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May 8, 2019
Keto After 60: A Doctor’s Advice for Losing Weight With the Keto Diet

Keto After 60: A Doctor’s Advice for Losing Weight With the Keto Diet

If you’re over 60 and are trying to lose weight, you may have heard of the ketogenic diet, or keto diet for short.

Over the last couple years, the keto diet has soared in popularity and is now one of the most talked-about diet trends. Netflix even released a documentary about it called The Magic Pill (2017).

Reviewers of the diet seem to be split down the middle. Proponents of the keto diet say that it boosts weight loss, reduces their appetite, and even increases a sense of mental clarity. Then there are the skepticists – mainly doctors and researchers – who aren’t so sure.

An April 2019 article from The Mayo Clinic explains that there’s not very much evidence supporting that this type of eating is effective or safe over the long-term. In addition, eating a low-carb diet can cause headaches, constipation, bad breath, and more.

Dr. Jocelyn Tan
Dr. Jocelyn Tan, MD, FACP

In 2016, Dr. Jocelyn Tan, MD, FACP, a professor, oncologist, and medical researcher started the second safety trial in the United States focused on the keto diet. In her trial of cancer patients, she temporarily stopped all radiation and chemotherapy and instead used a keto diet for treatment.

The goal of the study was mainly to see if advanced cancer patients can easily do the diet without developing any serious side effects. At the time of this trial, there wasn’t much out there about the ketogenic diet.

Dr. Tan says, “Now, you go to Amazon or Barnes & Noble and there’s a whole section on the ketogenic diet. I read all the books and they’re basically the same. It’s good in a way, because people are becoming aware, but I think they have to know that it has limitations.”

Ketosis Books on Amazon Ketogenic Diet
A slew of ketogenic products available on Amazon

So, what is the keto diet? And is the keto diet safe, particularly for seniors over 60 who want to lose weight for good?

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Where Did the Keto Diet Come From?

If you’ve never heard of the keto diet before, it originated back in the 1920s as a treatment for children with seizures. It was discovered that when children with seizures were given a diet high in fat and low in carbohydrates, their seizures stopped.

Later on, effective antiseizure drugs were developed, so the diet pretty much phased out. However, in 1993, there was a child named Charlie who suffered from seizures that continued to occur, even with medication. Switching to the keto diet stopped the seizures. That’s how the Charlie Foundation was established, and the foundation’s mission is to offer free information on the keto diet and how it can help other people. That’s also when the keto diet was reborn.

Dr. Tan explains, “A ketogenic diet is a medical diet. You have to do it correctly and with a goal.”

What Is the Keto Diet?

At its core, a keto diet is a diet that produces ketones. Ketones are produced when there are so few carbs that energy must be obtained by breaking down fatty acids.

Dr. Tan explains that a few different diets fall under this big umbrella of low-carb diets, including the modified Atkins diet, the Atkins diet, and the ketogenic diet.

With the popular, traditional ketogenic diet, you eat very high fat and very low carbs. The rest is protein. The ratios are approximately 75% fat, 20% protein, and only 5% carbohydrates.

The Atkins diet only requires you to count carbohydrates, which makes it easier to maintain. “You get twenty grams or less, and that’s it. Counting the fat and protein isn’t as controlled,” says Dr. Tan.

With the Atkins diet, you don’t necessarily have to get the bulk of your calories from fat – you’re simply limiting your carbs. When restricting carbs, most people will naturally turn to proteins, such as meat or fish, versus fats, like a stick of butter. “That’s why you hear some people saying that the keto diet is high protein,” explains Dr. Tan.

The modified Atkins diet is a cross between the two. You limit carbs and can’t indulge in protein. Fats are encouraged, but not as much as with the classic ketogenic diet.

What Is Ketosis?

The goal of any keto diet is to get into ketosis. Generally, your body uses glucose for energy. Glucose is a carbohydrate, which comes from sugar and starchy foods.

When your body doesn’t have enough glucose for energy, it starts burning stored fat instead. This results in a build-up of ketones, which is a type of acid.

Ketosis Explained
Ketosis explained, photo credit Nutraworx

A bonus of a ketogenic diet where you eat high fat and very low carbs is that you can eat fewer calories without feeling hungry. A 2008 study following obese men on a ketogenic diet confirms this.

Dr. Tan says you can tell you’re in ketosis by smelling your breath. “Ketone breath!” she says. “It smells fruity. Ketones are aromatic.”

That’s the easy way, but some people opt to check their blood. Dr. Tan explains that a study was published comparing the smell of the breath versus a blood test, and they correlated. A urine test, however, isn’t always correct, she says.

