The keto diet – what you need to know

Recently, the ketogenic diet (keto for short) has been in the spotlight as the new diet to try. With that dietitian, Retha Harmse, educates us on the ‘latest craze’ diet.

The keto diet is everywhere; it’s difficult to avoid seeing it on influencers’ Instagram stories; keto options in supermarkets and on restaurant menus; and even friends or relatives speaking about their wonderful results. But, let’s take a closer look at the ketogenic diet.

What it the keto diet?

The ketogenic diet is a high fat, low carbohydrate and low to moderate protein diet that changes the body’s metabolism into ketosis. Any diet where fat is metabolised instead of carbohydrate is essentially a ketogenic diet.

Understanding ketosis

During a ‘normal’ or well-balanced diet, the body’s main source of energy is carbohydrates. More specifically, glucose which is the end-product of carbohydrate metabolism/digestion.

But the body is also able to burn fat for energy, and this is utilised in the form of ketones. Ketones are molecules produced by our liver when fat is metabolised; this metabolic switch is called ketosis.

However, the body doesn’t go into ketosis if there is enough carbohydrates available. Consequently, carbohydrates need to be drastically reduced or eliminated to move towards ketones as the primary energy source.

What does it involve?

Generally, on the ketogenic diet, the macronutrient ratio varies within the following ranges:

  • 65 – 80% of calories from fat.
    • Fat-intake is often over 150 grams (double the usual intake of fat).
  • 20 – 25% of calories from protein.
  • 5 – 10% of calories from net carbohydrate.
    • Roughly 20 – 50 grams a day (compared to the recommended daily amount of 200 – 300 grams per day).

What does this mean in non-dietitian language?

The keto diet prescribes high amounts of fat (both animal and plant sources), low-carbohydrate vegetables, nuts, seeds, and modest protein in the form of meat, fish and eggs. It excludes grains, dairy, legumes, soy, most fruits and starchy vegetables.

Meticulous planning

Ketogenic diets require meticulous planning to ensure the liver continues producing a constant supply of ketones to supply the body with energy.

To maintain ketosis, an individual’s diet needs to be precisely planned and tracked daily, as limiting carbohydrates and increasing fat is not the only focus of the ketogenic diet.

It’s also imperative not to consume protein in excess, as proteins can also be broken down to glucose (through a process called gluconeogenesis). This will in turn inhibit the ability for the body to move into ketosis. Also, if carbohydrates are not restricted enough, it might result in ketonuria (ketones in the urine and not used as energy). This is detectable by urinary dipstick analysis.

The history of keto diets

Although ketogenic diets might seem like the new ‘craze’; they are nothing new. Ketogenic diets have been around from the early 1900s, when they were discovered to have an efficacy in the treatment and management of epilepsy in children.

It is still used for this purpose; although more recently these diets have gained popularity for the management of obesity and Type 2 diabetes.

However, it’s important to note that the macronutrient ratios and recommendations for the ketogenic diet in the management of paediatric epilepsy are substantially different than those advocated for the management of obesity and Type 2 diabetes.

What are the benefits?

In terms of weight loss, evidence suggests quicker initial weight loss. This might be due to the initial use of glycogen stores (glucose stored in the muscle and liver), or reduced energy intake due to increased satiety from eating a large amount of fat and protein.

But long-term differences in weight lost showed no significant difference in comparison to other diets.

As mentioned previously, ketogenic diets have been used for decades to treat epilepsy. But, more recently, research has suggested that they might have a role in treating Type 2 diabetes and inflammatory conditions, such as chronic pain. That been said, there isn’t sufficient evidence just yet to support ketogenic diets for these conditions in terms of its long-term safety and efficacy.

Lastly, research has found that people consuming fewer calories from carbohydrate tend to eat fewer foods high in added sugars, such as soft drinks, doughnuts, etc. Yet, other research has found that the more carbohydrate consumption is restricted, the greater risk there is for poor nutrient intake. 

Potential side effects

  • High fat diets, especially when it’s high in saturated fat, increases total cholesterol. More specifically LDL cholesterol which is the “bad” cholesterol.
    • Both total and LDL cholesterol are both biomarkers for poor cardiovascular health.
  • Reduced energy and decrease in performance in activities that use short bursts of power, because ketogenic diets depletes the energy stores in your muscles (glycogen as mentioned previously).
  • Fatigue, general weakness, headaches and sluggishness, or brain fog.
  • Due to the very low fibre intake of ketogenic diets, you may experience constipation, increased risk of digestive problems and microbiota imbalances.
  • Limited fruit, vegetables and grains consumption – thereby limiting nutrient intake that might lead to deficiencies.
    • Nutrients (lack of) of particular concern on the ketogenic diet are calcium, vitamin D, selenium, magnesium, zinc and phosphorus.
  • Increased oxidation and inflammation in the body.
    • Recent evidence has shown that high fat diets, especially saturated fat, may promote inflammation and lead to the progression of inflammatory diseases, such as Alzheimer’s disease.
  • Possible loss of lean muscle mass.
  • Dry mouth, frequent urination, halitosis (bad breath = acidic, fruity odour).

