Keto Diet: Who Should Avoid And Why

The keto diet is a high-fat, low-carb, moderate-protein eating plan that has become increasingly popular in recent years. While it may be effective for short-term weight loss, it is not suitable for everyone and can have several negative side effects. In this article, we will explore the potential risks associated with the keto diet and discuss who should avoid it.

Pregnant or may become pregnant

The keto diet is not recommended for women who are pregnant, trying to conceive, or lactating. This is because the keto diet is low in carbohydrates and high in saturated fat, which can be dangerous for expectant mothers and developing babies.

Nutritional Needs During Pregnancy

Pregnant women need a variety of brightly coloured fruits and vegetables, which are rich in vitamins, iron, and folate, to nourish their growing baby. These foods also contain fibre, which can help with pregnancy constipation.

The keto diet restricts carbohydrates, including fruits and most vegetables, which means that vital nutrients are missed out on. These include:

• Vitamin D (for healthy bones and teeth)
• Vitamin E (for healthy muscles and blood)
• Vitamin B-12 (for a healthy spinal cord and nerves)
• Folic acid (for a healthy spinal cord and to prevent spina bifida)

Weight Management

While the keto diet is often used as a weight-loss tool, it is not recommended as a way to lose weight during pregnancy. Most Americans, pregnant or not, would benefit from reducing their intake of simple carbs and sugars. However, it is important to eat a balanced diet with plenty of fruit, vegetables, whole grains, and healthy fats and protein during pregnancy.

Potential Benefits

Some sources claim that the keto diet may be a way to help treat epilepsy in pregnant women. A 2017 case study found that the keto diet helped control symptoms in two pregnant women with epilepsy, and both women delivered healthy babies. However, one of the babies was born with bilateral ear deformities, although it is unclear if this was caused by the diet.

Side Effects

The keto diet can cause many side effects, including:

• Dehydration
• Ketoacidosis
• "Keto flu" (including headaches, dizziness, fatigue, nausea, and constipation)

Prone to constipation

Constipation is a common issue for people on the keto diet. This is due to the diet's typically low fiber content, and the possibility of increased dairy consumption and decreased water intake.

Causes

Low Fiber Intake

The keto diet involves drastically cutting back on carbohydrates and increasing fat and protein intake. Carbohydrates like fruits and whole grains are some of the most common sources of fiber in the diet. Therefore, transitioning to a low-carb diet can lead to a significant reduction in fiber intake, resulting in digestive issues like constipation.

Dairy Consumption

The keto diet includes foods like cheese, yogurt, and cream, which are high in fat and protein. Dairy products are also high in lactose, which can be difficult to digest and lead to bloating, gas, nausea, and constipation.

Dehydration

A sudden drop in carbohydrate intake can lead to dehydration and an imbalance of electrolytes. This is because each gram of glycogen, the stored form of sugar, is stored alongside water within the body. As the body transitions into ketosis, it sheds water that had been stored with glycogen, which can result in dehydration if not properly managed.

Treatment and Prevention

Increase Fiber Intake

To treat and prevent constipation, it is recommended to add more fiber-rich, low-carb foods to the diet. These can include non-starchy vegetables, berries, avocados, and nuts.

Retrain Your Bowel

Reestablishing frequent bowel movements can help eradicate constipation. This can be achieved by drinking sufficient fluids and establishing a regular time for toilet breaks. Stimulation methods such as fiber supplements or suppositories may also be recommended.

Increase Water Intake

Sufficient hydration is essential for regular bowel movements. It is recommended to drink between 9 and 13 cups of water per day, or enough to keep the body well-hydrated.

Reduce Dairy Intake

If dairy is suspected to be causing constipation, reducing or avoiding dairy products may help. Dairy-free alternatives can be considered as a replacement.

Ease into the Diet

Introducing the keto diet gradually can help prevent constipation. Starting with a higher daily carb intake and slowly reducing it as the body adjusts can make the transition smoother.

When to Seek Medical Advice

It is recommended to speak to a healthcare provider before starting the keto diet. If constipation persists despite home remedies and dietary adjustments, it may be necessary to consult a doctor for further advice and treatment options.

Kidney problems

The keto diet may stress your kidneys and is not recommended for people with kidney disease. High-fat animal foods, such as meat, eggs, and cheese, are staples of the keto diet. Eating a lot of these foods may increase your risk of kidney stones. This is because a high intake of animal products can cause your blood and urine to become more acidic, leading to increased excretion of calcium in your urine.

Some studies suggest that the keto diet reduces the amount of citrate in your urine. Given that citrate can bind to calcium and prevent the formation of kidney stones, reduced levels of it may also raise your risk of developing them.

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 animal foods. This can lead to a state of acidosis, which can worsen the progression of CKD. Lower protein diets are often recommended for individuals with CKD, while the keto diet is moderate to high in protein.

A high intake of animal foods on the keto diet can lead to more acidic urine and a higher risk of kidney stones. This acidic state can also worsen the progression of chronic kidney disease.

