The long-term keto diet isn't recommended for everyone due to the potential health risks associated with it. It can be beneficial in conditions like certain types of epilepsy, some cancers, autism, and metabolic disorders, and others, but your doctor will guide you with nutritional support for diagnosed conditions. For people wanting to maintain a healthy weight, it might not be the best approach long-term.
If keto has helped you make strides toward your goals, you might be tempted to follow a keto pattern forever. But, it comes with some risks that you should take into consideration. Here’s what you need to know.
Potential negative effects of long-term keto
Long-term keto may affect gut health
Long-term keto could be negatively affecting your gut microbiome by disrupting the balance of beneficial bacteria in the gut. When on keto, you have to be intentional about getting your fiber in for digestive health, and a lot of people tend to fall short. Over time, you could be reducing the health and diversity of your gut microbes, and an off-balance gut microbiome might affect your overall health.
It is important to include prebiotic-rich foods such as vegetables, fruits, and legumes in order to introduce more fiber into your diet. It is also worth considering a probiotic supplement or fermented foods to help restore healthy bacteria balance in the gut.
Kidney stones
Studies have shown that sticking to a ketogenic diet for an extended period of time can lead to an increased risk of kidney stones. Especially if you have a family history of kidney stones, you might want to consider introducing healthy sources of carbohydrates to help off-set the risks. Kidney stones can be painful to pass and sometimes require surgery to remove.
Nutrient deficiencies
Long-term keto can sometimes be the root of nutrient deficiencies. A lack of variety in carbohydrate-containing foods can lead to vitamin and mineral deficiencies as well, since important vitamins and minerals are found in each of the macronutrient categories — protein, fat, and carbohydrates.
Cardiovascular concerns
People who follow a keto diet may be consuming more saturated fat than other eating patterns. High amounts of saturated fat in the diet could increase the risk for heart disease and stroke.
Furthermore, following a ketogenic diet over the long term may result in increased levels of cholesterol or triglycerides in the blood. Finally, those consuming high amounts of dietary fat and limited carbohydrates on a regular basis may experience bloating, constipation, and other digestive issues due to changes in gut bacteria.
Can you do keto without adverse effects?
Long-term keto is indicated for several health conditions, and if it’s helping you manage your medical issues, by all means, keep going with it. If you’re successfully managing your condition with keto, don’t let this article sow doubt. Your medical team is there to guide you every step of the way.
If keto works well for you and you want to stick with it, work closely with your doctor on this one. It might be a matter of taking breaks from periods of very low carb, or throwing in a few servings of nutrient-rich carbs a couple times a week to keep everything in balance.
The key to a good diet is to eat a broad array of foods, make sure you’re prioritizing vegetables, and follow your doctor or dietician’s advice when it comes to your individual breakdown of proteins and fats.
How to transition off of keto
If you’re following a keto diet to help manage a health condition, do not transition off without consulting your doctor first.
For the rest of us, transitioning can go smoothly or can be a little bumpy at first, depending on how long you have been on keto and how many carbs you’ve been consuming. Some people keep it very low, others do keto with a higher carb count — so transitioning may look different from person to person.
Tips for transitioning off of the keto diet
Transitioning off the keto diet is possible with mindful planning and an awareness of your body's needs. Here are some things to keep in mind when transitioning:
- Evaluate your dietary fat. If you’ve been eating high amounts of dietary fats, gradually reduce your intake.
- Slowly increase intake of complex carbohydrates from nutritionally dense sources such as legumes, whole grains, colorful vegetables, and fruits. Start with an extra serving of sweet potato or beans a couple times a week, and work your way up to an extra serving per day or more, depending on where you and your doctor or dietician decide you should land.
- Pay attention to how you feel. If you feel symptoms of high blood sugar after eating carbs, scale back and contact a medical professional for advice. (This one is important!)
- Eat adequate amounts of protein throughout the day. Protein can keep the extra carbohydrates on a steady release instead of spiking and crashing throughout the day. Your body will need some time to adjust, and protein can ease the transition.
- Increase dietary fiber intake to promote healthy digestion and regularity (aim for 25-35 grams per day). If you’re eating plenty of vegetables, your targets should be easy to hit.
- Know the difference between quality carbs and junk carbs. Even though you’re increasing your overall carb counts, sugary sweets aren’t doing you any favors. You can get sugar-free versions of your favorite treats that won’t throw you off.
Final Thoughts
The keto diet was developed for specific populations to address serious medical conditions. Although people have a lot of success with weight loss on keto, it may not be the best approach long-term. If you’re not sure whether long-term keto is right for you, seek nutritional guidance from a doctor or dietician.
References
Acharya P, Acharya C, Thongprayoon C, Hansrivijit P, Kanduri SR, Kovvuru K, Medaura J, Vaitla P, Garcia Anton DF, Mekraksakit P, Pattharanitima P, Bathini T, Cheungpasitporn W. Incidence and Characteristics of Kidney Stones in Patients on Ketogenic Diet: A Systematic Review and Meta-Analysis. Diseases. 2021; 9(2):39. https://doi.org/10.3390/diseases9020039
Wang DD, Hu FB. Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances. Annual Review of Nutrition 2017 37:1, 423-446