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Is keto safe in the long term?

Let me just begin by saying that the ketogenic diet has been (in a form) practiced since the early 1920’s with the treatment of severe epilepsy in children. While we might not be able to say that it has stood the test of time in the same way as say the pyramids, 100 years is generally a long enough time for most major health concerns to be brought to the surface.

Let’s look at the very fundamentals of what this diet represents – burning fat for energy. Burning fat for energy does not constitute in itself a health risk whatsoever. Fat burning is in fact, a very healthy state to be in. Contrast that with burning sugar for energy? We see a slough of potential health conditions directly following the rise in insulin levels. These include cardiovascular disease, diabetes, alzheimers, cancer, stroke, and kidney disease [1][2][3][4][5]. The constant rise and fall of blood sugar levels creates a strain on the body whereas fat burning (ketone burning) provides a steady flow of clean energy. Of course, this does not completely paint the entire picture. Let’s look at the claims made against the diet.

The Case of Cholesterol

One of the major concerns with the keto diet has been with the occasional case of cholesterol levels increasing. In most people, there is not a cause for concern, but generally both HDL and LDL numbers will be impacted by the diet. Unfortunately, the only way to know where you are at is to get a blood test done. LDL (bad cholesterol) number may be less impactful than the actual size of your cholesterol particles. The bigger the particle size, the better. It is important to note that recent studies regarding LDL are mainly  focused on the typical American high carb diet. So, the usual correlation between high LDL and heart disease may not directly apply to keto.

LDL Cholesterol levels normally fall within the following categories.

LDL LevelsReading
Good100 mg/dL or lower
Okay100 to 129 mg/dL
Borderline High130 to 159 mg/dL
High160 to 189 mg/dL

But wait a minute…

Just as there have been reports that LDL levels are higher in some individuals on a keto diet, there have been long term ketogenic diet studies that have actually proven the opposite is true. A study conducted in 2004 by The Academic Department of Surgery at Kuwait University found that overall body weight, LDL cholesterol, and blood glucose decreased significantly among the 83 individuals studied. The study was carried out over the course of six months. [6]

“The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol.”

University of Kuwait 2004 Study

What About Muscle Loss?

It is has been questioned whether or not intermittent fasting and the ketogenic diet can lead to muscle loss. In a way this may seem like a strange connection since human growth hormone (HGH) increases by some 2000% over just a few days of fasting. HGH in itself greatly assists in the overall growth of new muscle and life preservation.[9]

In addition, ketone bodies themselves create a muscle sparing environment. As long as an adequate amount of protein and fatty acids are consumed, the muscle is preserved.[8] In the ketogenic diet, this of course, is not an issue.

Although more long-term studies are needed before a firm conclusion can be drawn, it appears, from most literature studied, that a VLCARB is, if anything, protective against muscle protein catabolism during energy restriction, provided that it contains adequate amounts of protein.

Anssi H Manninen, Advanced Research Press

Are We Getting Nutrients We Need?

A high sugar/carbohydrate based diet is again a bigger issue in this area.  The insulin resistance that follows from excessive sugar intake may actually result in several mineral deficiencies – particularly with magnesium, potassium, and essential amino acid absorption.

However, during first few weeks of adopting a ketogenic diet, a person could actually develop lower levels of Magnesium and Potassium as well. The reason is that the body is transitioning from a fluid retaining diet to a fluid flushing diet where you’re peeing all the time. Sugar supports water retention. As Glycogen stores are depleted in your liver, less fluid is kept around. Magnesium, Potassium, and sodium intake are especially important during this time. Ensure that you are still getting enough green leafy vegetables in your diet, and of course, drink plenty of water! [10]

Electrolyte Enhancing Foods for Keto

  • Spinach
  • Kale
  • Mushrooms
  • Salmon

These foods will help keep your potassium and magnesium levels up. But, If you are concerned with going over your carb limit for the day with the greens, I would recommend at least supplementing with a powder form of potassium. This will allow you to meet your daily recommended intake of 4,700mg per day (which would be impractical in the pill form). BulkSupplements has a pretty good product for a reasonable price.

