Kidney stones, weight cycling, poor exercise performance... the list of side effects is LONG for those who follow the keto diet! Learn all about what makes this diet so popular, how it works, and how it doesn't work.
PS - it might surprise you to know that I've actually followed this diet before... take a listen to learn why & how it went.
As always, here is my honest and uncensored, dietitian review.
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You can’t talk about the keto diet without describing what ketosis, ketones, and ketogenic really is. With that being said, this is going to get a little science-y at points… but I’ll make it as easy and digestible to understand as I can (no pun intended).
What is the keto diet?
The keto diet, short for ketogenic, describes a dietary intake that restricts carbohydrates to very limited amounts (traditionally less than 50 g/day) paired with a high fat consumption--about 90% of one’s total energy intake.
It was introduced in the 1920’s as a potential treatment for epilepsy.
However, what most people refer to as the ‘keto diet’ today is typically your run-of-the-mill low carb diet, just like Atkins (remember that one?).
The idea of both the traditional and modernized keto diet is to lower carbohydrate intake enough that ketosis is induced.
How the keto diet works
The keto dieter cuts nearly all carbohydrates from their diet in order to enter a state of ketosis. When done correctly, 90% of energy intake comes from dietary fat, but the popularized version of the keto diet includes high amounts of protein as well.
With the drastic reduction in carbohydrates, the body will switch over to creating ketones from fatty acids to use as a fuel source.
What is ketosis?
Ketosis is not a band, a new Netflix show, or the Instagram handle of an influencer. It’s a physiological state where the body burns fatty acids for fuel rather than using it’s typical fuel-source, glucose.
It usually appears when a person has had a low carbohydrate intake for a long period of time, but there are other factors that can induce ketosis as well (such as activity level).
Ketosis is actually your body’s intelligently designed attempt to survive during starvation. It starts two different metabolic processes. The fancy names of these are gluconeogenesis and ketogenesis. If we take the root word ‘genesis’ and translate it, we see that it means formation. Thus, we can easily see that these two processes describe the formation of glucose and ketones.
Usually, glucose is the result of breaking down carbohydrates. The body can also create glucose from lactate, glycerol, and a couple amino acids.
What are ketones?
Ketones are a molecule made in the body and are used for energy… but only when needed. They are not your body’s preferred method of using energy. Ketones come from fatty acids and are made in the liver.
If you’ve heard of the keto diet, you’ve likely heard of the urine sticks used to measure ketone counts. This is how people monitor themselves to know if they truly are in ketosis.
Who is keto good for?
There is a small (small) chance that following a ketogenic diet can benefit you, just like any other diet… but the majority of the evidence points to it not being the dietary pattern of choice for most of us.
I personally do not recommend following a restrictive eating pattern unless all other options have been exhausted (especially intuitive eating) and it is deemed medically necessary.
At this point in time, the ketogenic diet has only been proven useful for children and/or adolescents suffering from epilepsy.
How does the ketogenic diet help with epilepsy?
The keto diet has been shown by multiple sources to reduce seizures, primarily in children & adolescents with epilepsy. The exact reason why it reduces seizures is not completely understood, but the theory is that the ketones, because of their antioxidant and anti-inflammatory effects, provide some sort of neurologic protection.
Why keto works for weight loss
Initially, weight will likely be lost because of calorie restriction and water loss.
At the end of the day, no matter how you spin it, keto (used for weight loss) is about calorie restriction. Fat and protein are both very filling, and if you are eliminating one of only THREE macronutrients, you are going to be eating less.
Additionally, having such a small intake of carbohydrates causes a shift in our c ells – water moves out and is eliminated. That’s why people “lose 5 pounds in one week”, it’s just water weight.
Why keto doesn’t work for weight loss
Eventually, the weight comes back. This is because 1) the diet is difficult to adhere to, 2) the metabolism slows to accommodate for a lower intake of energy, and 3) the body will drive an individual towards carbs and beg you to fail.
As we all know by now (or should know), 95% of dieters will regain the weight within 1-5 years. In fact, dieting is one of the strongest predictors of weight gain. The keto diet is no exception to this.
Are keto diets healthy?
Keto diets may raise LDL cholesterol levels (the type of cholesterol that is associated with cardiovascular events), and it lacks dietary fiber… which is a key nutrient needed for the body to function well and for managing LDLs.
Not everyone who follows a keto diet will see a rise in LDLs or have a massive deficiency in fiber, but it takes some serious effort to not let this happen.
