The ketogenic diet is a low-carb, high-fat eating plan designed to trigger ketosis, a metabolic state linked to improved weight management and a number of health benefits. Despite the positives, there are many misconceptions about the safety of ketosis and a low-carb diet.
Our guide helps set the record straight about reaching and maintaining ketosis, what to expect on a keto diet, and how you can boost ketone levels safely.
A Brief Overview
Ketosis is a metabolic state in which your body uses stored fat for energy instead of glucose. The most efficient way to achieve ketosis is to limit carbs through intermittent fasting or a low-carb diet. When you reduce carbs, the liver converts fats into ketones as your primary energy source.
Is the keto diet healthy and safe? The keto diet can be a healthy, safe solution to weight loss challenges and managing certain conditions. It’s always important to make sure you’re eating whole foods and maintaining the correct ratios of carbs, proteins, and fats. If you’re new to keto, talk to your healthcare provider about coming up with a plan that meets your unique needs, especially if you’re on medications or dealing with nutrition deficits.
Keto Diet Health Concerns
It’s wise to be concerned about potential side effects and changes to your health at the start of any new diet, but so much of the information out there about keto is misleading or incomplete. You can retain cardiovascular, kidney, and nutritional health on the keto diet.
Cardiovascular Health
Studies show the short-term effects of a keto diet include a reduced risk of obesity, metabolic syndrome, and lower blood pressure, which are all key predictors of cardiovascular disease down the line. (1)
Even so, the diet’s emphasis on fats may scare some away due to perceived impacts on cholesterol levels.
A healthy keto diet is a diet rich in high-quality fats from sources like avocados, olive oil, coconut oil, fatty fish rich in omega-3 fatty acids, and poultry. Healthy fats are linked to better heart outcomes and improved levels of high-density lipoprotein (HDL) cholesterol. (2)
Some keto dieters see a bump in low-density lipoprotein (LDL) cholesterol, commonly known as “bad” cholesterol, and triglycerides throughout the diet. (3) This doesn’t always increase your risk factors for heart disease, especially when you consider the overall effects of the diet.
Plus, while keto may increase LDL numbers for some, it does not actually lead to the plaque buildup often associated with high LDL levels. This is often the main concern with elevated cholesterol.
If you’re at a higher risk of heart disease and stroke, start with your doctor. They can recommend a safe path toward getting the nutrition you need to feel your best and reduce your risk long-term.
Muscle Mass
Most diets that promise to build bulk and lean muscle are high-protein diets. However, these fad, restrictive diet plans aren’t generally sustainable and can lead to nutritional gaps.
If you follow your macros and keep your fat intake high and protein consumption moderate — which is, again, the basis of a healthy state of ketosis — muscle loss won’t be an issue on keto. Your body will continue burning ketones for fuel without turning to your lean muscle.
Nutritional ketosis actually helps preserve and prevent muscle tissue from breaking down, especially if you’re staying active. (4) One of the biggest potential benefits of keto is weight loss, so you should expect to drop some weight while following the diet. If that isn’t your intention, talk with your doctor or nutritionist to make sure you’re meeting your needs. Using a ketogenic calculator can help, too.
Our Keto Calculator is a free, efficient way to help you identify the exact amount of fats, carbs, and proteins you need to meet your goals.
Kidney Health
High-protein diets may increase the risk of developing kidney problems, and sometimes keto diets are lumped into that category. The keto diet isn’t high-protein, though, and watching your carbohydrate intake may even support better outcomes of chronic kidney disease (CKD). (5)
A diet heavy in animal proteins can make your urine more acidic and raise your risk of kidney issues like kidney stones. Keto, a low-carb, high-fat diet, focuses mainly on healthy fats and a moderate amount of protein that shouldn’t overload your system.
If you have a history of kidney stones or an increased risk of kidney disease, it’s always best to consult your doctor or a registered dietitian before starting any new diet. They may suggest lowering your protein intake further than the recommended macros.
There are ways to further mitigate your kidney health risks on keto. Boost your potassium and electrolytes to reduce acids in your body, drink plenty of water, and monitor your kidney function closely.
Our Daily Electrolytes supplement is a doctor-formulated 4:2:1:1 ratio of sodium to potassium to calcium and magnesium to help you replenish and recover essential electrolytes.
Nutritional Needs
Like any diet, the keto diet can impact nutrition if you’re missing out on food sources of essential vitamins, minerals, and fiber. When done right, the keto diet gives your body all of the micronutrients it needs for overall wellness.
There is a huge misconception that following a keto diet means eating only red meat and butter. Keto focuses on healthy eating, which involves eating a lot of whole foods, fibrous vegetables, and salads, all of which are full of dietary fiber.
