For some people, the ketogenic diet is a great way to lose weight and lower inflammation for short periods of time. For others, it’s a permanent lifestyle.
But regardless of your dedication level, the chances are high that you’ve flirted with the idea of going off keto, at least temporarily. Perhaps you’ve even partaken of a few cheat meals recently.
You might be wondering whether you have to stay in ketosis permanently to keep the weight off. And what happens if you achieve your health goals with keto, then go back to eating carbs again?
In this article, you’ll learn how long you should stay in ketosis, the safety of long-term keto, and other research-backed advice to make the keto diet work for your goals.
The keto diet revolves around maintaining a state of ketosis, which results from restricting carbohydrate intake.
When you eat 30-50 grams of net carbs or less per day, your body has no choice but to switch to burning fat as a fuel source[*]. As this process occurs, your liver begins producing high-energy ketone bodies while breaking down fat[*].
The only way to know for sure whether you’re in ketosis is to test your ketone levels.
If you’re not in ketosis within 1-2 weeks, take a closer look at your diet for hidden carbs.
But other advantages of the keto diet may take time to occur. Improvements in blood sugar, easier management of type 2 diabetes, and the lowering of risk factors for health conditions like heart disease or cancer doesn’t occur overnight[*][*][*].
And if your main keto goal is to lose weight, remember that a healthy and manageable rate of weight loss for most people is around 1-2 pounds per week[*].
You might shed the pounds slightly faster or slower, but you shouldn’t rush the process, so plan accordingly.
And some of the health benefits of keto are virtually immediate, while others take time. Likewise, some are measurable (like blood glucose or fat loss) while others are subjective (like mood and energy levels).
The key to making keto work for you is to set clear goals, monitor your progress, and stay on track. At a bare minimum, stay in ketosis as long as it takes to achieve those goals.
After that, you can experiment to discover what works best for your body. You may find that the health improvements are sustainable with a healthy, whole foods-based diet with carbs — or you may find that your progress vanishes unless you stay on a strict low-carb, high-fat diet plan.
Another option is to go keto for a certain amount of time regularly or each year or to try hybrid versions of keto, such as the cyclical keto diet.
Next, we’ll examine whether a constant state of ketosis is necessary to maintain your weight loss results.
Not everyone has to stay in ketosis to maintain after losing weight, but credible evidence suggests it can help.
In theory, if you keep calories relatively low and make sure not to overeat, it’s possible to go off keto without regaining all the weight you lost.
But in practice, research shows that counting calories is not a very effective way to lose weight or stay slim[*].
Even if you’re a math whiz, your body can outsmart you. Studies suggest that for people who have lost significant amounts of weight, the body can become sluggish, reduce calorie burn, and increase appetite to encourage them to eat more[*][*].
If the keto diet has worked for you and you feel healthier than ever, you may not be interested to come off it.
Here’s what studies tell us about the safety of longer periods of ketosis:
There are “beneficial effects to a long-term keto diet
A 6-month study of keto from 2004 in obese patients concluded the following: “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.
Administering a ketogenic diet for a relatively long period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated” (Emphasis added)[*].
No adverse effects
A year-long study on the effects of a low-carb, high-fat diet on cardiovascular health published in 2015 found that “All the predetermined goals—namely safety, reduction of body weight and CV [cardiovascular] risk factors levels—have been reached with a significant reduction of body weight…These changes have not been associated to any clinically relevant adverse event” (Emphasis added)[*].
A 2017 year-long randomized clinical trial of people with type 2 diabetes compared a moderate-carb diet versus low-carb keto diet and found over double the weight loss with keto, and that some keto participants were able to safely discontinue diabetes medications[*]. The authors did not record any serious adverse effects.
Staying keto for a year is safe
A year-long randomized controlled trial published in 2018 compared a healthy low-carb diet to a low-fat diet in overweight adults and found that the rate of adverse events (less than 3%), most of which appeared to be unrelated to the diets, was evenly distributed between the two groups[*]. In other words, staying keto for a year was equally safe, or safer, than following a non-keto diet.
Bottom line: there’s no evidence suggesting that nutritional ketosis is dangerous in either the short-term or the long-term, and plenty of evidence suggesting it delivers lasting benefits to people who stay on it.
Some doctors and dietitians have gone on the record with concerns about nutrient deficiencies, insufficient fiber, or other problems they anticipate from cutting carb intake.
However, keep in mind that carbs are not an essential macronutrient, whereas protein and fat are. As long as you eat healthy, low-carb whole foods, the keto diet is at least as healthy and nutritious as any other diet.
Because the keto diet requires users to avoid nearly all carbs, it’s unlike any other diet. If you decide to experiment with going off keto, your best bet is to do so gradually.
A slow transition off keto allows you to avoid pitfalls like binge eating or rapid weight regain while also gauging how your body responds.
Here’s how to do it:
- Stick with healthy, organic whole foods whenever possible: Keto or not, you need to eat healthy foods to stay healthy. Choose wisely.
- Record your macros and increase carbs incrementally over a period of a few months. Try adding in around 50-75 grams of daily carbs each week at most. After strict keto, your body needs time to readjust.
- Weigh in regularly and track your results: During and after your transition, pay close
attention to the areas in which you noticed improvement during keto. Bodyweight, body fat percentage, blood sugar, and physical performance are measurable, so remember to monitor them about once a week.
- Listen to your body: Outside of quantifiable health markers, there are plenty of other important outcomes that affect your quality of life. Check in and notice your mood, energy levels, sleep quality, productivity, and stress levels.
- Make adjustments when necessary: Depending on your results, you may want to adjust your macros, calories, or food selection–or even return to a keto diet.
And avoid these mistakes:
- Don’t make up your mind ahead of time: Instead of being inflexible, keep an open mind as to what may happen next. View going off keto as an experiment and learning process.
- Avoid the “cheating” mindset: You most likely didn’t binge eat on keto, and you certainly shouldn’t overindulge on carbs or junk food if you stop keto. Keep a healthy, balanced mindset around food.
- Don’t neglect high-quality protein and healthy fat sources: Whether or not you stay keto, eating plenty of protein and healthy fats are essential for a healthy diet.
And if you experience symptoms of IBS or other gut issues, take a closer look at individual foods.
Keto sometimes acts as a de facto elimination diet for people with undiagnosed food sensitivities, meaning that if you resume eating carb foods, you might reintroduce a trigger food unintentionally.
Above all, compare your results off keto to what you noticed while following keto. After a few weeks to several months, you should have excellent insight into what works (and doesn’t work) for your body.
The keto diet is an amazing tool for health, whether you stay on it for a few months or the rest of your life.
You don’t have to stay keto forever, but many people choose to do so, and it appears to be safe.
The elevated fat-burning, decreased appetite, and increased energy levels can make it easier to stay healthy and lean.
But if you choose to experiment with other diets and they don’t work as well, you can always go keto again in the future.