Keto Diet: Long-Term Weight Loss Solution Or Fad?

The ketogenic diet, commonly known as the keto diet, is a popular weight-loss method that involves eating a high-fat, moderate-protein, and low-carbohydrate diet. While it has gained traction as a weight-loss strategy, there are concerns about its long-term effectiveness and potential health risks. The keto diet is challenging to maintain and may not be suitable for everyone. This paragraph aims to delve into the question: does keto actually work long-term?

Weight loss

The keto diet is advertised as a weight-loss wonder, but it is actually a medical diet that comes with serious risks. While it can be used for weight loss, it's best to make this only a short-term dietary change to help jump-start weight reduction.

The keto diet is a high-fat, moderate-protein, low-carbohydrate eating pattern. It encourages the production of an alternative fuel source called ketones from stored fat. The brain requires a steady supply of glucose, about 120 grams daily, and cannot store glucose. Therefore, when carbohydrate intake is minimal or during fasting, the body initially obtains glucose from liver stores. After 3-4 days, if stored glucose is depleted, the body enters a state called ketosis. During ketosis, the liver becomes able to produce ketone bodies, a type of fuel made from stored fat. In theory, the body will then eat away at its stored fat to meet its energy demands, leading to fat loss in an individual.

While keto dieters often experience a satisfying initial weight loss, this is a short-term result from the loss of body water that accompanies lower carbohydrate intake, not fat loss. This is because when we eat carbs, the energy that we do not use immediately is stored as glycogen molecules, and each gram of glycogen is stored with 3 grams of water attached to it. When you cut down on carbs, you quickly use up your glycogen stores, losing that water weight. Furthermore, the ketogenic diet’s restrictive nature makes it unlikely that people will follow it correctly, with over 50% of people failing to adhere to a ketogenic diet in many medical studies, which negates any short-term weight loss effects. Even if properly followed, a ketogenic diet is not intended to be adhered to long-term, nor is it uniquely effective. Studies show that after 6 months, a ketogenic diet does not lead to significantly higher weight loss than other weight loss approaches.

In a 24-week study of 83 obese patients, the weight and body mass index of the patients decreased significantly. The weight decreased by an average of 4.36 kg, and the body mass index decreased by an average of 5.71 kg/m2. In another study, obese women on a low-carbohydrate ketogenic diet lost 8.5 kg over six months compared with 4.2 kg lost by those in the low-fat diet group.

However, it's important to note that the keto diet is not sustainable for everyone. It restricts fresh fruits and vegetables, whole grains, and low-fat dairy that can help with long-term weight loss and overall health. The keto diet is also associated with an increase in "bad" LDL cholesterol, which is linked to heart disease. In a study of young, fit CrossFit athletes, following a keto diet for 12 weeks led to an average weight loss of 6 pounds but increased "bad" LDL cholesterol by 35%.

In conclusion, while the keto diet can lead to weight loss in the short term, it is not intended to be followed long-term and may not be sustainable for everyone. There are also health risks associated with the keto diet, such as an increased risk of heart disease, nutrient deficiencies, and constipation. It is important to consult a doctor or dietitian before starting any new diet, especially one as restrictive as the keto diet.

Nutrient deficiencies

The keto diet may lead to deficiencies in thiamin, folate, vitamin A, vitamin E, vitamin B6, calcium, magnesium, iron, and potassium. These deficiencies can cause a range of health issues, such as constipation, heart palpitations, and extreme fatigue.

Even when focusing on nutrient-dense foods, the keto diet is often reported to have multiple micronutrient shortfalls, lacking in vitamin K, linolenic acid, and most water-soluble vitamins. It is also typically low in fiber, which is necessary for healthy intestinal function, nutrient absorption, and immune function.

Additionally, the keto diet may not be suitable for pregnant women or those planning to become pregnant, as carbohydrate-restricted diets have been associated with an increased risk of birth defects and gestational diabetes.

