I’ll be blunt: A ketogenic diet is not a panacea. In fact, keto diets can be dangerous for some people. Going keto is not without risk, and the scientific research on the diet long term is still somewhat sparse. How do you know if keto is right–or not–for you? It’s critical to have a balanced discussion about ketogenic diets and explore the available research.
Ketogenic diets have been used therapeutically for over 100 years, but keto is really having a moment and becoming a fad. It’s easy to get swept up in the allure of weight loss, 6-pack abs, endless energy, and boosted brain power. While keto can be very beneficial for some bodies, it can also do more harm than good in others.
To be clear, I am not against the ketogenic diet per se! I have seen many wonderful benefits with keto, but I have doubts about the safety of the diet long term (say, for a period of years), and keto will not be the right diet for everyone. Certain people may experience adverse effects from a higher fat and/or lower carb diet due to their genetic makeup, current health status, or particular genetic mutations. There can be a dark side to keto; there are documented adverse reactions, and you need to be informed.
Keto Benefits
The ketogenic diet is a high fat, low carb, moderate protein diet. It’s been used historically to treat specific medical conditions, like epilepsy and diabetes. (source) When deprived of the glucose your body and brain require for energy, the body begins to burn stored fat, and the liver produces an alternative fuel called ketones. You can read exactly how keto works in my other post here.
People are attracted to the ketogenic diet because of its many benefits, including weight loss without hunger (and it does seem to work well for this, at least initially), crystal clear thinking, improved lipids, better energy, epilepsy treatment, and even a way to overcome type 2 diabetes. The ketogenic diet has been shown to produce beneficial metabolic changes in the short term. Along with weight loss, other benefits include improved insulin levels and reduction in blood pressure, cholesterol, and triglycerides. (source)
And we do have solid evidence showing that a ketogenic diet reduces seizures in children, sometimes as effectively or more than medication. Because of these neuroprotective effects, questions have been raised about the possible benefits for other brain disorders, but there are no human studies to support recommending ketosis to treat these conditions (Parkinson’s, Alzheimer’s, etc). (source) That’s not to say a ketogenic diet wouldn’t work for those diseases, though.
Long story short is that keto advocates say the body thrives better burning fat for fuel instead of carbs, which can leave you brain fogged and tired. In fact, you don’t even need carbs with all the fat to burn, they say! Eating carbs drives up insulin production, causing increased hunger and triggering the body to hold on to fat and suppress calorie burn. But when you replace carbs with fat, you’re not hungry, and fat magically melts away. With fewer carbs, your body also doesn’t produce as much insulin. (source) High insulin means diabetes and increased oxidation and fat storage.
NOTE: carbs include vegetables. All carbs are not bad. Everything that is not a protein or a fat is a carb.
And most people report feeling great on keto. The diet forces you to ditch processed, refined foods, simple carbs, and junk food. No sugar, booze, or Cheetos. And that single change is a good thing: You’re eating more whole foods. Keto encourages consumption of free-range animals and wild caught seafood, good fats, bone broths, organ meats, and fermented foods. And although keto diets exist on a spectrum (some drastically limit plant carbs while others get a pretty good diversity), it’s still minimal carbs at around 30 grams per day total carbs or less (equivalent to one sweet potato) and no grains or legumes. Not everyone (especially women) does well on such a low carb plan.
NOTE: whether you track net or total carbs depends on you and your health goals. Net carbs are total carbs minus the fiber. Some people will be fine counting net carbs; others will need to count total carbs to get into ketosis. The reason why people use net carbs (aka available carbohydrates) is because of the assumption that fiber doesn’t affect blood sugar. However, this claim isn’t entirely accurate because it only applies to insoluble fiber which cannot be absorbed and has no affect blood sugar and ketosis. (source)
Here’s the thing though: some of those benefits, while they sound wonderful, are still hypothetical. For example, while the ketogenic diet does work for short term weight loss, WHY it works is still a hypothesis (see carbohydrate-insulin hypothesis). There are no long term studies and no solid evidence that keto diets are beneficial for weight loss and lipid improvements in the LONG TERM. (side note: I did find this recent study on a small group of obese patients following a very low calorie ketogenic diet over a period of 2 years. They had continued weight loss success, but I did not see any info on other health markers in the study. This also suggests that obese people would fare better on keto as long as they still have weight to lose and are using the diet for this purpose).
When I say long term, I mean following a ketogenic continually diet for more than 6 months. (this study does show keto’s beneficial effects over a period of 24 weeks for obese people). We just don’t have those studies yet. And that’s why people may experience wildly different results with keto for longer than, say 3 months (more on this later). Some animal research even points to potential problems like nonalcoholic fatty liver disease from long-term adherence to the diet (source).
The Dark Side of Keto
Truly, we are more confused than ever about macronutrients (protein, fat, and carbs) in the diet. Fats cause heart disease; no, sugar does; all carbs are bad; too much protein is bad for your kidneys. Want to know why we are confused about what diet works best and what we should eat? Because there is no universal correct answer about the perfect human diet.
Except maybe that we could all stand to eat more veggies, but there are even caveats to that.
Why? Well, we all have different physiologies; we all require different macronutrient ratios, and based upon our genetics and lifestyle, some of us have greater or lesser needs for things (like fat) than others. You will not get the same results feeding different humans an identical diet. Furthermore, we can’t do controlled studies on humans because we cannot lock them up in a lab. Therefore, accounting for control factors like stress levels and lifestyle habits that strongly influence outcome is impossible.
Back to keto. Same principle applies here: A ketogenic diet is not an ideal diet for some people. And it may not be an ideal diet long term for ANYONE. It may improve one’s insulin sensitivity in the short term, and it may accelerate fat loss and reduce inflammation in those with metabolic syndrome, and it absolutely has benefits when used to treat epilepsy. But the ketogenic diet is a therapeutic diet. Think of it as a prescription that can be used temporarily to treat a condition until results are achieved. Long term keto can be a stressor on your adrenals, endocrine system, and possibly your liver.
Some researchers state that the ketogenic diet acts more as a drug than a diet because it emulates starvation and produces benefits to certain systems at the detriment of others (namely the endocrine system). (source)
In fact, in a recent study (one of the few long term studies of its kind) on carbs and longevity, new evidence suggests that neither high-carb nor low-carb diets are necessarily great for your health. Scientists studied more than 15,000 people in the US and another 432,000-plus around the world, and found that getting about 50-55% of a day’s energy from carbohydrates might be ideal for longevity. Conversely, people who derived more than 70% of their energy from carbs or got less than 40% of their daily calories from carbohydrates were more likely to die than people who ate something in between. Read all about it here.
Some of the only long term studies we actually DO have on the ketogenic diet are from tracking children who have seizure disorders. From these studies, we know with confidence that long term ketosis may pose substantial risk for health complications due to the side effects experienced by the thousands of children who have followed ketogenic diets over the years as a means of suppressing seizures unresponsive to drugs and procedures. Some of the side effects include stunted growth, kidney stones, heart issues, constipation. Other documented adverse reactions of the ketogenic diet include serious illness and death. That’s why it’s a must to research this diet when using it in a therapeutic manner.
But if you feel so great on a keto diet and you’ve lost so much weight, how can it be bad? You gotta look under the hood to understand exactly how it’s working for you. By that I mean your gut function and blood work, specifically lipid panels and inflammatory markers (best measured via hs-CRP). Not all individuals will respond well to diets high in fat from animal sources like meat and dairy. You can find out if this is you by checking your blood every 6 months.
Request the following labs to gauge how keto is working in your body:
- Cholesterol (with an advanced panel that includes fractionated LDL and HDL)
- Electrolytes
- Fasting glucose and hemoglobin A1C (a three-month snapshot of blood glucose)
- Inflammation (C-reactive protein, homocysteine)
- Thyroid function (with an expanded thyroid panel, including TSH, free T3, reverse T3, free T4)
- Sex hormones (cortisol, estrogen, progesterone, testosterone)
- Electrolytes and minerals (sodium, potassium, magnesium, copper, zinc, selenium)
For example, a doctor colleague of mine mentioned the following:
“I have a patient who’s been on a ketogenic diet for 7 months. She lost 14 stubborn pounds of body fat, her brain is clear, and her carb cravings are gone. She wants to continue this plan, BUT her LDL cholesterol went from 119 to 253. Total cholesterol from 199 to 355. HsCRP from 0.21 to 3.0.”
If you don’t speak labwork, it means this person is showing a major spike in inflammation. It’s confusing because she feels great, but her body is showing a dramatic elevation in inflammatory markers like LDL and CRP. And these results are not uncommon in those on a ketogenic diet. They are sometimes temporary as your body adjusts to a higher fat diet. Or it could be that this person doesn’t tolerate dairy, which may contribute to inflammation (keto diets encourage heavy cream and cheese); it’s too much animal fat for her physiology; or it’s not enough vegetables for her. After all, veggies and fruits are our highest antioxidant foods, and they are strictly reduced on a keto plan. Antioxidants squash inflammation and free radical damage.
