Is Keto Diet Dangerous?#3 | Yasser Kashef

Is Keto Diet Dangerous?#3

Keto Diet Dangerous

Table of Contents

“Doesn’t the keto diet cause dangerous ketoacidosis?”

Ketosis

Ketoacidosis

“Could the keto diet cause hormonal imbalance?”

Cortisol

Thyroid Function

“I’ve heard that the keto diet causes kidney stones and gallstones.”

Can Keto Cause Kidney Stones?

Gallbladder Issues

Is the Keto Diet Right For You?

“Doesn’t the keto diet cause dangerous ketoacidosis?”
These are two very different terms, but ketosis and ketoacidosis are often confused. The keto diet doesn’t cause ketoacidosis.

Ketosis
Ketosis indicates the presence of ketones in the blood at > 0.5 mM. Achieving ketosis can happen through diet or fasting.

When people reach ketosis through fasting, ketone levels naturally plateaued at ~8 mM after 41 days of starvation. This is far lower than ketone levels during ketoacidosis. A ketogenic diet should only result in ketone levels that fall within a natural and safe range.

Ketoacidosis
This is a condition typically seen in type-1 diabetics, where ketones and blood sugar levels are both dangerously high (ketone levels at 20+ mM). The key factor in the development of ketoacidosis is a lack of insulin. The cells cannot shuttle in glucose from the bloodstream for energy use and the body has no signal to stop releasing fats (which are converted into ketones). Those who have even a small amount of insulin secretion or signalling do not often reach this metabolic state.

When ketone levels get too high, the blood becomes too acidic, which could potentially become life-threatening. Other medical problems linked to ketoacidosis include alcoholism, overactive thyroid, and infections such as pneumonia or drug abuse.

Ketoacidosis isn’t a danger directly associated with the ketogenic diet.

“Could the keto diet cause hormonal imbalance?”
Hormonal response between individuals on the keto diet varies widely (including between men and women). A careful keto dieter should be able to maintain a healthy hormonal balance.

Hormonal imbalance is a hot-button topic when it comes to the keto diet. There’s a discrepancy in the scientific results, which may stem from differences in the exact dietary protocols used, and the cohorts studied.

Cortisol
This is one of the first hormones most people think will suffer via the ketogenic diet. Cortisol is called the “stress hormone” in the body due to its role in stress response, and several other functions like breaking down fat and protein to make glucose. It also controls sleep and wakefulness as well as regulation of blood pressure.

Chronically high cortisol levels are detrimental to health and may increase the risk of heart disease. Are these levels possible to attain while on the keto diet? Only if you aren’t careful.

A lack of sodium on the ketogenic diet can cause the brain to send signals to the adrenal gland to increase the release of hormones responsible for water balance. Cortisol is released alongside these other hormones.

If sodium consumption is enough to maintain a normal water balance, then cortisol levels should stay stable. Few studies have measured cortisol levels of people on keto and the results are inconclusive. One study found that cortisol increased over time in subjects given a ketogenic diet with a low/inadequate sodium intake 16.


Another study showed no change in cortisol after six weeks of a well-formulated ketogenic diet 17. Cortisol is infrequently measured, which may be an indication that generally, doctors and scientists have few concerns about cortisol on a ketogenic diet.

Thyroid Function
A supposed danger of the keto diet is a negative impact on thyroid function.

The thyroid hormones have several functions, including control of the body’s metabolic rate, digestion, and muscle control, among others. The ketogenic diet is linked with a decline in the amount of active thyroid (T3) (18) in the body, which is why it’s assumed the diet impairs thyroid functioning.

However, this is not backed by any solid studies. The body’s sensitivity to T3 has been hypothesized to increase as a result of the ketogenic diet, in a similar way increased sensitivity to other hormones occurs during the diet. As the body becomes more responsive T3, it may function just as well or even better than before with lower T3.

Studies point to the beneficial effects of lowered T3 to assist in sparing lean muscle 19. Lowered T3 is even hypothesized to be an adaptive mechanism increasing longevity 20.


