What are the long-term effects of low-carb diets that aim for ketosis, such as the Atkins diet? We really don’t know. This in and of itself has implications for our diet and nutrition plans.

What Do We Know About Low-Carb, Ketogenic Diets?

Very quickly, what we know is that if you keep carbs in your diet low enough, your body will change its energy source from glucose to ketone bodies. Ketones serve as an alternative fuel source for the brain when carbs, and therefore glucose, are scarce. Diets like Atkins aim to get you into this state, called ketosis, and keep you there because once you are, the main fuel source for your body becomes fat. That means you get to watch those pounds melt off. Especially if you are doing it for the first time, it works extremely well, but, how long will this last?

What Happens Over The Long-Term With Ketogenic Diets?

So this is the problem, we don’t really know what happens over a long period of time in ketosis. My search on the subject did not turn up much in the way of research and from what I have read from other authors, that’s because there isn’t much. So even if you are one of the rare people who can follow something like the Atkins diet for a long period of time without falling off, such as one person close to me has, the results are up in the air.

What Are The Potential Problems With Long-Term Ketosis?

We are now into speculation land. Remember there is not much in the way of research, so everything from here on out is what I think are problems based on my expertise in fitness, not in biological science.

1. There is at least one study that says ketogenic diets may be bad.

A 22 week study done in mice came to this alarming conclusion. They say at the end of their study that “This indicates that long-term high-fat, low-carbohydrate KD [Ketogenic Diet] lead to features that are also associated with the metabolic syndrome and an increased risk for type 2 diabetes in humans.”

That doesn’t sound good at all. You can read the abstract for yourself here: Long-term ketogenic diet causes glucose intolerance…

2. The body is great at adapting, even negatively.

The reason that even an initially effective diet might end up being bad over the long-term is because the body is great at adapting to its situation. A ready example is water intake. If you are someone who does not drink a lot of water, and then suddenly ups the intake, you’ll find that you have to use the restroom much more frequently. If you wait 10 days or so, however, your body will adjust to the new intake level and you’ll be peeing on a normal schedule again. I have often wondered if the same could be true for diets.

I have observed that for the person I know who has done Atkins for years, weight has come back on over time, leaving them still feeling frustrated. Might it be that the body adapted to this new status quo and has found a way to keep the body fat regulated at an amount it feels comfortable with – similar to the water drinking scenario? I would wonder further, and would love to see a study, about whether the body might even learn that since fat is its main fuel source now it should store more of it?

3. If our bodies were meant to run in ketosis, it would probably be the default system already.

I don’t generally like to make any big claims about what the body is ‘supposed’ to do, but I would say that from what I have gathered, ketone bodies are really more of an emergency system than anything else. When carbs are unavailable, we don’t want our brains to stop, so ketones can be produced to keep us going. Running on emergency power 24/7 may not be what nature had in mind. Again, not that what nature had in mind is necessarily the best approach in current circumstances. I’m just saying it’s worth considering.

Conclusion -Don’t Forget That Low-Carb Is Not Necessarily Ketogenic, And, I Didn’t Say Ketogenic Is Bad

Don’t confuse low-carb automatically with ketosis. You have to get into ketosis. This is why the Atkins diet has an induction phase over several days in which carbs are extremely minimal. This is to force it to switch to ketone bodies, which only happens after an extended time with close to no carbohydrate intake. Low-carb diets, as popularly interpreted, usually just clean up your worst habits. They do not allow you to eat the worst offenders out there such as donuts and bagels, because they are automatically way to high carb to be worth it. That can be a very effective diet strategy.

Finally, I’m not saying ketogenic diets are bad. I can’t say that because I’ve got no evidence to back that up, as I mentioned. I can say we don’t know how these diets perform over the long-haul. Based a bit on what I can find, and a bit of what I have observed, my personal opinion is that you are better off to eat healthy, whole foods, avoid heavily processed products, and keep the things we all know we shouldn’t be eating very often to a minimum (I’m looking at you, ice-cream). This kind of wholistic approach, focused on keeping the big picture habits in order for 85-90% of the time is very likely the best approach out there. Going more extreme routes, such as ketosis, is a more complicated and uncharted approach and like most magic bullets, might be more flash than it is practical for your average exerciser.

