effects recorded in adults include constipation, brain fog, irritability, increased levels of both good (HDL) and bad blood cholesterol (LDL), binge eating and relapse, adequate muscle maintenance and building and mild improvements in serum glucose levels.

Well, is it a friend or a foe? As a registered dietitian nutritionist, there is too much risk and not enough research to prove that following the keto diet will lead to greater weight loss and better health outcomes than other less restricted more realistically sustainable diets. Therefore, I would consider losing weight on the ketogenic diet as a foe for now. However, there are some positive sides of this diet that we can learn from to improve our health and wellness that include:

  • Being mindful with the quality and quantity of carbs we eat
  • Practice portion control
  • Overcome fear from fat and work in more healthy fats
  • Listen to hunger and fullness cues.

Please remember that there is no one size fits all when it comes to eating. We are all unique with different health issues, so it is important that we base our diets on what our individual body needs rather than following mainstream food trends.

Thanks to R. Farra, MDS, RD, LD for co-authoring this article with me.



5 Free Apps for a Healthy Lifestyle

Looking for easy ways to stay healthy and meet your nutrition goals in the New Year? These 5 free apps are a great way to manage weight loss, plan menus, track activity and fitness and navigate dining out.

  1. Lose It! A weight management app that allows users to track food intake, exercise, and water consumed, Lose It makes it easy to input goals, manage progress, and see real results. This app even has a barcode scanner to quickly add foods, graphs to show visual progress day over day, and even import data from other health and fitness apps.PROS: Able to save meals and scan barcodes to quickly track foods; connect with friends for accountabilityCONS: May feel a little time consuming to start; limited restaurant database

    SIMILAR: MyFitnessPal

  2. Foodily Foodily is an online catalog of recipes, indexed by hundreds of search criteria, allowing users to find just the right recipe in an instant. Get new ideas to update the standard chicken or crock pot dinner, find an innovative way to use up leftover vegetables, or just get inspiration for your next meal. Foodily incorporates user ratings, allergy information, and a social aspect to let you connect and share your recipe finds with friends. A forum of community recipes, Foodily provides realistic recipes by other home cooks, making it easy to find and create new meal ideas at home.PROS: Ease of use, photographs of recipes, save and share recipes with friends and social mediaCONS: Recipe index and limited depending on user uploads

    SIMILAR: Yummly

  3. Strava Log and track your fitness goals with this easy to use new fitness app. Strava uses a GPS tracker to map routes and log miles and paces for runners, walkers, and bikers. The app helps keep users motivated by connecting you with friends and incorporating monthly challenges to compete against yourself or others.PROS: Easy navigation; able to share activities to other social media platforms; connect with friends for motivation.CONS: Only tracks miles for running, walking, and cycling; GPS can drain phone battery.

    SIMILAR: MapMyFitness

  4. Healthy Out Not sure how to eat out and still stick to your healthy goals? Have specific diet restrictions or allergies? Healthy Out allows you to enjoy eating out without the stress or hassle of not knowing what options are available at many favorite restaurants.PROS: Easy access to filter menu items and restaurant listings based on wide variety of dietary needs; ability to save and share results with friends.CONS: limited city and restaurant availability but continuing to grow; must connect via Facebook

    SIMILAR: Food Tripping

Thank you to SD, dietetic intern, 2015 for input on this blog.


Contrave–New Weight Loss Drug

Prescription Contrave was just approved by the FDA in September 2014, making it the fourth prescription weight loss drug approved by the FDA for long-term use.

The other 3 prescription weight loss drugs include Qsymia and Belviq (approved for use in 2012) and Alli (Orlistat) the over the counter version of Xenical. But don’t forget that diet and exercise are still key components for any of these drugs to be most effective.

Last year, the weight loss industry in the U.S. brought in a wopping 60.5 billion dollars. Despite a small 1.8% dip in revenue last year, there’s no denying this industry is still booming.  From do-it-yourself diet books to weight loss surgery, the options for weight loss and maintenance are endless.

Contrave is actually a combination of two drugs that are already on the market, naltrexone, which is used to treat addictions, and bupropion, which is an anti-depressant.  The exact way that Contrave works is not fully understood, but it did outperform the placebo in clinical trials.

