Every diet has a moment when it stops being a way of eating and becomes an identity. Keto experienced that moment spectacularly. Bread became the enemy, butter was rehabilitated, and ketone test strips moved into the bathrooms of people who had not known what a ketone was a few years earlier.
The ketogenic diet did not originate on Instagram. It has been used for roughly a century in the treatment of certain forms of epilepsy — particularly in children for whom medication provides insufficient control. In that context its efficacy is not a wellness theory but part of clinical medicine.
The underlying idea is relatively straightforward. When carbohydrate intake is sharply reduced, available glucose levels and glycogen stores fall, insulin decreases, and the body relies more heavily on fat oxidation. The liver produces ketone bodies — primarily beta-hydroxybutyrate and acetoacetate — which can become a major energy source, including for the brain.
This state is called nutritional ketosis.
It is not the same as diabetic ketoacidosis, a dangerous medical condition that most commonly occurs in severe insulin deficiency. The similarity in terminology has created considerable confusion, but physiologically and clinically these are very different situations.
In practice, the keto diet typically means very low carbohydrate intake, moderate protein, and a large proportion of energy from fat. Exact limits vary, but 20–50 grams of carbohydrates per day is a common target in popular versions. That is low enough that bread, pasta, most grains, many legumes, much of the fruit spectrum, and a large number of everyday dishes suddenly become a logistical problem.
So why do people lose weight?
Because keto can be a highly effective way for some people to eat less energy overall. Protein and fat can contribute to satiety, the available food choices become more restricted, and eliminating entire categories removes a large quantity of easily accessible calories. In the early stages, water bound to glycogen is also lost, which can cause the scale to drop quickly.
Meta-analyses show that low-carbohydrate and very-low-carbohydrate approaches can produce weight loss and improvements in certain metabolic markers, particularly in the short term. In people with type 2 diabetes, carbohydrate restriction can improve glycaemic control and in some cases reduce the need for medication — though therapy must then be adjusted under medical supervision.
The problem arises when we move from can work to works because carbohydrates are bad.
For long-term weight loss, what ultimately matters is that energy intake remains below expenditure. Different dietary patterns can arrive at that outcome in different ways. When calories and protein are controlled, the advantage of one particular ratio of carbohydrates to fat often becomes far smaller than internet debates suggest.
Keto is also not a single diet in terms of quality. It can be built around olive oil, avocado, nuts, seeds, fish, eggs, and plenty of low-starch vegetables. It can equally be built around butter, processed meat, and cheese. Both can produce ketones. That does not mean they have the same effect on health.
In some people, LDL cholesterol can rise significantly on a ketogenic diet, particularly when saturated fat intake is high. Fibre can become a problem if the exclusion of grains, legumes, and fruit is not offset by careful selection of vegetables, seeds, and nuts. Restrictiveness is also not a trivial issue: a diet that is metabolically manageable is not necessarily a diet one wishes to live with.
That is the part frequently lost in discussions of optimal eating.
A person does not consume macronutrients in a laboratory. They eat with family, in restaurants, while travelling, after a difficult day, and at a birthday party. If a way of eating requires every such moment to become a negotiation with carbohydrates, the cost is not only nutritional.
For some people that cost is worth it. Keto reduces their appetite, simplifies food choices, and helps them manage their weight or glycaemia. For others it is an entirely unnecessary complication.
At VERA, we will not declare bread an enemy simply because keto exists. Carbohydrates can come from oats, vegetables, fruit, legumes, and quality bread — together with fibre, vitamins, and an entire culture of food that there is little sense in discarding without reason.
Keto is a tool.
A very useful medical tool in certain situations. A potentially effective approach for weight loss or glycaemic control in some people. And very poor evidence that a banana was a civilisational mistake.
Try it at VERA — specialty café and wellness bistro, Nikole Spasića 4, Stari Grad, Belgrade.
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