Keto, Low Carb Diets, and Gut Bacteria
Fruits, veggies, and legumes also feed the beneficial bacteria in your gut, and we don’t know the long term effects of reducing the fibers and starches these bugs need to keep you healthy. Again, keto is a spectrum, so some people may be drastically limiting the carbs they were eating (which, if refined junk carbs, is a good thing). In this case, a ketogenic diet is low fiber because of the strict carb restriction, and many people suffer constipation as a result after transitioning to keto. Fiber deficiencies *may* harm our guts and the population of friendly bacteria, your microbiome.
On the other hand, if a person was transitioning to a more plant-based keto diet from a refined carb diet, they may actually see a benefit to their gut flora when going keto. It depends on the person. Still, I recommend a probiotic like this one for keto folks.
Our gut bacteria modulate inflammation and immune response. High fat diets can adversely affect your beneficial gut bacteria. They need prebiotic fibers to thrive, and if they don’t get fed, they die. Reduced gut bug population could mean trouble in the long run; HOWEVER, other bacterial populations may bloom and thrive on a low carb diet. And if you become a healthier host as a result of your lower carb diet, you will see healthier bacteria grow. Conversely, if you feel terrible on a ketogenic diet and better on a diet with more fiber and vegetables, you will have healthier populations of gut bacteria and be healthier overall. So fiber content and resulting effects vary person to person.
And speaking of fiber, a large body of literature on centenarians (those who are 100 years old or older) shows that they often follow higher carb diets. Mind you, I’m not talking about bread and pasta and pizza, but detailed studies of centenarian diets show that over 80 percent of calories in their diet comes from vegetables, fruit, legumes, and complex carbohydrates, such as whole grains, brown rice, oats, and sweet potatoes. That’s a strong clue that the relationship between healthy carbs and fiber and the diet and longevity is a largely beneficial one. (source)
Side note: Whole grains won’t work for everyone, and I personally think humans fare better with lower grain and higher vegetable-based diets. I’m just citing the study above.
Check out my article on the Blue Zones (the areas with the highest numbers of healthy centenarians) for more on their diets, which all have one thing in common: On average, they’re 95 percent plant-based. This book (<–click link) on longevity research, fasting, and diet is fascinating also. Point is, longterm studies on the people who live the longest and are disease-free show their diets are not chronically high in fat and protein, but rather rich in all types of plant foods.
Keto Flu
Another common effect of the ketogenic diet is the “keto flu”: fatigue, lightheadedness, and dizziness people feel when they suddenly and greatly reduce their carb intake to get into ketosis. This effect should go away after you adjust, BUT yet another doctor colleague of mine had a patient sent to the ER due to severe electrolyte imbalance during the keto flu phase (proponents of keto will tell you to take electrolyte supplements to ensure this doesn’t happen, and you should. Regardless, that risk is scary!). AND staying on keto for a long time may lead to kidney stones, liver issues, high cholesterol, constipation, slowed growth (in young people), and bone fractures. (source) This study shows that a high fat ketogenic diet caused insulin resistance in mice.
There’s not a single historic traditionally living human population that was in chronic nutritional ketosis. Even the Inuit, who mainly subsisted on fatty whale, seals, and fish, were not in chronic ketosis because they developed genetic mutations that prevented them from overproducing ketones. (source)
The Paleo Mom has an excellent article here documenting adverse reactions (unwanted or dangerous reaction) and supportive scientific literature on keto diet dangers.
Should I Try Keto?
So you’ve probably gathered that I don’t recommend a keto diet long term UNLESS you are monitoring your blood work and your markers look great. Even then, we still don’t know the long term effects of such a low carb diet on your organs (it’s potentially stressful for your liver to be producing ketones) or your gut flora, and those bugs literally make up more of you than your cells, so they’re pretty important for longevity.
According to Dr William Davis (author of Wheat Belly),
Short term, however (think 6 months or less), the diet can be very effective to help you reverse chronic conditions or jumpstart weight loss, especially if other methods aren’t working. You can use keto to reach your goals, then determine your ideal long term diet after your keto jump start.
There’s enough evidence that shows increased lipids are a known and predictable consequence of a ketogenic diet, so that’s a risk to consider. If you have epilepsy or diabetes, or you’re obese, keto may be a great choice for you (how long depends on you). There’s even promising research on a ketogenic diet for cancer treatment.
There is even more controversy when considering the effect of keto on cholesterol levels, however. A few studies show some patients have an increase in cholesterol levels in the beginning, only to see cholesterol fall a few months later. However, there is no long-term research analyzing keto’s effects over time on diabetes and high cholesterol. (source) Note that high cholesterol (over 250 total) is a sign of inflammation in the body.
A keto diet can be dangerous if you have certain health conditions (that you may not be aware of) such as
- kidney disease
- fatty liver
- low thyroid function, hypothyroidism
- adrenal fatigue or hormone imbalance
- women with irregular cycles
- history of eating disorders
I do not recommend keto for people with hypothyroid, adrenal/mitochondrial fatigue, or chronic constipation.
I also have doubts about how well women fare on keto. Women often don’t do well on such low carb diets, because we have very delicate endocrine systems designed for reproduction. Renowned women’s health Dr Sara Gottfried says, “My anecdotal observation in my medical office and working with people online is that men perform better in nutritional ketosis compared with women, particularly women aged 40 and older. My female patients, myself included, have more problems on keto with their stress hormones (i.e. producing too much cortisol), thyroid function, and may develop menstrual irregularities. At the root of these problems is dysfunction of the control system for hormones, the hypothalamic-pituitary-adrenal-thyroid-gonadal (HPATG) axis.” (source)
The body senses famine is ahead when deeply restricting carbs and responds by shutting down fertility (via thyroid function) because it’s not a safe time to reproduce. I’ve worked with many women who are recovering from trashed hormones from doing keto, and some studies indicate very low carb diets can affect thyroid hormone production and conversion. (source) That said, I have seen keto be an effective weight loss tool for post-menopausal women when used for 3 months or less (anecdotal), and it does seem to work well for PCOS, probably because it reverses the insulin resistance associated with this hormonal imbalance.
Dr Gottfried also notes that up to 45 percent of adolescent females have menstrual irregularities on the ketogenic diet. JJ Virgin also only recommends keto short term. (source)
Other questions to consider include the following:
- Do the benefits of the diet outweigh the risks with what you’re using it for?
- What are the long term health impacts from a high fat diet?
- How does a high fat, moderate protein diet impact long term kidney and liver function? Gall bladder?
- Is a ketogenic diet appropriate for women, or will it harm fertility, hormones?
- How long should children go keto to treat epilepsy?
- Do you have hypothyroid issues or Hashimoto’s?
If you’re considering keto, please monitor your cholesterol laboratory results to gauge inflammation (you can even order labs yourself via Direct Labs or EverlyWell). Ketogenic diets can work wonderfully for some people, but ask yourself is this diet right for me, and what do my labs show?
Bottom Line: TL;DR
A ketogenic diet is a therapeutic diet that can be used to reverse health conditions like epilepsy, insulin resistance, obesity, diabetes, and even cancer. But it may not be safe long term, and not everyone will thrive on keto. Dr Gottfried also says, “There are at least ten genetic variations that may make a person less likely to benefit from keto.” (source) That’s quite fascinating, actually, as we enter into a era when we’ll have genetic testing available to tell us exactly which diets are genetically appropriate for us. No more guesswork.
Even Paleo/primal expert Mark Sisson says, Not everyone needs to be on a ketogenic diet. Even fewer need to be on a ketogenic diet for life. I’ll admit to being a bit leery of long-term, protracted ketosis in people who aren’t treating a medical condition. It just doesn’t seem necessary.” (source)
For certain folks, the ketogenic diet can be too much fat or too few carbs. Many health professionals, myself included, recommend using a ketogenic diet for a period of months (less than 6) until results are achieved, then reintroducing more healthy carbs such as veggies of all types, starchy root veggies, and legumes (if appropriate for you) and determining one’s carb tolerance for the long term. We need more studies and a thorough understanding of the pros and cons of keto before making generalized assumptions about it. No one single diet will be right for every person.
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Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. She combines a science-based approach with natural therapies to rebalance the body. In addition to her 1:1 coaching, she offers courses to help you heal your gut and improve your health. Mary lives in San Francisco and Lake Tahoe in Northern California. Read more about her coaching practice here and her background here.
It seems most people who follow a Keto diet long term limit their NET carbs, not their total carbs. They eat plenty of vegetables.
I went on KETO twice in the last year. I felt unbalanced and developed an aversion to the richness of the foods I was supposed to be eating. It just wasn’t worth it. I didn’t need to lose weight. Now I’m just eating what my body craves and I feel much better.
This is great information, thank you. This answers my question of what’s next? I’m a 60 yr. old man and I’ve been on Keto for three months now and lost 33 lbs of fat! Like any diet, it should be tailored to the individual. Most of the carbs in my diet are from veggies. Zucchini, eggplant, spinach, avocado, mushrooms, low carb tomato sauce are all a big part of my every meal. I love my veggies! I’ll have blood work done next month and report back. No diet is verbatim, so be careful!
As per above comment, the general requirement for verges is 10 cups of greens daily. That is more than what I usually take.
