Is Keto for Everyone?

Is Keto for Everyone?


Is the Keto diet recommended for everyone?



NO. A ketogenic diet is one in which carbohydrates are severely restricted (nearly eliminated), fat consumption is high and protein intake is moderate-low. The body’s process of converting its metabolism to fat-burning ketosis is a survival mechanism when carbohydrate supply is inadequate and dietary fat is plenty. [It shouldn’t be confused with diabetic ketoacidosis which also produces ketones, but with extremely high blood sugar.] Despite its short-term effectiveness for weight loss, I rarely recommend a Keto diet. Looking at all the available evidence, my professional opinion is that such an extreme approach is in opposition to a sustainable eating style that supports the whole body across one’s entire lifetime.

Following a ketogenic diet can cause long-term adverse effects such as hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies1. Since the ketogenic diet is very high in fat, those with gallbladder, kidney, liver, or pancreatic disease or problems with delayed gastric emptying should not follow it. Just as they shouldn’t be consuming a high sugar/refined carb diet, pregnant or nursing women also should not be on a keto diet. It may be ideal for certain populations, though. Healthcare practitioners may prescribe a classic or modified ketogenic diet for patients with epilepsy2. It may be prescribed for morbidly obese patients in the weeks leading up to bariatric surgery3 and for some patients with Type 2 Diabetes4.  


  1. Masood W, Uppaluri KR. Ketogenic Diet. [Updated 2019 Mar 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: Accessed 12.26.2019 
  2. Roehl K, Sewak S. Practice Paper of the Academy of Nutrition and Dietetics: Classic and Modified Ketogenic Diets for Treatment of Epilepsy. Journal of the Academy of Nutrition and Dietetics. 2017; 117:1279-1292. 
  3. Leonetti F, Campanile FC, Coccia F,et al. Very Low-Carbohydrate Ketogenic Diet Before Bariatric Surgery: Prospective Evaluation of a Sequential Diet. Obesity Surgery. 25, 64–71 (2015) doi:10.1007/s11695-014-1348-1 
  4. Azar ST, Beydoun HM, Albadri MR. Benefits of Ketogenic Diet For Management of Type Two Diabetes: A Review. Journal of Obesity & Eating Disorders. 2016; 2:2. doi: 10.21767/2471-8203.100022 

– Debbie J., MS, RD

This article should not replace any exercise program or restrictions, any dietary supplements or restrictions, or any other medical recommendations from your primary care physician. Before starting any exercise program or diet, make sure it is approved by your doctor.

Some questions have been edited for length and/or clarity.

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Skin-Saving Nutrients You Need Now

Skin-Saving Nutrients You Need Now

Why Do We Get Wrinkles?

Nourishing your skin from the inside out often means focusing on collagen production (vs. consuming collagen supplements) since it’s the major component of connective tissue in tendons, skin and ligaments1,2.  Your dermis layer’s collagen serves to provide skin with structure, allowing skin to rebuild and repair, and to withstand stretching1, providing skin elasticity and tone2. Although it’s the most abundant protein in the body, as we age our natural production of collagen wanes3. Collagen fibers break down or no longer regenerate, which lead to dreaded wrinkles2. 


Collagen is made up of several amino acids, predominantly the non-essential amino acids glycine, proline, hydroxyproline1,2, as well as alanine and arginine. Varying amino acid combinations make different types of collagen, so the collagen in skin (types I & III) is not the same as that in your joints (type II) or gut. In theory, boosting collagen production means furnishing your body with an adequate supply of amino acids from any protein source. However, the body prioritizes protein production to where it’s needed, say wound healing or antibodies for immunity, so it’s impossible to determine in advance where possible collagen peptides will be used in the body2. 

Still, consuming dietary sources of collagen ensures getting adequate amounts of hydroxyproline – the one amino acid not found in other proteins. Since collagen is concentrated in connective tissues, such as muscle, animal flesh (meat, fish, poultry, eggs) is a good source of collagen. Spirulina algae also contains collagen. Bone broth (which is simmered much longer than stock) also provides the amino acids necessary to build collagen2. 

