Similar to a dietary medusa, the ketogenic diet has emerged in the vacuum left by the fading popularity of other low-carbohydrate, high-fat diets such as the Paleo and Atkins diets. Sporting a new name but an unoriginal weight-loss strategy, the ketogenic diet calls for its followers to spurn carbohydrates in favor of eating high-fat and high-protein foods such as meat, eggs, and cheese—all of which are unhealthy. The ketogenic diet has the same allure of many fad diets that promise quick weight loss, but these diets also brings with them numerous health risks about which all dieters should know. So, instead of going keto, dieters should consider adopting a whole-foods, plant-based diet to lose weight while avoiding an ever-growing list of health concerns.
1. Weight loss or not?
The keto diet promises its followers weight loss under the guise of “changing one’s metabolism” through ketosis, but, in reality, followers shed weight—at least initially—by eating fewer calories and by losing water weight and lean muscle mass. Eating fewer calories to lose weight is not new and shouldn’t involve semi-starvation to the point of ketosis, nor should it involve a decrease in muscle mass. Worse, over the long-term, many keto dieters regain their weight and end up very close to where they started. In a meta-analysis of studies, researchers found that after 12 months of following the ketogenic diet, the average weight lost was less than a single kilogram. Meanwhile, a whole-foods, plant-based diet can be a very effective weight-loss strategy.
2. Keto flu
Every ketogenic dieter needs to know about the severe malaise that comes along with switching their body’s primary fuel source from carbohydrates to fats. Lasting from a week to a month, the keto flu, as it’s dubbed, can entail severe cramps, dizziness, upset stomach, constipation, irritation, brain fog, and insomnia. Whole-food, plant-based diets, on the other hand, don’t have any of these problems and might actually help followers feel better.
3. High cholesterol
High cholesterol levels are a major concern for anyone eating significant amounts of meat, eggs, and cheese. The ketogenic diet was originally designed to help treat children with refractory epilepsy, but even in this group of patients, cholesterol levels increased on the ketogenic diet. The same was seen with adult patients who went on the keto diet for weight loss. In contrast, a plant-based diet has been shown in numerous studies to significantly reduce cholesterol levels.
4. Heart health
High cholesterol levels are concerning because of their implications on cardiovascular health. The only extant population that eats a diet high in animal fat and protein are the Inuit, and they are known to have an even higher burden of cardiovascular disease than the average Western population, which is already high. In a study of type 1 diabetics, those eating higher amounts of fat and protein had higher coronary artery calcium, a maker for coronary artery disease, compared to those eating higher amounts of carbohydrates. By comparison, plant-based diets have been shown to actually reverse—not worsen—coronary artery disease.
Eating animal-based foods increases one’s risk of death. Not surprisingly, a meta-analysis of 272,216 people showed that those eating low-carbohydrate, high-protein diets full of animal-based foods saw a mortality rate that was 31-percent higher than other diets. Another study with a decade of follow-up showed a similar increase in mortality with low-carbohydrate, high-protein diets. The causes of death are varied, but in some cases, the causes have been related to a deficiency in the mineral selenium. Selenium deficiency has been seen in at least two pediatric patients on the ketogenic diet for epilepsy—both having cardiac arrhythmias that eventually lead to death.
6. Kidney stones
Another major concern for those eating high amounts of animal-based foods is kidney stones. Animal-protein consumption is a notorious risk factor for kidney stones. Unsurprisingly, ketogenic diets predictably increase one’s risk for developing a kidney stone. Kidney stones are extremely painful and can lead to complications such as urinary obstruction, infection, and kidney failure. Plant-based diets, however, can reduce one’s risk of having kidney stones.
It is commonly thought that by avoiding carbohydrates on a ketogenic diet one can treat diabetes, but, unfortunately, that is not the case. In a meta-analysis of dieters with type 2 diabetes restricting carbohydrate intake, no difference in diabetes control was seen after one year between those eating low-carb and high-carb diets. By comparison, a whole-foods plant-based diet has been shown to prevent and treat type 2 diabetes.
8. And more
The ketogenic diet has also been associated with numerous other health problems such as osteoporosis, bone fractures, fatal and nonfatal pancreatitis, gastrointestinal disturbances, vitamin and mineral deficiencies, slow growth, and acidosis. In stark contrast and with few exceptions, a plant-based diet is safe and healthy.
Shivam Joshi, MD, is a lifestyle physician and nephrology fellow in Philadelphia, Pennsylvania.