The low-carbohydrate ketogenic diet can sound too good to be true. (Eat butter! And red meat! And cheese! Eschew carbs and lose weight!) But search #ketotransformation on Instagram and you’ll see nearly 1 million posts proving weight loss is certainly a result of slipping into ketosis. So what are the downsides of the keto diet (besides giving up bread, meticulously tracking net carbs, and the keto flu)?
Let’s get back to the butter and red meat and not eating carbohydrates, which would have anyone with a baseline knowledge of cardiovascular health and heart disease asking, is the keto diet bad for your heart? It seems like a high-fat, low-carb diet would be bad news for your ticker (and your cholesterol levels), but that may not be the case. In fact, one 2017 review of studies published in the journal “Nutrition” found that a keto diet could improve HDL cholesterol levels, as well as reverse the course of Type 2 Diabetes by controlling blood glucose levels. In addition, the ketogenic diet has been proven as an effective dietary treatment plan for some patients with epilepsy. That said, most experts agree that more research is needed, and that the improvements in cardio risk factors may be limited.
Certain research also suggests that the ketogenic diet may have some adverse side effects, including potential kidney and heart complications (think kidney stones, especially if someone on keto isn’t hydrating properly). In addition, there have not been enough studies conducted over more than 2 years to determine the long-term effects of the ketogenic diet, which means we can’t be certain how producing more ketones may affect the body or the heart over a period of multiple years. Other side effects include digestion issues like constipation, low blood sugar, exhaustion, and headaches, although most side effects (also called the keto flu) should subside after the first few days on the diet as your body slips into ketosis.
Like other low-carbohydrate diets, while the ketogenic diet has some proven benefits, most experts say these benefits are greatly diminished if you “sort of” follow the ketogenic diet. For instance, you want to be keto compliant, so you order eggs and bacon to make sure you’re hitting your macros for protein and fat intake…but the French toast looks delicious, so you grab some from your dining mate’s plate. At this point, your body is no longer in ketosis, and the fatty foods on your plate might be doing more harm than good, says Doctor Stephen Sinatra, a cardiologist in New York City. While some studies show that a ketogenic diet may actually lower cholesterol levels for people who follow a strict ketogenic diet, experts worry that “keto” has become code to some for “go nuts at the Brazilian barbeque” says Sinatra, without fully committing to keto guidelines, including making sure the low-carb diet is done under the supervision of a doctor.
So can the ketogenic diet and remaining in a state of ketosis be a healthy way to help you achieve your weight loss goals without inciting heart disease? It depends on how strict you plan to be while following the diet, and to make smart choices in the foods you are allowed to have on the plan. Yes, you can technically have a fully keto meal from the drive-thru. But that red meat double double will most likely be loaded with saturated fat. “It’s important not to go overboard on saturated fats and focus on healthy, monounsaturated fats,” notes Sinatra. That’s because saturated fats are more likely to raise your LDL cholesterol level, regardless of whether or not you’re following the keto diet. Some smart keto choices and healthy fats include eating lean meats, fish, leafy green veggies like spinach and kale, above ground, non-starchy vegetables like cauliflower, broccoli and eggplant, and healthy oils like coconut oil, grape oil, and flaxseed oil.
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Bottom line, when it comes to the ketogenic diet and heart health research echoes what Instagram before and afters show: The ketogenic diet can be an effective form of weight loss. But it may not be the best option for you to lose weight. Talking to your doctor and getting a full workup, including blood work, prior to starting a ketogenic diet can help you monitor how the diet is affecting your body, including your heart.
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