By Jen Johnston, CHHC, senior marketing services account manager, for the Step into Natural blog series

Some independent retailers may have a difficult time identifying what is trending across the wellness landscape or which lifestyle diets are hot, resulting in missed opportunities to connect with customers around their self-care interests. Knowing what is popular with your patient base can also inform which natural products to sell.

While the ketogenic – or keto – diet isn’t inherently natural, it is being embraced by wellness influencers who are intertwined with natural products shoppers.
What is the ketogenic diet? Simply put: High fat. Moderate protein. Low carb.

Women’s Health magazine nicely describes the nuts and bolts of the diet: "Patients follow a meal plan that's 60-75% fat, 15-30% protein, and 5-10% carbs, which sends their body into a state called ketosis. When they hit this state, their body breaks fat into organic compounds called ketones, which it then uses for
energy." Essentially it uses the ketones for energy instead of glucose from carbs.

When was the ketogenic diet created? I would be remiss if I did not mention that many indigenous hunter-gather cultures regularly went into a state of ketosis during winter months when plants were scarce. During these times, ketones would sustain them when carbs that produce glucose were hard to come by. So, cyclical ketosis was likely a regular part of human existence until people were able to store more carbs in the winter months.

It wasn’t until the 1920s that its use as a therapy for epilepsy was discovered as a safer alternative to fasting, which was also being used to help epileptic patients. For two decades this therapy was widely used, but the diet fell out of favor once anticonvulsant therapies came onto the scene.

Over the next 50 years its use was fairly fringe, but in the 1990s, the ketogenic diet was once again in the spotlight for treating epilepsy. NBC‐TV's Dateline profiled a young child named Charlie Abrahams whose parents had run out of options to treat his epilepsy before discovering keto. On the diet, the seizures were able to be controlled and Charlie made significant cognitive development. Charlie’s father began the Charlie Foundation which brought notoriety back to the diet.

You could find archives of bodybuilders buzzing about the ketogenic diet in the early 2000s on internet forums. They were using it to lose fat without losing muscle. But it wasn’t until 2016 and 2017 that keto took off as a weight loss tool for average people. You can see very clearly on Google Trends when the term “keto” jumped into popular vernacular.

Who are the influencers? There are some celebrities who have tried the diet including LeBron James, as reported in Sports Illustrated, and Kourtney Kardashian, as highlighted in this People Magazine article.
However, the groundswell is really coming from everyday people-turned-social media influencers that talk about the diet predominantly on Instagram and YouTube, but also Facebook, Twitter, and others. They post their diet progress, recipes, and pictures of their meals, and they gain followers.

In addition, a flood of books on the keto diet have entered the market. And an Australian documentary was also released on Netflix during 2018 called The Magic Pill.  It describes how a handful of families lost weight, overcame autism symptoms, and more by eating a high fat, low carb diet.

So how is keto different from the paleo diet? They are both low carb diets, but keto is lower carb. Keto is also higher fat than paleo and only moderate protein. Keto also allows dairy which is why cheese is so popular on the diet. The keto diet also focuses on a primary goal of getting the body into ketosis and fat adapted. However, they are both lifestyle diets.

Wondering how the keto diet might impact your pharmacy? Certain patients should steer clear of this diet, such as patients with diabetes and pregnant women, so understanding when to counsel patients on who should avoid keto is important.

You may have a patient on the keto diet who wants to monitor the carb content of their prescription, so it helps to have a little background on this diet when fielding this question.

Some keto dieters want specific supplies, such as keto sticks which test the extra ketones present in the urine. This indicates ketosis has been reached, and it is a product they will want again and again to monitor their state. They are also more likely to seek supplements such as exogenous ketones, and keto-approved snacks, such as pecans or pork rinds.

With so many different lifestyle diets, it can seem overwhelming at times to try to appease everybody. But ignoring the changing face of wellness is no option. The personalization of self-care is here to stay. One of the best strategies you can take is to understand that today’s definition of natural and wellness is in the eye of the beholder, and meet your customers where they are.