Inner Circle Health Network

Is the Ketogenic Diet Dangerous?

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Doctor William Davis here, author of the Wheat Belly and Undoctored books. I'd like to raise, once again, this contentious question: is the ketogenic diet dangerous? And I raise this now, again, because more and more people are coming to me, and are indeed having health problems long-term, not near-term, but long term.

Now we know, with confidence, that a long-term ketogenic diet has bad effects. We know that because there have been thousands of kids, who were put on very strict ketogenic diets, over years, to suppress intractable seizures — which is a bad problem — intractable seizures. Put the children on these diets — there's about a 50% reduction in seizure episodes, which is really great, right? But what happens to these kids on long-term ketogenic diet?

  • They stop growing. Now, you're not growing. You don't have to worry about that. But it suggests that there is something fundamentally wrong, or missing in the ketogenic diet.
  • These kids develop osteopenia and osteoporosis. These are kids — not supposed to have osteoporosis at that age.
  • They develop a huge increase in kidney stones, both oxalate and urate kidney stones.

There's an up-front pleasant collection of metabolic improvements on a ketogenic diet: a rise in HDL, reduction in triglycerides, reduction of insulin resistance, reduction of small LDL particles, reduction in blood pressure, reduction in fatty liver.

But after many months to years, all that reverses. HDL goes down. Triglycerides go back up. Insulin resistance goes back up. Blood pressure goes back up. And, constipation, diverticular disease, and risk for colon cancer goes way up (long-term)

You know, we saw this before. We saw this in people who followed the Atkins Diet, because just like the ketogenic diet, the Atkins Diet does not purposefully help you replace prebiotic fibers. And that is one of the core issues that accounts for a lot of the adverse effects of ketosis, prolonged ketosis: the failure to take in sufficient quantities of prebiotic fibers; that is, fibers that nourish bowel flora.

So we know with confidence also, that a prolonged ketosis (ketogenic diet) changes bowel flora. There are some good things, and a lot of bad things. For instance, there's a reduction in bifidobacteria and a proliferation of E. coli — a marked increase in E. coli populations.

We also know that species diversity, the collection, the number of species of bowel flora in the gastro-intestinal tract, is markedly diminished, when you follow a ketogenic diet. Species diversity is a very powerful marker for health. Healthier people always have more species diversity than unhealthy people. Unhealthy people have narrow species diversity, with proliferation of unhealthy species like E. coli and Campylobacter and Shigella and others.

So, ketosis is fine, and physiologic, and natural, for brief periods.

I draw a parallel to the stress response. The stress response is a normal physiologic response, right? There's a sense of danger or excitement. What if you're a stress junkie, or an adrenaline junkie, and you want stress 'round the clock, 24×7, or your exposed to some awful life stress, like financial problems, someone close to you is ill or dies, or maybe you're taking of an elderly parent who's got dementia — chronic stress?. What happens in chronic stress: it's horrible for health, right? Cancer rates go way up; depression, heart disease, way up; all kinds of other conditions; the risks increase dramatically. Stress is normal and physiologic. Chronic stress is very harmful. Same thing here. Short-term ketosis is normal natural and physiological. Long-term ketosis is very destructive for health.

Now some people have argued that the beta-hydroxybutyrate ketone of ketosis is all you need for bowel health — you don't need the prebiotic fiber, you don't need all those bacteria, and E. coli proliferation… Well, there's no way you can justify that kind of an argument, especially in light of all the evidence coming to us in the microbiome.

The microbiome is the key here. We must make efforts to cultivate healthy bowel flora, because modern people have screwed up their bowel flora dramatically. So don't add to the effect by being chronically ketotic.

Use it near-term if you want to lose weight, reverse fatty liver, become non-diabetic, but then add the prebi… or even better, maybe address prebiotic fibers, just like we do in Wheat Belly Total Health and Undoctored — we do that from the start.

So there's so much now that relies on healthy microbiome. Don't let diet ruin it for you.