In order to receive a prescription for Contrave, adults must fall under the obesity classification with a body mass index (BMI) of 30 or more.  Overweight adults may also be eligible for a prescription if they have a health condition that can be related to their weight, such as type 2 diabetes or high blood pressure, in addition to a BMI of 27 or higher.

Before deciding whether or not to take a prescription weight loss drug, it’s important to consider a few other factors besides eligibility. Contrave is not a miracle drug.  Participants who took Contrave and followed a diet and exercise plan in the clinical trials, lost an average of 4.1% more weight than placebo users at the end of one year.  That’s right, diet and exercise are still part of the deal.  In fact, the FDA recommends that doctors stop Contrave if the patient doesn’t show a 5% weight loss in the first 12 weeks on the prescription.  In other words, you can’t just pop a Contrave and eat whatever you’d like.  Dust off your gym pass and be ready to skip the drive-thru, because if you’re thinking about asking for a prescription for this pill you’re going to have to back it up with health conscious eating and activity!

In addition to a lifestyle change, you will also need to consider possible side effects.  Contrave users reported experiencing nausea, vomiting, headache, and dizziness.  Constipation, dry mouth, diarrhea, and insomnia were also among the more common side effects reported.  Uncomfortable as these may be, they appear mild compaired to the list of risks associated with this drug.  The FDA warns that using Contrave can cause seizures, increase blood pressure, and raised heart rate.  When taken for other conditions, the two drugs that were combined to make Contrave have been associated with increased risk for suicidal thoughts and “serious neuropsychiatric events.”

Finally, even though it’s been approved for use, Contrave is still undergoing clinical trials.  The FDA is still evaluating cardiovascular risks that go along with its use, as well as performing studies on the relationships between Contrave and memory, impaired liver and kidney function, other drug interactions, and possible use in children.

Ultimately, the way you lose weight is up to you.  If you’re thinking about using Contrave or another prescription weight loss drug, be sure to talk with your doctor and a registered dietitian nutritionist in order to make the best, safest choice for you, and to make the most of your prescription.

Thank you to Meghan P., dietetics student at Eastern Michigan University, for her help with this blog!


Getting Those Zzzzzzs!

When it comes to our busy lives, we always look for ways to do things faster and more efficiently. We often find that there aren’t enough hours in the day to do everything we want to do. We try to give ourselves more time for work or play and unknowingly sacrifice one vital function of our lives. Can you guess which one? If you said SLEEP, you are absolutely right! Unfortunately, we only tend to think about sleep when we haven’t had enough of it. Giving yourself adequate time to sleep will do your body good and can actually have an effect on your nutrition.

The scientific explanation of this striking fact is that sleep is necessary for proper neuroendocrine function and glucose metabolism. Being awake for an extended period of time can trick the body into thinking we need more energy! Our body will compensate for the extra hours of wakefulness causing neuroendocrine, metabolic and behavioral changes leading to the increased consumption of food and increased energy retention. Altered neuroendocrine functions can cause an increased appetite and decreased satiety, making an individual feel hungry all the time. Metabolic changes can include a decreased resting metabolic rate or a decrease in the amount of energy an individual burns at rest. Lastly, behavioral changes, such as skipping the gym because all you want to do is sleep, can occur. Current epidemiologic and laboratory studies have found that altered metabolism can increase your risks of gaining weight and becoming obese, leading to the further development of chronic diseases such as cardiovascular disease and Type 2 diabetes.

So just how does limited sleep alter our metabolism?

Our glucose tolerance decreases the less we sleep causing our body to have increased glucose levels. This increase of glucose can contribute to hyperglycemia or high blood sugar levels and increase an individual’s risk for cardiovascular disease. At the same time, our insulin sensitivity decreases. This means our fat cells are unable to effectively use insulin, although our pancreas produces plenty of it. Glucose levels will thus remain high, contributing even further to hyperglycemia. To make matters worse, this change is likely to cause Type 2 diabetes.

Our cortisol secretions are increased the less we sleep, and as we know, cortisol is the steroid hormone released by the body in response to stress. Increased levels of cortisol are associated with higher amounts of abdominal fat, which can lead to further health problems such as the development of metabolic syndrome.

