EVANSVILLE, Ind. — Good morning, the Fat Foodie here, with the second installment of my Keto diet progress, five months in.

So far, so good. I’m 35 pounds down, and greatly enjoying my tasty meals. Sure, I miss pasta and bread, but I’ve come across some excellent low-carb products such as black soybeans which have opened up new recipe possibilities. I purchase baby spinach in the restaurant-sized bags at Sam’s. I once again enjoy walking six or seven miles on the Greenway or USI-Burdette trail. I bought a pair of pants in a size with a number 1 in the front.

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There continue to be hurdles. If I’m not very careful, I consume too much meat and too little water. I need to trade in the Hidden Valley for homemade ranch with no additives but haven't quite managed it yet.

There has been a time or two when I’ve lost resolve and eaten badly — our recent hot and sour soup tasting at the Courier building brought on a feeding frenzy including fried wheat noodles, crab Rangoon and General Tso’s Chicken, which resulted in a belly ache for the day and stalled weight loss for the week, maybe the month. Ketosis is sensitive like that, but back at it, I say.

As I’ve gone down this path, I’ve come across a remarkable number of others who are also finding success with the Keto diet after struggling for a lifetime with obesity. And also many who consider it a fad diet at best and unhealthy at worst.

In the interest of science and to respond to concerns, I approached a number of doctors and dietitians to find their opinion of Keto. I found that, in general, medical professionals are not willing to outright endorse a ketogenic diet because long-term studies of it as a weight loss tool have not been completed.

Some give it little to no consideration, but some are taking the view that if Keto is resulting in desperately-needed weight loss, then it is a net positive in the short term —assuming the patient is taking care to consume vegetables and fiber, minerals and vitamins necessary for overall health. After significant weight loss is achieved, they tend to feel a broader diet including some healthy carbohydrates should be re-introduced.

I found a kind endocrinologist, Dr. Vishal Bhatia with St. Vincent Medical Center, who was willing to answer my questions and explain, in detail, how a ketogenic diet works with your body. Below are his answers. I had to organize and edit for length. If anyone would like a full copy of his answers, email me at

Must you reduce your caloric intake on Keto to lose weight?

Bhatia: Keto diets may or may not cause weight loss, depending on the number of calories consumed as compared to the number of calories needed by your body. At the molecular level, body cells can utilize glucose, fatty acids, amino acids and ketones for making energy. After about 8-10 days of being on a low or zero carbohydrate diet, your body starts to run low on glucose. A normal blood glucose level is maintained because glucose is generated from proteins and fats, but the level of ketones starts to rise as an alternate source of energy. By week two or three, the ketones are generated from stored fat. If you eat more calories than you need on a Keto diet, then weight loss will not be substantial. You can also gain weight on a Keto diet if caloric intake exceeds caloric needs. Even without weight loss, a Keto diet will reduce blood sugar.

Keto affects insulin. How do hormones such as insulin affect fat storage and metabolism?

Bhatia: The metabolic rate for different people might be different, but lifestyle has a bigger role to play. Growth in fat tissue starts occurring right after birth. We all admire chubby children, but if their weight to height ratio is on the higher side it is cause for concern.

Pure hormone-induced obesity is rare. The hormones involved in metabolism are numerous and their actions subtle, e.g, thyroid hormones, cortisol, insulin, leptin and ghrelin to name a few. We do not routinely measure the levels of all these hormones but go by other markers of overall health, including waist circumference, blood pressure, blood sugar and blood cholesterol levels.


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How does a low carbohydrate, high-fat diet affect the production of insulin and how does this affect how fat is stored?

Bhatia: Fatty acids, which are produced by body fat, make the body resistant to insulin. To compensate for that effect, the body starts making more insulin. So, in obesity-related diabetes, body insulin levels are actually higher because more insulin is needed due to fatty acid-induced insulin resistance. High levels of insulin are not the cause of obesity, they are the effect of obesity. I repeat, high insulin is not the cause of obesity but the effect.

Fat comes first, then comes the high insulin levels. As the fatty acid level goes down due to reduction in body fat, your body becomes more sensitive to insulin. So, your insulin level goes down. If a diabetic is on insulin, they will require less insulin if they achieve weight loss through the Keto diet. Also, as they are eating less carbs, they will require less insulin to cover the carbs.

Most Keto dieters report a quick reduction in appetite. How do appetite hormones ghrelin and leptin figure in?

Bhatia: The key word is satiety. Several factors affect satiety — the acts of chewing, swallowing, stomach distension and the protein, fat and sugar content of food. A high-fat diet will have an effect in curbing appetite. It gives you more satiety and that is where the role of ghrelin and leptin is — generation of satiety. Also, fatty foods pass through the stomach slowly so you have a physical feeling of staying full longer. Proteins also maintain satiety longer vs. carbs.

What ripple effects throughout the endocrine system could this type of diet have, positive or negative?

Bhatia: I do not have data on lifetime Keto dieters. The metabolic benefits of Keto diet are certainly related to weight loss, which leads to reduction in other parameters — including blood pressure, blood sugar and you can say insulin levels and improvement in insulin resistance.

As humans have evolved around grains, if we deprive ourselves of healthy carbs we will also be depriving ourselves of natural fiber and essential minerals which only grains can provide. After significant weight loss has been achieved, carbs should be reintroduced keeping in mind that the caloric intake needs to be the same.

So, in my opinion, the Keto diet is good to get a kick start on weight loss and can be pursued for about six months at the most, and after that diet needs to be wholesome and inclusive of healthy carbs. Refined sugar, most commonly found in desserts and sweets treats and sweet drinks, needs to be strictly avoided.


Fathead Dough

2 oz cream cheese

3/4 cup shredded mozzarella

1 egg beaten

1/4 tsp garlic powder

1/3 cup almond flour

1 1/2 teaspoons baking powder


  1. Heat oven to 400. In a microwave, soften the cream cheese and mozzarella. Blend with fork, heating again if necessary to get a smooth paste. 
  2. In a separate bowl, mix the garlic powder, almond flour and baking powder. Work into the cheese mixture, mixing well. Mixture will be sticky until it starts to cool. Refrigerate 15 minutes or until dough is workable. 
  3. Form into two rounds. Place on parchment lined sheet pan and bake 10 - 15 minutes or until puffed and golden. Cool before slicing. 

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