The risks of the ketogenic diet

If today were May 30, 1994, and not 2024, we would find ourselves flooded with articles and miraculous tips on how to lose weight, drain, firm up, and tone up in anticipation of the bikini body test. Slaves to the mantra of diet-fasting-discipline, we would force our bodies to suffer and deny ourselves every little crumb just to match that slim image of a woman in a swimsuit that the world tell us is the only one that aligns with the idea of beauty. If we were in the distant '90s, we wouldn't care about the risk of endangering our health by following the restrictive diets proposed by magazines or the celebrity workouts. We would ignore the meaning of Body Positivity and it would never occur to us to believe that all bodies are valid. We would spend weeks prey to anxiety, fatphobia and body-checking, fearing the fateful hour when we would swap jeans for a bikini, exposing our imperfect bodies to our own judgment and that of others.

Diet Culture and Beach Body

It is now 2024. There is greater awareness, but unfortunately, we are not yet free from certain types of discussions. As summer approaches, more is said about diets on TV, in magazines, and on social media. The wellness community—made up of experts but also many charlatans—offers us all kinds of solutions to achieve the same waistline as Kim Kardashian or the post-weight loss silhouette of Gabriette. Blood type diets, intermittent fasting, baby food diets, paleo, no carbs till 4, gut health become familiar terms to us, perhaps too familiar. The topic is complex, but now studies are beginning to emerge highlighting the possible harms of these dietary regimes. The latest to be examined is the ketogenic diet.

What is the Ketogenic Diet?

The ketogenic diet is based on 70-80% fats, 20% proteins, and 5-10% carbohydrates. It is low in carbohydrates (50 grams or less per day) and instead rich in fats, used to trigger ketosis, a process that leads the liver to convert stored fats into substances known as ketones. When this occurs, the body burns and uses fat as a source of energy instead of glucose from carbohydrates, which is unavailable. In the pantry of someone following the ketogenic diet, anything containing sugars (both natural and added) is off-limits, while we find meat, fish, eggs, oil, butter, cheese, non-starchy vegetables, very moderate amounts of fruit, nuts, as well as coffee and tea as long as they are unsweetened.

Benefits of the Ketogenic Diet

Proponents of this diet—introduced in the 1920s to reduce seizures in drug-resistant epileptic children and becoming popular in the early 2000s with the mantra "fat is not the enemy"—praise its benefits, especially the rapid weight loss, followed by increased satiety, mental clarity, deeper sleep, higher energy levels, reduced inflammation, lower triglycerides, lowered blood sugar levels, and restored insulin levels.

What are the Risks of the Ketogenic Diet?

A new study suggests that the ketogenic diet could instead be harmful to health. "The ketogenic diet does not meet the criteria of a healthy diet," writes Joanna Popiolek-Kalisz, researcher and author of the article published in the March 2024 issue of Current Problems in Cardiology. The investigation found that the apparent benefits of this dietary regime are transient: most of them seem to vanish over time, including the rapid weight loss, likely mostly water weight that does not translate into any permanent positive changes in the body's health. Due to the high fat intake, those who follow keto generally have higher levels of LDL cholesterol, which is associated with a higher risk of heart disease, clogged arteries, and death. As Popiolek-Kalisz wrote, "A lower intake of carbohydrates in ketogenic diets may lead to a reduction in triglyceride levels, however, significantly increased levels of LDL cholesterol (or bad cholesterol) have also been noted. Furthermore, the positive effects of the ketogenic diet on triglyceride levels seem to diminish in longer observations."

According to other studies, in the long term, keto could trigger phenomena of cellular aging with possible negative effects on heart and kidney function, as well as significant vitamin and mineral deficiencies. Additionally, forcing the body into ketosis intoxicates the entire organism, negatively impacting the liver, kidneys, muscles, and nervous system. Here we recap the risks of the ketogenic diet:

• Dehydration;
• Gastrointestinal issues (such as constipation, diarrhea, nausea, or vomiting);
• Kidney stones;
• Reduced athletic performance (due to fatigue during exercise and muscle loss);
• "Keto flu" (headaches, brain fog, fatigue, irritability, nausea, difficulty sleeping, and constipation);
• Nutritional deficiencies (vitamins and minerals);
• Heart disease;
• Cognitive decline, confused thoughts, and mood swings.

How to Approach a New Diet?

It may seem unnecessary to emphasize this, but it is not: do not follow the diets of celebrities, friends, or anyone else. Nor believe blindly in what is written or said by magazines, blogs, and social media. Any dietary regimen should be personalized, developed, and followed according to various criteria such as age, body structure, any health issues, lifestyle, and many others that only a certified professional can advise on. It is advisable to consult and be followed by a doctor or a dietitian who can prescribe a balanced dietary regimen and any clinical tests for control and monitoring. If we do not know whom to turn to, we can ask our general practitioner, who will be happy to recommend someone.