Our ghrelin hormone secretions (the hormone that increases appetite) are also increased the less we sleep. Conversely, leptin hormone secretions (the hormone that decreases appetite) are decreased. As these two hormones work together, our appetite is increased and our satiety is decreased leaving us to feel the need to consume more food.

New research has emerged that suggests insufficient sleep related metabolic adaptations may also cause ill effects for those who are trying to lose weight. Although the individual is reaching their target level of physical activity and following a healthy diet, their sleep loss in the past can delay the success of their treatments. They may also tend to retain more fat if they have a history of excessive food consumption.

So before you hit the sack to clock in your hours of sleep, here are some tips to follow to get a better night’s sleep and wake up feeling healthy and refreshed!

  1. If you exercise in the evening, do it at least 3 hours before bedtime. This will allow your body to cool off and relax before bedtime. Cooler body temperatures will hasten sleep onset.
  2. Limit stimulants such as caffeine, nicotine or alcohol right before bed because it can make it harder to fall asleep. Less sleep will ultimately affect you the next day making your body cry out for more caffeine, eventually leading to a cycle of caffeine dependence.
  3. Aim for a regular bedtime and wake time, including the weekends. This will strengthen your circadian rhythm and will help put you to sleep faster.
  4. Begin a calming routine before bed, such as reading a good book or soaking in a hot bubble bath. Relaxation before bed can prepare your body for deep sleep.
  5. Avoid bright lights, such as your phone or computer. This often can signal increased activity of neurons which can delay your sleep onset.
  6. Eat at least 2-3 hours before bedtime to increase your sleeping comfort. Eating and drinking too closely to bedtime can stimulate your body due to the digestive process, leave you feeling full and may cause you to run to the restroom in the middle of the night.
  7. Regular exercise can help you fall into a deeper sleep.

When it comes to sleep, it’s best we don’t take it for granted! Our body is depending on us to get an adequate amount of sleep so it can function properly and keep us energized throughout our day. So, long story short, getting the sleep we require will help us work faster and more efficiently. And sacrificing sleep for more time will only harm our effectiveness. Following these simple steps, will lead us to live stronger, happier and healthier lives.

Thank you to E. C.–WIC Dietetic Intern, for writing this posting.


Penev, P.D. (2013). Sleep deprivation and human energy metabolism. In Handbook of nutrition, diet and sleep (pp.194-208). Wageningen Academic Publishers.  Accessed June 11, 2013.

Leproult, R., & Van Cauter, E. (2009). Role of sleep and sleep loss in hormonal release and metabolism.  Accessed June 12, 2013.

The National Sleep Foundation. Healthy Sleep Tips .Accessed June 12, 2013.

Green Coffee Extract–Weight Loss Truth or Myth?

It is no new news that overweight and obesity rates continue to increase not just in the U.S but also worldwide. With concern for good health and hope to achieve faster and better weight loss results, the use of dietary supplements has also increased among consumers. Current scientific research finds most of the supplements to be ineffective for many reasons. Some may not contain the adequate dosage to produce a positive effect on health, some may be poorly absorbed and others may become inactive in the presence of other substances. One “slimming” supplement worth discussing because of the gained popularity among dieters in the recent past years is the green coffee extract (GCE) dietary supplement. After being endorsed by celebrity health experts and extensively marketed by well-known manufactures, the sales of green coffee extract as a weight-loss aid have skyrocketed.

But what is green coffee extract?
Green coffee extract (GCE) is present in green raw coffee beans. It is also present in the roasted coffee but much of the GCE is destroyed. The major GCE constituent is cholorogenic acid (CGA). It is estimated that 100 grams of raw coffee can provide about 5 to 12 grams of CGA. Besides coffee, CGA can be found in many fruits and vegetables. Research indicates that CGA is highly absorbed and metabolized in humans; however, there is large variation among individuals on how much is absorbed in the body.

Green coffee extract has been marketed as a weight loss supplement in the capsule form under a wide variety of brands using the patented name Svetol. In the U.S market, Svetol – manufactured by the French company Naturex, is listed as an active ingredient on 25 dietary supplements. Svetol is also found in Norwegian Coffee Slender products such as instant coffee, decaffeinated tablets and mints, and chewing gum.

