Keto Diet: Is It Really All Good?

The keto diet is a low-carb, high-fat diet that has been associated with several health benefits, including weight loss, improved blood sugar control, and reduced risk of certain diseases. However, there may be potential risks and side effects associated with the keto diet that individuals should be aware of before adopting this dietary approach.

One of the main concerns with the keto diet is its high saturated fat content. The diet encourages the consumption of saturated fats from oils, lard, butter, and cocoa butter, which can increase bad LDL cholesterol levels and contribute to heart disease. Additionally, the keto diet may lead to nutrient deficiencies, especially if individuals do not consume a wide variety of vegetables, fruits, and grains. It is also important to note that the keto diet could overload the kidneys and liver, as they play a crucial role in metabolizing the high amounts of protein and fat, respectively.

Other potential side effects of the keto diet include constipation, fuzzy thinking, and mood swings. The restriction of carbohydrates can also lead to what is commonly known as the keto flu, which includes symptoms such as diarrhea, constipation, vomiting, poor energy, and digestive discomfort. These side effects usually occur during the initial phase of the diet as the body adapts to burning fat instead of carbohydrates.

While the keto diet has been praised for its weight loss and health benefits, it is important to consult with a healthcare professional before adopting this or any other restrictive diet to ensure it is safe and suitable for your individual needs and health status.

Nutrient deficiency

Nutritional deficiencies are a common issue with the keto diet. Because the keto diet restricts carbohydrates, and in some cases eliminates them completely, it is easy to miss out on essential vitamins and minerals.

The keto diet can lead to deficiencies in selenium, magnesium, phosphorus, and vitamins B and C. B vitamins are particularly at risk, as these are necessary for turning food into energy. Calcium, magnesium, and phosphorus are also crucial for strong bones, and iron is needed to carry oxygen and support growth and development.

The keto diet restricts or eliminates whole grains, fruits, and starchy vegetables. This means that foods such as bananas, bread, rice, and legumes are off the menu.

To avoid nutrient deficiencies on the keto diet, it is important to eat a variety of nutrient-dense foods. This includes grass-fed meat, pastured poultry, wild-caught fish, eggs, and colourful raw vegetables, especially leafy greens.

Supplements can also be taken to ensure adequate nutrient intake. A multivitamin containing all the essential micronutrients is a good option, and there are also specific supplements that can be taken to target particular deficiencies. For example, those on the keto diet may benefit from an "active" folate supplement, which provides the body with a form of folate that is ready to be used by the body.

It is also important to be aware of any nutrient deficiencies you may already have before starting the keto diet, as these could be made worse by the diet.

Nutrient deficiencies can have a range of negative effects on the body. For example, biotin deficiency has been linked to thinning hair, dry skin, scaly rashes, brittle nails, conjunctivitis, depression, fatigue, and numbness or tingling in the arms and legs. Folate deficiency can lead to low energy, mood swings, and cravings due to its role in regulating serotonin and dopamine.

Yes, there are tests available that can measure levels of certain vitamins and minerals in the blood, such as vitamin B1, vitamin B6, vitamin B7, vitamin B12, calcium, iron, magnesium, and phosphorus. These tests can be purchased online and can help to identify any deficiencies that may be caused by the keto diet.

Liver problems

The keto diet may be beneficial for people with nonalcoholic fatty liver disease (NAFLD) because it can decrease insulin levels, help reverse the disease process, and suppress appetite, promote weight loss, and improve heart health markers.

NAFLD occurs when fat accumulates in the liver, causing inflammation and dysfunction. Weight loss is the main treatment for NAFLD, but restoring insulin sensitivity by following a low-carbohydrate diet like the keto diet may also help.

A 2018 study evaluated the effects of carbohydrate-restricted-induced ketosis in 262 obese or overweight patients. After one year, participants had improved blood sugar parameters, reduced cardiovascular risk factors, and reduced the need for medications to manage high blood pressure and diabetes. Liver enzymes (ALT) used to measure liver health also improved in this trial.

However, the keto diet is high in saturated fat, which has been linked to heart disease. With so much fat to metabolize, the diet could make any existing liver conditions worse. Therefore, it is important to consult a healthcare professional before starting the keto diet.

Kidney problems

The keto diet may stress your kidneys and can be particularly dangerous for people with kidney disease. The diet's high animal fat content can cause your blood and urine to become more acidic, leading to an increased excretion of calcium in your urine. This can cause kidney stones.

According to Shivam Joshi, MD, clinical assistant professor of medicine at the NYU Grossman School of Medicine in New York, the average keto diet consists of 1.2-2.0 g/kg/d of protein, which he considers to be a high amount. However, supporters of the keto diet view this protein intake as normal or average.

