Keto's Long-Term Success: Is It Sustainable?

The ketogenic, or keto, diet is a high-fat, low-carb eating plan that has been advertised as a weight-loss wonder. While it has been tried for weight loss, it is best to make this only a short-term dietary change to help jump-start weight reduction. The keto diet is used to help reduce the frequency of epileptic seizures in children. It is also beneficial for those with obesity, those trying to control their blood sugar levels, and people with certain hard-to-treat forms of epilepsy.

The keto diet is different from other low-carb diets, which focus on protein. A keto plan centres on fat, which supplies as much as 90% of daily calories. The keto diet is not a miracle diet for weight loss or a fix for all health problems. It can be dangerous for certain people (like those with kidney disease), and because it's not a long-term plan, dieters must carefully manage their diet after stopping keto.

There is limited long-term research on the keto diet, so there is no telling for sure what cutting out certain major food groups and cutting carbs will eventually do to the body. However, there is some evidence that the keto diet may be beneficial in the long term for people with diabetes, certain cancers, and various neurodegenerative diseases.

Keto may lead to vitamin or mineral deficiencies

The keto diet is a low-carb, high-fat, moderate-protein regimen that promises quick weight loss results. While it can be effective for weight loss, there are concerns about its long-term effects on the body. One of the main concerns is the potential for vitamin and mineral deficiencies due to the restriction of certain food groups.

Fruits and Vegetables

Following a keto diet typically involves cutting back on fruits and certain vegetables, which are good sources of vitamins and minerals. This can lead to deficiencies over time. Some of the specific vitamins and minerals that may be lacking on a keto diet include:

• Folate (B9)
• Biotin (B7)
• Selenium
• Choline
• Vitamins A, E, and D
• Chromium
• Iodine
• Magnesium
• Molybdenum

High-Fat, Low-Carb Diets and Calcium Absorption

High-fat, low-carb diets can also affect calcium absorption. The body may use calcium from bones to buffer the increased acid production, leading to higher calcium loss in the urine and lower bone density. This can increase the risk of kidney stones.

Micronutrient-Dense Foods

To avoid potential vitamin and mineral deficiencies on a keto diet, it is important to include micronutrient-dense foods such as:

• Grass-fed, pastured meat
• Poultry
• Wild-caught fish
• Liver
• Spinach
• Kale
• Nuts
• Seeds

Additionally, supplementation with certain vitamins and minerals may be recommended to prevent deficiencies.

It may negatively impact athletic performance

The keto diet may negatively impact athletic performance, particularly in high-intensity activities such as cycling and running, as well as Crossfit, HIIT, and obstacle races, and longer-distance efforts like marathons. This is because the body is in a more acidic state when in ketosis, which may limit its ability to perform at peak levels.

A 2019 study published in the Journal of Sports Medicine and Physical Fitness found that participants performed worse on high-intensity cycling and running tasks after four days on a ketogenic diet compared to those who spent the same amount of time on a high-carb diet. The body's ability to perform high-intensity exercise may be hindered by a lack of readily available glucose, which is the body's preferred source of fuel for these types of activities.

Additionally, a ketogenic diet tends to be low in soluble fiber, which is important for gut health and can impact athletic performance over time. While protein can assist in the production of short-chain fats that feed the gut, a lack of fiber in the long term can be detrimental to overall health and athletic performance.

Furthermore, the keto diet restricts some of the best sources of carbohydrates, which are essential for replenishing muscle glycogen stores after intense exercise. This may lead to reduced exercise capacity and performance over time.

Therefore, for athletes or individuals who engage in regular high-intensity or endurance exercise, the keto diet may not be the best long-term dietary approach to support their performance goals. It is important to consult with a healthcare professional or sports dietitian to determine the appropriate diet that fuels both overall health and athletic performance.

Relaxing the rules can cause weight regain

Even though the keto diet can be a great way to jump-start weight loss, it is not easy to stick to it for a long time. People may transition to a more relaxed form of keto that allows for more carbohydrates or less monitoring—sometimes known as lazy keto, keto cycling, or "maintenance mode". However, this can lead to weight regain. Annette Frain, RD, program director with the Weight Management Center at Wake Forest Baptist Health, warns that "keto can be a great jump-start to weight loss, but the reality is that most people can't adhere to it for very long".

People often go into ketosis and lose weight, and then come out and gain it back, falling into a yo-yo pattern, which is extremely frustrating and linked to a higher risk of early death. Furthermore, the type of weight gained back is important. When on keto, people usually lose some muscle mass along with fat tissue. When they transition to a high-fat diet, they will probably gain back more fat and less lean muscle, which not only looks and feels different on the body but also burns calories at a slower rate. This can affect metabolism and make it more difficult to lose weight again in the future.

Therefore, it is important to strive for balance, not extremes, when it comes to dieting. It is crucial to look at what is missing in a diet and what is truly sustainable. It is important to make sure that the diet provides satisfaction and satiety from the foods being eaten and that one feels good and is getting great nutrition from a variety of foods. This is what will help keep the weight off in the long term.

It may damage blood vessels

The ketogenic diet has been praised for its short-term weight loss results, but there are concerns about its long-term sustainability and potential negative impacts on health. One of the key concerns is the potential damage it may inflict on blood vessels.

It may increase the risk of chronic diseases

The keto diet is associated with an increased risk of chronic diseases, including heart disease and certain types of cancer. Here are some of the potential risks associated with long-term keto:

• Liver problems: The keto diet involves metabolising large amounts of fat, which can strain the liver and worsen existing liver conditions.
• Kidney problems: The high protein content of the keto diet may overload the kidneys, which play a crucial role in metabolising protein.
• Constipation: The keto diet is low in fibrous foods like grains and legumes, which can lead to constipation and other digestive issues.
• Fuzzy thinking and mood swings: The brain functions optimally when it has a sufficient supply of sugar from healthy carbohydrates. Low-carb diets like keto may cause confusion, irritability, and other cognitive issues.
• Nutrient deficiencies: Restricting fruits, vegetables, grains, and other food groups can lead to deficiencies in essential vitamins, minerals, and antioxidants. This can have negative consequences for overall health and increase the risk of chronic diseases.
• Increased risk of heart disease: The keto diet is typically high in saturated fat, which can lead to elevated levels of "bad" LDL cholesterol, a known risk factor for heart disease.
• Potential cancer risk: While some claim that keto may help mitigate the risks of certain cancers, there is also evidence that cancer cells thrive on elevated blood sugar and insulin levels, which can be a consequence of the keto diet.

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