Agreed with the comment above. Actually keto encourages 8-10 cups of vegetables a day. Read Dr Berg, Ken Berry or a few other high profile keto advocates. Combine that with healthy fat and moderate healthy protein and it IS a long term diet. I don’t know why people post articles that are not accurate.
Im not sure what would make you believe keto diets are high in dairy. Vitamin d, 2% and fat free milk are incredibly high in sugar and not recommended.
The only alternative is heavy whipping cream which can only be used to an extent. Almond and milk and coconut milk are awesome alternatives without any dairy.
Also vegetables arent cut in the diet – its a huge aspect.
Doctors also heavily recommend Keto to PCOS insulin resistant women with a lot of great results including my own.
A lot of this information is misleading.
It’s true that people without epilepsy have only been using keto for a short time and diet research funding is very low, so we don’t have many studies. I can only speak for myself and the patients I have on keto. However, my experience has been the exact opposite. I’ve seen reversal of fatty liver, and hyperlipidenia in patients on keto. My lipids after 3 years of keto, are total cholesterol 145, LDL 60, VLDL 9, and normal CRP. I am one of the only people in my family without diabetes. It may not be for everyone, but for some people it does work very well.
Oh please. What kind of credential is N.C. The proof is in the numbers, especially for diabetics…reduction in FBS from 220 to CONSISTENTLY below 120 in 4 months AND a 25 pound weight loss is nothing to sneeze at. How old is this article anyway? This person is clearly not up on the latest studies and seems to buy into the outmoded demonization of meats and fats. One of the ways keto works is satiety occurs sooner and with fewer calories than with SAD. I eat plenty of leafy greens and broccoli, cauliflower, etc. I also eat lots of berries. If you’re going to write an article like this, get up to speed on the latest studies and tell the truth.
Unfortunately you draw many conclusions that are not scientifically based. I would have hoped for a more comprehensive review, rather it is full of unsubstantiated assumptions in an attempt to prove a point.
Here are a few concepts you should study more upon:
– Ancient man (prior to grain farming) would hunt in the morning, eat 1-2 meals in the afternoon, and maintain in a state of ketosis. This is what most that follow this lifestyle strive for: intermittent fasting and ketogenic diet. I didn’t see anything about intermittent fasting in the article, the 2-normally go hand-in-hand.
– I agree that children should include higher carb diet than adults. Keto in children is normally restricted to those that can benefit from an existing medical condition. Point should be that children should not have long term carb restricted diets, but keto cycling may be appropriate. This does not presume the same for adults. Each have totally different nutritional needs.
– High overall cholesterol is not a bad thing. The medical profession has flip-flopped when it comes to proper cholesterol levels and related food consumption. The focus and attention should be on ratios, not overall cholesterol.
– The Keto diet emphasis mostly vegetables that grow above ground, these tend to be lower in natural sugars/carbs. You elude that the keto diet does not allow for sufficient vegetables. This could not be further from the truth. If a person does not consume sufficient vegetables, it means that a person is not properly educated in the ketogenic diet. With any diet, education and understanding is key.
– Vegetables do provide carbs, but are offset by fiber. The ketogenic diet is about net effective carbs. By looking at the carb content (grams) of your vegetables and subtracting the grams of fiber, determines net effective carbs.
– To say “ANYONE” is not fair. There are many that have benefited from long term ketosis. I would even go as far as saying that everyone could benefit from short term ketosis (the only exception may be Type 1 Diabetics).
– Some may need to cycle on and off from Keto to maximize the benefits
– My last comment, Cancer patients can use keto short term to slow progression, but then should transition to Gerson Therapy diet for long term healing. Keto is not effective for Cancer long term.
Sherri, 10 cups of veggies per day would range around 200-250 total grams of carbs. To stay in ketosis, most people must limit carb intake to 35 – 50 total grams of carbs/25 grams net carbs. 2 cups of veggies contains 48 grams of total carbs, for reference.
Thank you to everyone who has chimed in thus far. These debates are useful. However, please be respectful. It’s easy to sit behind a computer and hurl insults, but would you ever speak like that to someone’s face? I do not tolerate that kind of BS on my site. Please move along.
Now then, to address the negativity, I am not bashing the ketogenic diet. This post is filled with keto’s benefits. What I am saying is that THE DIET DOES NOT/MAY NOT WORK FOR EVERYONE. You should monitor your blood work to make sure it is working well for you. And if it is, great! But that doesn’t mean everyone should blindly follow a diet just because it works well for you personally. This is a diet that has documented adverse reactions, including death. People need to be informed about all aspects of any diet they choose for health. And we don’t have long term info or studies on how the ketogenic diet affects the microbiome, which is critical for overall health. There are questions about potential negative effects of keto long term (more than a year). And that’s how the scientific process works: evaluating and reevaluating. I’m really sick of this rudeness (looking at you, Inga. What are your credentials?).
Mary Vance. I’m curious as to what veggies you used to get your calculation of carbs. Also did you subtract the fiber to get the net carbs, or is that number just the total amount?
Mike, I am using total carbs. Typically about 35 grams of total carbs and 25 grams of net carbs is the standard. But when it comes to calculating net carbs, it’s not so black and white when you’re dealing with both soluble and insoluble fibers. In fact, studies show that soluble fiber can be absorbed and used for intestinal gluconeogenesis which was thought to increase blood sugar and therefore affect ketosis. In terms of total vs net carbs, that again depends on the person and their health goals. Some people are very carb sensitive and will be affected by certain starches/fibers in carbs whereas others may have little to no impact. Whether or not you count net vs total will depend on how you react.
Not all veggies are created equal. Different carb counts. Aprox. 3 C. Of Romaine lettuce is about 3 whole carbs.
Sara, yes. But one needs a diverse array of veggies of all types ideally, as they all provide different antioxidants, minerals, fibers, and disease-fighting nutrients.
Kidman, those are mostly good points, but it’s not so black and white. For example, some people may not be able to get into ketosis counting only net carbs. Also there is evidence that soluble fiber may affect blood sugar, so the type of fiber matters. All that aside, focusing on low carb veggies only means excluding particular fibers and starches your gut bacteria need to thrive. Regarding cholesterol, you’re correct in that the standard medical “high” cholesterol numbers are fairly meaningless. In fact, I wrote a whole post about it to dispel some myths: https://www.maryvancenc.com/high-cholesterol/
But high LDL and very high overall cholesterol can indicate inflammation, which is why it’s important to track CRP and other inflammatory markers. And finally, your assumption about cancer treatment is just that: your opinion and an unsubstantiated claim. Can you provide any scientific studies that support the use of using keto to “slow” progression, then transitioning into the Gerson diet?
I’m glad to see that not everyone agrees with this post. While I ALWAYS agree that people need to find what works for them and listen to their bodies, this article is very misleading. Too many people in my life have found Keto to be an amazing plan that works for them. Lab work backs that up over a few years as well. So, basically everyone just needs to listen to their bodies. Do not let the info in this article deter you from trying the keto lifestyle as it’s benefitted so many on my life personally. Then, if it’s not working for you, fine! But I certainly love how I feel when I’m keto, and my labs say my body does, too.
Yes, there are adverse reactions to his diet… and to any other diet. Do what is right for you.
At the same time, it seems not enough research has been done on this article.
I found this article to be well balanced in it’s presentation (pros and cons) with excellent sources linked to substantiate the data cited. Personally, I believe the Fasting Mimicking Diet outlined by Dr Valter Longo is more beneficial than the Paleo Diet and with less potential side effects (for me personally). I would be interested in reading your critique on the Fasting Mimicking Diet, Ms Vance. Thank you for your objective and educational blog.
Correction to previous comment
I meant to say Ketogenic Diet – not Paleo Diet
Apologies,
Ok. I totally don’t think you should take this down . I also don’t totally agree with you . I belong to a keto group on Facebook and have seen the results from real people over time (and their labs )before and after . I tried this diet and found it difficult for me to feel nurised or satisfied. It’s popular right now so people are sensitive about it. Everything has pros and cons and people are just trying to be the best versions of themselves. That being said ——- Bread is life .
Keto isn’t for everyone. I lasted three days, developed an inflamed gall bladder and had to spend hundreds of dollars for an ultrasound to make sure I didn’t need surgery. Our bodies need fruit, it’s the best detox tool for our lymphatic system and food for healthy flora in our gut. Keto is a diet, which isn’t long term. If you’re on keto make sure you’re getting your blood work checked no matter how old you are. I’m now happily following a moderate protein, good carbs and healthy fat diet. Finally saw reduction in PBF.
Ok so you’re saying to use it therapeutically and then go back to eating the way that got you there? What would you recommend to someone that heals from it and then you tell them to stop? That alone makes no sense. I personally follow Dr Berg (mainly) and several others in practice who recommend plenty of vegetables healthy fats and proteins. Also promote eating foods that act as pre and probiotic for our gut flora. Lost 18 lbs in 3 months and my health is great. There are many studies reflecting the impact of sugar and “bad” carbs on the human body. Please do more research.