Overall, dermatologists recommend a diet rich in nutrients and antioxidants to preserve skin health. Several play a key role in the production and maintenance of collagen to keep skin smooth and firm, while others protect against sun-induced skin aging and free radical damage in skin cells. Specifically, the skin-saving nutrients and phytochemicals to include regularly in your diet should be:  

Vitamin C

This antioxidant is a necessary cofactor in collagen synthesis and protects existing collagen from degradation2,4 and subsequent skin damage. Good food sources include citrus fruit, kiwifruit, peppers, strawberries, papaya, tomato juice, kale, cabbage, Brussel sprouts and broccoli4.

Vitamin E

As with vitamin C, this antioxidant helps fights free radicals produced from sun exposure4. Sunflower seeds, almonds, avocado, wheat germ, sunflower oil and grapeseed oil are good sources.

Linoleic Acid

An essential fatty acid used in making ceramides to build a strong skin barrier4. Research also suggests that higher intakes may reduce skin aging4. It’s found in nuts and seeds, grapeseed oil, sunflower oil, safflower oil and canola oil.

Omega-3 Fats

This type of fat from fatty fish (such as salmon, trout and sardines) and certain plant oils (flaxseed, soybean, and canola) preserves collagen and reduces inflammation caused by ultraviolet rays4. 


Found in Brazil nuts, mushrooms, wheat germ, sunflower seeds, turkey and seafood, this antioxidant mineral protects skin cells from free radical damage and guards against skin cancer4. 


A mineral commonly found in eggs, broccoli, onions, and garlic2 that’s needed for the structural formation of collagen.


Foods such as red meat, poultry, beans, nuts, certain types of seafood, whole grains, and dairy products provide this necessary mineral co-factor for collagen production2. 


These compounds in foods such as green tea, berries, beans and cocoa powder may reduce inflammation, improving skin elasticity and reducing wrinkles4. 


The liquid of life helps maintain skin moisture, delivers nutrients to your skin, and flushes out toxins. 

Besides thinking about producing new collagen, it’s equally important to consider protecting existing collagen from damage and subsequent skin sagging. Lifestyle factors that negatively affect collagen integrity include smoking and sun and pollution exposure2.

Quitting smoking, wearing sunscreen and avoiding microscopic contaminants help to save your skin. A big dietary factor in skin aging is high sugar intake2 because the binding of sugar molecules to collagen fibers forms advanced glycation endproducts5, causing permanent damageTo prevent wrinkles, include only natural sugars in whole foods like fruit and milk, and avoid added sugars.


  1. WH Freeman and Company. Collagen: The Fibrous Proteins of the Matrix. Molecular Cell Biology, 4th Edition. ©2000 Accessed 11/15/2019 
  2. J Santa Cruz. Dietary Collagen — Should Consumers Believe the Hype? Today’s Dietitian, March 2019. Issue Vol. 21, No. 3, P. 26 
  3. Varani J, Dame MK, Rittie L, et al. Decreased collagen production in chronologically aged skin: roles of age-dependent alteration in fibroblast function and defective mechanical stimulation. American Journal of Pathology. 2006;168(6):1861–1868. doi:10.2353/ajpath.2006.051302 
  4. L Beck. “Can taking supplements or certain nutrients actually improve your skin?” The Globe And Mail. August 8, 2015. Accessed 11/15/2019. 
  5. Gkogkolou P, Böhm M. Advanced glycation end products: Key players in skin aging?. Dermatoendocrinology. 2012;4(3):259–270. doi:10.4161/derm.22028 

Your Guide to Creating Your Own Meal Plan

Your Guide to Creating Your Own Meal Plan

Any good workout plan needs a good nutrition plan. Over the years, we’ve learned a lot from our registered dietitian, Debbie James. Today, we’re compiling pieces of her best advice to help you construct your perfect meal plan. 

How to Build Your Own Meal Plan 

Many of our readers want to know what they should be eating for weight loss, for healthy weight gain, for muscle gain, and more. To help simplify your search for the right answer, look no further than the article: How to Create a Meal Plan. 

