How Safe Is the Keto Diet?

The Ketogenic Diet, better known as the Keto Diet, has caught fire in the media shifting from its original intention as a medical treatment to a weight loss phenomenon.

Despite limited research or evidence supporting the Keto Diet, it is promoted as a safe option for weight loss and health.

With limited research it is imperative to explore if the Keto Diet should be recommended and to identify any potential harms.

History of The Keto Diet

The Keto Diet was developed by Dr. Russel Wilder in the 1920s [1]. The original purpose of the diet was to treat refractory seizures or epilepsy in pediatric patients [1].

Hans Krebs was the first to differentiate physiological ketosis from pathological ketoacidosis [3]. Pathological ketoacidosis is seen in type 1 diabetes and can result in organ failure [3].

Pathological ketoacidosis occurs during very-low-calorie ketogenic diets [3] and places the body at higher risk of harmful health outcomes.

Physiological ketosis was not found to have the same impacts on the body and was promising in treating epilepsy. The diet gradually shifted to a weight loss focus when it was found to have a perceived positive impact on fat loss.

What is the Keto Diet?

The Keto Diet is a low-carbohydrate diet that promotes moderate protein and high fat. This diet is meant to induce what is called ketosis.

Ketosis happens when the body shifts from using carbohydrates to fat as its primary energy source to fuel the metabolism.

After 3-4 days of severe carbohydrate restriction the body is forced to find an alternative form of nutrition [3]. Make no mistake, this is not a positive change, this shift is happening as the body’s survival mechanism.

This means the body needs additional resources to meet energy needs for the body and mind [1]. Ketone bodies are produced through the breakdown of fat and as a result fat loss occurs [3].

Keto Diet Effects

Initial impacts of the Keto Diet are described as the keto flu. Symptoms include fatigue, headache, dizziness, nausea, vomiting, and constipation [1]. Interestingly, these are all side effects of carbohydrate restriction.

Although it is said that symptoms typically diminish after a couple days to weeks, this short-term impact on the body should raise a red flag.

Food for Keto Diet

Apart from short-term effects, potential long-term impacts may include [1]:

  • Heart disease
  • Decline in liver function
  • Kidney stones and/or decline in kidney function
  • Hypoproteinemia
  • Vitamin and mineral deficiency
  • Constipation due to lack of fiber
  • Development of disordered eating or eating disorders

Most research studies only review the impact of the Keto Diet from 3 to 36 months. The long-term effects on cardiovascular and other risk factors are unclear. However, a diet primarily focused on fat will no doubt long-term impact cardiovascular health.

Studies have shown those who follow a very-low-carbohydrate ketogenic diet have significate increases in LDL cholesterol [1]. An increase in LDL cholesterol long-term again could lead to the development of accelerated atherosclerosis and ultimately increase ricks related to cardiovascular disease [1].

Keto Diet as a Fad Diet

People are quick to adopt diets that claim to promote a quick fix [2]. Fad diets are considered imbalanced and lack adequate energy and nutrients.

Fad diets share some common characteristics including [2]:

  • Promising fast weight loss or immediate results
  • Restricting one or more food groups
  • Promoting miracle or super foods and beverages
  • Promoting large quantities of single foods or food groups
  • Based on no or limited research

The Keto Diet has gained immense popularity over the last decade. This is primarily due to its successful short-term effect on weight loss [1].

Unfortunately, anyone who has been stuck in the cycle of dieting knows the difficulty of sustaining unrealistic expectations. Ultimately, leading many to go on and off diets, continuously looking for the next quick fix.

The Impact of Extremes on Health and Safety

Seidelmann et al, showed the existence of a U-shaped relationship between carbohydrate intake and mortality [3].

The study revealed higher rates of mortality with both extremely high and low carbohydrate intake [3]. The risk of dying was lowest with carbohydrate intake between 50-55% of daily energy needs [3].

A challenge with low carbohydrate diets is the limit or deprivation placed on the body. If carbohydrates are limited then foods such as vegetables, fruits, and grains are restricted [3].

Long-term low-carbohydrate diets with high fat may lead to stimulation of inflammatory pathways, oxidative stress, and the promotion of biological aging [3]. Of course these would be results, because many compounds that inhibit oxidation, such as antioxidants, are eliminated in these diets.

Not only is physical health impacted, but mental health as well. The promotion of fad diets consistently tells people they are not good enough and that they should continue to fight with their body.

This message leads many to struggle with disordered eating and eating disorders. Creating chaos, rather than peace with body and mind.

What Diet Does Work?

Fad diets are unsustainable and do not take the big picture into account. Each person has a different relationship with food and their body. This means each person may be dieting for different reasons.

Society promotes diets for health, but is that truly the motivator or is health being compromised for vanity?

The key to having a lifestyle that works is focusing on long-term health. This includes practicing intuitive and mindful principles. Having an all foods fit mentality and providing permission to have nourishing, enjoyed, and desired foods.

The key may just be focusing on choices we make most of the time and allowing freedom to honor your body and mind.

Related Reading


[1] Batch, J. T., Lamsal, S. P., Adkins, M., Sultan, S., & Ramirez, M. N. (2020). Advantages and Disadvantages of the Ketogenic Diet: A Review Article. Cureus.

[2] Khawandanah, J., & Tewfik, I. (2016). Fad Diets: Lifestyle Promises and Health Challenges. Journal of Food Research5(6), 80.

[3] Mohan, V., & Shilpa, J. (2018). Ketogenic diets: Boon or bane? Indian Journal of Medical Research148(3), 251.


The opinions of our writers do not necessarily reflect the views of Eating Disorder Hope

Author: Raylene Hungate, RDN, LD/N