Have you ever heard of the Keto diet? Unless you have been living under a rock for the past twenty years, then chances are that you have. In the case that you haven’t seen the light of day, or just need further explanation, the keto diet is a rapid weight loss method that limits one’s carbohydrate intake to 5-10% of their diet while the rest of their diet is made up of 70-75% of fat and a 15-20% of protein. The reason for the high intake of fat and low carbohydrate is so that the body will stop using glucose made from carbohydrates for energy and instead use ketones made from fat for energy. In the theory of keto, ketones are a more efficient energy source when losing weight because, unlike glucose, ketones are burned, and not stored. (Williams, 2019)

In the short term, there is no question that following the keto diet has effective results on weight loss. According to Yancy and associates review of 94 trials on the efficacy of a low-carbohydrate diet vs. a low-calorie diet for obese individuals during a 6-month time frame, those who followed the low-carbohydrate diet lost on average 12.9% of their body weight as opposed to a 6.7% loss for the participants of the low-calorie diet. (Yancy, 2004)

Outside of the short-term is where the questions and concerns of adverse health effects can be seen. There are 3 Major Health Risks related to the Keto diet if followed for longer than 6 months.

First, are heart complications. The Keto diet is not approved by the American Heart Association because of its high saturated fat and cholesterol content (Strychar, 2006). One heart condition that can develop is coronary heart disease. Coronary heart disease is a common term for plaque, which is made up of fatty deposits and cholesterol, that sticks to the walls of one’s arteries or veins. Over time, the plaque grows with excessive consumption of saturated fats and cholesterol. When enough plaque builds up in the coronary arteries, blood flow to the heart becomes limited, which can lead to heart attacks, strokes and death (Fisher, 2015). Once enough plaque exists in a vein or artery, it can slow or even prevent blood from flowing to and/or from the heart. Though saturated fat itself is not linked to coronary heart disease, it does raise lower density lipoprotein, or LDL, which has been proven to lead to coronary heart disease (Karger, 2017). It is not that fat is unhealthy. In fact, there is plenty of nutritional value to fat. Not to mention the human body requires it to maintain a healthy and balanced diet. It is the excessive consumption of fat that is unhealthy and poses risks for serious health issues. To put it into perspective, according to the American Heart Association dietary guidelines, one’s energy intake should not exceed 35% from total fat, more than half of the amount of fat consumed with the keto diet (Zhao, 2018). While the premise of the diet is based on fat, and is great for losing weight in the short-term, the long-term effects can be dangerous to the function of one’s heart.

Second, chronic diseases can develop. Many chronic diseases, such as hypertension and heart disease are developed later in life due to long periods of continuous eating habits that are contrary to being healthy (Whelton, 2017). Cholesterol is not only a threat to cause heart complications, but also for developing a chronic disease. The human body, like all mammals, produces its own cholesterol. According to the Harvard Health Journal, the human body creates 80% of its cholesterol from the liver and receives 20% from the diet (Corliss, 2019). Majority of meat and dairy products contain cholesterol. Since meat and dairy makes up the majority of a normal keto diet, a high amount of cholesterol is allowed to be consumed, which can lead to hypertension and heart disease (Fisher, 2015). Another risk factor of chronic diseases from the keto diet is an insufficient amount, or lack of vitamins and minerals. Many vitamins and minerals come from fruits, vegetables, and grains, which are limited with the keto diet. Vitamins A, B6, E, folate, calcium, magnesium, iron, potassium, and fiber are some of the most important micronutrients and are contained in fruits, vegetables, and grains. These vitamins and minerals are required to be consumed daily to maintain sufficient levels within the body. Insufficient levels of vitamins A, B6, E, folate, calcium, magnesium, iron, potassium, and fiber can lead to cardiovascular disease, osteoporosis, and certain cancers (Drake, 2017).  Excess levels of cholesterol and inadequate levels of nutrients are not dangerous to one’s health in the short term, but if practiced longer than six months can lead to chronic diseases to develop. If the keto diet is to be followed for longer than six months, then one should consider adjusting the levels of energy intake by lowering fat, and raising protein and carbohydrate intake to allow for a more nutritious, balanced diet. If adjusting energy intake is not an option, it is advised to consult a doctor, or dietician about ways to supplement vitamin and mineral deficiencies.

The third major health risk that is posed by the keto diet is kidney complications. One of the main functions of the kidney is to filter waste. Protein is a macronutrient that produces a large amount of waste. According to the Harvard Medical School, one’s daily energy intake of protein should be no more than 10% for optimal kidney function, half as much as recommended for the keto diet. When protein is ingested, waste is created, enters the bloodstream, and is filtered by the kidney’s nephrons (functional unit of the kidney). A set of functioning kidneys in a healthy individual should have no problem filtering waste within the body in the short term, but can cause damage in the long term. According to the Journal of the American Society of Nephrology, “High dietary protein intake can cause intraglomerular hypertension, which may result in kidney hyperfiltration, glomerular injury, and proteinuria” (Gang-Jee Ko, Connie M. Rhee, Kamyar Kalantar-Zadeh and Shivam Joshi 2020). If kidney hyperfiltration occurs, then the body will filter too much waste. Essential minerals that are supposed to stay in the body such as sodium, potassium, and calcium will be eliminated, and cause an imbalance in the body. In addition, if proteinuria occurs, then there is damage to the kidney allowing protein to leak into the urine (National Kidney Foundation, 2016). Hyperfiltration, glomerular injury, and proteinuria (abnormal quantities of protein in the urine) in the kidney can lead to worsening effects in the rest of the body such as hypertension and heart disease.

The keto diet swept across the United States in the 1990’s becoming a weight loss trend. Today, it seems more popular than ever. Although the keto diet has proven to be more effective at helping people quickly lose weight than a balanced low-calorie diet there are long term health risks associated with a keto diet lasting longer than six months. Heart complications, chronic disease, and kidney complications are three major risks associated with sticking to the keto diet for longer than six months (Karger, 2017). When making a decision to follow a keto diet, rapid weight loss and an increased risk of health complications should be considered. For those looking to lose weight, alternative dietary methods for maximizing weight loss while minimizing the risk of health complications should be the balance to strive for to promote homeostasis within the body. Enlisting the help of a personal trainer, health coach, and/or nutritionist while following a more balanced diet such as the DASH, or mediterranean method are safer, and more sustainable weight loss alternatives to the keto diet.

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