Keto Diet: Is Long-Term Use Safe?

The ketogenic, or keto, diet is a high-fat, low-carbohydrate, and moderate-protein eating plan. It has become increasingly popular due to its ability to promote quick weight loss. However, there are concerns about the potential long-term health risks associated with following this diet for an extended period. While some proponents of the keto diet warn against sticking to its strict guidelines long-term, others argue that the negative health consequences may outweigh any short-term benefits.

Keto can lead to vitamin and mineral deficiencies

The keto diet is typically very low in carbohydrates, modest in protein, and high in fat. This often means cutting back on fruits and certain vegetables, which are sources of vitamins and minerals. Annette Frain, a program director with the Weight Management Center at Wake Forest Baptist Health, warns that spending more than a few weeks on this type of diet can lead to vitamin and mineral deficiencies.

According to Frain, "Fruits and vegetables are good for us; they're high in antioxidants and full of vitamins and minerals. If you eliminate those, you aren't getting those nutrients over time."

One study found that folic acid supplements did not prevent birth defects in pregnant women on a low-carbohydrate diet. Restricting carbohydrates during pregnancy is linked to an increased risk of birth defects and gestational diabetes.

A keto diet can also affect your athletic performance. A 2019 study found that participants performed worse on high-intensity cycling and running tasks after four days on a ketogenic diet compared to those on a high-carb diet.

How to avoid vitamin and mineral deficiencies on keto:

• Include leafy green vegetables such as kale, chard, and spinach in your diet.
• Eat a varied diet, including grass-fed meat, pastured chicken and pork, wild-caught fish, eggs, bone broth, and colourful raw vegetables.
• Take a multivitamin that contains all the micronutrients you need.
• Consume more salt to make up for the sodium lost through sweat.
• Eat more potassium-rich foods such as spinach, chicken breast, salmon, avocado, and broccoli.
• Include magnesium-rich foods such as shellfish, leafy greens, spinach, Swiss chard, pumpkin seeds, oysters, yogurt, and avocado in your diet.

It may negatively affect athletic performance

The ketogenic diet may hurt athletic performance, especially for athletes involved in high-intensity, short-duration sports. Researchers from Saint Louis University found that people on a ketogenic diet performed worse on anaerobic exercise tasks than those eating more carbs. Their performance was 4 to 15% lower than the high-carbohydrate group.

The body is in a more acidic state when it's in ketosis, which may limit its ability to perform at peak levels. While the keto diet can help athletes lose weight, which can be helpful for speed and endurance, lead researcher Edward Weiss expressed concern that "people are attributing the benefits of weight loss to something specific in the ketogenic diet." He suggested that the benefits of weight loss could be cancelled out by reductions in performance.

In light of these results, Weiss advised athletes to avoid keto diets unless they have compelling reasons for following a low-carb diet. Other experts have also warned that keto diets could be detrimental to athletic performance. Mike Israetel, head science consultant at Renaissance Periodization, stated that while one "can still perform well at your chosen sport on very few carbs...you are unlikely to perform at as high a level as you're accustomed to."

However, it's important to note that the effects of keto diets on athletic performance may vary depending on the type of sport and the individual athlete. Some studies have found that keto diets can improve performance in endurance athletes, such as marathon runners and long-distance cyclists, by increasing fat oxidation and reducing lactate accumulation after exercise. Additionally, keto diets have been shown to improve recovery time post-exercise.

Overall, while keto diets may offer some benefits for endurance athletes, there is a risk of reduced athletic performance, especially for those involved in high-intensity sports. More research is needed to fully understand the effects of keto diets on different types of athletic performance.

It can cause weight regain

The keto diet can be an effective way to lose weight, but it is important to be aware of its potential downsides. One of the main concerns is that the weight loss achieved through keto may not be sustainable in the long term.

The keto diet is notoriously difficult to stick to due to its strict guidelines, which include limiting carbohydrates to 50 grams or less per day and closely monitoring your food intake to ensure your body enters ketosis. This can be challenging and time-consuming, and many people find it difficult to adhere to the diet for an extended period.

