The ketogenic diet, often referred to as the keto diet, is characterized by its low carbohydrate and high fat composition, making it a popular choice for individuals aiming to lose weight effectively. By drastically reducing carbohydrate consumption and elevating fat intake, the body enters a state known as ketosis. In this metabolic condition, the body primarily utilizes fat as its main source of energy rather than relying on carbohydrates. While the keto diet can be beneficial for some, it is essential to recognize that it also comes with potential risks that you should consider. Below are seven notable dangers associated with the ketogenic diet that everyone should be aware of.

1. Potential Onset of the Keto Flu

Embarking on a keto diet often involves a significant reduction in carbohydrate intake, typically limited to less than 50 grams daily, which can be quite a shock to your system. This drastic change prompts your body to deplete its carbohydrate reserves and transition to utilizing ketones and fat as its primary energy source. During this adjustment period, many individuals may encounter flu-like symptoms.

Common symptoms include headaches, dizziness, fatigue, nausea, and constipation, which are largely attributable to dehydration and imbalances in electrolytes that occur as the body shifts into a state of ketosis. It's crucial to keep an eye on these symptoms throughout your keto journey.

Most individuals who experience the keto flu notice an improvement within a few weeks; however, remaining vigilant about hydration and incorporating foods that are rich in sodium, potassium, and other essential electrolytes is key to easing this transition. As your body becomes accustomed to burning ketones and fats for energy, these flu-like symptoms may arise in the initial phase of the keto diet.

2. Potential Stress on Your Kidneys

The keto diet is characterized by its reliance on high-fat animal products such as eggs, meats, and cheeses, primarily due to their low carbohydrate content. However, excessive consumption of these foods may elevate the chances of developing kidney stones. This increased risk is attributed to the fact that a diet rich in animal products can result in a more acidic environment in both the blood and urine, subsequently leading to higher levels of calcium excretion in the urine.

Research indicates that the ketogenic diet may also diminish the citrate levels in urine. Citrate plays a crucial role in binding with calcium, which helps prevent kidney stone formation; thus, lower citrate concentrations can heighten the likelihood of stone development.

Moreover, individuals with chronic kidney disease (CKD) should exercise caution regarding the keto diet, as compromised kidneys may struggle to filter the acid buildup in the bloodstream caused by these animal-based foods. This condition can result in acidosis, potentially accelerating the progression of CKD. It’s also worth noting that lower protein diets are generally recommended for those with CKD, while the ketogenic regime tends to be moderate to high in protein.

In summary, a high intake of animal products within the keto diet can contribute to more acidic urine and an increased risk of kidney stones, complicating the management of chronic kidney disease.

3. Potential Digestive Issues and Alterations in Gut Microbiota

The ketogenic diet, which significantly limits carbohydrate intake, often makes it challenging to fulfill daily fiber requirements. Essential sources of fiber, including high-carb fruits, starchy vegetables, whole grains, and legumes (also known as ??? in India), are largely excluded from this dietary approach due to their higher carbohydrate content. Consequently, individuals following the keto diet may experience digestive troubles such as discomfort and constipation.

A comprehensive study spanning a decade involving children with epilepsy on the ketogenic diet indicated that a notable 65% of participants encountered constipation as a prevalent side effect. Furthermore, fiber plays a crucial role in nourishing the beneficial bacteria residing in our digestive system. A healthy gut can enhance immunity, uplift mental well-being, and reduce inflammation. Therefore, a low-carb diet that falls short in fiber, like keto, could adversely influence gut microbiota, although existing research on this matter presents varied findings.

Fortunately, there are several keto-compatible foods rich in fiber, such as flax seeds, chia seeds, coconut, broccoli, cauliflower, and various leafy greens (Palak in India). However, due to its inherent carbohydrate restrictions, the keto diet often results in a fiber deficiency, potentially leading to constipation and detrimental impacts on gut health.

4. Potential Risk of Nutrient Deficiencies

The keto diet often imposes significant restrictions on various foods, particularly those rich in nutrients like fruits, whole grains, and legumes. As a result, it may not deliver the essential vitamins and minerals that are recommended for our daily intake.

Research indicates that the keto diet may fall short in providing adequate levels of crucial nutrients such as calcium, vitamin D, magnesium, and phosphorus. For instance, a comparative study on dietary nutrient compositions found that very low carbohydrate diets, similar to the Atkins diet, managed to supply sufficient quantities of only 12 out of the 27 vital vitamins and minerals necessary for the body from food sources.

Over an extended period, this dietary approach could potentially result in nutrient deficiencies. Notably, clinical guidelines suggest that individuals following a very low-calorie keto diet for weight loss should consider supplementation with potassium, sodium, magnesium, calcium, omega-3 fatty acids, psyllium fiber, and vitamins B, C, and E.

