Keto Questions and Answers – [Part 4]

Q&A Question Mark Showing Questions And Answers Response

Is being in ketosis safe over the long term? If not, then who should avoid doing it?


Sustained, long-term ketosis can have side effects in some individuals, but these are usually easily managed and are most common during the first few months, when the individual is gradually becoming keto-adapted. Most of the problems people have with the ketogenic diet are experienced early on and can usually be remedied by proper hydration and mineral supplementation.

– Dr. Dominic D’Agostino


Because of the common confusion about ketosis, primarily from those who mistake it for ketoacidosis, questions about the long-term safety of a ketogenic diet have arisen. But a study by researcher Dr. Hussein Dashti that was published in the Fall 2004 issue of the medical journal Experimental and Clinical Cardiology found that a ketogenic diet produced “a significant decrease in the level of triglycerides, total cholesterol, LDL cholesterol and glucose, and a significant increase in the level of HDL cholesterol in the patients” and that “the administration of a ketogenic diet for a relatively long period of time is safe.” I’ve been eating this way for over a decade, and I know plenty of others who have been keto-adapted for much longer. There is no evidence of problems related to following a ketogenic diet as a permanent lifestyle choice.

So is there anyone who should avoid getting into ketosis? While the vast majority of people will find tremendous health benefits from being on a ketogenic diet, it may not be right for everyone. As we’ll cover in more detail in a moment, type 1 diabetics should approach it with caution because of the risk of ketoacidosis (as discussed in chapter 1). Also, if you have any problems with your gall bladder, you may need to address them before beginning a ketogenic diet (more on that later).

For everyone else, if you’ve been following a well-formulated ketogenic diet that keeps carbohydrates and protein at your personal limits and that includes large amounts of whole-food sources of dietary fats for a period of six to twelve months, you have ample amounts of ketones when you test your blood or breath, and you are not seeing any improvements in your weight and health markers, then perhaps you should move on to something else. But I’ve never heard of anyone who ate a ketogenic diet and produced plenty of ketones and did not experience all the amazing benefits we’ve been talking about.

If you are concerned about your long-term health on a ketogenic diet, find a medical professional who is willing to work with you in a positive manner and monitor your progress. (A list of ketogenic-friendly doctors is available at lowcarbdoctors.blogspot.com.) Here’s a list of lab tests you can have run periodically to check your overall health:

  • Fasting insulin
  • Fasting blood glucose
  • Homocysteine
  • hsCRP
  • NMR LipoProfile test
  • Standard lipid profile
  • Uric acid
  • Full thyroid panel

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: There are a few very rare hereditary conditions in which the body is unable to use fat for fuel—commonly referred to as “inborn errors of metabolism.” These conditions are discovered very early in infancy, so adolescents and adults who haven’t already been diagnosed don’t need to worry.

Should a type 1 diabetic be on a ketogenic diet?


Obviously ketosis may not be appropriate for some type 1 diabetics. Otherwise, we have not observed any complications with this dietary approach.

– Dr. David Perlmutter


This is a fair question, especially since type 1 diabetics need to be concerned about ketoacidosis. But as long as your blood sugar levels are well controlled (which, coincidentally, a ketogenic diet will help with), then the level of ketones in the body will not rise to dangerous levels. And that holds true for everyone, including people with type 1 diabetes.

Keep in mind that a type 1 diabetic cannot make insulin, the hormone that pushes glucose into cells. But according to a May 2012 study published in the medical journal Diabetology & Metabolic Syndrome, type 1 diabetics who consumed a carbohydrate-restricted diet over a four-year period found that their requirement for insulin was greatly reduced.

In other words, their condition became better as a result of a low-carb diet. If you have any specific questions or concerns about this, please consult with a physician who understands the biochemistry of low-carb, high-fat, ketogenic diets. You can find a medical professional in your area at lowcarbdoctors.blogspot.com.

Registered dietitian Franziska Spritzler says that people with diabetes, including type 1 diabetes, “often experience dramatic improvement in blood glucose control” while in a state of ketosis. Spritzler notes that there is research showing that if a type 1 diabetic is producing ketone bodies through a low-carb, moderate-protein, high-fat diet, they can continue to be just fine even if their blood sugar dips below 70 mg/dl—even though that level of blood sugar will cause hypoglycemia in anyone who uses glucose as their primary fuel source. This is why full keto-adaptation is so helpful for type 1 diabetics.

Do I have to count calories to make ketosis happen for me?


The major benefit of nutritional ketosis is that it helps regulate appetite in a way that prevents the consumption of surplus calories that would ultimately lead to weight gain and metabolic dysregulation.

– Dr. Dominic D’Agostino


This is one of the most freeing parts of a ketogenic diet—you don’t have to count calories. When your carb and protein consumption is dialed in to your personal specifications and you consume enough fat in your diet, then something pretty amazing tends to happen: you are able to feel completely satisfied, with no cravings, no hunger, and no stressing about every little morsel of food you put in your mouth. That’s what I call dieting, and it’s time to break free from the bondage of calorie-counting forever. (If you’re interested in learning why calories really aren’t what you think they are, check out The Calorie Myth by Jonathan Bailor.)

Does this mean you have free rein to gorge yourself on as much food as you want within your low-carb, moderate-protein, high-fat diet, without consequences for your weight and health? Not at all. But if you are not stoking hunger by consuming too much carbohydrate or protein and are eating delicious and filling whole-food sources of fat, then you won’t want to eat until you’re stuffed, and calories naturally fall into line exactly where they need to be.

Ketosis changes the way you think about food; you start to see it more as a means for fueling your body than as a physical pleasure. That’s not to say you don’t enjoy food on a ketogenic diet—you do!— but it takes away any urge to binge.

What side effects can I expect to experience when I begin getting into ketosis?


When you think about it, the potential side effects from eating low-carb or ketogenic are really no big deal. If you want to see truly serious side effects from eating a diet, try eating the Standard American Diet (SAD). It’s like a lesion that makes the practice of medicine extremely profitable for physicians while keeping your life utterly miserable. The choice is yours—a very short period of annoying symptoms as you become keto-adapted versus a lifetime of poor health and less than optimal functioning. To me the best choice is pretty obvious.

– Dr. Bill Wilson


During the transition from burning sugar to burning fat, some people experience a temporary feeling of discomfort that’s referred to affectionately as the “keto flu.” This can manifest in any number of ways, including bad breath, frequent urination, feelings of fatigue, lightheadedness, blood sugar dips, constipation, carb cravings, muscle aches, headaches, diarrhea and gas, and disrupted sleep. The thing to remember is that you may or may not experience these side effects, but even if you do, they won’t last for more than a few weeks. If they do continue beyond a few weeks, it may signal a failure to become fully keto-adapted; you may be staying in “no man’s land” between being a sugar-burner and a fat-burner. Get into ketosis and stay there to make these conditions go away.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: “Fat-burning” involves the use of fatty acids and ketones for fuel while “sugar-burning” involves glucose. Technically, the body always has some fat-burning and sugar-burning going on at the same time. If you are burning sugar, though, it is difficult to burn much fat because sugar-burning turns off fat-burning. The body only stores a few days’ worth of energy as sugar (glycogen), so if the sugar storage capacity has been reached, additional sugar must be either burned or turned to fat. That means that burning excess sugar becomes the body’s priority, while fat stays in storage.


Leave a Comment