The keto diet, often hailed as a fast track to weight loss and improved health, has recently gained significant popularity. With its promise of quick results, it’s no surprise that about 7% of Americans adopted the diet in 2022.
Despite its widespread appeal, experts like Christopher Gardner, a professor of medicine at Stanford University, believe that the diet has extreme restrictions that make it difficult to follow. Along with other nutrition specialists, Gardner highlights the challenges that keto followers face, including its restrictive nature and lack of long-lasting effects.
What makes the keto diet so hard to stick to?
The keto diet operates on the principle of drastically reducing carbohydrates to about 5% of total calorie intake. Gardner explains that this shift forces the body into a state of ketosis, where it burns fat for fuel instead of glucose. Achieving ketosis requires not just cutting carbs but also maintaining a high-fat intake of around 75% of daily calories.
This approach creates an eating plan far removed from the average American diet, which typically consists of about 50% carbs and 35% fat. Adhering to such a restrictive regimen means giving up bread, pasta, rice, potatoes, and most fruits. Even healthy grains and legumes, known for their fiber content, are off-limits.
Nancy Oliveira, a dietitian at Harvard Medical School’s Brigham and Women’s Hospital, notes that the focus on fats and low carbs makes it hard to maintain a balanced diet, as you miss out on key vitamins and minerals. This can lead to deficiencies and digestive issues, like constipation, especially in the early stages.
The high intake of saturated fats can also raise “bad” cholesterol. Gardner cautions that this and the diet’s low fiber content can risk heart health and gut microbiome diversity.
Keto diet effects: short-term wins, long-term challenges
For many, the keto diet’s biggest draw is its ability to promote rapid weight loss and improve markers like blood sugar and “good” cholesterol in the short term. This can be particularly beneficial for individuals with pre-diabetes or diabetes.
However, the sustainability of these benefits is questionable. A 2019 meta-analysis found that the diet’s positive effects often diminish after six months, with most individuals unable to maintain the regimen for a full year. Gardner attributes this to its highly restrictive nature, which leads to diet fatigue.
Beyond weight loss, some people use the ketogenic diet for medical reasons, such as managing epilepsy. But even in these cases, there are potential long-term side effects like an increased risk of kidney stones and gout due to elevated uric acid levels.
An alternative to the keto diet
If the keto diet isn’t sustainable for most, what’s the alternative? Experts like Gardner advocate for less restrictive, nutrient-rich eating plans, such as the Mediterranean diet. This approach emphasizes whole foods, healthy fats, and plenty of fiber, making it easier to maintain.
“The Mediterranean diet is […] not restrictive, and allows for more people to follow this pattern for longer periods of time”, Gardner explains. By reducing processed carbs and incorporating more unsaturated fats and fiber, people can achieve sustainable weight loss and improved health without the extreme sacrifices required by keto.
In the end, while the keto diet may work for some in the short term, its rigid rules and potential health risks make it a challenging choice for most. For long-term success, focusing on moderation and balance —not restriction— could bring better results.