From the Guidelines
The keto diet is not recommended for long-term use in most individuals due to potential risks to morbidity, mortality, and quality of life. While it may be beneficial in the short term for specific medical conditions, such as epilepsy, obesity, or certain metabolic disorders, extended adherence can lead to nutritional deficiencies, kidney problems, bone density loss, and cardiovascular concerns 1. The most recent and highest quality study available, published in 2024, highlights the potential benefits and risks of the ketogenic diet, but also emphasizes the need for careful monitoring and consideration of individual health needs 1.
Key Considerations
- Long-term ketosis may cause side effects including constipation, bad breath, muscle cramps, and the "keto flu" 1.
- Certain populations, such as pregnant or breastfeeding women, people with liver or pancreatic disease, those with gallbladder issues, and individuals with certain metabolic disorders, should avoid long-term keto diets 1.
- The diet's restrictive nature makes it difficult to maintain over years, and many nutritionists recommend more balanced approaches like Mediterranean or DASH diets that have stronger evidence for long-term health benefits and sustainability 1.
Recommendations
- Anyone considering a keto diet long-term should work closely with healthcare providers to monitor health markers, ensure adequate nutrient intake, and assess ongoing appropriateness 1.
- A thorough evaluation of the individual's health status, nutritional needs, and potential risks should be conducted before initiating a keto diet 1.
- Alternative diets, such as the Mediterranean or DASH diets, may be more suitable for long-term use due to their balanced nutrient profile and stronger evidence for health benefits 1.
From the Research
Long-Term Appropriateness of the Keto Diet
The keto diet's long-term appropriateness for anyone is a topic of ongoing debate and research. Several studies have investigated the potential risks and benefits of this diet, particularly in relation to cardiovascular health and kidney function.
Potential Risks
- The keto diet may not be better than comparator higher carbohydrate diets over the long term, and it has low adherence levels in studies lasting ≥12 months 2.
- The diet's emphasis on fat, which often comes from animal fat, increases the consumption of saturated fat, which may increase the risk of heart disease 2, 3.
- The keto diet has been associated with an increased risk of kidney stones in patients using it for the treatment of refractory epilepsy 2.
- A study found that progression of coronary artery disease was more pronounced in people with low-carbohydrate intake, especially when the compensatory calorie intake was from animal sources as compared to plant-based sources 3.
- The keto diet has been linked to severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among participants 4.
Potential Benefits
- A case report demonstrated that a long-term ketogenic diet in a person with type 1 diabetes had considerable therapeutic benefits, including successful glycemic control and a 43% decrease in daily insulin requirements 5.
- The keto diet has been shown to cause rapid and sensible weight loss, along with favorable biomarker changes, such as a reduction in serum hemoglobin A1c in patients with diabetes mellitus type 2 6.
Considerations
- A plant-based version of the ketogenic diet may mitigate some of the concerns with animal-based versions of the ketogenic diet 2.
- More research is necessary to ascertain if a ketogenic diet can be sustained over the long term and how it affects endpoints that are more clinically significant, such as morbidity and mortality due to obesity 4.