Overall, the restrictive nature of the keto diet makes it challenging to ensure adequate nutrient intake, and there are concerns about the potential long-term health consequences of this diet.

Athletic performance

The ketogenic diet has been a topic of interest for athletes, particularly endurance athletes, as a performance enhancer. The diet involves a drastic reduction in carbohydrate intake, which is replaced with fat. This shift in metabolism puts the body in a state of ketosis, where fat is burned for energy instead of glucose from carbohydrates.

Benefits for Athletes

The keto diet has been found to have several benefits for athletes, especially those in endurance sports.

• Fat Burning and Weight Loss: The keto diet can lead to enhanced fat burning during submaximal exercise, which may result in lower body fat levels and an improved power-to-weight ratio. This can be advantageous for endurance athletes as it could lead to reduced reliance on stored muscle glycogen, potentially improving performance over longer distances.
• Health Benefits: The keto diet has been associated with improved health outcomes, particularly for individuals with certain medical conditions such as obesity, type II diabetes, and epilepsy. It can also help reduce lactate accumulation after exercise, contributing to enhanced recovery.
• Improved Body Composition: The keto diet may lead to favourable changes in body composition, resulting in a leaner physique. This could be beneficial for athletes in sports that require making weight, such as gymnastics and taekwondo.
• No Performance Decrement: Some studies have shown that the keto diet does not cause a significant performance decrement for endurance athletes, even at higher intensities. This suggests that athletes can maintain their endurance capacity while reaping the benefits of increased fat burning.

Potential Drawbacks

However, there are also potential drawbacks and limitations to the keto diet for athletes, especially those involved in high-intensity, short-duration sports.

• Performance Impairment: Research suggests that athletes in high-intensity sports may experience a drop in performance while on the keto diet. This is because high-intensity activities rely heavily on carbohydrates as the primary fuel source.
• Nutrient Deficiencies: The keto diet may lead to deficiencies in certain micronutrients and electrolytes that are essential for athletes, such as potassium, magnesium, vitamins A and C, and folate.
• Digestive Issues: The low fibre and carbohydrate content of the keto diet could lead to digestive problems and constipation in some individuals.
• Difficulty Sustaining: The keto diet may be challenging to sustain over the long term due to its restrictive nature and potential side effects like poor energy, mental function, and sleep issues.
• Not Suitable for All Athletes: The keto diet may not be suitable for athletes who need to consume a certain number of calories to support their physical activity. It may also not be optimal for those looking to gain muscle mass, as it is moderate, not high, in protein.
• Adaptation Period: The body needs time to adapt to the keto diet, and performance may be impaired during this transition phase. This adaptation period can last several months, and athletes may experience reduced muscle glycogen, hypoglycemia, and impaired performance.

Practical Recommendations

For athletes considering the keto diet, here are some practical recommendations:

• The keto diet may be most beneficial during periods of low-intensity, base training, as it can enhance fat burning and aid in weight loss.
• Expect an increased perception of effort and fatigue during exercise, especially at higher intensities.
• Allow sufficient time for adaptation (at least five days) before expecting performance benefits.
• Avoid experimenting with the keto diet during periods of high-intensity training, as it may compromise performance and recovery.
• For races or competitions under three hours, continuing the keto diet is not recommended, as it may harm maximal performance.
• If a race is approaching, switch to a high-carbohydrate diet 24-36 hours beforehand, and consume carbohydrates during the event.
• Be aware of potential side effects, which can vary significantly between individuals. Ensure proper hydration during the keto diet.
• If the keto diet is too restrictive, consider a modified keto approach, which is less extreme and may provide similar benefits.

The ketogenic diet has shown mixed results for athletic performance, with some studies indicating benefits for endurance athletes, while others suggest impairments for high-intensity, short-duration sports. More randomized controlled trials are needed to fully understand the effects of the keto diet on different types of athletes and performance outcomes. Additionally, the impact of genetics, recovery, sport type, and sex on the effectiveness of the keto diet warrants further investigation.

