Wait…what? For a website named Keto Bandeeto you wouldn’t expect to see a title questioning if the diet it’s named after is bad for you. That’s a fair point… the short answer is that we often look at things in black and white, good and bad, benevolent and evil, but the truth is that while we try to categorize life in this manner, there are very few things that are black and white… most things are varying shades of gray. In this post, we’ll play the devil’s advocate to an extent and explore the questions that anyone considering the ketogenic diet should ask themselves.
Is the keto diet bad for you… diets are not inherently good or bad, a diet is a strategy or regimen of the kinds of food that a person, animal, or community habitually eats. Following a diet, any diet is going to elicit a result, an outcome, some of those outcomes are desired, other outcomes are not. Ultimately it is up to the individual (with advice from their physician, preferably) to weigh the pros and cons of any dietary regimen and decide whether it makes sense for them and their goals
Is Keto safe long term?
Even though the ketogenic diet has been around since the early 1900s, its purpose was to treat epilepsy patients (see my post on The Ketogenic Diet and Epilepsy for more info). It wasn’t until the 1990’s that the keto diet gained popularity as a strategy for weight loss. It’s important to note that Dr. Robert Atkins published his Diet Revolution in 1972, a high-protein/low-carbohydrate diet. Here again, this diet didn’t gain widespread popularity until the late ’90s, early 2000’s.
With low carb diets such as the keto diet & Atkins diet being relatively new there is not a lot of data on the benefits and dangers of following these protocols long term. However, there are some that warn that sticking to the diet long-term could be dangerous. Here are some of the examples:
- Vitamin or mineral deficiencies – The Keto diet prohibits unhealthy highly processed foods like refined sugar, white breads, flour & rice, but they also cut back on many fruits and certain vegetables like apples, oranges, bananas, potatoes because of high sugar/carbohydrate content. These fruits & vegetables are high in antioxidants and full of vitamins and minerals. Getting enough fiber can also be a concern on keto because cutting out carbs includes eliminating whole grains, a large source of fiber. Besides fiber, important nutrients and minerals to consider supplementing include Magnesium, Potassium, Omega 3 fatty acids, Vitamin D. Thomas DeLauer renowned health author, nutrition expert & YouTube celebrity has an excellent video on the subject (Link to video)
- Athletic performance – A study from the Journal of Sports Medicine and Physical Fitness concluded that: Short-term low-carbohydrate, ketogenic diets reduce exercise performance in activities that are heavily dependent on anaerobic energy systems. These findings have clear performance implications for athletes, especially for high-intensity, short-duration activities, and sports. It should be noted that the participants of this study were placed on the keto diet for (4) days of being on the diet. Anyone that has been on the Keto diet knows that within the first week of keto you can experience symptoms known as the “keto flu” as your body adapts to eating low carb… it would have been interesting to see this study on athletes that had been on the keto diet for a much longer time (Link to study). This is a concern for competitive athletes, but not as important to the average person trying to lose weight.
- Weight re-gain – This makes sense and it’s easy to agree with this point. If you stop following the diet you can re-gain the weight. However, that can be said of EVERY diet! Prior to starting my keto journey, I ate a standard American diet. If I decide to stop following the keto diet and return to eating the standard American diet, I’m fairly certain that I know what the outcome of that decision will be. A study was conducted on participants of The Biggest Loser a popular weight-loss reality show. Of the 16 contestants participating in the study, (4) had gained all the weight back and then some and as a whole, the group regained 70% of their original weight, only one contestant participating in the study managed to keep all the weight off (Link to study)
- Keto can put stress on the kidneys – A study published in the Journal of Child Neurology noted that 13 out of 195 children following a ketogenic diet as a treatment for epilepsy from 2000 to 2005 developed kidney stones. Although, the study mentioned that children supplementing with potassium citrate saw a decreased likelihood of kidney stones, the question of the keto diet putting stress on the kidneys is raised.
Dr. Keith Runyan, MD (a nephrologist and obesity medicine specialist who also has type 1 diabetes.) does an excellent job of exploring this topic in-depth in a post on Dietdoctor.com concludes that: A well-formulated low-carb diet is completely safe for people with normal kidney function. A low-carb or ketogenic diet helps prevent diabetes and high blood pressure. Because these diseases are the biggest causes of kidney damage, a low-carb diet is not just safe for kidneys, it may actually help prevent kidney damage in those with normal kidney function or early-stage kidney disease.
- Low carb diet linked to heart rhythm problems – A study by the American College of Cardiology links low carb diets to an increased risk of developing atrial fibrillation (Link to Study). Atrial fibrillation is a condition that causes the heart to beat irregularly and doubles the risk of heart-related deaths and is associated with a 5-fold increased risk for stroke. Cardiologist and author of the study, Dr. Xiaodong Zhuang, MD, PhD does go on to say that “while the research shows an association, it cannot prove cause and effect. A randomized controlled trial would be needed to confirm the relationship between carbohydrate intake and AFib and assess the effect in a more ethnically diverse population.”