9 Off-Limit Foods When On the Keto Diet

If you’re over 60 and are interested in trying the keto diet to lose weight, Dr. Tan actually advises focusing on what not to eat.

But first, you should know that this diet is a pretty easy one to follow, so don’t be discouraged by all the off-limit foods. “If you have motivation, it’s easy after that. Once you’re in, you realize you’re not hungry. This is a nice diet to have,” says Dr. Tan.

1. No fruit.

First and foremost, you have to focus on cutting out carbs. And yes – that includes fruit. “You can’t eat fruit because of the sugar. That also includes tomatoes,” says Dr. Tan.

2. Nothing labeled “fat-free.”

Shy away from any products labeled as “fat-free,” because they likely have starch added. A common product that tricks keto dieters is mayo. Make sure it’s real mayo!

3. Meat is fine, but limit processed meat.

Some people wonder… why is it OK to eat slim jims but not apples on a keto diet? While apples have too much sugar and will pull you out of ketosis, Dr. Tan advises choosing fresh meat over processed meat, because most processed meat contains sodium nitrite, a chemical preservative linked to increased colon cancer risk.

“If everyone just ate meat from the farm, they’d be better off,” she says.

Eating Meat on Keto Diet for Seniors Age 60 And Up
“If everyone just ate meat from the farm, they’d be better off,” says Dr. Tan.

4. Limit keto baked goods.

“I see these keto blogs where they post keto baked goods,” says Dr. Tan. “You have to watch out with those, because they do have sweeteners added that can make you hungry.”

Xylitol and sugar alcohols in general – you can spot them because they end in “-ol” – should be avoided. Dr. Tan says they’ll make you hungry, causing you to increase your calorie intake.

Dr. Tan explains, “Once you start increasing the amount you eat, you’re no longer restricting calories, so the ketogenic diet should be treated like a drug. Anything in excess is bad.”

5. Watch out for ketchup and spice blends.

Ketchup and spices have hidden sugars. Next time you’re walking through the spice aisle, take a look at the ingredients list. You may be surprised to find that one of the first ingredients is sugar!

6. No ice cream.

“Ice cream – that’s a no,” says Dr. Tan. “Learn to cook. Buy whipped cream and whip it yourself.”

7. No caffeine.

Something a lot of keto dieters don’t realize is that caffeine intake can be harmful if you’re in ketosis. “Caffeine produces a spike in your glucose,” says Dr. Tan. “It’s a gray area. I sometimes let people have caffeine, but definitely not all the time. You don’t want a continuous spike of sugar.”

8. No milk.

A lot of people don’t think about cow’s milk having carbs, but it does! Instead, Dr. Tan advises soy, coconut, or almond milk as an alternative.

9. No bread, rice, potatoes, soda, cookies, candy, chocolates.

Once again, avoiding carbs is the key. All of these carb-heavy foods and snacks are a no-go when doing the keto diet (or any diet, really!).

What Should You Eat While Doing the Keto Diet?

When you cut out a major macronutrient like carbohydrates, some wonder… well, what should I eat?

The key, says Dr. Tan, is eating foods that are low in carbs yet high in nutrition. That includes foods like meat, poultry, fish, eggs, and cheese.

Eat Meat Ketogenic Diet for Seniors
The key, says Dr. Tan, is eating foods that are low in carbs yet high in nutrition. That includes foods like meat, poultry, fish, eggs, and cheese.

And of course, fat! Butter, ghee, coconut oil, and mayo are all good choices.

Dr. Tan has learned some tricks along the way to help make keto dieting easier, including snacks like celery sticks with creamed butter or hard-boiled eggs.

“You’ll probably want to learn to like pork rinds if you don’t already,” laughs Dr. Tan. Pork rinds are high in fat and protein and have no carbs. It’s a tried-and-true keto snack. “Non-pork eaters can learn to make similarly-made beef rinds or chicken crisps. I saw that on YouTube,” she continues.

Other hacks include using riced cauliflower or broccoli instead of rice or replacing regular flour with almond or coconut flour. Another fun idea is to make cheese chips, which is baked cheese that becomes crunchy. “It makes for a great low-carb snack, and it’s perfect for non-meat eaters,” says Dr. Tan.

Cauliflower Rice on Keto Diet Over 60
An example of cauliflower rice, a great alternative to regular rice when doing the keto diet

Finally, you can spiralize zucchini into noodles instead of eating regular pasta, which is made with flour and contains carbs.

“People say they can’t afford a keto diet cause it’s all meat, but you can,” says Dr. Tan. “It’s just low carbs. If you can’t afford meat, buy eggs or cheese that you can slice.”