The keto diet may be especially harmful to people with kidney disease. Neal Barnard, MD, an adjunct professor of medicine at the George Washington University School of Medicine, states that "a keto diet can really strain already troubled kidneys." High protein intake accelerates the loss of kidney function in patients with reduced kidney function due to diabetes, hypertension, or infection.

Additionally, people with chronic kidney disease (CKD) should avoid the keto diet. Weakened kidneys may be unable to remove the acid buildup in the blood that results from high animal fat consumption. This can lead to a state of acidosis, which can worsen the progression of CKD.

The keto diet has also been linked to an increased risk of kidney stones. Past research observed that among children following the keto diet as a treatment for epilepsy, 13 out of 195 subjects developed kidney stones.

Constipation

Causes

There are several theories as to why the keto diet causes constipation.

• Decrease in fiber intake: The keto diet restricts many common sources of fiber, such as whole grains, fruits, and beans. This acute decrease in fiber can lead to temporary constipation as the body adjusts to the change.
• Dehydration: The transition to a very low-carb diet can cause an increase in urination, leading to mild dehydration, which is associated with constipation.
• Change in body electrolytes: The keto diet can alter the balance of electrolytes in the body, which may affect stool frequency.
• Caloric decrease: The keto diet often results in a natural caloric decrease, as low-carb foods tend to be less energy-dense. Eating less can lead to a decrease in stool volume or frequency.

Prevention and Treatment

• Stay hydrated: Adequate hydration is important to prevent and treat constipation. Aim for at least four urinations per day and ensure your urine is clear, not yellow.
• Increase salt intake: Increasing salt intake can help with fluid retention and dehydration prevention. A good starting point is between 4 and 6 grams of sodium per day (about 2.5 teaspoons).
• Eat more fiber: Increasing fiber intake may be the most effective way to prevent constipation. Focus on getting fiber from whole foods, such as above-ground vegetables, nuts, and seeds.
• Take magnesium supplements: Magnesium is a well-known laxative and is often recommended for constipation.
• Add MCT oil: Medium-chain triglyceride (MCT) oil can help promote ketosis and stimulate gut motility and bowel movements.
• Be physically active: Regular physical activity may improve constipation and has other health benefits.

When to See a Doctor

If constipation persists despite trying the interventions mentioned above, it is recommended to consult a doctor. They can work with you to find the best treatment, which may include over-the-counter stool softeners or laxatives.

Preventing Constipation

To prevent constipation when starting the keto diet, it is recommended to introduce the diet gradually. Start with a higher daily carb intake (around 50 grams) and slowly reduce it as your digestive system adjusts.

Additionally, ensure that the fats and proteins you consume come from whole foods, as processed meals and fast foods can put extra stress on the gastrointestinal system and are typically low in fiber.

Drinking enough water is also crucial, as proper hydration is essential for regular bowel function. Finally, include plenty of keto-friendly, high-fiber foods in your diet, such as non-starchy vegetables (greens, broccoli, asparagus, cauliflower), nuts, and seeds.

Fuzzy thinking and mood swings

Brain Fog and Confusion

The keto diet has been linked to brain fog, a condition characterized by forgetfulness, cloudy thinking, and difficulty thinking, focusing, and communicating. This can have negative consequences in various areas of life, including work, relationships, and daily tasks. While brain fog can be caused by various factors, including hormonal changes, sleep deprivation, and stress, it has also been identified as a temporary side effect of the keto diet, particularly during the initial "transition period." During this period, the brain is adjusting to using ketones for energy instead of glucose, which can result in a short-term state of energy deprivation and cognitive impairment.

Irritability and Mood Swings

In addition to fuzzy thinking, the keto diet may also contribute to mood swings and irritability. The brain's preferred fuel source is glucose, which is derived from carbohydrates. When the brain is deprived of its main energy source, it can lead to crankiness and irritability. This is a common issue with low-carb diets, as the body and brain adjust to using alternative fuel sources.

Strategies for Mitigating Negative Effects

To counteract the negative effects of the keto diet on mental clarity and mood, it is essential to ensure adequate hydration, sodium intake, and sleep. Additionally, giving the body and brain sufficient time to adapt to the new diet is crucial. The transition to using ketones for fuel can take several days or even weeks. During this adaptation phase, it is normal to experience symptoms such as brain fog, irritability, and mood swings.

While the keto diet may cause temporary fuzzy thinking and mood swings, some studies suggest that it can have long-term benefits for mental health. The keto diet's anti-inflammatory properties may help fight depression, and its ability to optimize the production of the neurotransmitter GABA may help stabilize mood and alleviate conditions like mood swings and depression.

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