Here, you will find Debbie’s step-by-step process to construct a nutrition plan that meets your desired calorie count and macronutrient content. Because you’re making it yourself, you can easily tailor your “menu” to include only the foods you will actually eat. Paired with examples of how to follow each step, and tips for success, this article is a great place to start building your nutrition plan. 

If, before getting started, you’d like some general information on carbs, fats, and proteins, you can read her post: Let’s Talk About the Basics. 

Healthy Meal Options and Sample Plans 

As you put together your meal plan, you’ll be looking for ideas. What are examples of healthy pairings? Should you go for protein or complex carbs? What are healthy substitutions for foods you’re trying to cut-out? Fortunately, Debbie has explored these types of questions as well. 

In her post on Healthy Suggestions for Breakfast, Lunch, and Snacks, Debbie offers a breakdown of potential meals that are about 750 calories each.  

Another post on Breakfast and Lunch Options on the Go offers some sample meals that come in at about 600 calories each. 

Depending on what your daily caloric needs are, you can add, remove, or swap items with healthy alternatives from the list you made in the first step of creating your meal plan. Keep in mind that sample meal plans are not meant to be repeated every day. The hope is that you will follow the structure but switch up your food choices so you can benefit from the nutritional content in your various food choices. 

Customizing Your Plan 

Vegan – For vegan meals, tasty options abound. Not only does Debbie talk about Vegan Breakfasts, she offers possible food combinations to give any meal more variety and provides readers with a list of the top vegan sources of protein. 

Vegetarian – What if your meal plan is leaning towards vegetarian? Here, Debbie lists some high protein and low carb vegetarian foods that you can work into your meal plan. You’ll also find her response to questions about How to Lose Weight on a Vegetarian Diet or How to Gain Healthy Weight on a Vegetarian Diet. 

Low-Carb – If you’re trying to go low carb, you might be interested in this piece on Cauliflower Substitutions, the most recent craze in terms of rice and dough alternatives. Or, perhaps you want to know about the Best Time of Day to Eat Starchy Carbs. Yup, there’s a piece on that too! 

Nutritious Snacks

Snacks are also on our radar when we’re structuring our food for the day. They keep us from getting too hungry before our next meal and can help keep us feeling full and energized throughout the day. What you choose to put on your snack list, however, is just as important as what goes into your meals. Debbie’s Super Snacking Guide offers a nice breakdown of what you should aim for when putting together your snacks. 

If you still need some more ideas or feel like your options are limited by your dietary restrictions, you may find her answer to this reader’s question helpful. It offers some insight into healthy substitutions for sugary and salty snacks. Other answers share which snacks will keep hunger at bay and which can help boost your energy. We haven’t forgotten about our readers with gluten sensitivities or intolerances. This list on Gluten-Free Snacks can help guide your decision-making as well.


If this all sounds like just a little too much to read, you can listen to Debbie’s advice in many of our podcasts. Some relevant topics you might enjoy include:  

How to Never Fail at a Diet Again 

How to Meal Prep the Right Way 

What You’ve Been Wanting to Know About Fad Diets (Paleo, Keto, and More) 

How to Read a Nutrition Label 

Do You Have a Nutrition Question?  

Your nutrition questions are always welcome and Debbie is ready to help! Simply email or submit your question online and it may be featured in an upcoming article! To access our monthly blog post highlights, subscribe to our newsletter, today! 

It’s an Acquired Taste – How to Love the Taste of Health Foods

It’s an Acquired Taste – How to Love the Taste of Health Foods

As children, we don’t have much choice in the foods we are provided and the habits we are taught to cultivate. This is why changing our diet is so difficult; you have to retrain your taste buds. Fortunately, this is completely doable, even if it’s a bit difficult.  

We’re taking things step-by-step to help you transition to a healthier style of eating. Read on for your complete guide on how to love the taste of health foods!

Your Step-by-Step Guide 


Decide on which changes you’d like to start with

Before you can build new habits, you need to look at your current eating patterns. Make a food log and, over the course of a week, write down everything you eat and when you eat it. If you like, color-code your information so you know which foods were meals, which were snacks, and maybe even which ones you ate when you knew you weren’t hungry.  