Cardiovascular health

Weight Loss and Obesity

The keto diet is often used for weight loss, and obesity is a major risk factor for cardiovascular disease. The keto diet can be effective for weight loss, but the mechanisms behind this are not entirely clear. Some studies suggest that it is due to reduced caloric intake and increased satiety from proteins. Other studies indicate a metabolic effect, such as increased energy expenditure and reduced appetite induced by ketosis. However, the problem with the keto diet is that it can be challenging to maintain long-term, and weight regain is common when people stop following the diet.

Non-Alcoholic Fatty Liver Disease (NAFLD)

The keto diet has been linked to the development of NAFLD in rodents. This is due to increased hepatic inflammation and lipid accumulation. However, these findings have not been consistently reported in human studies. The role of fibroblast growth factor 21 (FGF21), which is increased in NAFLD, may be important in this process. FGF21 levels are elevated in NAFLD and correlate with hepatic triglyceride content. In rodents, FGF21 levels are increased by the keto diet, and it may play a role in counteracting hepatic insulin resistance.

Insulin Resistance and Type 2 Diabetes

The keto diet has shown mixed results regarding insulin resistance and type 2 diabetes. In rodents, the keto diet often leads to insulin resistance and glucose intolerance. However, in humans with type 2 diabetes, the keto diet is associated with improved glucose control and a reduction in antidiabetic medications. The keto diet may improve insulin sensitivity and reduce glycemic variability in type 2 diabetes patients.

Dyslipidemia

The impact of the keto diet on the lipid profile differs between rodents and humans. In rodents, the keto diet is often associated with worsened levels of total cholesterol, HDL, and LDL cholesterol, as well as increased triglyceride levels. In humans, the keto diet has been linked to a reduction in total cholesterol, an increase in HDL cholesterol, a decrease in triglycerides, and no significant change or a slight increase in LDL cholesterol. The composition of the keto diet, especially the type of fats (saturated vs. unsaturated), may play a crucial role in these differences.

Blood Pressure

There is limited evidence regarding the effect of the keto diet on blood pressure. Some studies in humans have shown a slight reduction in systolic and/or diastolic blood pressure, but the effect is not significant. More research is needed to fully understand the impact of the keto diet on blood pressure.

Long-Term Effects and Adverse Events

The long-term effects of the keto diet on cardiovascular risk factors are not well established. Some studies suggest that the benefits of the keto diet, such as weight loss and improved glucose control, may be limited in time. Additionally, the keto diet may be associated with adverse events, such as kidney stones, osteoporosis, impaired growth, and increased mortality in the long term.

Longevity

The ketogenic diet, or keto, is a high-fat, moderate-protein, and low-carbohydrate eating pattern. It involves reducing carbohydrate intake to less than 50 grams per day and deriving 70-80% of daily calories from fat. While keto is often undertaken as a short-term weight-loss strategy, some people consider it for the long term.

There are several potential benefits and risks of long-term keto. On the one hand, keto may be therapeutic for diabetes, mitigate the risks of certain cancers, and help treat or prevent various neurodegenerative diseases. It has also been shown to reduce body weight and body mass index in obese patients. Additionally, it can lower blood sugar and increase "good" HDL cholesterol, which are beneficial for health.

On the other hand, long-term keto may lead to vitamin or mineral deficiencies due to reduced intake of fruits, vegetables, and whole grains. It could also negatively impact athletic performance, especially for high-intensity activities. There are concerns about the impact of long-term keto on heart health, with some studies suggesting it may increase the risk of cardiovascular disease and increase "bad" LDL cholesterol.

The decision to follow keto long-term depends on individual physiology and goals. It may be beneficial for some, while others may prefer a cyclical approach, combining periods of keto with periods of carbohydrate consumption. It is important to consult a healthcare professional before starting any new diet, especially one as restrictive as keto.

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