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  1. Hi Andrew....( I pasted this in with paragraphs...hope it shows) I’m interested in your opinion on a NYT article with a dramatic title by 2 doctors citing evidence about low carb diets.....” Before You Spend $26,000 on Weight-Loss Surgery, Do This.” Sept 11. Also, re article---HOW SUGAR INDUSTRY SHIFTED BLAME TO FAT ... which you read. I was surprised at so many reader comments fiercely denouncing sugar as a health destroyer. Do you think they’re exaggerated? Here’s several example clips: Sugar can be as addictive as alcohol ... with the resultant epidemic of pathology you see everywhere....slow-motion sugar poisoning of people's bodies Sugar deserves a SURGEON GENERAL WARNING on all processed foods with large added sugar contents - soda, candy, juice, cookies, ice cream and all the other junk sugar food on the market... Excess SUGAR is bad for your body, may cause diabetes, obesity, immobility and will likely shorten your life and decrease your quality of life. re food labels.....the Recommended Daily Allowance for sugar is never listed. The RDA for all other ingredients is listed but not sugar. I cut out most of the added sugar in my diet in January and lost about 25 pounds within 3 months without dieting. I stopped drinking anything with sugar. I ate no sweets for the 3 months. I eat a dinner high in protein with roasted vegetables. I can also have a few drinks. The best part is I am never hungry. With the weight loss I was stop able to stop taking medication for my arthritic knees. I'm kicking myself for not doing this 10 years ago. • 265Recommend

    • Hi Meredith, Let me start by saying that I do think we have to realize that nutrition is not a simple either/or proposition. Things are rarely, if ever, all bad or all good. That being said, a quick summary of my opinion on sugar: 1: Sugar is everywhere and I think most people don't fully realize how much of it they are taking in. When it is hidden in things like bread, ketchup, muffins, etc. awareness is low and this leads to over-consumption. 2: More and more the evidence seems to be showing that it is sugar's effect on our blood chemistry which is playing a major role in a lot of health issues that have previously been blamed solely on fats. BUT 1: "Sugar" as a term is being used indiscriminately and demonized, which is a little misleading. Sugar is in lots of things we would not consider unhealthy, such as fruits. Also, everything we eat eventually ends up being broken down into "sugar" in the body. 2: The delivery system is at least equally important to consider. For example, plain yogurt with 15 grams of sugar would be preferable to a banana muffin with 11 grams. I plan to write a post soon about the fact that nutrition is really not an either/or proposition, but rather a balancing act. Keep an eye out and thanks for writing!

  2. Andrew, if there's any way to get your site to make paragraphs it would be much easier to read these posts! Who wants to plow thru all those lines? Could you check this, when you have time? Another blog I've posted to does keep the paragraph spaces, so it is possible, I guess. Thanks.

  3. Pingback: The 'Right' Diet Doesn't Exist - do the movement April 10, 2017

    […] Let’s start from the start. A lot of diets and nutrition strategies legitimize their approach by referencing the way our bodies are designed. The Paleo Diet says we evolved to eat the things that were available in Paleolithic times. Vegan diets claim that we have evolved to eat vegetables, which have always been more abundant and easier to gather. Other diets like Atkins or Southbeach claim that our bodies work better in a ketogenic state. […]

  4. While most of the emphasis in Atkins is on the diet, nutritional supplements and exercise are considered equally important elements. The Atkins Diet represents a radical departure from prevailing theories. Atkins claimed there are two main unrecognized factors about Western eating habits, arguing firstly that the main cause of obesity is eating refined carbohydrates, particularly sugar, flour, and high-fructose corn syrups; and secondly, that saturated fat is overrated as a nutritional problem, and that only trans fats from sources such as hydrogenated oils need to be avoided.