Pick out certain foods, maybe just one or two at first, and decide to replace them with a healthier alternative  

The reason we’re going through this step first is because we’re planning on introducing new foods. To avoid adding additional calories to your day, it’s probably a good idea to replace calories that you would have typically eaten anyway. 


Decide on the health foods you want to learn to love

There are a lot of options here and many of them are shunned for their acidic, bitter, pungent, or seemingly tasteless profiles. Examples include: Lemon, vinegar, kale, spinach, arugula, quinoa, plain yogurt, and fatty fish. 


Start chipping away at your aversion

Instead of forcing yourself through a plateful of kale, start training your taste buds to like the type of flavors in your chosen foods. For example, introduce more sour, bitter, and umami flavors into your diet. If you’re unfamiliar with umami, it’s the distinct taste you can find in foods like seaweed, miso, salmon, and hard cheeses like parmesan.1 

How to Like Sour Foods



Start adding sour foods that you do enjoy to your diet. 

If you want to eventually enjoy vinaigrette on your salad but you don’t like the acidity and sourness of it, regularly eating sour foods that you do like can build your tolerance for sour flavors. Here is a list of nutritious sour foods: 2,3  


  1. Grapefruit 
  2. Oranges 
  3. Kumquats 
  4. Kiwi 
  5. Strawberries 
  6. Green grapes 
  7. Green apples 
  8. Lemon 
  9. Lime 
  10. Tamarind 
  11. Kefir 
  12. Plain Yogurt 
  13. Tomatoes 
  14. Vinegar  

How to Like Bitter Foods


Following the same principle as before, start incorporating bitter flavors that you do enjoy. 

Here is a list of nutritious bitter foods.3,4 Choose one you’re comfortable with and slowly push the boundaries of what you’d normally eat until you arrive at a tolerance (and hopefully enjoyment) for the level of bitterness you want to achieve. 

  1. Arugula 
  2. Broccoli 
  3. Cauliflower 
  4. Cabbage 
  5. Watercress 
  6. Bok choy 
  7. Bitter Melon 
  8. Brussels sprouts 
  9. Kale 
  10. Radishes 
  11. Dandelion greens 
  12. Citrus Peel 
  13. Green Tea 
  14. Dark chocolate 

How to Like Umami Foods


 Start Incorporating umami flavors 

The umami flavor comes from a compound extracted from dry kelp.3 It is this flavor, and others like it, that have the savory taste you’ll find in many Oriental dishes. Here is a list of nutritious umami foods5 that you can add to your diet. 


  1. Seaweed 
  2. Soybeans 
  3. Tofu 
  4. Miso 
  5. Parmigiano Reggiano 
  6. Cheddar 
  7. Gouda 
  8. Kimchi 
  9. Sardines 
  10. Tuna 
  11. Yellowtail 
  12. Cod 
  13. Shrimp 
  14. Scallops 
  15. Anchovies 
  16. Mushrooms 

Don’t Cut it Out, Change the Recipe

Another tactic is to learn to make your favorite dishes in ways that are healthier. Slowly substitute an ingredient or two, each time you make it, until you’ve crafted a healthier version of the same recipe! Here are some substitutions, straight from the Mayo Clinic, for commonly used recipe ingredients. For the full list, visit their post on Healthy recipes: A guide to ingredient substitutions. 


Original Ingredient 



Rolled Oats/Crushed Bran Cereal 


Applesauce/Prune Puree 

White Rice 

Brown Rice/Bulgur/Pearl Barley/Wild Rice 

Whole Milk 

Reduced Fat Milk/Fat Free Milk 

Ground Beef 

Lean Ground Beef/Ground Chicken/Ground Turkey 


Food is Fuel

Ultimately, you have to change your mind-set before you can change your taste buds. Food is what fuels your body. The more nutritious that fuel is, the better your body will feel and the more easily it can process what you put in. Gradually learning to enjoy flavors found in health foods is the key. So, take it slow, and work your way to a more nutritious lifestyle. 