To maintain nutritional balance, you’ll want to plan your meals and shop smarter, just as you would with any diet. If you find you are missing anything, supplements can help, but they’re not necessary for long-term health.
Digestive Health
In the short term, you may experience temporary gastrointestinal issues like constipation from the higher fat intake, especially if you’re used to a high-carb diet. Less fiber may also alter your gut microbiota, which affects immunity, metabolism, and energy levels.
The best way to preserve solid gut health is to incorporate keto-friendly foods that are high in fiber, like avocados and flax seeds, as well as low-carb legumes like green beans and broccoli. Low-carb whole grains like bulgar are also easy to incorporate without exceeding your carb limits.
Incorporating more probiotics while on keto is also beneficial to a healthier balance of gut bacteria. (6) Kimchi, sauerkraut, and pickles are all low-carb natural sources of probiotics.
Regarding Ketosis
We’ve covered popular misconceptions about the diet, but there are a few more things to cover on the process of ketosis. Reducing your carb intake is the most efficient way to achieve ketosis, but intermittent fasting, supplements, and physical activity can help get you there, too.
All of these are safe, effective methods to reap the benefits of ketosis. (That includes neuroprotective effects against Alzheimer’s disease, Parkinson’s disease, and epilepsy, improved blood sugar levels, and a reduced risk of hyperglycemia.)
How long is it safe to be in ketosis? It’s safe to remain in ketosis for 6-12 months. Some dieters choose to cycle in and out of ketosis to manage certain health conditions, such as those with type 2 diabetes. In these cases, you should work with a doctor to watch for signs of hypoglycemia, also known as low blood sugar. (7) Side effects at the start of keto are typically temporary and a response to rapid changes to your diet.
The Keto Flu
Are there side effects of ketosis? The “keto flu” refers to side effects some people experience when the body is switching from glucose to ketones for an alternative source of energy. Symptoms may include headaches, fatigue, gastrointestinal issues, irritability, and brain fog.
You may also notice bad breath or “keto breath.” It’s often described as fruity-smelling or resembling acetone, which increases in your body during ketosis.
Keto flu symptoms usually go away after a week or two, if they appear at all. (8) To reduce your risk of seeing symptoms, try taking these steps:
- Take exogenous ketones. Increasing the number of ketones in your system can reduce transition symptoms faster than just relying on a very low-carb diet.
- Drink lots of water. Stay hydrated by drinking at least 32 ounces of water in the morning, especially if you drink coffee, and continue throughout the day. This can help reduce headaches and other symptoms caused by dehydration.
- Increase your salt intake. Your kidneys excrete more sodium on a ketogenic diet, which can lead to nutrient deficiency. Try adding Himalayan pink salt to your dishes, drinking bone broth throughout the day, or snacking on salted nuts in moderation.
- Eat enough calories and fat. A super-low calorie intake is harmful to your hormones and metabolic needs. Keep your calories up and your brain nourished with plenty of healthy ketogenic-friendly fats and enough protein to replace the carbs you’re limiting.
- Get enough exercise. Regular exercise can help your metabolism work more efficiently as you switch from carbs to ketone bodies for energy.
- Test your ketone levels. Make sure you’re actually getting into ketosis and test ketone levels often to check you’re staying there.
Ketoacidosis
Though the names are so similar, ketosis and ketoacidosis have huge distinctions. Ketosis is a natural process where the body burns ketones for fuel instead of glucose. It’s a safe shift brought on by changes in someone’s diet plan.
Ketoacidosis is a dangerous and potentially life-threatening level of ketosis that can occur in diabetes patients if they aren’t managing their insulin levels and diet properly. This is also known as diabetic ketoacidosis (DKA). (9)
Can ketosis lead to ketoacidosis in healthy individuals? Healthy bodies regulate ketone levels, preventing them from rising to harmful levels seen in ketoacidosis. It’s most common in type 1 diabetes patients, but it can also happen with type 2 diabetes.
DKA can also occur in diabetics after a bout of pneumonia or other illness or infection. Either way, the medical condition involves an extremely high level of ketones in the blood that causes it to turn acidic.
The Bottom Line
Ketosis is safe and healthy when following a well-planned ketogenic diet of whole foods. Following a balanced and keto-friendly meal plan, controlling carbohydrate intake, and maintaining a healthy lifestyle will keep you in ketosis, which optimizes health in a variety of ways.
If you’re curious about the differences between the keto diet and other diets, read these next:
- Atkins Diet vs. Keto: What’s the Difference?
- The Mediterranean Diet vs. Keto: Which Is Healthier?
- Paleo vs. Keto: Which Diet Is Healthier?