It’s crucial to remember that the nutritional quality of your diet heavily relies on the specific types of foods consumed. A diet abundant in healthy low-carbohydrate options, such as avocados (butter fruit), nuts, and non-starchy vegetables, offers a greater array of nutrients compared to processed meats and commercial keto snacks. Various studies have raised concerns regarding the keto diet's inadequate supply of essential vitamins and minerals like potassium and magnesium. Over time, this deficiency could escalate into significant nutritional shortcomings.

5. Potential Risk of Significantly Low Blood Sugar

Low carbohydrate diets, such as the ketogenic diet, have demonstrated effectiveness in managing blood sugar levels for individuals living with diabetes. Various studies indicate that ketogenic diets may contribute to a reduction in hemoglobin A1c levels, which serves as an indicator of average blood sugar over time.

However, those diagnosed with type 1 diabetes could face a heightened risk of experiencing low blood sugar episodes (hypoglycemia), characterized by symptoms like confusion, tremors, exhaustion, and perspiration. If left untreated, hypoglycemia can escalate to severe consequences, including coma or even death.

Research involving 11 adults with type 1 diabetes adhering to a ketogenic regimen for more than two years revealed that the average incidence of low blood sugar events was nearly one per day. Individuals with type 1 diabetes are particularly susceptible to low blood sugar when they administer excessive insulin without adequate carbohydrate intake. Consequently, a low-carbohydrate ketogenic approach may heighten this risk.

This concern is theoretically applicable to individuals with type 2 diabetes who are also on insulin therapy. While low carb diets have been recognized for their benefits in enhancing blood sugar regulation among those with diabetes, it is crucial to acknowledge that they may inadvertently elevate the likelihood of hypoglycemic episodes, particularly among those with type 1 diabetes.

6. Potential Risks to Bone Health

The ketogenic diet, while popular for its weight loss benefits, has also raised concerns regarding its impact on bone health. Research indicates that this diet may lead to weakened bones. Animal studies have demonstrated a connection between the keto diet and reduced bone strength, primarily attributed to decreases in bone mineral density as the body transitions into a state of ketosis.

For instance, a significant study involving 29 children with epilepsy on the keto diet revealed that a staggering 68% exhibited a decrease in bone mineral density scores after six months on the regimen. Additionally, another investigation involving 30 elite walkers found that participants adhering to the keto plan for 3.5 weeks had notably elevated levels of blood markers associated with bone breakdown, in contrast to those consuming a carbohydrate-rich diet.

Despite these findings, it is essential to note that further and more comprehensive research is necessary to draw definitive conclusions. Therefore, while the ketogenic diet may contribute to a reduction in bone mineral density and potentially initiate bone breakdown over time, additional studies are crucial to fully understand these effects.

7. Potential Increase in Chronic Disease Risk and Early Mortality

The impact of the ketogenic diet on the likelihood of developing chronic conditions such as heart disease or cancer remains a topic of extensive debate and is not completely understood. Some research indicates that diets high in fats and low in carbohydrates, particularly those that prioritize animal-based foods, may result in adverse health consequences. In contrast, diets that focus on plant-derived sources of fats and proteins appear to offer health benefits.

A comprehensive long-term observational study involving over 130,000 adults found a correlation between animal-sourced low carbohydrate diets and elevated mortality rates from heart disease, cancer, and overall causes of death. Conversely, diets that are low in carbohydrates and emphasize vegetable sources were linked to reduced mortality rates from heart disease and all causes.

Furthermore, another study involving more than 15,000 adults revealed comparable findings, indicating that both low and high carbohydrate diets were associated with increased all-cause mortality compared to moderate carbohydrate diets, where carbohydrates constituted approximately 50–55% of daily caloric intake. However, there is a pressing need for more rigorous studies to draw definitive conclusions. While findings are varied, some evidence suggests that low carbohydrate diets rich in animal products may be related to higher mortality rates associated with heart disease, cancer, and other causes.

The Bottom Line

Although the keto diet is often associated with weight loss and various short-term health advantages, it can also result in nutrient deficiencies, digestive challenges, compromised bone health, and other issues if followed long-term. Given these potential risks, individuals suffering from kidney disease, diabetes, cardiovascular issues, or bone disorders, among other medical conditions, should consult their healthcare provider prior to embarking on the keto diet. Additionally, seeking guidance from a dietitian can be beneficial in crafting well-rounded meals and keeping track of your nutrient intake while following this diet, thereby aiding in the mitigation of potential complications and nutrient shortfalls.