Fact Checked By Christine VanDoren NSCA-CPT, ACE
August 23, 2021
The keto diet should not be tried simply as an experiment, as many health risks come along with it (1).
Multiple studies have been conducted, but they have only studied the short-term results, as the diet has not been commonly used for a long period.
It is still up in the air whether or not it is safe to utilize long-term.
Because of this, keep in mind the following possible risks if you are considering trying the ketogenic diet.
Note: Most people following the keto diet do not experience any or all of the issues mentioned below at all.
It is very restrictive.
Like many diets, the ketogenic diet has its restrictions and rules that you need to be aware of and follow for it to work.
If you eat too many carbohydrates or proteins, your body will not be able to go into ketosis, which is the main goal of this diet (2).
To properly follow the nutrition regimen, you typically eat a large number of fats, a moderate amount of protein, and a very small amount of carbohydrates.
The carbs must be either below 50 grams a day or less than 10% of your overall calorie intake.
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Because of this severe restriction, most keto dieters do not consume any cereals, grains, or bread, and carbs from all sources are limited.
Fruits and vegetables also tend to be mildly consumed because they contain carbohydrates.
Since your body will be going through drastic changes, it is recommended that you make a slow transition both when getting on the diet and when coming off.
This will minimize the stress your body endures.
There are possible nutrient deficiencies.
One of the most likely side effects of following the ketogenic diet is developing nutrient deficiencies in a variety of vitamins and minerals.
This happens because you will no longer be consuming a wide variety of grains, fruits, and vegetables that you otherwise would.
Removing the majority of carbohydrates from your diet is bound to bring along at least a few deficiencies, with the most common being fiber.
While you cannot increase your carb intake to make up for the loss, you can be selective with what carbs you do ingest.
Some of the most nutrient-dense sources are sweet potatoes, quinoa, steel-cut oats, and low-carb fruits (3).
Also, many fat sources that you will be either introducing to your diet or simply increasing to make up for calories lost from decreased carbohydrate intake contain few to no nutrients beyond the healthy fats (4).
Sources such as fish oil, beef grease, coconut oil, avocado oil, and canola oil are commonly consumed on the keto diet and each contains 0 grams of potassium, calcium, magnesium, folate, or vitamin C.
Taking a multivitamin and other supplements are highly recommended while on the ketogenic diet to help close the gap and aid your body with being fueled properly.
You could get the keto flu.
You may have heard of the keto flu before, as many people experience it.
You will know if you have it if you start experiencing a group of symptoms 2 to 7 days after making the diet change.
You should not experience it before then, as your body will not enter a state of ketosis until you have been on the diet for at least 48 hours.
If you get the keto flu, you could experience the following symptoms (5):
While studies have been conducted about the ketogenic diet as a whole, none have dove into why people experience the keto flu.
Not everyone experiences all or any of the symptoms, but you are more likely to if you ate very unhealthy before making the dietary switch.
Many people become discouraged and want to quit because of getting the keto flu, but don’t give up!
Allow your body a week or two, and if you are still feeling bad at that point, the keto diet may not be right for you.
Alternatively, try exogenous ketones to bypass this stage (6).
Stress is put on your kidneys.
A commonly known long-term risk of the ketogenic diet is kidney stones (7).
The kidneys are responsible for metabolizing protein, and people tend to consume more protein than usual on the keto diet.
This means that the kidneys can become overloaded, especially since there is a lower intake of nutrients that usually prevent kidney stones from developing.
Also, the keto diet can cause your urine to become more acidic, which is a major risk factor for kidney stones.
As a preventative measure, make sure to get regular blood tests to identify irregular levels of minerals in the bloodstream that lead to kidney stones.
It can cause digestive issues.
Also a symptom of the keto flu, constipation is the most common digestive issue that you may experience on the ketogenic diet.
This happens because you will more than likely be lacking fiber in your daily diet, as most high-fiber fruits, grains, and legumes are consumed in low amounts.
Diving deeper, a UC San Francisco study showed that the keto diet can cause quite an impact on your microbiome (8).
This was proven when researchers exposed the guts of mice to many different components of the human microbiome that were adhering to the keto diet; altered microbial populations were the results.
One alteration stood out in particular, and that was a drastic decrease in the number of Th17 immune cells-a T cell that is critical for fighting off diseases.
Generally, high-fat diets have been shown to reduce colon bacteria overall and cause the microbiome to respond differently than usual (9).
Consuming higher amounts of fat, along with an absence of carbs, promotes ketone production, and that is all it takes for gut changes to start occurring.
A high-fat diet can cause a leaky gut, as it increases intestinal permeability.
When this happens, genes that code for proteins that make up tight junctions start turning off.
The seals that are usually between intestinal cells that are responsible for stopping dangerous gut contents from leaking through the gut wall and into the bloodstream start to thin and weaken.
This can lead to a variety of additional health problems, and it needs to be taken seriously.
There are many benefits of the ketogenic diet, but nothing comes without risks.
Only the short-term risks are known of this low-carb diet: nutrient deficiencies, the keto flu, kidney stones, and digestive issues.
Not everyone experiences all or any of these problems, but it is important to keep them in mind.
It is recommended to speak with your physician before switching to the ketogenic diet.
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