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Going Keto To Lose Weight Or Balance Blood Sugar? This Doctor Wants You To Think Twice

Shivam Joshi, M.D.
Internal Medicine Physician
By Shivam Joshi, M.D.
Internal Medicine Physician
Shivam Joshi, M.D. is a board-certified internal medicine physician with an interest in plant-based health, evolutionary diets, and plant-based diets in kidney disease. He received his B.S. from Duke University. He received his M.D. and his residency training from the University of Miami and Jackson Memorial Hospital.
Photo by Cameron Whitman

mindbodygreen was one of the first to talk about the ketogenic diet, which is quickly gaining fame and becoming one of the most popular diets out there for anyone from people suffering from chronic pain to those trying to maintain a healthy weight. But like any diet, it has its pros and cons and it’s not right for everyone. Here, Dr. Shivam Joshi—board-certified internal medicine physician with an interest in plant-based health, evolutionary diets, and plant-based diets in kidney disease—explains why keto isn’t for everyone and what to look out for before starting a new diet. —The editors  

Obesity is one of the biggest problems facing our world today. And it's not only a health risk in itself, it's been connected to major leading causes of death—like heart disease, cancer, and diabetes—as well. As long as people are overweight or obese, there will be no shortage of diets claiming to be the latest, greatest solution to our world's adiposity woes. The ketogenic diet is the latest to capture our attention.

If you haven't heard of it before, the ketogenic diet (also known as the keto diet) has captured the world's attention for its apparent ability to help people lose weight and treat their diabetes by eliminating all carbohydrates and focusing on a high-fat diet. However, I believe that a closer look at the science around this way of eating reveals that the results aren’t as impressive as many other dieting techniques, especially considering how restrictive it is. In fact, it may even have the risk of potentially serious side effects. Here's what I mean:

1. It'll help you lose weight, but it might not be the best way to lose weight.

Proponents of the ketogenic diet are quick to point out that it's the best diet for weight loss, but a large meta-analysis1 comparing ketogenic, low-carbohydrate diets to high-carbohydrate diets showed less than a kilogram of difference in weight loss between the two dietary strategies after 12 months—a minimal benefit when taking into account how overweight or obese many dieters are and how much effort is required to be in ketosis, the state of producing ketones while on the ketogenic diet. It's also possible that any initial weight loss on the ketogenic diet may be more a product of water2 loss from the diuretic effect of ketones. In a randomized, controlled trial3 of 811 participants, it didn’t matter which diet a person was on as long as they limited their caloric intake.

2. It can help manage diabetes, but it won't treat it.

The ketogenic diet has garnered a lot of publicity for being able to "treat" diabetes. However, withholding all carbohydrates from diabetics is not new4 and actually was a method of managing diabetes before the discovery of insulin almost a century ago. Although one can control blood sugar spikes with a ketogenic diet, the underlying diabetes remains, which is why meta-analysis1 analyzing ketogenic, low-carb, and high-carb diets showed no difference in fasting glucose or hemoglobin A1c levels (both markers of diabetes) after one year.

3. Not all fats cause heart disease, but some do.

The keto diet encourages its followers to double down on fats, with up to 70 to 80 percent of calories coming from fat. The only population to have even come close to consuming this amount of fat are the Inuit of the Arctic regions, who—contrary to popular belief—had a high rate of heart disease despite eating large amounts of fish and other marine sources of fat. Further, the high amount of fat encouraged by the keto diet puts people who aren't quite as well-versed in nutrition at risk of consuming some fats that are unhealthy, like trans and saturated fats, which increase the risk of cardiovascular complications like heart disease and stroke.

4. When it comes to the standard American diet, there are bigger fish to fry.

Keto diet experts warn their followers that eating foods like fruits, vegetables, grains, and legumes will prevent ketosis due to their carbohydrate content and recommend avoiding these foods entirely to gain the benefits of the ketogenic diet. However, the costs of forgoing these foods—which have been associated with several desirable health benefits—could be pretty steep. For example, in a large meta-analysis, fruits and vegetables have been shown to reduce the risk of dying with greater benefits with additional servings consumed. Whole grains5 and legumes6 have also been shown to be beneficial by reducing the risk of heart disease, death, and cancer. If one were to get rid of certain foods from the standard American diet, getting rid of some of the healthiest foods in our diet doesn’t seem like the place to start.

5. Plain and simple: Prolonged ketosis can be dangerous.

The keto diet, like many other extreme nutrition protocols, comes with its fair share of risks—including kidney stones7 and mineral deficiencies8 that can have serious consequences. The diet also comes with its own period of transition as the body adjusts to a state of carbohydrate starvation known as the "keto flu," which includes symptoms such as gastrointestinal9 disturbances. Other more concerning side effects of the diet include potential fractures10, acidosis11, and pancreatitis12. The potential for harm is the main reason I do not recommend the keto diet to patients.

Readers looking to lose weight may feel hopeless knowing that the keto diet may not be as helpful as they once thought. However, the healthiest and safest diet for humans is one that emphasizes eating whole, plant-based foods, of which there are many healthy variations. And that is something certainly to take comfort in!

Looking to reach your happy weight? Take mindbodygreen's Boost Your Metabolism class with JJ Virgin.

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