Keto Diet: Early Death Or Long Life?

The ketogenic diet is a low-carb, high-fat diet that has gained popularity for its ability to aid weight loss and manage blood sugar levels in people with diabetes. However, there are concerns about its long-term effects on health and lifespan. Some studies have linked low-carb diets like keto to an increased risk of premature death, with one study finding that low-carb dieters who consumed large amounts of meat and dairy had a higher risk of early death. Other potential risks of the keto diet include vitamin and mineral deficiencies, digestive issues, negative effects on athletic performance, and increased risk of chronic diseases such as heart disease and cancer. While the keto diet may offer short-term benefits, more research is needed to understand its long-term impacts, and it is always recommended to consult a healthcare professional before starting any new diet.

Keto may cause vitamin or mineral deficiencies

The keto diet restricts carbohydrates and protein, which can lead to deficiencies in certain vitamins and minerals. Here are some of the key nutrients that may be lacking on a keto diet:

• Vitamin B9 (Folate): Folate is essential for methylation, a process that keeps cells functioning and is involved in energy production, hormone balance, gene expression, mood control, and cravings. A diet low in leafy greens, which are often avoided on keto to maintain ketosis, can result in a depletion of folate.
• Vitamin B7 (Biotin): Biotin is important for hair, skin, and nail health. It is also necessary for embryonic growth during pregnancy. On a keto diet, biotin is used up more quickly due to the processing of fatty acids.
• Selenium: Selenium plays a role in heart health, immunity, thyroid function, and protection against oxidative stress. High-fat foods tend to be low in selenium, and studies have shown that epileptic children on keto diets experience decreased selenium levels over time.
• Calcium: Calcium is important for bone and teeth health, blood vessel function, and muscle and nerve communication. People on long-term keto diets may lose calcium through urine, and the acidic nature of the diet can lead to calcium loss from bones.
• Magnesium: Magnesium is essential for energy production and the proper functioning of nerve cells and the brain. It is also associated with heart health and the prevention of conditions like migraines. A keto diet may lead to decreased magnesium levels due to reduced intake of magnesium-rich foods like fruits and grains.
• Iron: Iron is necessary for energy production and the formation of red blood cells. The high-fat content of the keto diet can interfere with iron absorption, leading to potential deficiencies.
• Sodium and Potassium: These electrolytes help maintain fluid balance, blood volume, pressure, and pH in the body. The keto diet can lead to increased loss of sodium and potassium, especially during the initial stages, resulting in symptoms like constipation, headaches, muscle cramps, and weakness, known as "keto-flu."

To mitigate these potential deficiencies, it is important to include nutrient-dense foods in your keto diet, such as grass-fed meat, poultry, wild-caught fish, liver, leafy greens, nuts, and seeds. Additionally, supplementation with certain vitamins and minerals may be necessary to ensure adequate intake.

It could damage blood vessels

The ketogenic diet has been linked to an increased risk of blood vessel damage. Researchers from the University of British Columbia found that indulging in a high-sugar treat while on a high-fat, low-carb diet can damage blood vessels. The study, published in Nutrients in 2019, showed that a "cheat day" on the ketogenic diet can have long-term consequences for blood vessel health.

Senior author Jonathan Little, an associate professor in the School of Health and Exercise Sciences, expressed concern that people on the keto diet may be undoing the positive impacts on their blood vessels if they suddenly consume large amounts of glucose. The data suggests that the ketogenic diet should be followed consistently, without frequent "cheat days," to maintain blood vessel health.

Additionally, two studies from Sweden and Italy found that patients on ketogenic diets may exhibit early signs of blood vessel injury, as evidenced by reduced distensibility on ultrasound. The Swedish study, conducted by Dr. Kapetanakis and colleagues, observed that carotid arteries became stiffer after 12 months but returned to normal by 24 months. Similarly, the Italian study, led by Dr. Coppola, found that ketogenic diet participants had less distensible blood vessels compared to the control group, indicating increased stiffness. However, neither study reported any clinical changes or cardiac symptoms in the participants.

While the exact mechanism is not yet clear, the reduced distensibility of blood vessels observed in the studies could be related to the diet's impact on cholesterol and triglyceride levels. The studies suggest that the potential cardiac risks associated with the ketogenic diet warrant further investigation, especially considering the diet's popularity for weight loss and its effectiveness in managing seizure disorders.

In conclusion, while the ketogenic diet may offer certain benefits, it is important to consider the potential risk of blood vessel damage. More research is needed to fully understand the long-term effects of the diet on blood vessel health and to determine ways to mitigate these risks.

May lead to dangerously low blood sugar

Keto and the Risk of Dangerously Low Blood Sugar

The keto diet, a low-carb, high-fat, and adequate-protein diet, has been linked to a risk of dangerously low blood sugar levels, known as hypoglycemia. This condition occurs when blood sugar drops below the normal range of about 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per litre (mmol/L). While hypoglycemia is more common in individuals with diabetes, it can also occur in people without diabetes, including those on the keto diet.

