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Is the Keto Diet Safe? 5 Things You Need to Know

No other diet trend has seen the explosion in popularity quite like keto, but is it really safe for everyone to try? The uniqueness and strictness of this eating style has left many experts questioning its validity and how healthy this approach truly is for certain populations. To help you get the facts straight, we turned to the science. Here are the top things you need to know when it comes to your health and going keto.

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What’s a Keto Diet and How Does it Work? 

A keto diet is a very low carbohydrate diet - with carb intake typically at 5% of your calories or less. By restricting carbs to very low levels and eating high amounts of dietary fats, your body is forced to switch to fats as its primary source of energy. Thus, making you more efficient at metabolizing and burning fat through a process called ketogenesis. 

Ketogenesis is a well-known, natural phenomenon and results in a metabolic state referred to as ketosis

While achieving ketosis is not technically required for a diet to be considered keto, it is a highly desired side effect by many keto-goers. It is also at the center of much of the controversy surrounding the potential health risks of a ketogenic diet. 

Learn more about keto and the science behind it in this detailed ketogenic diet review from a doctor and a registered dietitian.

Why Keto Gets a Bad Rap

Keto is frowned upon in certain circles for a few different reasons:

Ketosis is often confused with ketoacidosis, a dangerous condition that occurs in diabetics. But these two are not the same thing and it is extremely rare that ketosis would become life-threatening in healthy adults without diabetes. 

keto flu is what some people refer to as the unpleasant side effects many people experience when first starting the ketogenic diet, including bad breath, mood swings, and fatigue. While these aren't desirable feelings for anyone to experience, they aren't dangerous and they go away after your body adjusts to the diet. Ketoacidosis, on the other hand, is a very dangerous condition that most often occurs in people with diabetes, commonly involving abdominal pain, nausea, vomiting and sometimes confusion and requires immediate hospitalization to fix.

The emphasis of high intake of fat and animal-based products leads many to have strong concerns about poor nutrition including too much-saturated fat, high intakes of processed red meat, and insufficient intake of nutrient-dense fruits and vegetables. But the thing is, not all ketogenic plans are created equal. And it's entirely possible to have poor nutrition on any meal plan - not just keto! Considering potato chips and soda are technically vegan.

Lastly, keto is likely not the best for all athletes and active individuals. Fat is a valuable source of fuel for many long distance and endurance athletes, but fat (in the form of ketones) probably cant power high intensity training and explosive movements the same way sugar can. It also isn't the greatest approach to muscle gain either, considering carbs can play a favorable role in muscle growth

Is Keto Really Healthy? Top 5 Things To Know

For the most part, low carb diets, including keto, are considered safe for a lot of people. But that also doesn’t mean it's the best solution for everyone either. 

Here are five important factors to consider when it comes to deciding whether or not trying keto is the right choice for your health. 

1. Keto Diet Research Is Ongoing

While it seems like the latest craze, keto isn't exactly new. The ketogenic diet was originally used in the 1920s as a way to treat epilepsy in children. And as far as we know, it has been extensively studied and shown to be safe even in this population (1). 

As for using keto to promote fat loss in adults, what we’ve seen in the short term so far is promising, but there is still a lot to discover about this approach. 

Alzheimer’s Disease, Parkinson’s Disease, traumatic brain injury, and stroke have all been suggested to benefit from the keto diet, and some animal studies suggest that there may also be a role of the keto diet in the treatment of some cancers (2,3,4,5,6). Although, while there have been many hypotheses on potential benefits the keto diet could have on these conditions, studies have not yet shown any evidence that the keto diet helps neurological conditions other than epilepsy.

Low carb diets and ketosis in specific seem to help insulin work better (7).

Additionally, some research demonstrates that the bad type of cholesterol (LDL) is often lower in people on a keto diet and good cholesterol (HDL) is higher (8,9).

However, it’s critical to not equate these early theories and associations with causation or cures. Most of these studies are small and done on animals and we don’t have many studies looking at the long-term health consequences of adults following a strict keto diet to lose weight (10). 

2. Your Keto Food Choices Matter

Achieving a nutritious balanced diet on keto can feel like a serious challenge. Weight loss methods that cut out entire food groups, or macros, can significantly increase your chances for nutrient deficiencies. 

Carbohydrates don’t just come from processed foods, bread, and sugar, pretty much all plant-based foods contain some amount of carbohydrates. Even commonly celebrated keto foods contain carbs, like avocados, nuts, seeds, and leafy greens.  

In fact, it is pretty impossible to avoid carbs altogether and still get adequate nutrition. All that would be left is meat, oil, and some cheeses. 

This is why net carbs are used - total daily carbs minus fiber intake. Many nutrient dense plant foods are also a source of fiber, a type of carbohydrate that is not easily absorbed by the body and doesn’t seem to impact blood sugar and your ability to achieve ketosis in the same way sugar does. And yes, this is exactly how avocados and cauliflower fit into a more balanced keto meal plan. 