Additionally, there are some reports that low carbohydrate diets high in animal proteins and fats were associated with a twofold risk of type 2 diabetes in men.
Lastly, a keto diet can decrease exercise performance, an important aspect of overall health.
Why keto is dangerous / why keto is bad for you
If someone follows a ketogenic diet loosely and does not spend time investigating where the gaps in their nutrition will be and how to fill them, they may find themselves in the hospital. Followers of the keto diet may experience extreme and dangerous electrolyte shifts, fluid loss, dizziness and lightheadedness, and malnutrition.
Other side effects of the keto diet can include gastrointestinal disturbances, constipation, kidney stones, bone fractures, dyslipidemia (whack cholesterol levels), and micronutrient deficiencies.
Can keto cause ketoacidosis?
Ketoacidosis is a life-threatening condition that occurs when the body is not making enough insulin. The reason ‘keto’ is in the name is because ketone levels climb abnormally high during this event.
Ketoacidosis typically only happens in those with type 1 diabetes. Those following a keto-lifestyle shouldn’t experience ketoacidosis, but there are a few reports of lactating women and individuals with type 2 diabetes experiencing ketoacidosis as a result of keto-living.
So nursing mamas, do not try to lose the baby weight by following the keto diet.
Can keto cause hair loss?
Micronutrient deficiencies are common among restrictive diets if proper precautions are not taken. Because of this, individuals following the keto diet may experience hair loss due to missing some vitamins/minerals.
Are keto pills safe?
Maybe. They are unregulated and not FDA-approved, therefore we can’t be sure. I don’t think it’s worth the risk. Additionally, there is no evidence that these products do what they claim to.
Can keto cause kidney stones?
The keto diet is associated with a HIGH risk of kidney stones.
From The Kidney Dietitian, Melanie Betz:
“[There] are reasons why we think this happens. Essentially, a keto diet is lacking in all the GOOD things that prevent kidney stones, and has too much of the stuff that causes them.
In addition, a keto diet can be harmful for people who have #chronickidneydisease because of too much protein. High protein diets cause kidney disease to progress FASTER.”
Can keto cause constipation?
Yes. Because keto eliminates the main sources of dietary fiber: beans, grains, and most fruits, it is extremely difficult to have a healthy, regular digestive tract.
Can keto reverse diabetes?
Yes and no.
Diabetes is a disease where carbohydrates are not processed well. To say that keto reverses type 2 diabetes is a bit like saying glasses can reverse poor eyesight. While the glasses are in use, the eyesight is certainly not an issue. However, the glasses do not cure the eyesight issues. Once they are taken off, the eyes are still going to see poorly.
Additionally, like any other diet, the keto diet has a high failure rate. Failing a diet leads into binge eating, weight cycling, and stress: all things that can worsen diabetes.
Strict adherence has been shown to aid in blood sugar control without negatively impacting cholesterol, but it’s not the only option for diabetics and it must be both realistic and manageable for that person.
Interestingly, in animal studies, keto actually increased fat accumulation in the liver and insulin resistance. Granted, these were animal studies… but worth noting.
Does keto work for PCOS?
Keto has been suggested by some to be a great solution for women diagnosed with Polycystic Ovarian Syndrome (PCOS). I even tried it myself at one point for this very reason.
However, the literature on using the keto diet for PCOS shows weight loss + improvements in PCOS ailments. So is it the diet or the weight loss that improved PCOS symptoms?*
The problem is, the weight is likely to come back. Additionally, dieting can lead to binge eating and disordered eating. For these two reasons, I do not recommend the keto diet for women struggling with PCOS.
*Note: I do not think the blanket prescription of ‘just lose weight’ is helpful for women with PCOS, nor do I believe that being “overweight” (a term I hate) is the reason PCOS exists. PCOS is complex and still largely misunderstood. There are many women who struggle with PCOS symptoms and are medically a “normal weight.”
Will keto lower blood pressure?
Not necessarily. As with any other diet, if it somehow does successfully shift someone’s lifestyle behaviors to be more health promoting, blood pressure may be lowered. However, if someone is having a large amount of deli meats/sausage as they follow the keto diet, my guess is that their blood pressure will not be happy.
So, should you do keto?
If you’ve made it this far, my hope is that you’ve been talked out of doing the ketogenic diet UNLESS you are a child/adolescent struggling with epilepsy AND the ketogenic diet is not completely a burden on you and your family.
Keto can lead to a number of side effects including: kidney stones, disordered eating, nutrient deficiencies, weight loss then regain, and a poor quality of life.