Holly, no. Where did you get this from the article? Where do I say to go back to the way you were eating before? Come on. I say, and I quote, once results are achieved to “reintroduce healthy carbs such as starchy root veggies and legumes and determine one’s carb tolerance for the long term.” Some of us have different carb needs. Some people will naturally need to eat lower carb while others have a higher demand for carbs. It depends on the person. You can determine you carb tolerance via trial and error, genetic testing, or glucose monitoring. Keto can be a great baseline to heal metabolic damage, then you can determine your carb tolerance long term. It’s often recommended to include starchier carbs at the evening meal, with more protein and lower carb during the day to support healthy cortisol rhythms. And starchy veggies (and some legumes and gluten free grains) in particular convert to tryptophan which converts to serotonin which converts to melatonin to support healthy sleep patterns. Seriously, where on this entire blog would I ever recommend people go back to how they were eating before? The entire point of my job is to disengage people from their poor dietary habits and instead provide them with a long term, sustainable, health-promoting whole foods diet, whatever that may look like as appropriate for their physiology.
Mary, thank you for posting this great article shedding another opinion on the praised keto diet. I tried pairing keto and intermittent fasting together back in December, and like most results instantly lost 5 lbs, love handles and had an overabundance of energy. However, I actually described these same affects to friends with ‘a dark side’ because of a few other things I noticed: I experienced a hefty dose of ‘the dawn phenomenon,’ something that happens where I’d wake up extremely early, say 5-5:30, sometimes 4:30am, and be fully energized. To some this may sound great, but it was not a nice, slow wake up, it was more of a jolt of energy as if I was on drugs and could not go back to bed. My energy was focused, and for the first few days I found it awesome, but then craved feeling normal and getting a sound sleep. Secondly, I wasn’t working out and lost weight without it, however when I went for a run or did hot yoga (which I regularly do both of), my heart was beating out of my chest and I could barely last for 20 minutes without feeling faint or like I was going to pass out. Third, I grew a fear of carbs and noticed my love handles returning or a small belly even if I ate a sweet potato.
Although the quick and easy results that IF and ketosis combined gave me, I did not feel they were sustainable long term, I value having energy to exercise daily for the mental and oxygen-boosting, even spiritual benefits those grant, rather than being energized through not working out. I know it’s different for everyone, and I love what keto taught me in managing and being aware of my macro intake, and time of eating, but definitely agree that people need to beware and truly check in with themselves. Even Dave Asprey in his Bulletproof book states that keto should not be done for over 1 month. Keep up the amazing work and for all the trolls out there, move right along!
Mary, what kind of (if any) research do you know of that has been done with this diet and the inflammatory bladder disease “ICS”? Just curious if anybody with this has tried it out.
thank you for writing this article. I finally feel like someone has heard me!
My thyroid function is screwed up and I now have low progesterone. My periods are every three weeks. True, I have not gained weight (except when i am bloated than it is 5-6 pounds of painful stomach issues), but I have not lost any weight either. Peole still ask when my baby is due and I am not pregnant.
Kudos to the thousands who can make this work. I for one am making myself sick over the disgusting fat sources I am supposed to eat to satiate a hunger. I am ALWAYS hungry! And I am tired of havimg the green bean and an apple as The Enemy.
I don’t know what to do to loose weight, 5 full months of my very best attempt at KETO isn t the dream promised for me.
So keep your comments on what you did to yourself. I have tried whatever it is you did with no results.
Hi Nichol, I haven’t researched the use of keto for interstitial cystitis. I do know that ICS is linked with overgrowth of certain bacteria, such as strains of e coli, so consider a stool test and reworking your microbiome. And for any inflammatory condition, an anti-inflammatory diet helps: https://www.maryvancenc.com/anti-inflammatory-diet/
Keto eliminates many of the sugars and starches that feed bad bacteria, so it very well could be therapeutic for this if you’re doing a gut protocol to kill bad bacteria. And if you’re overweight or have any other metabolic issues that fuel inflammation keto could help for that in this instance also. I’m just speculating here. But the key for a healthy microbiome long term and to prevent recurrence is diversity in starches and fibers that feed your gut bugs.
The food pyramid universally recommended by doctors and dietitians was adopted without long term double blind studies, but no one is warning about that unknown entity despite the fact that Americans are less healthy than they were before it was touted as the only way to eat.
Hi Thanks for the article! Very interesting perspecive…
I have been on a keto diet for a year or so T2D diagnosed a couple of years ago…Since adopting lost 30lbs, off all meds (5) BS normalizing.
Yes my LDL went up to 135 but my HDL doubled from 38-75! and my triglycerides dropped from 130’s to 66!! Even with the high LDL cardiologists are saying this combination lowers risk of cardiac disease.
This is a b.s. Article we all know the risks and how to balance then at this point. More electrolytes and primarily leafy greens take away all the negatives. Plus the cholesterol measurement is totally misunderstood by all health care providers it’s a false measurement unless you eat high carbs. That being said just listen to your body if you feel good it’s ok.
I have been following a Keto lifestyle for 4 yrs and I’m healthier now than I have ever been. I have an autoimmune disease and my inflammation markers are lower now than they have been in 15 years! I did extensive research before trying Keto and I still think that because of my insulin resistance it’s my best option. This article is your opinion because there are studies available if you look for them but big pharma doesn’t want people to know they can reverse their type 2 diabetes because it effects their bottom dollar!
Mike, so you’re saying we shouldn’t research potential effects of how a diet may affect us? We should just go ahead and assume it’ll all work out OK? Is it true that “we all know the risks?” That’s a pretty generalized statement, and it’s myopic to assume everyone understands all sides of how any particular way of eating affects their health.
I like having feedback from any sources just so I can use it for reference while trying any eating plans so I have ideas on what to expect good or bad. I’ve been on keto about 5mos. I didn’t get the great weight loss others mention so soon but I mainly started Keto because so much trouble with my stomach & bowels. Killer heartburn ugh. 1 mo or even 6mos wouldn’t have worked for me. I DID get the immediate relief to my stomach issues. I never had constipation but have the opposite loose. I definitely wanted to lose weight but is coming off very slow, currently down 16lbs. I still have long way to go, about 50-60 at least. I’ve gotten my labs done twice and numbers are coming down some but my labs weren’t that bad to start so down few points ok by me, I only got labs too make sure I wasn’t killing my self with the increased fat. I’ll keep monitoring labs to make sure Keto stays ok for me. I’m 52 menopausal, had gallbladder removed about 15 years ago and had hyperthyroidism in my 20’s. I’m feeling pretty good overall but still have aches and pain that thought was inflammation, not sure now. Love everyones feedback and opinions, very informative. Thanks for article. (Ignore any typos or misspellings per had trouble with glitches)
As for my experiences with keto, it is a no go for me. I have painful gallbladder attacks while attempting to be on this diet due to the high fat content and the dairy. I’m so lost at this point because I also cannot eat how I used to, so I am still searching for a diet to benefit me. Thank you for your opinions and this article. My primary care physician also says the same about the increased cholesterol levels and since mine are less than ideal already, she does not want me to be on it at this time. My OB/GYN recommended the keto diet but was not aware of my other issues (my fault).
I was on the Keto diet for 3 months, I felt great in the beginning, followed every guide line, drank plenty of water, including electrolytes, added suppliments to my diet. After about a month, once I was in Ketosis I began experiencing severe abdominal pain. I ended up in emergency by ambulance. It was horrible! Doctors found nothing wrong with me, however, my blood pressure was pretty low. I quit the diet, and went back to a healthy diet full of every nutrient. I am so much better now. I loved the fact that I lost almost 15 pounds, but in the end it was not worth it. It was pretty scary.
I enjoyed the article, especially the link to the cancer study.
As a two-two-time survivor my interest in Keto stems in starving cancer if it reappears.
Weight loss isn’t an issue so I’m more interested in a healthy diet that prevents an increase risk of reoccurence. My husband is a survivor too, so I want to protect him as well.
We’ve both had 35 Rads/7Chemos for H&N. I had hyperthyroidism pre-treatment have he’s prone d/the radiation.
We have already decided to go with the option of “carb ups” and monitor our lab carefully. My BFF is a Nutritionist married to a Physcian and we’ll be supervised closely.
I am also looking to reduce inflammation as we both have autoimmune disorders.
Thank you for your information. I agree we need to be informed and listen to different researched options. I started Keto 5 months ago to help my Husband who was diagnosed with Alzheimers the Keto way of eating is recommended by some very knowledgeable and researched doctors who I respect a lot. So this protocol is recommended. I as a bonus lost 9 pounds of fat gained 2 pound of muscle and the same in bone mass.
Feeling great is new in my life. When I do my shopping all I see in others shopping cards is packages with low-fat high sugar junk food
To know children start the day with cereals full of sugar orange juice full of sugar no wonder they feel terrible and hyper a couple of hours later. But I agree this lifestyle is not for everyone it is work and research to do this the right way.
There is an Alzheimer and diabetics epidemic going on . So try the alternative to get people out of hospitals and of medications that are prescribed very freely without giving nutrition a thought.
I am doing a keto diet for 10 months and I would really like to know if there is really bad effects of keto. As for keto flu it is temporary. This article is very very vague. Can we get some reference to some kind of research content. Saying keto “might” be bad in long term does not mean much as long as there is no solid grounds. High Cholesterol is not always a bad thing.