Take-home message

Currently, there is a lack of strong evidence for ketogenic diets, based on their health claims about longevity, gut microbiome and heart health. Diets that are higher in carbohydrates and lower in protein, in fact, have the strongest links to longer lives and happy guts.

There are various probable side effects when following a ketogenic diet, which is why there is a need for ongoing monitoring and consistent assessment by a qualified dietitian.

Overall, unless medically indicated, I do not recommend following a ketogenic diet. Considering fat and carbohydrates, it’s all about balance.

  • The types of fat you include and the quantities you consume does matter.
  • Carbohydrates does form part of a healthy balanced diet.

My tactic is always to look at sustainable changes you can make that doesn’t include elimination of entire food groups.

Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.


Retha Harmse (née Booyens) is a registered dietitian and the ADSA public relations portfolio holder. She has a passion for informing and equipping the field of nutrition. She is currently in private practice in Saxonwold, Houghton, and believes that everyone deserves happiness and health. To achieve this, she gives practical and individual-specific advice, guidelines and diets.

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Getting to know me

Noy Pullen shares the positive revelations she encountered when she started the journey of ‘getting to know me’.

“Getting to know you
Getting to know all about you
Getting to like you
Getting to hope you like me”

The King and I by Rodgers and Hammerstein

My father had high cholesterol and high blood pressure. My older brother and sister use blood pressure tablets and statins. In our Agents for Change courses, we always invite the participants (all of whom work in the health sectors in the rural regions of SA) to go for regular check-ups.

As someone who should be walking the talk, I decided, a year ago, to go for the various basic health tests: blood glucose, blood pressure, cholesterol and body mass index (BMI). It has been a good journey of getting to know me a lot better, as well as a scary journey where decisions that need commitment and courage were made. I have gotten to know my body and I think it has gotten to like me.

Writing on the wall

Every year medical aids send out SMSes to their members to have their readings checked. So, I went to the local pharmacy clinic for the first time in years. I had to cross the threshold of fear, to pluck up the courage to go. I hate needles. My heart beat faster as I sat on the clinic chair.

The Sister was kind, yet professional, guiding me through the various finger pricks, weighing and measuring techniques. The results were all available in a matter of five minutes. I was in for a shock and had to face some uncomfortable moments. My blood glucose was within the ‘green’ of the medical aid constraints. My BMI was just in the orange and my blood pressure and cholesterol were high.

I went to check my blood pressure later that morning at another clinic. It had come down by 10 points on both systolic and diastolic beats. The first lesson I learnt, was to not to chop and change facilities and for future checks I would stick to one facility.

Patient choice

The advice I got was to take medication to reduce the readings. This seems to be the easiest way. But I remembered that my brother developed a chronic cough after going on to his blood pressure tablets. I also knew the side effects of statins; there has been controversy about them. I considered these facts. This was not the route I wanted to take, even though these medications have added many health benefits to patients. What were my other options? Pamphlets were pressed into my hand by the Sister. My medical aid sent an email and an SMS with a large red alert warning which made my blood pressure rise; I could feel it!

Starting point – trusting my own attitude to life

I have spent my whole life trusting in a natural way of living. Natural childbirth, natural remedies, herbal teas and using doctors’ prescriptions only when the natural method was not serving me. So, I used this as my point of departure. I also knew that my thoughts, the way I feel, and how I do things affect my well-being. I had three paths to walk down at the same time.

A description of my prescription

  1. Thoughts

Can I change my mind-set? One of the pamphlets the Sister gave me spoke about ‘waking up softly’. Not to hit the ground running as I was used to doing. I’ve never been a ‘quiet time’ morning person, but as it would have no bad side effects and it’s free, I decided to look in to it.

If one were so inclined, one could choose a prayer or aphorism (an observation which contains a general truth), or to simply write a few pages about how one was feeling. In Julia Cameron’s excellent book, The Artist’s Way, she writes about this morning discipline which has changed many people’s lives for the better. She says, “The bedrock tool of a creative recovery is a daily practice called Morning Pages. Morning Pages are three pages of handwriting, done first thing in the morning. They are about anything and everything that crosses your mind – and they are for your eyes only. Morning Pages provoke, clarify, comfort, cajole, prioritise and synchronise the day at hand.”1

As I have done this in the past, I decided to try something new and chose a special verse that strengthens me. I say it aloud every morning and then spend a few moments thinking of who I would meet that day, as well as my loved ones.

