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Why keto may not be a good “ke(y) to” weight loss!

Keto diets have become all the rage in recent years, but it may not be the panacea adherents hope it to be; however, predictably, it won’t be the last fad diet to come around that promises results either.


Ketogenic diets are often used as a therapeutic diet for the prevention & treatment of epileptic seizures in patients who suffer with seizures despite interventions with medication. The diet has been used as far back as 1920 to treat this condition by changing how the brain gets energy to function.


The IOM acceptable macronutrient distribution range (AMDR) recommends intake of 20-35% fat (limiting saturated & limiting/avoiding trans fat), 10-35% protein, & 45-65% CHO. Ketogenic diets, however, typically follow a macronutrient distribution of 70-80% fat, 10-20% protein, & 5-10% carbohydrate (CHO). Carbs are usually restricted to less than 20-50g, & it is this restriction of CHO combined with the high fat component of the diet that induces “ketosis, or the production of ketone bodies that serve as an alternate energy source for neurons & other cell types that cannot directly metabolize fatty acids” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322232/), & it is this state of ketosis that “uniquely alters the ‘excitability’ of the brain, thereby reducing the tendency to generate seizures” (https://my.clevelandclinic.org/health/treatments/7156-ketogenic-diet-keto-diet-for-epilepsy ).


More recently, ketogenic diets have been explored as an option in the treatment of other neurological disorders & diseases, including Alzheimer’s, autism, Parkinson’s disease, & multiple sclerosis. Other health conditions being researched for keto diet efficacy include traumatic brain injury, migraines, some cancers, glycogen storage disease, polycyclic ovary syndrome, obesity, non-alcoholic fatty liver disease, diabetes, & metabolic syndrome.


Keto diets have also been adopted by many as the latest trendy weight loss diet; however, “given often-temporary improvements, unfavorable effects on dietary intake, & inadequate data demonstrating long-term safety, for most individuals, the risks of ketogenic diets may outweigh the benefits (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322232/).


Outlined below are some of the many contraindications, complications, & dangers associated with following this very restrictive diet:

  1. Keto flu: headache, weakness, fatigue, irritability, nausea, vomiting, dizziness, brain fog, gastrointestinal discomfort, decreased energy, feeling faint, heartbeat irregularities, & muscle soreness

  2. Dehydration & electrolyte deficiencies

  3. Constipation due to inadequate dietary fiber & dehydration

  4. Changes in gut health/microbiome

  5. Impaired immunity

  6. Halitosis/bad breath

  7. Hypotension/low blood pressure

  8. Hypoglycemia/low blood sugar

  9. Difficulty thinking

  10. Mood swings

  11. Sleep difficulties

  12. Low energy & desire to engage in & sustain physical activity/decreased physical performance

  13. May decrease muscle mass & damage muscles, including the heart muscle

  14. Irregular menstrual cycles

  15. Decreased bone mineral density, osteoporosis, & bone fractures

  16. Increased risk of birth defects & gestational diabetes in women following a low CHO diet prior to/during pregnancy

  17. May increase overall chronic disease risk by skewing the diet towards foods that have been linked to increased risk for many of the diseases the keto diet is touted to help: cancer, diabetes, heart disease, Alzheimer’s disease

  18. May contribute to heart disease due to high intake of fats & saturated fats

  19. High cholesterol/increased LDL “bad” cholesterol

  20. Kidney stones, damage, or impairment

  21. Increased risk for gout

  22. Decreased diet quality & insufficient intake of fruit, vegetables, whole grains, & legumes

  23. Inadequate in phytochemicals & nutrients: CHO, fiber, vitamins, minerals

  24. Can lead to micronutrient deficiencies

  25. May increase cravings, lead to binge eating, disordered eating patterns, &/or yo-yo dieting

  26. Unsustainable due to restrictive nature

  27. Unsafe for those with the following pre-existing conditions:

    • Thyroid conditions: may slow/further impair thyroid function, which can result in weight gain, hair loss, depression, fatigue, & many other complications

    • Liver conditions: may result in liver problems/damage due to high consumption of fat

    • Gallbladder disease: high fat, high cholesterol, low fiber diets can exacerbate or result in gallstone issues

    • Pancreatic disease: high fat diets can cause the pancreas to release more enzymes at once than it normally would, leading to an attack of pancreatitis

    • Kidney disease: may stress the kidneys due to higher protein intake & the increased risk for dehydration when following the ketogenic diet

    • Eating disorders: severe restriction of food groups, carbohydrates in this case, may reinforce eating disordered behaviors, food fears, increased anxiety around eating CHO containing foods, rigidity around food, increase fixation on weight & weight loss, increase cravings, obsessive thoughts about food, & contribute to binge &/or binge/purge eating behaviors, & may contribute to medical complications often observed in those who struggle with eating disorders


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