For help creating a meal plan, read our registered dietitian’s post on How to Create a Meal Plan. If you need help catering to picky kids and teens, read her post on How to Get Your Kids to Eat Right. To access our monthly blog post highlights, subscribe to our newsletter today! 


  1. MasterClass. “What Is Umami? Learn About Umami and How to Incorporate Umami Flavors in Your Cooking – 2019.” MasterClass, MasterClass, 2 July 2019, 
  2. Reino, Nicole. “11 Sour Foods That Boost Endurance and Power.”,, 27 Oct. 2016, 
  3. Roper, Stephen D. “Signal Transduction and Information Processing in Mammalian Taste Buds.” SpringerLink, Springer-Verlag, 28 Apr. 2007, 
  4. Julson, Erica. “9 Bitter Foods That Are Good for You.” Healthline, 3 Sept. 2018, 
  5. Raman, Ryan. “16 Healthy Foods Packed with Umami Flavor.” Healthline, 21 Jan. 2019, 
  6. Mayo Clinic Staff. “Your Guide to Healthy Ingredient Substitutions.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Oct. 2019, 

Should You Exercise on an Empty Stomach?

Should You Exercise on an Empty Stomach?

The Truth About Fasting and Exercise

Evidence Based 

There are a lot of reasons a person would consider exercising on an empty stomach. Many people simply like to exercise first thing in the morning. Then we have trending diet plans like Intermittent Fasting that make it difficult to schedule exercise around food consumption. Others incorporate fasting into their lifestyle for faith-based reasons. All the while, our exercise routines continue according to or despite our nutritional timing.  

So, what happens when you exercise on an empty stomach? Is it good or bad for weight loss? Does it help you burn more fat or does fasting negatively impact your workout? 

Let’s tackle these questions one by one. Here’s what you need to know if you’re considering working out while fasting: 

What Happens to Your Body When You Fast? 

When we say “fasting” we typically mean you’ve gone 8 to 12 hours without food. This would be like waking up in the morning after a good night’s sleep and deciding to work out before you have your first meal. If you participate in Intermittent or Prolonged Fasting, you may be going without (or with very little) food for 12, 16, 48, or even 72 hours.1 Here’s what’s happening in your body when you fast: 

By 6-8 Hours –  Your body is still  burning through its glycogen supply. This is the most readily available form of energy. 

By 12 Hours – You enter the metabolic state called ketosis in which your body begins to break down fat.1  

By 18 Hours – You’re now in “fat-burning mode.” Your body is generating more ketones which tell your body to reduce inflammation and to make repairs to damaged DNA.1  

By 24 Hours – Your body starts a process called autophagy. This means your cells work harder to recycle old components and to break down misfolded (damaged) proteins. Misfolded proteins are connected to Alzheimer’s and other diseases.1 

If you’re interested in learning what happens once you hit 48, 54, and 72 hours of fasting, check out this article on the 5 Stages of Intermittent Fasting. For the purpose of this article, we don’t need to delve that far. 

What Happens if You Exercise While Fasting? 


Now that we know what’s happening on a biological level while fasting, let’s take a look at what happens when exercise is added to the equation.  

As you exercise, your body starts by using glycogen for energy. You typically have enough stored up to last you about 24 hours.3 If you manage to deplete your glycogen stores (say you’re an endurance athlete running a triathlon and you haven’t been replenishing your energy as you go), you’ll hit exhaustion. Your body still has plenty of energy stored as fat, why doesn’t it use it when glycogen levels are low? 

The body is not adapted to this. However, it can be trained! Following a low-carb diet or exercising while fasting can teach your body to draw energy from your fat-stores.3 Before this all starts to sound too good to be true, let’s define what we mean by “drawing energy from your fat-stores.”   

A terrific example by Dr. Jason Fung in his article on Fasting and Exercise, starts to illustrate this concept pretty well: Imagine that your glycogen supply is like energy stored in the refrigerator. It is ready to use but the supply is limited. Your fat is like energy stored in the freezer; it takes a greater process to make it usable but you can store a larger supply.  

