Navigating the Risks: Is the Keto Diet Safe?

In recent years, there’s been a buzz about the keto diet. It is touted as a way to lose weight fast, lower your diabetes risk, and improve metabolic health. However, this restrictive very low-carbohydrate diet is not without risks. In this article, we will evaluate the safety of the keto diet and give you some tips on how to make the keto diet healthier and safer.

What is Ketosis?

Under normal circumstances, the human body uses glucose (sugar) from carbohydrates for energy. The name ketogenic or keto diet comes from the word “ketosis.” Ketosis is a metabolic process in which the body uses stored fats to survive in periods of famine. When the body is in ketosis, it uses substances called ketones or ketone bodies to fuel the body’s energy needs. Ketones are produced when the liver breaks down fat. It takes about 72 hours for ketosis to set in after you start eating a low-carb, high-fat diet. Check out our blog: Are Carbs Bad for You? What to Know.

What is a Keto Diet?

A keto diet is a high-fat, moderate-protein, very low-carbohydrate diet. To achieve ketosis, you need to obtain:

80% of your calories from fat (instead of 20-35% in a normal diet)
5% of your calories from carbohydrates (instead of 45-65% in a normal diet)
15% of your calories from proteins (same as 10-35% in a normal diet)

Eating a keto diet forces your body to switch from using carbohydrates for energy to using fats for energy. This can result in fat loss and weight loss.

Brief History of the Ketogenic Diet

The ketogenic diet was developed by a doctor at the Mayo Clinic in the 1920s to treat drug-resistant epilepsy in children. It continues to be used worldwide to treat severe recalcitrant epilepsy.

Rise in Popularity for Weight Loss and Health

In the 1970s, the ketogenic diet rose in popularity for weight loss as an alternative to low-fat diets. The popularity of the keto diet was fueled by the Atkins diet, which is also a low-carb diet. However, the Atkins diet involves a slow reintroduction of carbohydrates, whereas the keto diet strictly excludes carbohydrates from the eating plan indefinitely. The keto diet has also become popular because it is believed to have several health benefits.

Health Benefits of the Keto Diet

Neurological Disorders and Epilepsy

The ketogenic diet is a high-fat, low-carbohydrate diet. It can help to control seizures in children with epilepsy who have not responded to antiepileptic medications. The keto diet for epilepsy is a highly restricted diet. It is prescribed by a healthcare provider and supervised and monitored by a dietitian. Seizure Disorder Vs. Epilepsy: What's The Difference?

Is Keto Good for Epilepsy in Adults?

The keto diet is typically not used for adults with severe recalcitrant epilepsy because it is harder to stick with, requiring careful measurement of calories, carbohydrates, fats, proteins, and fluids. Adults with drug-resistant epilepsy may instead benefit from a modified Atkins diet.

Rapid Weight Loss and Obesity Management

Research shows that eating a ketogenic diet can result in rapid weight loss, which can lower cardiovascular risk. The high-fat, moderate-protein content of a keto diet also helps to regulate appetite, which is typically the biggest challenge with low-fat diets.

Find out more about the Low-Carb, High-Protein Diet: Pros & Cons.

How Does the Keto Diet Cause Weight Loss?

The ketogenic diet reduces the amount of carbohydrates you eat and forces your body to burn fat for energy instead. The typical American diet contains 250 grams of carbs per day, mostly in the form of refined grains, processed meats, and other highly processed foods. The keto diet limits carbohydrate intake to 50 grams per day. Weight loss occurs on a keto diet because people cut out large amounts of unhealthy carbs.

How Much Weight Can You Lose on a Keto Diet?

Results vary from person to person, but there are anecdotal reports of people losing anywhere from 1 pound (0.5 kg) to 10 pounds (5 kg) in the first week on a ketogenic diet. Note that most of this is water weight. Loss of body fat typically starts after you enter ketosis. The larger you are, the more quickly you are likely to lose weight on keto.

Improved Blood Sugar Control and Impact on Type 2 Diabetes

Studies suggest that a ketogenic diet can help control blood glucose levels in people with type 2 diabetes. The reason is that a keto diet shifts energy metabolism from carbohydrates to fats. Eating carbohydrates, especially simple sugars, causes a rapid elevation in blood glucose levels.

A keto diet can lead to a decrease in blood glucose levels, increased insulin sensitivity, and a reduced risk of diabetes in people who don’t already have the condition.

Can Keto Reverse Diabetes?

The ketogenic diet can help in controlling blood sugar levels in people with diabetes. It may make such individuals less dependent on anti-diabetes medications. However, most people do not have success in completely reversing diabetes on a keto diet, partly because it is challenging to stick with a strict ketogenic diet. Read more about “Is Diabetes Preventable Through Healthy Habits?”

Non-Alcoholic Fatty Liver Disease

More research is needed, but there is some evidence that carbohydrate restriction and weight loss on a ketogenic diet can improve non-alcoholic fatty liver disease (NAFLD). This is a liver condition that occurs due to a buildup of fat in the liver in overweight and obese individuals who do not drink alcohol.

Cardiovascular Health Outcomes: Pros and Cons

Obesity, high blood glucose levels, high cholesterol, and high blood pressure are leading cardiovascular risk factors. The keto diet can reduce the risk of heart disease and other chronic diseases by promoting weight loss and lowering blood sugar levels.

However, the keto diet is a high-fat diet. For the keto diet to be healthy, it’s important to choose healthy fats to achieve the daily recommended fat intake. People who choose saturated fats may not get the cardiovascular benefits of a keto diet due to elevated cholesterol levels. Find out “What to Eat for Lower Cholesterol.”