Bidisha, that’s the whole point of this article– we don’t KNOW the long term effects of a ketogenic diet because there have no been long term (a period of years) studies to date. That is the entire point here– that WE JUST DO NOT YET KNOW. It was designed to be used temporarily and therapeutically for certain conditions.
Kids using the keto diet for seizures are on it for years, if not a lifetime…
https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet
Can the diet ever be stopped?
If seizures have been well controlled for some time, usually 2 years, the doctor might suggest going off the diet.
Usually, the person is gradually taken off the diet over several months or even longer. Seizures may worsen if the ketogenic diet is stopped all at once.
Children usually continue to take seizure medicines after they go off the diet.
In many situations, the diet has led to significant, but not total, seizure control. Families may choose to remain on the ketogenic diet for many years in these situations.
It’s all right there, on credible sites, from credible organizations. The Charlie Foundation was started by J.J. Abrams – his son’s name is Charlie.
(look up J.J. Abrams if you don’t know who he is)
Jack, the article you linked also states:
“Other side effects that might occur if the person stays on the diet for a long time are
Kidney stones
High cholesterol levels in the blood
Constipation
Slowed growth
Bone fractures”
Yes, the diet is therapeutic for epilepsy. We know that. Even so, there have been documented adverse reactions (including death) in children on the diet longterm. This article by the paleo mom explains further: https://www.thepaleomom.com/adverse-reactions-to-ketogenic-diets-caution-advised/
“Five scientific papers have reported deaths as an adverse effect from long-term ketogenic diets (here’s the citations: Stewart, et al., 2001, Kang, et al., 2004, Kang, et al., 2005, Bank, et al., 2008, Suo, et al., 2013 and make sure to check out the free PDF download of my Literature Review at the bottom of this post which contains details on all of the papers reporting adverse reactions). Two of these papers are case studies, and the other three are papers derived from two separate clinical trials, all studies in epileptic children. Some of the deaths can be attributed to extra complications from secondary conditions or accidents that befell the child during the course of the clinical trial; however, other deaths—most typically from severe infection or heart disease—are attributed directly to long-term ketosis.”
Again, it doesn’t mean that longterm ketosis is a 100% no-go. It just means more research is needed.
I like Mark Sisson’s approach to keto. He recommends going strict keto (starting at 50 carbs per day, modify lower if needed) and after that eat a healthy, whole food diet. I believe he thinks it’s better to go in and out of ketosis naturally, and do a 6 week keto reset once or twice a year if you want. What I really liked is that in his approach vegetables are the bulk of your food. No bulletproof coffee or fat bombs.
Jenny, I recently ran across a post of his about going in and out of ketosis. I’ll research that approach more, thanks for sharing.
The long story short, was’nt. When you mention inflammation on the ketone “lifestyle” you disregard the serious health problems caused by inflammation from eating carbohydrates. I am eating more fresh vegetables than I ever did more than 4 years ago when I changed to the ketogenic aka banting lifestyle. This is not simply about weight loss. I had serious problems with Osteo Arthritis often having cortisone shots in my knees and elbow to ease the problem. Since changing I have never experienced these problems again. I am 68 years old and only just retiring. I have more energy now than I did in my late fifties. We are proud of and grateful to Dr Tim Noakes who promotes the ketogenic way of life in South Africa, because it keeps his insulin resistance at bay, when nothing else would and because of it’s health benefits. He formally was a proponent for carbo loading as a source of energy for running sports until the penny dropped. We have recently had a landmark case in South Africa where he was challenged by the South African Dieticians Association for “giving medical advice” on ketogenics to a mother who was looking for advice about her baby. They lost their case. I will never go back to carbs.
Greg Bauermeister: you say “I will never go back to carbs” and mention you are “eating more fresh vegetables than ever.” If you are eating vegetables, you are eating carbs. anything that is not a protein or a fat is a carbohydrate. You’re failing to distinguish between inflammatory carbs (breads, pasta, processed carbs, refined carbs, sugar, or high glycemic carbs like white potatoes) and beneficial carbs like vegetables (of all types, even the starchy root veggies). Grains are also carbs, but some people, esp those with inflammatory conditions, may not fare well on grains either. The point is, if you were eating inflammatory grains or carbs prior to cutting those out via a ketogenic diet, of course you are going to have relief from inflammatory conditions. THE TYPE OF CARB MATTERS. If a ketogenic lifestyle works for you to treat a medical condition, fine. It may not be right for everyone, and as Mark Sisson even says, “I’ll admit to being a bit leery of long-term, protracted ketosis in people who aren’t treating a medical condition. It just doesn’t seem necessary. Not everyone needs to be on a ketogenic diet. Even fewer need to be on a ketogenic diet for life.”
Wow increase legumes? Have you no education in how harmful lectins in many veggies and legumes are for the gut?
Debbie, have you no education in biochemical individuality? That means what works for one person will not work for another. If you have an inflammatory condition or autoimmune disease, legumes, grains, and nightshades in particular may not be ideal for you. But legumes contain fibers and starches that provide our gut bacteria with ideal prebiotics to feed our probiotics for a healthy microbiome, the base of your digestion, ability to absorb nutrients, and your immune system. One theory about the increase in digestive issues and autoimmune conditions if that more than half of the population (even up to 80%) has a compromised microbiome due to poor quality foods and restrictive diets (and antibiotic use). The more restrictive your diet, the more you are starving your beneficial bacteria population (a grave concern for those who follow AIP or keto diets longterm). Some people are fine with legumes. Not everyone has to avoid lectins. If it works for you, great, but you can’t make sweeping generalizations about how certain foods affect everyone. Legumes can be one person’e health food and another’s inflammatory food.
PS I said to INTRODUCE legumes. If they work for you, fine. If they cause bloating, pain, flares, or other inflammatory symptoms, that’s your body’s way of saying they do not work for you.
Do you have any information about intermittent fasting in combo with keto. I’m testing out 22:2 fasting, 22hr fast/2hr eating. I eat a balanced keto dinner 5-7pm, fat/protein/carb macros are lower and calories lower than 2 meals a day. Nutritional fats are lower so body fat is used.
Wow Mary, you troll the comments on your own article and are pretty angry about it. I understand the need to try to correct people but maybe your information isn’t as solid as you think and that’s why you have such a long steady stream of negative comments. I’m two months into Keto and am still researching and fumbling around. Went through the flu and am down 18 pounds. There’s more reasons for most of us sugar poisoned food addicts to do it than not. No matter what you’re trying to prove by snapping at people here in the comments I’ll tell you that as an open minded person your article read like a huge scare tactic despite whatever good intentions you may have had. If you believe in your work and your sources and what you got from them might I be so bold as to suggest you settle down and let your article speak for itself?
Hi Lorri, thanks for your comment. You’re exactly right. I respond in kind to the tone of the messages I receive. Take a moment to read some of the comments that people post, and you’ll understand that it’s easy to sit behind a computer screen and forget about courtesy or respect to someone else’s research and work. As I stated earlier, I welcome thoughtful debates, but I have a zero tolerance policy for people who a) don’t read the entire article before commenting, and b) insult me, my resources, and/or education (bonus points for mansplaining). I can be dramatic, so yeah, it may come across as defensive and snappy, but the interesting larger point I’m seeing here is that people are so fiercely defensive of a diet that works for them that they assume it’s a panacea for everyone. I’d like people to do the research and get the facts and understand that only researching the positives doesn’t count, even if all you are experiencing is positives. I think it’s wonderful if a ketogenic diet works to get you off sugar, alcohol, diabetes meds, or to clear up arthritis. But please put the in the time to understand the long term impacts and to think objectively.
PS are you skipping over all the comments where I’m nice?? 😀 😀 😀
The long term affects are being studied by those that have been on the diet long term. That’s the beauty of the never ending reach of social media. We read each other’s stories, good and bad. We’ve already seen the long term affects of the SAD that has studies done and squashed so what do we really have to lose here? We believed our doctors and the AHA and thought we were all pieces of crap with no will power. We never knew that the way our bodies processes carbs made it impossible to gain control the way were told to. All of this arguing about vegetables and nutrients and most of the people on this diet were killing their bodies (me included) with fast food, processed food, and everything in between. This diet has made me pay more attention to what I’m eating and making sure it’s balanced. By default you’re eating good things if you’re doing it right.
I’ve been eating keto for 5 years. Never ‘cheated’. Never felt better. I have FH and I used to take statins, which made me unwell. My total cholesterol remains high (600+) but triglycerides, CrP, thyroid, liver and kidney test results are all fine. I think people who use keto to indulge in low carb but unhealthy foods, or too many omega 6 foods, will obviously have more inflammation as a result. I’m pretty certain that what I eat (below 20g net carbs, entirely home made meals, pasture-raised animal produce, wild fish, organic fruit and veg. including high fibre ones, roots and pulses, a few nuts, cold pressed oils and home made desserts) is healthy and I would never go back to my previous carb life. I don’t take any meds whatsoever, not even paracetamol, as I never get headaches. I’ll be 55 next month but I feel decades younger.
