Reducing carbs in your diet has been shown to have both positive and negative long-term effects. The benefits of keto long-term often result from following it in the best possible way, such as paying attention to your nutrient intake and prioritizing whole foods.
On the other hand, downsides may occur from a lack of understanding or mistakes that put your health at risk. This is why you’ll hear stories about keto causing vitamin deficiencies and increasing cholesterol levels.
This article examines the long-term effects of the keto diet from a scientific standpoint. What does the research say?
If you don’t eat certain foods in your diet, you increase your risk of nutrient deficiencies. A keto diet, which cuts out many carbohydrate sources to pursue weight loss, can result in a loss of vitamins and minerals, such as vitamin A, B vitamins, calcium, magnesium, potassium, and iron (*).
Take note, however, that people don’t become deficient in micronutrients if they’re making sure to eat a variety of animal foods and non-starchy vegetables.
Another important area of concern on keto is lipid response. More specifically, keto may increase low-density lipoprotein (LDL) cholesterol in a subset of individuals. Recent evidence suggests that these individuals, called “lean mass hyper-responders or LMHRs” see increases in their LDL with readings of 200 mg/dL or higher (*).
However, the difference is that unlike those who are at risk for heart disease and metabolic syndrome, lean mass hyper-responders have low triglycerides and high levels of high-density lipoprotein (HDL) cholesterol (*). These are beneficial readings and they indicate a diet that is rich in healthy fats.
Individuals with pronounced LDL levels may find this frightening, especially that more research is needed to understand the LMHR phenotype. If you are concerned even though the rest of your cholesterol numbers look good — know that reintroducing a small amount of carbs can lower LDL.
A recent journal article mentioned weight regain as one of keto diet side effects long-term. More specifically, those on keto end up regaining more weight than those who follow low-fat and Mediterranean diets (*).
If you’re looking to embrace keto as a lifestyle, it’s vital to dig deeper into the reasons why dieters regain the weight they lose. Keto or not, weight regain is caused by a combination of factors, including calorie deprivation, dietary non-adherence, and a lack of exercise (* , *).
People struggling with weight and health problems can be safe on keto by first checking with their healthcare provider.
For example, if you are taking medications for diabetes, blood pressure, or both — let your doctor know so they can adjust your current medication dosage. Keto results in substantial improvements in blood pressure and blood glucose and your current dosage may be more than you need based on your body’s response (*).
When trying the keto diet, it may also be a good idea to ease into it instead of drastically cutting carbs. This will make your transition less troublesome — due to keto flu symptoms (which is a collection of short-term side effects on keto).
Eva De Angelis, a dietitian nutritionist and health and nutrition writer at Health Canal, emphasizes the importance of knowing the most nutrient-dense foods to eat on keto and reading food labels so that you’ll know if a packaged food will fit into your diet.
Make sure to get all the nutrients you need so that you can function optimally. Some people may call keto restrictive, but in reality, there are plenty of nutrient-dense low-carb foods. The key is to rotate keto foods for variety. For example, eat various meats and seafood, and include different non-starchy fruits, vegetables, nuts, and seeds in your meal plan.
Eva adds, “It’s important to eat choose low-carb vegetables to get all the vitamins and minerals needed for proper nutrition. Good choices include kale, broccoli, spinach, asparagus, mushrooms, and peppers.”
By preventing nutrient deficiencies, you can stave off a lot of diseases.
Additionally, keep in mind that while ketosis has therapeutic benefits, staying in ketosis indefinitely isn’t probably the best for you. Athletes and those who workout often and at higher intensities may benefit from a cyclical keto approach to enhance their performance.
With so many keto diet variations to choose from nowadays, people can decide how to do keto in a way that allows for flexibility and makes them feel comfortable.
Diabetes reversal, particularly type 2 diabetes, is one reason people choose to restrict carbohydrates. According to a recent systematic review, type 2 diabetes patients continue to experience decreases in their HbA1c levels, less reliance on their diabetes medications, and weight loss (*).
This is good news for individuals requiring help with normalizing blood glucose levels. Making type 2 diabetes reversal last, however, should be done through proper medical supervision. Since the keto diet significantly reduces blood glucose, medications need to be adjusted according to a patient’s results (*).
Another area of interest is keto as a form of treatment for psychiatric conditions. We’ve learned that keto helps with epilepsy and other neurological disorders. But recently, a retrospective analysis of 31 adults with severe, persistent mental illness showed that the keto diet improved their depression and psychosis symptoms. The participants limited their carbohydrate intake to a maximum of 20 grams per day (*).
Following hospital discharge, 46% of the patients reported good adherence to the keto diet at home. Those who chose to continue keto did so to maintain or improve their psychiatric outcomes, as well as their metabolic health (*).
For those who want to use keto to improve body composition, findings from a recent study showed that the keto diet reduces body fat while maintaining muscle mass (*). Beta-hydroxybutyrate (BHB), which is produced during ketosis, inhibits protein breakdown. This would explain why the keto diet protects you from muscle loss (*).
The keto diet may be supported by studies in various aspects of health, but it’s up to people to choose if it’s right for them. Being aware of the possible outcomes of doing keto long-term will help you decide, along with other considerations, such as your personal goals, readiness, and current state of health.
Unwin D et al. Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care. 2019 July 26
Paoli A et al. Effects of Two Months of Very Low Carbohydrate Ketogenic Diet on Body Composition, Muscle Strength, Muscle Area, and Blood Parameters in Competitive Natural Body Builders. 2021 January 26