Risks and Adverse Effects of a Keto Diet

Short-Term Side Effects of a Keto Diet

Keto Flu

People on a keto diet often develop a group of symptoms called the keto flu. This usually occurs in the first 2-7 days. Symptoms of the keto flu include:

Tiredness
Low energy
Headaches
Dizziness
Bad breath
Nausea
Constipation
Foggy brain
Mood swings
Problems sleeping

These symptoms usually go away once the body adapts to ketosis. In the meantime, you can manage keto flu symptoms by staying well hydrated, choosing healthy permitted foods to optimize nutrition, and easing into a ketogenic diet slowly instead of suddenly.

Long-Term Health Risks of a Ketogenic Diet

Nutrient Deficiencies: The keto diet restricts certain food groups, such as carbohydrates from whole grains, fruits and vegetables, and low-fat dairy. These nutritious foods contain important nutrients like vitamins and minerals. Restrictive diets such as the keto diet can, therefore, put you at risk of deficiencies due to inadequate intake of vital nutrients.
Constipation: Low carb intake can result in low fiber intake. Constipation is common in people who are on a ketogenic diet. Learn what foods cause constipation.
Low Blood Sugar: A very low-carbohydrate diet can lead to hypoglycemia (low blood sugar levels). People who are on diabetes medications may need an adjustment in their dose within a few days of starting a keto diet.
Kidney Stones: Studies show that people on a ketogenic diet are at an increased risk of developing renal stones. You should talk to your doctor about taking potassium citrate supplements while on this diet to lower your risk.
Heart Disease: The keto diet emphasizes low carbohydrate and high dietary fat intake. However, it’s important to pay attention to the types of fats and proteins you use to replace carbohydrates. A high intake of saturated fats can lead to high cholesterol, insulin resistance, and an increased risk of heart disease.
Mental Health Issues: A restrictive diet such as a ketogenic diet can lead to social isolation. It can also trigger disordered eating in some people.

Pros and Cons of a Ketogenic Diet

Pros

A keto diet may help overweight and obese individuals with chronic weight management by promoting rapid weight reduction.
Potential benefits also include control of blood sugar levels. This can result in a reduced risk of diabetes and heart disease.
Some people find a keto diet easier to stick to compared to other diets that involve calorie counting.

Cons

A strict ketogenic diet can be very challenging to stick with long-term and may result in yo-yo dieting.
Research shows that the long-term weight loss benefits of a low-carbohydrate keto diet are not superior to low-fat diets.
Weight gain can occur on a keto diet if you eat a lot of saturated fat (unhealthy fats) or high fat dairy to meet the requirement of 80% calorie intake from fats.
Keto diets are linked to short- and long-term health problems, including keto flu, constipation, kidney stones, and low blood sugar.

Common Questions

How Safe is the Keto Diet?

The keto diet can cause health problems even in healthy adults. Potential health risks include constipation, kidney stones, and an increased risk of heart disease due to a high-fat diet containing large amounts of saturated fats. However, there are ways to make the keto diet healthy while still meeting your goals for net carbs, for example, by choosing healthy fats, eating fiber-rich plant foods, and staying well hydrated.

Who Shouldn't Do Keto?

A ketogenic diet may not be safe for people with chronic constipation, kidney stones, kidney disease, diabetes, heart disease, liver disease, thyroid disorders, or health conditions involving digestive organs such as the pancreas or gallbladder.

How Do I Protect My Kidneys on a Keto Diet?

Some of the things you can do to protect your kidneys on a keto diet include:

Stay well hydrated
Control salt (sodium) intake
Limit intake of animal proteins
Avoid kidney-stone-forming foods
Consult a healthcare provider for advice on dietary supplements

What are the Side Effects of Going on a Keto Diet?

A keto diet can cause both short-term side effects, such as the keto flu, as well as long-term health risks, including constipation, kidney stones, low blood sugar, high cholesterol, and an increased risk of heart disease if you eat unhealthy fats.

How To Make a Keto Diet Healthy?

A ketogenic diet requires 80% of your daily calories to come from fat. It’s important to choose healthy fats such as extra virgin olive oil, and fatty fish like salmon, avocado, nuts, and seeds to meet your daily fat intake goals on a keto diet. If you choose unhealthy fats, such as saturated fats (bacon, butter, cream), it may have unwanted health effects. Try to keep calories from unhealthy saturated fat to less than 10% per day. Additionally, for your permitted 50 grams of carbs daily, include healthy carbs such as starchy vegetables, beans, and berries.

Safe Practices to Manage Keto Diet Risks

Have Realistic Expectations

While a ketogenic diet can result in significant weight loss and other health benefits, it also carries certain health risks and may not be safe for everyone. Remember that everyone is different. Your weight loss results on a keto diet may not be the same as someone you know.

Consult a Healthcare Provider

It’s important to consult your healthcare provider before starting on a keto diet or other low carb diets. Your provider can guide you on protective measures for kidney health including kidney stone prevention. They will also recommend periodic laboratory testing to monitor blood sugar and blood cholesterol levels.

Talk to your healthcare provider about other eating plans such as the Mediterranean diet which have proven health benefits without the health risks associated with a ketogenic diet.

Consult a Wellness Dietitian

If you’re planning to go on a ketogenic diet, work with a wellness dietitian. They can help you understand how to make healthy keto-friendly choices for balanced nutrition. As mentioned, choosing high-fat foods while on a very low-carb diet, such as keto, can increase your risk of cardiovascular disease due to an increased intake of saturated fats.

Make an Informed Decision

By understanding the benefits and risks of a ketogenic diet, you can make an informed decision about going on keto. This restrictive diet can help you achieve your personal health goals but also carries certain health risks. You should be especially careful about going on a keto diet if you have existing health conditions.