I know keto is great for some people, but you’re right that it’s not for everyone. My sister and her husband had been doing keto for over a year and were both trim, healthy versions of their former selves. Then he had a heart attack. Despite being careful about their fat choices, it affected him differently. They had to start a whole new eating plan to avoid so many fats. The keto diet just isn’t for everyone!
For one thing, there are not many doctors that know anything about keeping people healthy, they are trained to manage medicine. Keto is not really a diet, it is a lifestyle, a lifestyle that I intend to live the rest of my life. I have had ankylosing spondylitis since I was a teenager. I spent all of my 20’s and 30’s following doctors advice and taking lots of medication. I ended up with an artificial hip at age 35 and a case of the shingles that led to partial paralysis of my right arm. I also have had renal insufficiency for 20 years. I have been keto for 2.5 years. I had a checkup and blood work after being keto for 2 years and my kidney function is normal. I’m now 45 and I am not taking medication and feel better than I did in my 20’s. I will say it is not always easy living this lifestyle as there is not always good choices of food when you are away from home and I don’t drink alcohol any more.
I posted earlier ^^^. Not sure if it’s OK to do this, but it may help those following the keto lifestyle or considering it. Keto-foods such as farmed meat/fish, packaged foods, and cheap, manufactured (albeit low-carb), products, are known to be pro-inflammatory. My blog QUEENKETO.COM offers plenty of low-carb ideas, often aiming for high omega 3s and fibre content, which is essential for a healthy microbiome. Sorry if mentioning my blog is inappropriate.
Anyta, that’s fine, thanks for sharing and asking.
I really enjoyed this article. I have been on the Keto lifestyle since January of this year. I really love it, but also know its not for everyone, (my mom would pass out when she tried it) I experienced all of the great benefits people talk about in the comments (weight loss, I wasn’t needing 10 hours of sleep anymore, my skin cleared up, and i was generally in a better mood) I do however, allow myself to eat “off of keto” if thats what you want to call it, when I go on vacation, go to concerts, special occasions. Im not talking plates full of pasta, but I do have drinks, potatoes, pretzels, more fruit than normal, and the occasional toppers pizza ;). I would say im in ketosis 80% of my life and out the rest. It’s all about what makes the individual feel good, and happy! I love feeling energized from keto,and i’ve always been a gym junkie, but i also love to eat a pizza and lay on the couch w/ my boyfriend:) One thing that was interesting to me about your article was the irregular periods.. I started experiencing that and attributed it to not being on the pill anymore and NEVER thought it could be from my diet, do you have any more info on that?
I know a lady who has done nutritional Ketosis for 20 years. Her name is Deborah Murtagh and you can find her on Facebook. I follow her program and have been on it for over a year. All keto programs are not created equal!
I have read this article and found it informative and some points are correct we do not know some of the effects on people in the long term.
I have learned through my own journey that there is not a diet out there that is suited to all people as every person is made as an individual and what works for one person may have a serious problem for another.
I agree with the author that blood tests are one way to keep an eye on the whole bodies effect. But if some I’ll effects happen but some benefits are also happening then the diet needs tweaking and that is when input from Drs, specialist and Dietitian is needed.
In a wrap up if you are doing a ketone/ Palio diet don’ Be discouraged be informed and use information like this as a tool so you can take control of your own body
I wish you all well in your own journey in life.
I call BS.
When the comments are full of attacks on the writers credentials, word choice, possible implications she’s shared… it’s an exhausting read.
Coming back with individual experiences that cannot possibly cover even 10% of the population, kills any chance for a intelligent conversation on the matters at hand.
I was hoping the comments would be filled with individual anecdotes on the myriad of tests we should consider, side-effects to be watchful for, et cetera.
I was hoping someone would touch on the invisible implications of the processed meats in play, even for organic products… the failing water supply and so on.
Oh Mary, we have so far to go if we are now going to act just as the medical community, USDA, et cetera… confuse the topic.
At some point you have to be accountable. We are all able to become nutritionists for our own body. It’s the only one you’ve got. These claims you hurl, won’t save you, should you ignore these warnings and make a grave error.
Please come to your senses…
Everyone has an opinion and keto may not work for everyone. I have tried low carb diets and have lost weight but they are very hard for me to stick to. I love, love, love carbs. My granddaughter is on keto right now and is doing great so I’m going to give it a shot. My thoughts are, no one will know if it works until they try it so hopefully it will work for me.
I’m a woman in my 40’s and I went on Keto in 2016 to lose weight. I had to stop the diet after a month because I developed severe anxiety verging on panic attacks starting three weeks in. I also didn’t lose weight on it unless I counted my calories. My mother in her 60’s tried it. She developed insomnia and anxiety and had to go off of it as well. We were told that our symptoms were caused by an electrolyte imbalance, but we were past the low carb flu stage.
My husband, however, does great on Keto and uses it a couple of times a year for a month to lose 10 pounds. He’s never had his labs done though, so we don’t see how his body is actually reacting.
This is a well written opinion piece but it is just that an opinion.
Kate, yes, you’re exactly right. This is my opinion, though I have offered research so the reader can make an informed decision. It’s entirely possible to cherry-pick data (see The China Study for a glaring example of this) to support one’s opinion, but I have presented both the positives and the negatives here. I still recommend keto to many of my clients, esp those with PCOS, stubborn weight to lose, and GI issues like SIBO, for example. I cited many experts: Sara Gottfried, Mark Sisson, Sarah Ballantyne, Dr William Davis, as well as studies that both support keto and warn us of potential dangers. But in the end, you’re correct: It is my opinion that we need to perhaps be wary of long term ketosis until we know more.
Tonya, yes, very low carb diets can affect female hormones. Dysfunction in the HPA (hypothalamic-pituitary-adrenal axis) and in fertility hormones (luteinizing and follicle-stimulating) can cause cycle irregularities or amenorrhea in as much as 45% of women on keto. Low carb diets may also affect T3 thyroid hormone production which can disrupt your cycle. There’s a lot of info and research out there on this topic. Here’s a brief summary: https://www.healthline.com/nutrition/low-carb-and-womens-hormones
While the long term affects of keto may be questionable, the long term affects of the standard american diet are VERY CLEAR.
Wendy, fortunately there are additional ways to eat rather than just following keto or SAD!
Hi, Mary. Thank you for posting such an articulate article; I have bookmarked it for later research and sharing. I live in a household of eight people, and we have been trying the Keto lifestyle for about three months now, with varying levels of success and satiety. I am personally not doing well in it, with symptoms of the Keto flu popping up frequently. I am not hungry or having any cravings, but I am often nauseous, low on energy, and emotionally drained with all the changes I am forcing my body through. While I am losing weight, I feel that it simply isn’t worth the illnesses. Being the sole cook of the household, I find it immensely difficult to appease everyone’s appetite and impulsive eating habits, especially when I feel like I’m about to keel over. I am neither the head of household, nor the main homemaker, but everyone else seems to be doing so well in this new lifestyle, while I’m struggling to make it fit all of our needs nutritionally. I have spent a lot of my free time researching this topic, and am finding it more and more difficult to support it fully. Though I have seen it work in others, especially with my uncle who is Type 2 Diabetic, my body is not so easily convinced.
I get it, Keto is not for everyone. I happen to love it. I have been Keto for a full year. Down 55 lbs, and some minor health issues are GONE (IBS, Plantar Fasciitis)
I just wanted to give my OPINION on your mention of fertility issues on Keto. I know of more than one woman who was able to conceive on Keto, when nothing else worked. (my daughter is one, and she suffered several miscarriages prior to Keto) A popular thread on Reddit is Keto Babies. Lots of testimonies of women who were finally able to conceive.
While I agree that Keto is not for everyone, it has made sooooo many lives better!! Including mine:) And my blood work came back last month (after 11 months strict Keto, 25 carbs or less per day) My doctor was very happy with the results.
Hi Lorna, thanks for your comment. What you describe could indicate underlying hormonal dysfunction, adrenal fatigue or hypothyroid issues. Or it may simply be too much fat for you. If you haven’t run blood work to check hormones and thyroid, that might be a good next step. Keto may not be right for you, but it’s also important to know if there is a hormone imbalance.
You had my interest up until you said keto was starvation. There are so many variations being put out there. Apparently you are basing that comment on one that likes the fasting plan. Ugh, you did not address the inflammation of joints and how this helps. I am just at a loss at how you can state starvation is a part of keto. So not about that.
Actually, Cathie, I didn’t say that. I quoted a source. The quote comes from The Paleo Mom’s (she is a scientist) article: https://www.thepaleomom.com/adverse-reactions-to-ketogenic-diets-caution-advised/
and she says (and I quote) “The ketogenic diet is different in that it was designed to emulate starvation, taking advantage of the biochemical benefits of starvation for certain body systems (mainly neurological, but this is also why weight loss is a common result of a ketogenic diet) while tolerating the detriments to other body systems (such as endocrine and immune systems).”
Also, you’re missing the point here. This quote is not saying the ketogenic diet is about starvation. The quote is saying that the keto diet EMULATES (mimics) the biochemical effects of starvation in the body. That’s what happens when the body switches from burning glucose to fat. Also I do mention that the diet may have anti-inflammatory benefits, and it does. This is not about the ketogenic diet being synonymous with starvation.