In the evening, I go through the day backwards, looking for a miracle in the day. For example, an event which delayed me, possibly saving me from an accident, or helping me meet someone I otherwise would not have met, or a surprise telephone call that changed the course of my day. For those who battle to get to sleep, this practice is an excellent sleeping agent. One can hardly finish it before one has fallen asleep.

  1. Feelings

Can I control my anger, pain or fear that sets my heart pounding? I decided to do some observations to find out what the warning signs are of these feelings.

As soon as I felt the tell-tale symptoms, I pictured myself at a crossroad and asked (if I caught it in time): do I want to go down the same old road of rage and frustration or can I do something different?

Two techniques emerged from this: I have chosen to change the way I speak about difficult issues, and to breathe before reacting. I realised that I can calm myself down if I get there in time.

In Byron Katie’s book, Loving what is, she offers a technique called ‘The Work’. This consists of four questions that, when applied to a specific problem, enables you to see what is troubling you in an entirely different light.

  1. Is it true? 
  2. Can I absolutely know it’s true in this moment now? (If the answer is a definite yes then move onto another question/belief you have).
  3. How do I react when I believe this thought?
  4. Who would I be without this thought? 

“Contrary to popular belief, trying to let go of a painful thought never works; instead, once we have done The Work, the thought lets go of us.”At that point, we can truly love what is, just as it is. I do this technique any time anywhere in less than two minutes, even on a napkin in a coffee shop.

  1. My physical body

Loving nature

Every morning, for 20 minutes, I practise eurythmy (an art-form of movement and imagination initiated by Rudolf Steiner). It’s gentle, enlivening and brings a positive attitude. When we do this in the Agents for Change courses, the participants become joyful and express their appreciation for its effects.

Nature can bring joy and serenity. So, I’ve prescribed a half an hour walk every day. I walk along Zandvlei’s embankment, amused by the dogs playing with their owners. Conversations happen. Suddenly I am more connected with my neighbours. And I have lost two centimetres around my waist. I notice how valuable this is for my mood as well as the body.

Staying with nature I have spent this year living closer to nature’s rhythms. My logic is that it could change my blood pressure. Call me crazy but my readings have come down substantially.

I go to bed earlier and wake earlier to enable me to have quiet time. I also increased my sleep time by one hour and my partner reads an extract of a story each night aloud. We do not use any screens after 9pm.

A surprising discovery is the joy of growing plants. Recently, I collected some potatoes from my kitchen that had started sprouting and I planted them in my garden. I sowed some bean and chilies seeds into pots. Watching them come up is a mood-lifter and connects me to nature in a very immediate way. It’s good physical activity – bending and stretching – in a meaningful way. And, I get to eat them!

Herbal supplements

For the past year, I chose to take daily herbal supplements which help lower the effects of high blood pressure and stress levels.

I cut my meat consumption by half and increased my oily fish consumption. Every day I eat a handful of tree nuts to supplement this. I added a daily herbal remedy to lower cholesterol. The cholesterol pamphlet suggested a daily dose of omega oil in various forms which I started taking. Raw salads with fruit nuts and some cheese have become my regular choice for lunch.

I drink at least four large glasses of pure water with infused lemon and cucumber slices, or mint. I have a glass dispenser with a tap and every time I pass it I’m reminded of this delicious refreshing drink.


  • Blood pressure is 130/70; a vast change (one of the readings in the past year was 160/101).
  • Blood glucose remains in the 5,5 range.
  • BMI has decreased by 1 point due to losing  2cm around my waist and the scale tells me I am 2kg lighter.
  • Cholesterol is down from 7,4 to 6,3. It’s still in the orange.

The only disappointment I had was that my medical aid sent a red alert message via SMS and email after the huge effort of my experiment, with absolutely no encouragement or reference to the improvement, and although there is not one measurement in the red range on their scale.

Be that as it may, the important thing is that I feel empowered and have managed to change every aspect of my health, and I thoroughly enjoy these new habits I have prescribed. By using salutogenesis (origins of health) as a model for my health rather than pathogenesis (origins of disease), I’m getting to know me, getting to like me, loving my new life, and focusing on factors that support and increase well-being rather than on factors that merely prevent disease.3

The power of this way of working is that: you find out what makes you joyful, and you think about how you got into this state, and how you may overcome these aspects that aren’t having a positive effect. The results take time and a change of attitude to life. You free yourself and your health practitioner as you take responsibility for your own health. It is worth a try and is fun, this, ‘getting to know me’.