Moreover, even though less than 20 grams of carbs is often advertised as the target carb amount for keto, the ideal keto macro balance can differ from one person to the next and depends on multiple factors. Some people can handle a lot more carbs than this, giving them more opportunity when it comes to nutrition intake.

3. Keto Supports Weight Loss

Traditional low fat diets just aren’t for everyone. And for those that enjoy more savory, rich-tasting meals, keto gives them the option to lose weight and still enjoy their food. 

Bottom line, sometimes just losing weight can drastically improve your health, even more so than choosing healthy foods alone (11,12,13,14,15).

Besides food preferences, ketogenic meal plans can support weight loss in other ways, like reducing hunger. In one study, those on keto seemed to feel more full and have lower appetites, allowing them to cut calories with less food intake overall (16).

Ketosis may spike your metabolism slightly and increase your ability to burn fat efficiently, which may make fat loss even easier (17,18,19). However, these theories have yet to be proven in well done human studies.

Additionally, low carb diets have a good amount of scientific backing when it comes to weight loss. However, there has not yet been any good evidence to show that the ketogenic diet is superior to other low carb diet plans for fat loss (20,21,22).   

Of course, whether you achieve ketosis or not, you still need to control calories in order to lose weight on a keto diet. There is just no way around this - the amount you eat is still much more important than what when it comes to losing weight. 

4. A Keto Is Difficult To Stick To Long Term

Going full keto means a lot of rules and dietary restrictions - and cutting out a lot of favorite foods! Not to mention cheat days on keto can be a little more drastic than other diets - especially if you are trying to stay in ketosis. Thus sticking with keto long term can seem really hard. 

This is why some keto dieters only follow keto short term to achieve a certain weight loss goal, and then resume to their normal diets soon after. And why many other keto-goers don’t follow the diet as strictly and enjoy a more moderate approach they can utilize for more than a few months at a time 

Regardless, the difficulty of this style of eating doesn’t make it unsafe or even ineffective for that matter. It really depends on the person and what works for you. Understanding that keto isn’t a magic bullet and using it as a framework to control calories and achieve your health and fitness goals is still a valuable approach for many people. 

5.  Keto Isn’t a Good Fit For Everyone

The keto diet is largely regarded as safe in both children and adults. However, the keto diet is probably still not a good choice for some, especially those with specific medical conditions.

Who should not do keto

The following groups of individuals should consult their primary care physician before jumping on to any keto food plan.  

Keto Diet in Pregnancy

Pregnant and breastfeeding women should not be following a ketogenic diet due to their increased glucose needs to support their pregnancy.

Sustaining extremely low levels of carbohydrates can be dangerous for pregnancy. 

It is generally recommended that anyone pregnant or breastfeeding consume at least 50 grams of carbohydrates daily (23).

Keto Diet in People with Kidney Problems

People with renal disease (anyone on dialysis and other individuals with a consistently elevated creatinine) are probably not a good fit for the traditional keto diet. Because the kidneys are in charge of processing much of the protein we eat, the moderate to high protein intake recommended in the keto diet has the potential to be dangerous for people with kidneys that do not function properly (24). Make sure to talk to your doctor before starting the keto diet if you are unsure if your kidneys are functioning well.

Keto Diet in Diabetes

This is probably not the best diet for people with type 1 diabetes as they have a much higher risk of developing a dangerous condition called diabetic ketoacidosis as well as hypoglycemia. However, some type 1 diabetics committed to the keto diet lifestyle can enjoy success provided extremely careful blood glucose monitoring and working closely with their doctor for frequent medication adjustments.

On the contrary, the ketogenic diet may be ideal for people with type 2 diabetes as it may contribute to fat loss and improve insulin sensitivity while maintaining a low and steady carbohydrate intake.

However, advanced type 2 diabetics on insulin and oral medications still have an increased risk of developing hypoglycemia and diabetic ketoacidosis. It is therefore extremely important all diabetics taking medications to work closely with their doctors prior to and throughout the course on the keto diet as more frequent blood glucose checks and medication adjustments may be necessary.

How to Do Keto Safely

If you’re looking to start a keto diet, here’s how to do it without sacrificing good health or good nutrition in the process.

  1. Talk with your doctor if you have a medical condition or are concerned about how keto may impact your wellbeing.
  2. Learn your daily calorie needs and keto macros to achieve your health goals. 
  3. Find nutritious, keto friendly foods you enjoy to start building your meal plan.
  4. Learn how to meal prep your own healthy keto meals at home.
  5. Track your daily intake in a nutrition app to ensure you are getting what your body needs each day. 

Still not sure if keto is the right fit for you? Take this 5 minute quiz to get paired with your perfect meal plan to help you reach your health goals.