What are some of the suspected benefits of cholorogenic acid (CGA)?
The chlorogenic acid in the green coffee extract is believed to have antioxidant properties and in animal studies, it has been shown to inhibit fat accumulation. In humans, the consumption of caffeinated coffee can lead to long-term weight loss; this is believed to be a result of the effects of caffeine intake possibly working along with green coffee extract on metabolism.

The findings of current research indicate, but not convincing evidence, that intake of green coffee extract fortified with chlorogenic acid may promote weight loss. These results must be interpreted with caution, as the methodology in many studies is poor and further investigation is needed. More rigorous trials with larger sample size and longer duration are required to assess the effectiveness and safety of green coffee extract as a weight loss supplement.

As a consumer, you have the power of your purchasing decision. However, informed choices can prevent you from wasting your money on products that may not give the expected results and that may have long-term adverse effects on your health and body. The best approach to avoid weight gain or promote weight loss, one must use all the calories consumed on a daily basis. Researchers, physicians, registered dietitians and dietary supplement industry agree that eating a variety of whole foods, practicing portion control and exercising regularly is the foundation to maintaining a healthy weight.

Thank you I.I. UTHSCSA Dietetic Intern, March–2013

1. Onakpoya I, Terry R, Ernst E. Use of green coffee extract as a weight loss-supplement: A systematic review and meta-analysis of randomized clinical trials. Gastroenterol Res Pract. 2011; 2011:1-6.
2. Vison J, Burnham Bryan, Nagedran M. Randomized, double-blind, placebo-controlled, linear dose, crossover study to evaluate the efficacy and safety of a green coffee bean extract in overweight subject. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2012; 5:21-27.

Mindful Eating

Choose Mindful Eating–Not Diets

If you, like many others, have set a new years resolution to lose weight, there is a good chance that by now you have already given up. And no wonder! Diets can be depriving and can’t be sustained over a lifetime. They can cause a decrease in your metabolism, a preoccupation with food and a sense of failure. Why don’t you do something different this year? Start a new lifestyle rejecting the diet mentality and instead utilizing Mindful or Intuitive Eating. The basic principle of Mindful Eating is that we are all born with an internal mechanism that lets us know when we are hungry or full. Unfortunately, after years of being told to clean our plate, eat by the clock, and choose this food as advertised, our intuitive eating behaviors become suppressed. It may be challenging to modify your current dieting rules, but a new, healthier lifestyle will probably last much longer. Imagine a new year without guilt and totally tuned into your natural body signals!

So how can you develop a healthier lifestyle without dieting? Here are a few principles to consider.

  • Do you dislike your body shape? You can be healthy at any size. Embrace the body you were intended to have. Focus on having a healthy body from the inside out, instead of being a certain size or weight.
  • Can you recognize your body’s hunger and fullness signals? Pay attention to what your body is telling you. When you feel that you are about 80% full, stop eating. Eat slowly so you can recognize your body cues and analyze if you are truly still physically hungry. Focus on enjoying the aesthetics of every bite of food—the taste, temperature, texture, color and smell.
  • Do you allow yourself to eat when you are hungry? Keeping your body fed in smaller more frequent meals will help you eat in moderation. There is no magic number of meals required per day. Choose moderate portion sizes.  Don’t allow yourself to become excessively hungry, because you will experience a natural drive to overeat.
  • Do you eat to feel better? Using food for emotional comfort is not the answer. Being active can make you feel better and helps burn the energy/calories from foods you have eaten.  Could you start off by just walking 2 minutes a day?
  • Do you think you are a bad person because you consume a certain food or beverage? Get rid of the food police mentality. Give yourself permission to be imperfect and time to adjust to a healthier way of living. No one is a perfect eater. All foods should be able to be worked into your food choices, as long as you are mindful when eating them.

Let’s see if making peace with food and being mindful of your own body signals works for you! The good thing is that if you need assistance or more information, you can contact me–Linda Farr, RD/LD. I can provide you with personalized guidance throughout your progress to a healthier way of living!


Tribole, Evelyn, and Resch, Elyse. Intuitive Eating: a Revolutionary Program that Works. New York: St. Martin’s Griffin, 2003. Print.

The Center for Mindful Eating: The Principles of Mindful Eating.