Note: I have not listed the dreaded keto flu from this list even though it’s one of the most talked-about topics when it comes to the negative effects of the keto diet. The keto flu is a collection of flu-like symptoms (Nausea, constipation, headaches, fatigue) in addition to sugar cravings that many people experience to some degree or other when adapting to a high fat, low carb diet (Fat Adapted). These symptoms are typically short-lived and not relative to long term risks of a ketogenic diet.
What is the difference between ketosis and ketoacidosis?
Both ketosis and ketoacidosis involve the body producing ketones. While ketosis is generally considered safe, ketoacidosis is dangerous and possibly life-threatening for some.
- Nutritional ketosis occurs when the body starts burning fat instead of glucose. The ketogenic diet is based on getting the body into nutritional ketosis by restricting carbohydrate intake and forcing the body into a “starvation” mode (ketosis) that forces the body to burn stored fat for energy.
- Ketoacidosis is a serious complication of type 1 diabetes, although it can happen with type 2 diabetes also, it is much less common. An overview of ketoacidosis from Mayoclinic.org: The condition develops when your body can’t produce enough insulin. Insulin normally plays a key role in helping sugar (glucose) — a major source of energy for your muscles and other tissues — enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated. Link to full report
Although ketoacidosis can be very dangerous, it can be effectively managed by proper diet, frequent blood level monitoring, staying vigilant with insulin dosage as prescribed by a physician & checking ketone levels. Persons that suspect that they have diabetic ketoacidosis (high blood sugar & High ketone levels in the urine) need to seek immediate emergency care.
How long should you do Keto?
As mentioned earlier, it can take several days to weeks to get the body into nutritional ketosis. In order to see significant and meaningful results, it’s widely recommended that you follow the ketogenic diet for at least 3 months. Debates on the effects of following the ketogenic diet long term are ongoing, but for now, doctors tend to agree that’s long as your bloodwork is at proper levels and your weight is within a healthy range, there is nothing wrong with following a ketogenic diet long term… the bigger problem for most people is staying on the ketogenic diet long term.
The keto diet is very restrictive and there is no “cheat day” on keto. Once in ketosis if you chow down a donut or slice of pizza the body will immediately switch back to burning it’s preferred fuel, glucose and you’ll fall out of ketosis, the liver will stop burning fat for fuel and you would need to begin the process of getting into ketosis all over again.
The problem with any diet is the inference that it’s a finite event, meaning that it has a beginning and an end… with keto as is with most diets, once you drop off and go back to eating as before the weight is most likely to pile back on. The key is to make a lifestyle change, using the keto diet to bring dramatic change to your weight in spurts, then easing off into a more manageable low carb lifestyle can be very effective. Adding in good carbohydrates like fruits, starchy vegetables & legumes in moderation while still restricting highly processed foods like sugar, flour, most fast food, and sugary drinks is essential.
So back to the original question, is the keto diet bad for you? For most people, it’s a safe and effective method to lose weight but not without pitfalls. Sir Isaac Newton’s third law is: “For every action, there is an equal and opposite reaction”… and the keto diet is no exception. There are short term and possibly long term implications, some of which we’ve outlined here. The question that came to my mind in my decision to follow a low carb lifestyle was…. “is keto bad for you (me)? Compared to what?”
Pushing 300lb on the typical American Diet making decisions based more on marketing campaigns rather than nutritional value.
To this day if I know by heart that a Big Mac is “2 All Beef Patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun” (thanks McD Marketing team, I can’t remember my home phone number, but I remember this jingle from the ’70s!). Ads like these were driving food decisions and that’s a reckless strategy for long term health. Following the typical American Diet as I was, these are some of the risks I was putting myself in for:
- Heart disease and stroke.
- High blood pressure.
- Some cancers.
- Gallbladder disease and gallstones.
- Breathing problems, such as sleep apnea (when a person stops breathing for short episodes during sleep) and asthma.
Not to mention the emotional pain endured… Compared to that, for me, the answer is No, the keto diet is not bad for me, in fact, it has opened my eyes to a broader understanding of nutrition and the thirst for learning more. One of the biggest detractors of the ketogenic diet is how restrictive it can be. However, it could also be one of its greatest gifts. By being so restrictive and forcing me to count macros, measure ingredients, read labels I have forever changed my relationship with food.
Will I stay keto long term? Who knows what’s next… it’s all a journey (Vegan Keto, anyone?). The nutritional awareness that I learned through keto is what has changed my life and that’s ultimately what I needed… a change in my life, not a diet… a lifestyle change!
Is the keto diet bad for you? After checking with your physician to make sure you’re not one of the few with underlying conditions that should not consider the ketogenic diet, the real question you should ask yourself is…
Can the keto diet be good for me?