Symptoms of Hypoglycemia

Hypoglycemia can cause a range of symptoms, including:

• Lightheadedness
• Dizziness
• Sweating
• Difficulty concentrating
• Irregular or increased heart rate
• Fatigue
• Hunger
• Shakiness
• Nightmares
• Bad dreams
• Restless sleep
• Headaches
• Seizures
• Unexplainable tantrums or crying

Causes of Hypoglycemia in Keto Dieters

The keto diet involves severely restricting carbohydrate intake, which leads to lower blood sugar levels. This restriction can cause hypoglycemia, especially if combined with other factors such as intense exercise, alcohol consumption, or certain medications. Prolonged periods of not eating, fasting, or illness can also contribute to the development of hypoglycemia.

Treatment of Hypoglycemia

The treatment for hypoglycemia is simple and involves boosting blood sugar levels with glucose (sugar). Consuming small amounts of carbohydrates, such as fruit or sugary snacks, can help resolve hypoglycemia symptoms. If symptoms persist or if the person is unable to eat or drink due to vomiting, sluggishness, or seizures, emergency medical attention is required.

Long-Term Health Risks of the Keto Diet

While the keto diet can be effective for weight loss and blood sugar management, there are potential long-term health risks associated with it. These include vitamin or mineral deficiencies, negative effects on athletic performance, weight regain after relaxing the strict guidelines, damage to blood vessels, and an increased risk of atrial fibrillation and cancer. Additionally, the keto diet may be difficult to sustain over an extended period, and there is limited research on its long-term effectiveness and risks.

May increase the risk of chronic diseases and early death

The ketogenic diet's potential effect on the risk of chronic illnesses, such as heart disease and cancer, is a topic of debate and ongoing research. While some studies suggest that high-fat, low-carb diets that focus on animal foods may lead to poor health outcomes, others indicate that diets emphasising vegetable sources of fats and proteins offer health benefits.

Long-term observational studies:

A long-term observational study of over 130,000 adults found a correlation between animal-based low-carb diets and higher mortality rates from heart disease, cancer, and all causes. In contrast, vegetable-based low-carb diets were linked to lower mortality rates from these causes.

Another study of more than 15,000 adults found similar results, associating both low and high-carb diets with a greater risk of death from all causes compared to moderate-carb diets (50-55% of total daily calories).

The role of animal-based and plant-based sources:

Some evidence suggests that low-carb diets that emphasise animal foods may lead to higher death rates. A study published in The Lancet concluded that:

> "Low-carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality."

The impact of weight regain:

Additionally, the yo-yo effect of weight regain after discontinuing the keto diet is linked to a higher risk of early death. Relaxing the strict keto guidelines and transitioning to a more relaxed version of the diet often results in weight regain, which can affect metabolism and make future weight loss more challenging.

The need for further research:

While the research is mixed, with some studies suggesting a correlation between low-carb diets and increased mortality, more comprehensive studies are needed to establish a definitive causal relationship. The existing studies are primarily observational, indicating associations rather than cause-and-effect relationships.

May cause digestive issues and changes in gut bacteria

The keto diet may cause digestive issues and changes in gut bacteria. The diet is low in fibre, which can lead to an increased risk of constipation. High-fibre diets are also thought to protect against digestive disorders such as hemorrhoids, stomach ulcers, gastroesophageal reflux disease (GERD), and diverticulitis.

The keto diet may also alter your gut microbiome. The gut microbiome is thought to play a central role in several aspects of health, including digestion, immune function, mental health, and disease prevention. Some research suggests that the keto diet could damage the concentration and composition of gut bacteria. One 6-month study in 217 people linked a high-fat diet to several unfavourable gut changes, including increased inflammation and reduced beneficial fatty acids. Another study in 23 children with epilepsy showed that 3 months of the keto diet damaged gut microbiome composition compared to a control group.

However, other studies have found inconsistent results. For example, a small study revealed that 1 week of the keto diet reduced seizure frequency in infants by 50%. It also reduced concentrations of proteobacteria, a form of harmful gut bacteria.

Due to these conflicting findings, more research is needed to evaluate how the keto diet affects the gut microbiome. While the keto diet may harm your gut microbiome and lead to digestive issues, some research suggests that the diet could benefit digestive health. For instance, the keto diet may reduce inflammation and help treat conditions like irritable bowel syndrome (IBS) and Crohn's disease.

If you decide to follow a keto diet, be sure to eat a variety of gut-friendly foods to promote digestive health. Gut-friendly foods that can be enjoyed as part of a keto diet include avocados, leafy greens, coconut oil, kimchi, and butter.

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