BulkSupplements Pure Potassium Citrate Powder (250 grams)

Let’s talk about fat now. Fat does more than just provide our bodies with the fuel it needs to function. The raw ingredients found in fat(especially some animal fats) are also the building blocks for several important functions. For example, Essential fatty acids are used in the formation of cell membranes, improving circulation, assisting with oxygen uptake, and managing inflammation. Hormone production is also very reliant on the availability of fat.

I’ve Heard Ketoacidosis  is Really Bad!?

Yes, it is! But, the truth is that ketosis and ketoacidos are two very different things. Let me explain.

Ketoacidosis is a state in which the blood becomes overwhelmed by high levels of Ketones to the point that it becomes acidic. In this state, Insulin is not able control rising levels in blood sugar. The body becomes starved of energy and in response to that, it produces toxic levels of ketones. This in turn could result in the person needing hospitalization. So, ketoacidosis is a very serious condition. But, keep this in mind… In order for a person to get to this point, they HAVE to be a type 1 diabetic. In people with CONTROLLED diabetes, this won’t ever be an issue. [7]

“In normal individuals, or those with well controlled diabetes, insulin acts to cancel the feedback loop and slow and stop the overproduction of ketones.”

Ryan Attar, ND

KETOSIS on the other hand, is a healthy dietary state where the body is safely using Ketones as it’s primary energy source. The key difference here is having a healthy insulin response. In people without diabetes or with CONTROLLED diabetes, insulin will manage the rise in blood sugar. As a result, ketone production will never get to the toxic levels that we see in ketoacidosis.

Increased Chance of Kidney Stones?

There is definitely some scientific research to support this claim. However, just as we pointed out above – electrolytes are very important on the ketogenic diet and consuming them will mitigate the risks of developing kidney issues.

A 2007 study by John’s Hopkins School of Medicine placed 195 children on the ketogenic diet for the treatment of Epilepsy. They found that 13 of the children developed Kidney stones. However, supplementation with potassium citrate greatly reduced the occurrence. [11]

Thirteen children (6.7%) developed kidney stones. The use of oral potassium citrate significantly decreased the prevalence of stones (3.2% vs 10.0%, P = .049) and increased the mean time on the ketogenic diet before a stone was first noted (260 vs 149 patient-months, P = .29). As oral potassium citrate was preventative, prospective studies using this medication empirically are warranted.

Johns Hopkins Medical Institution, 2007

So, be sure to eat your green leafy vegetables or supplement with Potassium like we discussed above and you won’t have a problem here.


The ketogenic diet has been around for nearly a hundred years. For each claim made against it, there is often a plethora of research suggesting the opposite. For example, the argument that “the ketogenic diet increases bad cholesterol” is controversial. When practiced correctly, current research suggests that the diet should actually decrease levels of LDL Cholesterol and increase HDL Cholesterol.

As for muscle wasting, this claim does not line up with the primary components involved during Ketosis – which are HGH and Ketone bodies. Both of these elements promote a muscle sparing. Interestingly, during ketosis, the body may sometimes need to generate it’s own sugar from protein. As long as we are getting an adequate amount of protein in our diet, the needed protein will NOT be taken from our muscles.

Some have confused the link between ketosis and ketoacidosis. Ketoacidosis is a life threatening condition that is only possible in type 1 diabetics when insulin fails to control blood sugar levels. While Ketones do come into play here, the condition cannot surface in healthy people or even in people with controlled diabetes. Ketoacidosis results from UN-CONTROLLED type 1 diabetes. Fat burning is extremely healthy.

Research suggests that there may be a link between kidney stones and the ketogenic diet. But, that same research points out that supplementing with potassium citrate greatly reduces this risk (if not eliminates it). As always, ensure that you are getting enough green leafy vegetables in your diet and this won’t be an issue.

In closing, I would always recommend that you approach any new diet with caution – even keto. Do your own research, ask questions when needed, and always listen to what your body is telling you about the changes you are making to it. While this diet may not be for EVERYONE, there certainly aren’t any glaring points to be made that it isn’t a healthy option.

Wishing you the best of luck on your journey to better health!













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