In patients with any reduction in kidney function due to diabetes, hypertension, or infection, high protein intake accelerates the loss of kidney function. A keto diet can strain already troubled kidneys.

What to Do if You Have Kidney Problems

If you have kidney disease, it's best to avoid the keto diet. People with kidney disease often need to consume a low-protein diet, which may not align with the keto diet. Consult a doctor or dietitian for guidance on an appropriate diet for your individual needs.

Nutrient deficiencies

The keto diet is a low-carb, high-fat diet that can lead to weight loss. However, it can also result in nutrient deficiencies, especially when the diet is prolonged. The keto diet restricts several food groups, including nutrient-dense fruits, whole grains, and legumes, which are essential sources of vitamins and minerals.

• Folate (Vitamin B9): Folate is crucial for methylation, a process that keeps our cells functioning. It also regulates neurotransmitters that control our urges and moods. Folate is found in leafy green vegetables like spinach, kale, and chard. On a keto diet, folate levels can run low due to the restriction of carbohydrates, as many plants contain carbs.
• Vitamin B7 (Biotin): Biotin is important for hair, skin, and nail health. It is naturally found in keto-friendly foods like liver, egg yolks, meat, and salmon. However, biotin is used up extensively in the processing of fatty acids while on a keto diet, and deficiency can occur.
• Selenium: Selenium is a trace mineral that acts as an antioxidant, boosts immunity, and ensures normal thyroid function. It is found in Brazil nuts, mushrooms, oysters, tuna, liver, and meat. Selenium deficiency is a known complication of long-term keto diets.
• Choline: Choline is an essential nutrient for normal metabolism and the transport of fats, neurotransmitters, and homocysteine. It is found in egg yolks, liver, meat, poultry, and fish. Choline deficiency can lead to fatty liver, and extreme restriction of carbs and protein on a keto diet may deplete choline levels.
• Vitamin D, Vitamin E, Chromium, Iodine, Magnesium, and Molybdenum: These micronutrients were found to be consistently low or non-existent in individuals following a keto diet.

To prevent nutrient deficiencies while on a keto diet, it is important to include a variety of nutrient-dense foods, such as grass-fed meat, poultry, wild-caught fish, eggs, bone broth, and colorful raw vegetables. Supplementation with a high-quality multivitamin containing active forms of B-vitamins and other essential nutrients can also help prevent and correct deficiencies.

History of disordered eating

The keto diet is a low-carb, high-fat diet that is advertised as a weight-loss solution. While it can be beneficial for people with epilepsy, it is not suitable for everyone. The diet is associated with several health risks and can be particularly dangerous for people with a history of disordered eating.

Rigid Food Rules

The keto diet involves adhering to strict rules about which foods to eat and avoid. This can promote an unhealthy obsession with food choices and weight loss, which is a risk factor for eating disorders. The restrictive nature of the diet may also trigger binge eating or a relapse of binge eating disorder.

Increased Carb Cravings

The keto diet severely restricts carbohydrates, which can lead to increased cravings for "forbidden" foods. This may trigger binge eating or other harmful practices such as purging to control weight. While some studies suggest that keto may reduce carb cravings, the overall impact on individuals with a history of disordered eating is unclear.

Unsustainability

The keto diet is challenging to maintain in the long term, and most people regain the weight they lost. This weight cycling can be dangerous for people at risk of developing an eating disorder or with a history of disordered eating. It can worsen mental health conditions like anxiety and depression, leading to a vicious cycle of disordered eating behaviours.

Orthorexia Risk

Orthorexia is an eating disorder characterised by an obsession with eating only "healthy" or "pure" foods. The restrictive nature of the keto diet may lead to a preoccupation with labelling foods as "good" or "bad," which can contribute to orthorexia. This fixation on food quality over quantity can negatively impact an individual's life, inducing stress and anxiety.

Diet Culture and Perfectionism

The keto diet is surrounded by an intense diet culture that promotes perfectionism and strict adherence to rules. Failure to maintain the rigid diet can lead to guilt, shame, low self-esteem, and poor body image, all of which are risk factors for developing an eating disorder. The pressure to follow a restrictive diet can be triggering for individuals with a history of disordered eating.

Nutritional Deficiencies

The keto diet restricts several nutrient-dense foods, including fruits, whole grains, and legumes. This restriction may lead to nutritional deficiencies over time, including vitamins and minerals such as calcium, vitamin D, magnesium, and phosphorus. Nutritional deficiencies can have serious health consequences and further negatively impact mental health.

In conclusion, while the keto diet may offer some health benefits, it is not suitable for everyone. For individuals with a history of disordered eating, the keto diet can trigger unhealthy behaviours and negatively impact both physical and mental health. It is crucial for individuals considering the keto diet to consult with a healthcare professional and seek support from a registered dietitian to ensure a safe and balanced approach.

Frequently asked questions