Over time, exercising while fasting increases the production of fat-metabolizing proteins.3 Our muscles essentially become more efficient at breaking down fat in order to use the energy. It’s all part of how the body adapts to its circumstances.

What Other Studies Say


So, what does other research have to say about this? An article from the Strength and Conditioning Journal reviewed the results of multiple studies on the subject.  

The review found that endurance trained individuals who performed moderate to high-intensity cardio (while fasting) break down significantly more fat than the body can actually use.4 So, yes, the body does break down that fat, but what isn’t immediately used goes back to its original form.4 The ultimate conclusion was that the net effect of exercising while fasting was negligible and may even have negative effects on muscle strength and growth.4 

Another study examined body composition changes between a group that fasted before exercise and a group that did not. Their findings showed no difference between the two groups! They both lost significant amounts of weight and fat mass but fasting seemed to have no implication on the results.5 

So, the evidence seems to lean in two directions. The body is clearly responding to the need for energy but there are split conclusions on whether this response is beneficial. Until more research is done, fasting before exercise may come down to a matter of preference. If you’re still seeking some answers and still interested in giving it a try for yourself, let’s find out a little bit more. 

Will Fasting Before Exercise Cause You to Eat More? 


A study on exercising in the fasted state hypothesized that exercising on an empty stomach would increase calorie intake throughout the day. They were surprised to find that not only did their participants eat less, they were also more motivated to work out.6 These results are promising if you’re worried about your hunger causing you to overeat on days you both fast and exercise.  

Does Fasting Decrease Your Ability to Effectively Work Out? 


Well, it depends what you’re doing. If you’re working out on an empty stomach, keep in mind that your body has been running on its glycogen stores while you fasted. It will pull from those same stores when you exercise, at least until you run out. If you’re doing steady cardio, you’re likely to be just fine.

High-intensity exercises, however, rely on glucose for muscle contraction.7 If your energy stores are low because you’ve been fasting, your body might break down your lean muscle to get you through your workout.7 If you recall, this was the same concern that came up in the article from the Strength and Conditioning Journal. 

Closing Thoughts 

Clearly, this subject merits further research before any definitive conclusions can be drawn. Evidence can be found to back both sides of the argument. Some athletes swear by it, and there is science to prove that something is in fact happening to release and utilize your fat stores, but is it all enough to make a difference and are there significant adverse effects?  

With the research at your fingertips, it remains up to you to decide whether you want to fast or feast before your workout. Which do you prefer? Let us know in the comments below! 

For more thought provoking posts, check out What Happens to Your Body When You Stop Working Out, or, read this post to debunk some big Muscle Building and Fat Burning Myths. To access our monthly blog post highlights, subscribe to our newsletter, today! 


  1. Jarreau, Paige. “The 5 Stages of Intermittent Fasting – LIFE Apps: LIVE and LEARN.” LIFE Apps | LIVE and LEARN, 22 May 2019, 
  2. “4 BIG Health Benefits of 12 Hour Intermittent Fasting.” Clean Cuisine, 5 Dec. 2019, 
  3. Fung, Jason. “Fasting and Exercise.” Diet Doctor, 14 Sept. 2018, 
  4. Schoenfeld, Brad. “Does Cardio After an Overnight Fast Maximize Fat Loss? : Strength & Conditioning Journal.” LWW, Strength and Conditioning Journal, 2011, 
  5. Schoenfeld, Brad Jon, et al. “Body Composition Changes Associated with Fasted versus Non-Fasted Aerobic Exercise.” Journal of the International Society of Sports Nutrition, BioMed Central, 18 Nov. 2014, 
  6. Bachman, Jessica L, et al. “Exercising in the Fasted State Reduced 24-Hour Energy Intake in Active Male Adults.” Journal of Nutrition and Metabolism, Hindawi Publishing Corporation, 2016,
  7. Niedziocha, Laura. “What Happens If I Workout Without Eating?” LIVESTRONG.COM, Leaf Group, 24 Mar. 2019, 



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