Regarding metabolism: one study found when men on either the ketogenic diet or the low-fat diet were compared, their resting metabolic rates were not different despite lowered T3 on the ketogenic diet (20). Of the several studies done on the ketogenic diet, none have reported significant cases of hypothyroidism–essentially, the thyroid can function fine while following a ketogenic diet.

“I’ve heard that the keto diet causes kidney stones and gallstones.”
The unfounded association between the ketogenic diet and kidney stones is perhaps due to the supposed link between dietary protein and kidney stones–there’s a common confusion between the ketogenic diet and a high-protein diet.

Can Keto Cause Kidney Stones?

Kidney stones are mineral deposits in the kidneys. They can be caused by multiple things–including dehydration, high sodium intake, family history, and excessively high consumption of protein (> 200g per day). A true ketogenic diet is low-carb, moderate-protein, and high-fat. So there’s no solid evidence that protein consumption at levels seen in a typical ketogenic diet could cause kidney stones.

Gallbladder Issues


Another common false connection exists between the keto diet and increased risk of gallbladder issues. Why?

The main role of the gallbladder is to store bile (which is made in the liver), and in turn, the role of bile is to digest fat. People assume that eating a lot of fat is somehow linked to an increased risk of gallstones, which are solid deposits of cholesterol and bile that can form in the gallbladder. But most of the cholesterol in the bloodstream is made inside the body (as part of a tightly regulated process inside the liver), not derived from the diet.

None of the common causes of gallstones (including inherited body chemistry, body weight, low gallbladder motility, and low-calorie diet) is linked to the keto diet.

Comparing those who lose weight on a low-fat diet versus a low-carb diet, studies show those on the low-fat diet are more at risk of developing gallstones (22). And eating high fat is thought to stimulate gallbladder emptying, which could be even protective against stone formation.

Is the Keto Diet Right For You?

It’s important to survey the information available and sift facts from the myths. Many of those myths are covered in a cloud of confusion surrounding the relevance of the research, inadequate facts, and media hype.

Many of the perceived dangers are minor inconveniences which can be overcome by careful diet and lifestyle management. These “dangers” are also issues present in any calorie-restricted diet (including low-fat diets) and are not unique to just the keto diet.

It’s obviously important to keep in touch with a doctor for health-related lifestyle changes. But feel confident embracing a properly-formulated ketogenic diet–rich in whole foods, adequate hydration and electrolyte consumption–to help avoid any of these dangers.

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Citations:

17.Volek, J.S., Sharman, M.J., Love, D.M., Avery, N.G., Gomez, A.L., Scheett, T.P., and Kraemer, W.J. (2002). Body composition and hormonal responses to a carbohydrate-restricted diet. Metabolism 51.
18.Kose E, Guzel O, Demir K, Arslan N. Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. J Pediatr Endocrinol Metab.2017 Apr 1;30(4):411-416.
19.Kaptein EM, Fisler JS, Duda MJ, Nicoloff JT, Drenick EJ. Relationship between the changes in serum thyroid hormone levels and protein status during prolonged protein supplemented caloric deprivation.Clin Endocrinol (Oxf). 1985 Jan;22(1):1-15.
20.Rozing MP, Westendorp RG, de Craen AJ, Frölich M, Heijmans BT, Beekman M, Wijsman C, Mooijaart SP, Blauw GJ, Slagboom PE, van Heemst D; Leiden Longevity Study (LLS) Group. Low serum free triiodothyronine levels mark familial longevity: the Leiden Longevity Study. J Gerontol A Biol Sci Med Sci. 2010 Apr;65(4):365-8
21.Meckling K, O’Sullivan C, Saari D. Comparison of a Low-Fat Diet to a Low-Carbohydrate Diet on Weight Loss, Body Composition, and Risk Factors for Diabetes and Cardiovascular Disease in Free-Living, Overweight Men and Women. Nutr Metab (Lond). 2004; 1: 13.
22.Stokes CS, Gluud LL, Casper M, Lammert F. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol. 2014 Jul;12(7):1090-1100.e2; quiz e61.


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