Veggies are a great addition as long as they’re low-carb. Examples of low-carb vegetables include:

  • Kale
  • Spinach
  • Celery
  • Cauliflower
  • Broccoli
  • Asparagus
  • Mushrooms
  • Zucchini
  • Brussel sprouts
  • Cabbage

Veggies like corn, carrots, or tomatoes should be avoided since they have more carbs and can cause you to get out of ketosis.

Is the Keto Diet Safe After 60?

The question of whether or not the keto diet is safe was part of Dr. Tan’s 2016 study on cancer patients. She came across a trial done in New York that used the Atkins diet to treat cancer. There were only 10 patients enrolled in the study.

She decided to start the second safety trial in the United States based on this concept. What made her study unique is that all of the patients were from the same hospital, and they were given the same diet. The trial had a good variety of cancers, and it concluded that the ketogenic diet is safe for cancer patients. There were also some slight benefits to the patients’ quality of life.

If you’re worried about doing the keto diet and you’re over 60, two of the four trial patients were in their 80s!

I think the keto diet is fine for 60 years olds,” says Dr. Tan. “The problem with the keto diet is there’s a bad reputation. People think fat will clog your arteries, but that’s not the case with the keto diet.”

Eating more fat when you’re on the keto diet might actually prevent you from having a heart attack. Why? Because when you’re doing the keto diet, you actually burn fat and lose weight. However, this is still a controversial topic will little data to support each opposing side. More research is needed.

Keto Diet Salad for Women Over 60
“We have data on children who have done the keto diet for 12 years or more, and they’re fine. In the next 10 years, we’ll have even more evidence behind this diet," says Dr. Tan.

As far as doing the diet long-term, Dr. Tan says there’s already data on its safety: “We have data on children who have done the keto diet for 12 years or more, and they’re fine. In the next 10 years, we’ll have even more evidence behind this diet. I think it’s safe as long as you have a doctor checking you out before you start.”

The Keto Diet If You’re Diabetic and on Insulin

Dr. Tan explains that if you’re diabetic and are on insulin, doing the keto diet could be a problem. “I still think it would benefit you, but you have to realize that when you go on this diet, your blood glucose will drop,” she says.

Dr. Tan explains that when your sugars are low, you’d normally feel light-headed and would have trouble functioning. But with the keto diet? You don’t have that complication because of the ketones, which provide energy to your brain.

“People on insulin go on the keto diet, their sugar goes down, and they inject themselves with insulin. That’s when there are problems,” explains Dr. Tan. “You have to have a doctor who is managing your sugar or you might experience a hypoglycemic episode (dangerously low blood glucose) during the first few days of the keto diet.”

The plus side is that many diabetic patients report no longer needing their medications after doing the keto diet. “If you’re diabetic, I think you should be on the diet, but with guidance.”

Hard Boiled Egg for Keto Diet After 60
Dr. Tan explains that when your sugars are low, you’d normally feel light-headed and would have trouble functioning. But with the keto diet? You don’t have that complication because of the ketones, which provide energy to your brain.

The Keto Diet If You Have Kidney Failure or Kidney Stones

If you have kidney failure, the keto diet may still be followed, but you must pay attention to certain dietary restrictions like limiting phosphorus. Cheese could be a problem, so don’t go overboard with the protein. “Keep focused on the fat and carbs. Get a dietician to help you,” advises Dr. Tan.

In addition, if you have kidney stones, you could experience an attack due to an increase in your uric acid. “In our trial, we saw that when the blood levels of uric acid went up, it was only temporary,” Dr. Tan says.

In the long run, uric acid levels become stable, but there is an initial rise which may worsen active gout or trigger an attack of kidney stone colic.

Even if you don’t have kidney issues, you should still check with your doctor first before doing any diet.

Over Age 60? Give the Keto Diet a Try!

If you’re over 60, you know how difficult it is to lose weight. Whether you’re suffering from menopause or you simply have more time to socialize and eat, dropping weight after 60 isn’t exactly a piece of cake. Pun intended!

If nothing else has worked for you, Dr. Tan says to give keto a try: “It might make you healthier in the long run.”


Dr. Jocelyn Tan, MD, FACP is a Clinical Associate Professor at the University of Pittsburgh School of Medicine and a Medical Oncologist and Gastrointestinal Cancer Director at the Veterans Affairs Medical Center in Pittsburgh, PA. Dr. Tan started the second safety trial in the United States focused on the ketogenic diet and how it may be a treatment for cancer. You can find Dr. Tan on her blog or her virtual office.

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