I have high cholesterol and my doctor is totally for me being on keto. Here’s the thing… I personally think if you are just taking in your macros with eggs, eggs, bacon and more bacon your cholesterol of course has nowhere to go but up but if you really go to clean keto and relearn how to cook your cholesterol will get better in a few months. Mine is genetic btw
The standard North American diet (SAD) is much worse!
In the end, eating healthy organic foods which include good quality healthy fats, proteins and fibrous carbs (vegetables and if you want a small amount of fruit) is what should be recommended!
What should be recommended is to take time to understand your body, the implications on your lifestyle and genetics and to be careful with yourself. Taking the word of the medical community or anyone else is a recipe for disaster.
Based on my genetics, culture and lifestyle, these physicians almost killed me with their “practicing”…
The practice of covering symptoms versus looking for causes is stupid.
Example: Allergy tests are largely based off what most white people are allergic to, I’m not only white! The test contained items not at all in my diet or environment. Seems they’d start off asking what I eat.
Anyway… I’ve learned to love words like startvation as that was the only way I could get out of the acidic, allergic, inflammation filled hell I was in.
Found similar outcomes with birth control chemicals and so on.
Pretty sure I’ve read resolved the ADHD assessment issued to my son as well.
Mary is ultimately correct. take care.
The article and the long-term implications of keto are very interesting to me. I have done keto for almost 4 months and actually love this lifestyle, BUT I have found what works for me. I used the ketogains calculator, which more accurately (in my opinion) ties protein to lean body mass, and is more moderate fat. I refuse to Add fat to foods unnecessarily, and I don’t eat fatty meats except for fish, mainly because I don’t like it. It also promotes a higher net carb count of about 30 and when you enter maintenance can go up to 50-100. I eat a 4 oz serving of meat and the rest of my plate is vegetables…except root vegetables (although I do allow myself carrots pretty frequently.) I also do not fast as I really have no desire nor need to do so.
I do see people struggling to get fat in and I just don’t think that is necessary. I also don’t think IF or egg fasts or beef and butter fasts or whatever are necessary. There can be a happy medium between cutting unhealthy carbs and not filling up on fat. In my case, I have found what works for me. I have a ton of energy. I eat a normal amount of calories when I am hungry and feel great. I also have real dessert and a sugary cocktail once a month (and a glass of red wine several nights a week), which does not kick me out of ketosis anymore.
There is a poster above that said not all forms of ketosis are created equal. I tend to agree with him/her.
Vegan Keto…before I started Keto I was already vegan. I studied this from every angle. I, being vegan keto, get plenty of fiber. It is actually a micro I track. I have added two things that make me not 100% vegan. Again, I researched why I craved them or felt drawn to use them. The benefits are huge. Eggs, farm raised, free range and beef collagen peptides.
I’m still trying to recover from my attempt at eating keto. I was grain free prior due to health issues from all grains. I was vegetarian during the week and ate meat on the weekends. I’m a surgery RN and I understood the keto diet and followed it easily. Two weeks of the diet and I felt fantastic. The next 5 weeks have been a nightmare and I’m struggling to recover. My diabetic husband is doing well on keto and I curse the day I started it. I did lose 23/70# I’d like to lose. But I became so incredibly constipated that starting probiotics, magnesium and eventually mag citrate took three weeks to help. I’ve developed a painful bleeding rectal fissure that I’m having a terrible time getting to heal. Keto is NOT for everyone. Do your research beforehand.
Karen Herbst, MD, of the University of Arizona at Tucson is known worldwide for her research on fat disorders. She recently posted the following articles which discuss outcomes from groups following keto or low carb diets which you may find interesting. I, too, think a keto diet has many short term benefits, yet there is new evidence combing to light that shows we don’t know enough about its “dark side” to be able to recommend it long term. A healthy alternative is intermittent fasting, of which Dr. Herbst is a proponent. It not only can have remarkable effects on weight loss, it also can be adopted as a lifestyle change long term and prevent the rebound that happens when most diets are stopped when a weight loss goal is achieved. https://www.livescience.com/62687-high-protein-diet-heart-failure.html?utm_source=notification
https://www.mdlinx.com/endocrinology/top-medical-news/article/2018/08/28/7543032/?utm_source=in-house&utm_medium=message&utm_campaign=epick-endo-aug29
Hi Natalie, thanks for sharing. I’ll look it over. I recently listened to a podcast about nutritional genomics that said you can feel great on a keto diet and maybe even have good results, but if you have certain genes or even mutations, saturated fats may be inflammatory for you. It’s really quite fascinating, and I think the future of nutrition is DNA testing where we’ll learn from our genes exactly what we should be eating. My point is for certain genomes, keto can be dangerous because of the inability to process such high amounts of fat. And for these folks, long term keto absolutely can be detrimental.
I have been on Keto 7 months now and my lab work is the best it’s ever been I am now off 6 BP meds because my weight is down. I know longer need my metformin for the sugar and I have been taken off my cholesterol meds. I am sure it isn’t for everyone one and I do think that as with any change in dieting you should always be under doctors care and get blood work done faithfully.
Holly, that is wonderful. It’s empowering to use diet to come off meds. Glad you are monitoring your labs.
Hello, I would like to state that 2 keto dudes is a podcast that lists a lot of science for this diet. They also have many leading professionals speak throughout the series.
The author of this particular article, is attempting to layout arguments for and against the diet. Where the errors seem to orrcur is in the bolding of certain passages to grab reader attention to those sections over the whole article. This seems to have lead to the strong reaction in the comments. I am observing through reading the article and comments that perhaps an update is in order, a long with a clear definition of a full-term ketogenic diet. I say this with the comments of fasting in mind. For example: the use of fasting during the diet, Types of fasting, definition of nutritional ketosis and if this is based on testing regularly(I so what type of testing), colesterol research and how the body uses colesterol, protein and how to determine appropriate protein levels, and deficit eating for weight loss vs eating to maintain or gain weight on a ketogenic diet.
Finally, I saw discussion on the ketogenic diet and exercise. I would say were those individuals ensuring that they had proper hydration, and fuel (aka food) before and after exercise. We’re they overweight or within a comfortable weight range? Were they fasting? There are many variables to consider with each comment.
For example to expose my own position. The keto diet is not for everyone. For example it is not for those who cannot metobolically digest fats. I personally have been keto for 4 months. I have lost 55lbs and I am still obese. I discovered food allergies on this diet, which I am grateful for. I realize that scary situations can happen, but it’s also what we learn from them that matters. It is easy to look for a scapegoat in this diet as a whole, but it may also be one portion or how you follow the version of the diet that you are on
I tend to do intermittent fasting with a 4-6 hour feeding window. I would also mention that I didn’t start fasting right away I listened to my body telling me I wasn’t hungry. I have learned to listen to hunger signals and not emotional signals; I do sometimes snack during the day as needed.
My PCOS symptoms have abated some, I do not expect complete relief from these symptoms as I have had PCOS my whole life. I have also enjoyed some mental health benefits through this eating lifestyle.
My husband is in a maintenance phase and starting to learn what his body needs to maintain weight and stop weight loss.
We are all individuals and while there is no one way to eat for everyone I do believe that we need to change the dietary guidelines and take a stance on how we raise our foods ( both plant and animal).
I appreciate your post. I felt it was very balanced and discussed both the benefits and drawbacks of the keto lifestyle. I have many friends who have seen great results in the short term, but I do worry about their long-term bloodwork and effects on their health. I have several autoimmune conditions, and keto was the worst thing I ever did for my body. It sent me into near-constant flares. I was in agony daily. I’m glad it works for some, but there are many of us who need to stay far far away from this diet.
I consume less than 20 NWT carbs per day for the past 125 days. I’m down 40 pounds and I feel amazing. My carbs are from romaine lettuce, celery, cucumber, tomato, peppers, broccoli, cauliflower, to name a few this lifestyle change is the best thing I could’ve done for my health. I am a 46 year old mother of 5 – nursing student & im never going back! If anyone wants to talk to me – [email protected]
For me, Maria Emmerich & Dr. Eric Berg are keto experts and can answer any question you may have
So here’s the issue, this author has ZERO credentials. She knows some doctors, not many of them know much about the keto diet. We also don’t understand what we thought we did about cholesterol. Look at our history, if “low cholesterol” is what we wanted then why did we not achieve this with low fat foods? So why then did heart disease go up instead of down? You know what else went up? Dementia. I think it would stand to reason that there might be a correlation here. Morale of the story; find someone who knows what they are talking about.
Appreciate you, Siobhan, speculating on my credentials to discredit me. And you’re correct: there is a lot of misunderstanding about cholesterol. In fact, I’ve written an entire post about that and how “high” cholesterol isn’t always bad. I wonder if you’ve studied lipids, apoproteins, lipoproteins, etc as thoroughly as I. No matter, you can read the post if you like: https://www.maryvancenc.com/high-cholesterol/
Thing is, we’re not talking about just plain old “high” cholesterol. We’re seeing numbers in the 300 and 400s, and that’s a problem. It depends on your genetics: Some people just don’t metabolize high amounts of saturated fats in their diets, and for those people, the ketogenic diet will be inflammatory. Period. It depends on your genome, and the only way you’ll know this is DNA testing or to monitor your labs. So before you blow into this post on your high horse, please look at all angles; understand the risks; understand genetic testing; and understand that a ketogenic diet can be a lifesaver (literally) for some people and an inflammatory nightmare for others.
