The ketogenic diet is a low carb, high fat diet commonly used for weight loss.
Restricting carbs and increasing fat intake can lead to ketosis, a metabolic state in which your body relies primarily on fat for energy instead of carbs (1).
However, the diet also carries risks you should be aware of.
Here are 7 keto diet dangers to know about.
Carb intake on the keto diet is typically limited to fewer than 50 grams per day, which can come as a shock to your body (2).
As your body depletes its carb stores and switches to using ketones and fat for fuel at the start of this eating pattern, you may experience flu-like symptoms.
While most people who experience the keto flu feel better within a few weeks, it’s important to monitor these symptoms throughout the diet, stay hydrated, and eat foods rich in sodium, potassium, and other electrolytes (3).
As your body adjusts to using ketones and fats as its primary energy source, you may experience flu-like symptoms at the beginning of the keto diet.
High fat animal foods, such as eggs, meat, and cheese, are staples of the keto diet because they don’t contain carbs. If you eat a lot of these foods, you may have a higher risk of kidney stones.
Some studies also suggest that the keto diet reduces the amount of citrate that’s released in your urine. Given that citrate can bind to calcium and prevent the formation of kidney stones, reduced levels of it may also raise your risk of developing them (5).
Additionally, people with chronic kidney disease (CKD) should avoid keto, as weakened kidneys may be unable to remove the acid buildup in your blood that results from these animal foods. This can lead to a state of acidosis, which can worsen the progression of CKD.
Eating a lot of animal foods on the keto diet can lead to more acidic urine and a higher risk of kidney stones. This acidic state can also worsen the progression of chronic kidney disease.
Since the keto diet restricts carbs, it can be difficult to meet your daily fiber needs.
Some of the richest sources of fiber, such as high carb fruits, starchy vegetables, whole grains, and beans, are eliminated on the diet because they provide too many carbs.
As a result, the keto diet can lead to digestive discomfort and constipation.
What’s more, fiber feeds the beneficial bacteria in your gut. Having a healthy gut may help boost immunity, improve mental health, and decrease inflammation (8).
Some keto-friendly foods that are high in fiber include flax seeds, chia seeds, coconut, broccoli, cauliflower, and leafy greens.
Due to its carb restrictions, the keto diet is often low in fiber. This may trigger constipation and negative effects on gut health.
Since the keto diet restricts several foods, especially nutrient-dense fruits, whole grains, and legumes, it may fail to provide recommended amounts of vitamins and minerals.
In particular, some studies suggest that the keto diet doesn’t provide enough calcium, vitamin D, magnesium, and phosphorus (9).
A study that evaluated the nutrient composition of common diets revealed that very low carb eating patterns like Atkins, which is similar to keto, provided sufficient amounts for only 12 of the 27 vitamins and minerals your body needs to obtain from food (10).
Over time, this may lead to nutrient deficiencies.
Notably, guidelines for clinicians who manage people on a very low calorie keto diet for weight loss recommend supplementing with potassium, sodium, magnesium, calcium, omega-3 fatty acids, psyllium fiber, and vitamins B, C, and E (11).
Keep in mind that the nutritional adequacy of this diet depends on the specific foods that you eat. A diet rich in healthy low carb foods, such as avocados, nuts, and non-starchy vegetables, provides more nutrients than processed meats and keto treats.
Some studies suggest that keto provides insufficient vitamins and minerals, including potassium and magnesium. Over time, this could lead to nutrient deficiencies.
Low carb diets like keto have been shown to help manage blood sugar levels in people with diabetes.
However, individuals with type 1 diabetes may be at a high risk of more episodes of low blood sugar (hypoglycemia), which is marked by confusion, shakiness, fatigue, and sweating. Hypoglycemia can lead to coma and death if not treated.
A study in 11 adults with type 1 diabetes who followed a ketogenic diet for over 2 years found that the median number of low blood sugar events was close to 1 per day (15).
Individuals with type 1 diabetes typically experience low blood sugar if they are taking too much insulin and not consuming enough carbs. Thus, a low carb keto diet may increase the risk.
Theoretically, this could also happen to individuals with type 2 diabetes who are taking insulin medications.
Even though low carb diets have been shown to improve blood sugar control in people with diabetes, they may also increase your risk of low blood sugar events — especially if you have type 1 diabetes.
The keto diet is also associated with impaired bone health.
In fact, a 6-month study in 29 children with epilepsy on the keto diet discovered that 68% had a lower bone mineral density score after going on the diet (18).
Another study in 30 elite walkers determined that those who followed keto for 3.5 weeks had significantly higher levels of blood markers for bone breakdown, compared with those who ate a diet higher in carbs (19).
All the same, more extensive research is warranted.
The keto diet may reduce your bone mineral density and trigger bone breakdown over time, though further studies are needed.
The ketogenic diet’s effect on your risk of chronic illness, such as heart disease or cancer, is hotly debated and not entirely understood.
Some evidence suggests that high fat, low carb diets that focus on animal foods may lead to poor health outcomes, while diets that emphasize vegetable sources of fats and proteins provide benefits (20, 21).
On the other hand, vegetable-based low carb diets were associated with a lower rate of death from heart disease and all causes (21).
Another study in over 15,000 adults found similar results but tied both low and high carb diets to a greater all-cause death rate, compared with moderate carb diets in which carbs comprised 50–55% of total daily calories (22).
Yet, more substantial studies are needed.
While research is mixed, some evidence suggests that low carb diets that focus on animal foods may lead to higher death rates from heart disease, cancer, and all causes.
While the keto diet is linked to weight loss and other health benefits in the short term, it may lead to nutrient deficiencies, digestive issues, poor bone health, and other problems over time.
Due to these risks, individuals with kidney disease, diabetes, heart or bone ailments, or other medical conditions should speak to their healthcare provider before trying the keto diet.
You may also want to consult a dietitian to plan balanced meals and monitor your nutrient levels while on this diet to help minimize the risks of complications and nutrient deficiencies.