Keeping a regular check on my readings will enable me to monitor how effective my own method of maintaining my health is and when intervention is needed.




Please contact Noy Pullen if you would like more information: [email protected] or 072 258 7132.



Screen for life – know your score

We hear why diabetic retinopathy screening, Screen for life, is so important for diabetes patients.

Modern technological advances have made it possible to detect the earliest signs of diabetic disease by taking a photograph of the retina at the back of the eye. A new appreciation of the importance of the detection of any retinopathy has changed the way doctors are managing the disease.

The detection of retinopathy, done by human and artificial intelligence graders, informs the risk of future disease, including blindness. This makes it imperative for people living with diabetes to know their retinopathy score while there is still time to change it by looking after themselves better.

#Redflag communication system

The Ophthalmology Society of South Africa (OSSA) has developed the Screen for life programme to help communicate these important messages, using three red warning flags. The #Redflag communication system is communicated using the patient held record:

  • Screen for life, #Flag 1: Detection of any retinopathy determines the person to be retinopathy positive. This increases the risk of future complications, especially heart attack. The primary care giver needs to be informed of this.
  • Screen for sight, #Flag 2: Detection of sight-threatening retinopathy, glaucoma, and age-related macular degeneration. Referral to an ophthalmologist is indicated for this.
  • Screen for progression, #Flag 3: Progression of retinopathy disease means that the steps to control the disease are not working and more help is needed to prevent severe disease. This will require more urgent intervention by the primary care giver and may require referral to a diabetologist.

All people living with diabetes should be screened to determine whether retinopathy is present. If no retinopathy is detected, the person is advised to be screened in one year’s time. Diabetic patients are encouraged to keep looking after themselves well to stay retinopathy negative. When retinopathy is present, review is advised based on the severity of disease detected. This may be yearly, six-monthly or three-monthly. Once retinopathy is more severe, referral to an ophthalmologist is indicated.


Stephen Cook is an ophthalmologist and works at the Eye Centre which strives to provide a comprehensive eye service to people in the region. He is also a part-time consultant at the Frere Hospital and supports the registrar training programme for Walter Sisulu University. His special interests lie in making medical services more accessible and communication regarding conditions more understandable. He has developed the Screen for life diabetic retinopathy screening programme on behalf of the ophthalmology society (OSSA).

The Screen For Life programme helps communicate these important messages, using three red warning flags.

All you need to know about Suganon Stevia and Suganon Xylitol


You wouldn’t eat 22 packs of sugar. So, why are you drinking them?

Why is it advisable to use high amounts of added sugar, and foods and drinks high in added sugar sparingly?

  • A higher than recommended daily consumption of added sugar has shown to contribute to an increased energy intake that can cause weight gain.
  • Weight gain puts us at risk for diabetes, heart disease and certain cancers.

Suganon offers healthy alternatives to help you living a healthier life with the Suganon Stevia and Suganon Xylitol offerings;

Stevia is a zero-calorie, plant-base sweetener of natural origin. Stevia has been used for hundreds of years and is well known as a source of natural sweeteners derived from extracts of the Stevia leaf.

The health benefits of using Suganon Stevia:

  • Suganon Stevia is a great option to use in recipes, offering its touch of sweetness & adaptability in baking & cooking.
  • Create great tasting food & beverage products with fewer kilojoules with Suganon Stevia.
  • Stevia itself contains no carbohydrates, so it does not affect blood sugar or insulin levels, hence approved and endorsed by Diabetes South Africa and Glycaemic Index Foundation of South Africa as an often food.

Xylitol occur naturally in most plant material, including many fruit & vegetables. Xylitol is widely used as a sugar substitute for people with diabetes.

The benefits of using xylitol are:

  • The use of xylitol-containing products can significantly reduce the rate of cavity formation in both adults & children
  • Xylitol tastes sweet, but, unlike sugar, it is not converted in the mouth to acids that cause tooth decay.
  • It also reduces levels of decay-causing bacteria in saliva and also acts against some bacteria that cause ear infection.

*Dog owner should know that Xylitol is toxic to dogs.

The Suganon natural sweetener range consists of: 

Suganon Xylitol 30’s

4g sachets | Predominately used in sweetening of hot beverages.

Suganon Xylitol 500g

Targeted for household usage | Used in baking or cooking.

Suganon Stevia 30’s

3g sachets | Predominately used in sweetening of hot beverages | 95% less kilojoules then sugar | Suganon Stevia is sourced from the global leader in the product of Stevia.

Extra Tip!! Reducing your fizzy drink intake can slash your daily sugar intake by 50%. Still craving something a little sweet, add fresh fruit to your water for a delicious and healthy alternative.