On any diet you must eat 7-10 cups of veggies for vitamins and antioxidants. I follow Dr. BErgs modified Keto and I don’t understand how people have constipation on Keto, if you make any Keto breads or sweets you should be getting fiber from nuts and/or coconut flour or tigernut flour. If you simply eat fat and protein without veggies and fiber then you are missing the point, fat and protein alone are more Atkins than Keto! For example a 16 oz container of spring mix lasts me for 3 salads, greens and lemon water alone will prevent fatty liver.
When I’m on keto, I do more of a “South Beach”-type keto. Meaning, I eat lean meats and get my fats primarily from olive oil and avocados. I also do a carb-up day once a week, where I add a sweet potato, or roasted carrots, or similar to my meals. It seems to work for me. I never understood the obsession with bacon in some keto circles, but I say find what works for your body, and stick to it! 😉
I like that approach, Kristina.
I can say I followed a Keto plan for 3 months. My cholesterol went very high, my LDL went up and I had severe lightheaded feeling. I want to love the program, but my body really fights it. I do have a concern with fatty liver as it is very difficult to see in blood work and once it reaches cirrhosis, there’s no turning back. The liver doesn’t like such a high fat diet especially from animal meats. Most ppl say those who lived in primitive times did this, but these people also rarely lived to see 50 years old. Just my 2 cents on the subject. I envy those who have lost significant amounts and feel great. Always check bloodwork. Any elevated liver markers should not be ignored.
Vanessa, you might check out Dr Will Cole’s new book, Ketotarian, which is a more plant-based keto plan: https://drwillcole.com/ketotarian/
It really depends on your genetics as to how much fat you can safely metabolize without inflammation. Some people do very well on a high fat diet, and others just don’t. I like his plan, as it’s more moderate, and you could even include anti-inflammatory seafood like wild salmon, sardines.
Hi. I just read your blog about the keto diet. First let me explain a little about myself. I’m 46 and had a massive bilateral cerebellar stroke a little over 3 years ago. I am left with many issues but some of the hardest have been cognitive issues including loss of executive function, short term memory issues, and in general my brain has difficulty functioning like it used to. I also have Cerebellar Cognitive Affective Syndrome as well as PBA (pseudobulbar affect). I am at my Psychiatrist’s office regularly. This past visit he said he wanted me to begin the ketogenic diet for brain health. I am over weight but he said he is not recommending this for weight loss but like another piece of my ongoing treatment. For me, a positive side effect is weight loss as well. He does not want me to jump right in. He wants me to learn everything that I can and begin planning. Meal planning in a planner used only for my food. He will be overseeing my changes and the content of my eating as well as any positive effects it may have on my brain health. I am really sure that if this eating style is not done properly it could be harmful instead of helpful. That is why I feel better about it being overseen by my physician. Like any medication your physician prescribes it with the educated knowledge of health benefits are greater than the risk of going without it. So that is the way I am seeing this as I learn and start planning. It is a piece of my overall health plan…like medication. I am going to treat it with the same importance and I do my ongoing medication. Good luck to those who choose to try the keto diet and I wish success and health.
Tracy
I underwent keto twice a year back. I have PCOD ‘n both times I concieved..after 15years. So I can safely say that it does wonders for ones fertility provided you consult an expert.
It’s funny to me all the negatives this way of eating produces. I’ve been doing keto since the end of October 2018 till now and I’ve never felt better. Up till now I’ve lost about 12 pounds and still losing but I’ve also lost a whole lot of inches. I think this way of eating is healing my very sick body. It’s probably going to put a lot of doctors out of work! No wonder why there are so many Drs against it!
Theres no long term data on keto diets? What do you suppose our ancestors ate 10s of thousands of years ago? They were not eating whole grains, beans, and corn I can tell you that. We would not be alive today and as intelligent had it not been for our ancestral meat eaters. They consumed a hight fat, pretty much 0 carb diet and died from the elements, not from diabetes, heart disease, etc. It only takes common sense and some reading of clinical studies to see that it makes sense.
Julia, do you have a citation for your claim? Because that is absolutely incorrect. Our ancestors foraged and ate a diet that was anywhere from 18-40 percent carbs, mostly from tubers, berries, fruits. They hunted and gathered (which is why they are called “hunter gatherers”), meaning they both killed and foraged. Sometimes there was meat. When there wasn’t meat around they’d eat more carbs. All you have to do is literally google “what did our ancestors eat” to get more information and learn that nowhere will you find a claim that says they consumed a high fat, zero carb diet.
How in the heck does anyone really know what people actually ate thousands of years ago? A book that was written by assumptions… lol. NCs post was not a debate people. It’s her opinion / conclusion of what she RESEARCHED. It has taken me 3mths to lose 25lbs doing Keto and holding. It was a great kick start to my weight loss journey. This way of eating is not a one size fits all diet. Consider any modalities you have, Check with your Dr, and know that pork rinds and bacon are not healthy fats. If doing keto? lol
Hi Leasa, we get information about our ancestors mainly through fossils. One of the best clues about their diet is via osteology (the study of bones). Entire skeletons or bones, even if they are thousands of years old, can reveal specific information about an individual’s diet during their lifetime. Also studying their fossilized teeth and how the teeth wore down can give us insight. Tooth wear or decay often can indicate things like the amount of sugar in an individual’s diet. The type and extent of tooth wear can also indicate whether someone ate meat on a regular basis. Archaeology is how we get information about evolution and the planet before we were in it.
Keto dieters can successfully go from keto to Paleo rather easily and maintain their weight.
I’ll be blunt, too: The scientific research on the long-term benefits of the ketogenic diet are numerous and go back approximately 100 years…yes, that’s correct…ONE-HUNDRED YEARS…and this fact is well known and documented, but ALARMIST such as yourself need clicks to generate money. Shame on you!
Yes, Kevin, you are correct: the research on the ketogenic diet does go back 100 years IN REGARDS TO USING IT TO TREAT EPILEPSY, mostly in children. What we DO NOT HAVE IS CURRENT and up-to-date research on people following the diet long term for reasons other than epilepsy, which is basically the entire point of this article: we don’t know the effects of following a ketogenic diet for 6+ months for reasons other than epilepsy or neurological disorders. And, as mentioned, it can worsen inflammation in those who genetically don’t process saturated fats well. The diet isn’t for everyone. Period. Try actually reading and approaching information with an open mind rather than through the veil of your bias and vitriol next time.
I did Keto for 10 weeks. I was planning on cycling on 3 months then off three months untilI lost all the weight I wanted. In the 10 weeks I went from 201 pounds to 176. I felt great. Then I got a kidney stone…not my first, And I broke my foot. I started doing more research and learned that for people predisposed to kidney stones Keto isn’t the best diet for them. I also learned that itcan be easier to break bones because of the increase of calcium lost in your urine. I’m nervous about going back on it but the weight loss was enough incentive for me to try again. I will pay more attention to exactly what I am consuming not just my macros but the actual nutritional content of my food. It is actually a lot of work to do it this way but if you are going to do keto you should do it correctly to avoid some of the negative side effects, and yes get your blood work done.
My husband started keto 5 months ago. He weighed 415 pounds and has lost 91 pounds. He has a doctor appointment tomorrow to check his labs. He feels great and loves the keto lifestyle. I’ll report back with his results. He hasn’t had any negative side effects. He keeps his carb intake around 10 or less a day!
That’s great, Judy! Report back and let us know how it goes.
Your so full of crap and a list there are tons of scientific evidence for the Keto diet do your research.
Really Kenn? Why don’t you provide some research to back up your claims then? Please, go ahead and link to recent, peer reviewed LONG TERM studies on the ketogenic diet (other than the decades old studies on children and epilepsy, and other than the studies I’ve linked in this article) and prove your point. Nearly every credible practitioner and keto evangelist cautions against a continual, long term ketogenic diet. In fact, when you google “long term ketogenic diet studies” you get pages of results questioning the safety of a long term keto diet bc we do not yet have that data. So, while keto can be beneficial for a period of months to reduce weight and metabolic syndrome (in some people), it should not be followed indefinitely.
Thanks for your BALANCED approach and your advice to avoid extremes in either direction. Your honest provision of links to a variety of research sources is appreciated. My choices as to what sort of diet may be of benefit to me are more well “informed” choices now. Thanks Mary Vance.
You need to go see Dr Ken Berry and debate this Live with him.
Great article and blog. I’m sorry you’ve had to deal with so many folks who are stuck in their echo chamber of brain farts. Whether Keto, Carnivore, Vegan, Paleo, or any other branded diet, people become zealots and unable to accept any new or contradictory information. Such groups are like religions and cults — but, I repeat myself. You only have to be right once, in order to invalidate all the nonsense the zealots spew. Obviously, you’ve been right numerous times.
Exactly, Irwin. Diets can be very cult-like. There’s never a one size fits all approach!