Keto Diet Explained and Easiest Diet to Stick to 2019



One of the biggest selling points made by proponents of the ketogenic diet is that it’s supposedly a lot easier to stick to than other diets. If true, then the keto diet will improve the crucial element of ADHERENCE. Although a great marketing soundbite, whether evidence of improved adherence exist is another matter. In that case, does the scientific literature show greater adherence with the ketogenic diet? Let’s find out.

To analyze keto adherence,  first we searched for the relevant studies. In doing so, we made sure to exclude metabolic ward and feeding studies. Studies where participants were given pre-prepped meals. Such studies are great for observing specific ketogenic elements but does not mimic real-life adherence. Thus, the exclusion. Accounting for this and other criteria, like prescribing subjects to eat at most 70 grams of carbs daily and the goal required is weight loss, it came down to 10 suitable studies.

As far as measuring adherence, one method is to see if participants remained in ketosis. A blood ketone level of 0.5 millimoles per liter or higher is commonly accepted by keto proponents as being in the state of ketosis. If subjects were not above this mark when they’re supposed to be, thus not in ketosis, then we would assume they were eating too many carbs thus lack adherence.


Now, let’s get to the findings. Out of the 10 studies, only two groups ever actually achieved ketosis at any point of the experiments. Others were within borderline ketosis but ketone levels decreased over time. Now some have theorized, without clear evidence, that keto adaptation will naturally decrease blood ketone levels, thus lower levels don’t necessarily mean a lack of diet adherence. However, if we do look at those metabolic ward studies where diets are more tightly controlled, we should see a decreasing ketone effect if the adaptation theory is true.

But, we do not.We instead see ketone levels remaining high throughout the experiment, contradicting the adaptation theory. But, beyond blood ketones, we can also at look self-reported carb intake data. If subjects reported eating above their carb limit, then clearly, they did not adhere to the diet. That being said, in long-term studies, it was common to see groups break well above the 70-gram carb threshold, at times more than double.

Short-term studies at 13 weeks or fewer, though, did show better adherence. However, self-reported data isn’t exactly the most reliable information. In fact, studies on the self-reported intake show that people typically think they eat less than they actually eat, especially when trying to lose weight. Something to consider. Luckily, there’s one more factor to observe that’s also a bit more concrete for measuring adherence.

We can look at drop-out rates. The guys at sci-fit.net pooled together 1,307 experimental keto participants, of which 319 dropped out, versus 1,294 control participants, where 311 dropped out. That’s 24.4% of dropouts in the experimental groups versus 24% for the control groups. AKA, dropout rates were virtually the same.

 Now with scientific data, it looks like keto advocates might not have been entirely accurate with the “easier to stick to” agenda. But if you PERSONALLY feel that you can stick to the diet without much problem, then by all means continue with it. For those that repeatedly struggle eating so few carbohydrates, you might be better off trying something else.

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