As a result, some people may transition to a more relaxed version of the keto diet, sometimes known as "lazy keto," "keto cycling," or "maintenance mode." This typically involves allowing for more carbohydrates, less monitoring of food intake, or an increase in "cheat days." While this may provide a sense of flexibility and relief from the strict rules of the standard keto diet, it can also lead to weight regain.

According to Annette Frain, a registered dietitian and program director at the Weight Management Center at Wake Forest Baptist Health, "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... Often, people are going into ketosis and losing weight, then coming out and gaining it back and falling into this yo-yo pattern, and that's not what we want." This pattern of weight loss and regain can be extremely frustrating and is linked to a higher risk of early death.

It is important to note that the type of weight gained back is also important. When you initially lose weight on the keto diet, you lose both muscle mass and fat tissue. However, when you transition to a more relaxed keto diet or a different diet altogether, you are more likely to gain back more fat and less lean muscle. This can affect your metabolism and make it even more difficult to lose weight in the future.

Therefore, while the keto diet may be a tempting option for quick weight loss, it is important to consider the potential challenges and risks associated with long-term adherence. Relaxing the strict rules of the keto diet may provide some relief, but it can also lead to weight regain, which can have negative consequences for both your physical health and mental well-being.

Keto may damage blood vessels

The ketogenic diet has become increasingly popular due to its ability to promote quick weight loss. However, health experts warn that there may be dangerous long-term health consequences. One concern is the potential for keto to damage blood vessels.

The keto diet is a low-carb, high-fat regimen that pushes the body into a state of ketosis, where it burns fat for fuel instead of carbohydrates. While this can lead to weight loss, it also has some potentially negative side effects.

Blood Vessel Damage

Research has found that the keto diet may cause early signs of blood vessel injury. Two studies, one from Sweden and one from Italy, found that patients on ketogenic diets had less distensible (or more stiff) carotid arteries. This indicates a potential risk of blood vessel damage. However, neither study reported any clinical changes in the children studied, and the changes seemed to revert to normal over time or after the diet was stopped.

The Impact of Cheating

Additionally, researchers from the University of British Columbia found that indulging in a high-sugar treat while on a keto diet can actually damage blood vessels. This is because a sudden blast of glucose can undo some of the positive impacts of the keto diet on blood vessels. Therefore, it is not recommended to have cheat days while on the keto diet, as the negative consequences may outweigh any short-term benefits.

Long-Term Health Risks

The keto diet has been linked to several other long-term health risks, including heart disease, high cholesterol, kidney failure, Alzheimer's disease, diabetes, and cancer. The diet's emphasis on animal products and restriction of nutrient-rich fruits and vegetables may contribute to these negative side effects. As a result, health experts warn that the risks of the keto diet may outweigh the benefits, and it is not a sustainable or healthy long-term solution for weight loss.

It can increase chronic disease risk

The ketogenic diet, or keto, is a very low-carbohydrate, modest-protein, and high-fat diet. It restricts carbohydrates to 50 grams or less per day, which means cutting out unhealthy foods like white bread and refined sugar, but also fruits and certain vegetables. While this can lead to weight loss, there are concerns about the long-term health effects of keto.

Heart Disease

Health experts worry about the impact of a long-term keto diet on the heart and arteries. Research has found that people on low-carb diets are more likely to develop atrial fibrillation (AFib), which raises the risk of blood clots, stroke, and heart failure. A 2019 study in the Journal of the American College of Cardiology also found that low-carb dieters who consumed large amounts of meat and dairy had a higher risk of early death.

Cancer

A 2018 study in The Lancet found that low-carb dieters who consumed large amounts of meat and dairy had a higher risk of early death from cancer and all other causes. The study's authors suggest that this is due to the nutrient quality of the food being eaten on a keto diet, which emphasizes products that are linked to colon cancer, heart disease, and Alzheimer's disease.

Kidney Disease

The keto diet can be particularly dangerous for people with chronic kidney disease (CKD) as the high amounts of protein consumed can place excess stress on the kidneys and worsen long-term internal damage.

Alzheimer's Disease

Keto has been found to improve cognition in subjects with mild-to-moderate Alzheimer's disease in the short term, but the nutritional profile of the diet could increase the risk of developing Alzheimer's disease in the long term.

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