Is the keto diet safe for everyone? Probably not.

Just because the keto diet is an effective weight-loss tool doesn't mean everyone should try it.

  • The keto diet might be a fad diet, but it's unique in that involves putting the body into an alternate and natural metabolic state.
  • However, the diet likely isn't safe for everyone, particularly when it's implemented poorly.
  • Children, pregnant women, breastfeeding women and those at risk for heart disease should understand the risks of the keto diet before experimenting with it.

People experiment with all kinds of crazy, unhealthy diets to lose weight: eating cotton balls soaked in orange juice, intentionally ingesting tapeworms, and surviving on only grapefruit, to name a few. Some would add the keto diet to that list. As it's gained popularity in recent years, many have questioned whether the diet really is the hyper-effective weight-loss tool its supporters claim it to be, or simply another fad diet that could lead to serious health complications.

Unlike other fad diets, the high-fat, low-carb keto diet involves putting the body into a natural metabolic state called ketosis, in which the body burns fat for fuel instead of glucose. Although this metabolic state is a generally safe way to help you lose weight, it can be very difficult to maintain. For example, eating just one carb-heavy meal can kick you out of ketosis, forcing you to restart the process. It can also lead to health complications when done improperly, or when people with certain health conditions attempt the diet.

In short, it's not for everybody. So, who exactly shouldn't try it?

Pregnant women

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Dieting of any kind isn't recommended for pregnant women, who are advised to eat about an extra 300 calories per day while expecting, according to the American Pregnancy Association. The keto diet doesn't seem to be an exception: Multiple studies on rodents have linked maternal ketosis to fetal abnormalities.

One reason the keto diet is potentially unsafe for pregnant mothers is that it can result in fewer and less diverse nutrients. Fats, after all, don't pack as many nutrients as many other proteins and carbs.

"Nourishing your baby is the most important thing when you are pregnant," Charles Seltzer, a nutritionist based in Philadelphia, told INSIDER. "Ketogenic diets steer you away from really nutrient dense foods like fruit, which are packed with vitamins and minerals. These are crucial for the development of a baby."

What's more, subjecting newborns to a limited diet could lead to serious changes in their developing bodies.

"If you're restricting carbs while pregnant (like you would be on the keto diet), this restriction tells your baby's developing body that carbs are not a readily available food source," wrote registered dietician Laura Schoenfeld on her website. "So their body learns that foods high in this macronutrient won't be as available when they're born.

This can theoretically lead to conditions like obesity, metabolic syndrome, and insulin deficiency in the child if they end up eating a diet that has a much higher quantity of carbs than a ketogenic diet.

Unless you keep your child on a ketogenic diet for their entire lives, you may be setting your kid up for future metabolic inflexibility."

Ultimately, there's no solid research proving the keto diet is good or bad for pregnant women, but given the potential risks involved it's almost surely not worth experimenting with.

Breastfeeding women

Generally, medical professionals recommend that breastfeeding women avoid strict low-carb diets. One reason is because sudden weight loss can slow down — or, in some cases, stop — milk production.

"You need more carbohydrates and sugar to produce milk than most keto plans allow in the weight-loss phase," Amber Edwards, a board-certified lactation consultant, told Romper.

Elizabeth Ward, a dietician and author of "Expect The Best: Your Guide to Healthy Eating Before, During, and After Pregnancy", advised against the keto diet for pregnant women.

"I can't endorse such an extreme eating plan for breastfeeding women," said told Parents.com, noting that the diet tends to limit fruit and healthy grains. "Inadequate intake of starchy foods, such as whole grains, potatoes, and beans, is bad news for gut health because beneficial bacteria feed on the fiber in those foods."

Still, women who want to cut carbs are probably fine sticking to the maintenance phase of the diet, which calls for eating relatively more carbs than earlier phases. Of course, it's always best to check in with your doctor before making big changes to your diet – especially if pregnant or breastfeeding.

"... in the maintenance phase, you're allowed significantly more carbs and fruit, which means that you can continue to produce an adequate supply of milk," Edwards told Romper.

​Children

It's probably not a good idea for kids to go on the keto diet unless they're extremely obese or suffer from epilepsy (low-carb diets, by the way, are known to help reduce seizures in epileptics). The main reason is that the dietary needs of kids are different than those of adults.

"Many sources of carbohydrates like whole grains, fruits and dairy have essential vitamins and minerals for growing kids," wrote Jessica McGee, the Food and Nutrition Services Clinical Nutrition Manager at Children's National Health System. "Even adolescents require higher amounts of certain nutrients and should continue to eat a well-rounded diet with a variety of foods into adulthood."

"Feel free to limit (or eat in moderation) carbohydrates like candy, baked goods and sugar-sweetened beverages as these have little nutritional value and can have a detrimental impact on health. Incorporating a balance of healthy carbohydrates, fats and lean protein sources in your kids' diets is encouraged."

People at risk for heart disease

The keto diet has been called both potentially helpful and harmful in terms of cardiovascular health. For instance, a 2013 review found that low-carb diets were associated with higher rates of cardiovascular disease and mortality rates. However, not all of these diets were necessarily ketogenic, and it's possible that these risks arise when people on low-carb diets turn to unhealthy foods.

However, other research suggests a well-implemented keto diet improves cardiovascular health in all measures except low-density lipoprotein cholesterol – the "bad" cholesterol – which the diet seems to increase.

But when it comes to cardiovascular health, perhaps the biggest risk of the keto diet is "yo-yo dieting" – or, losing a bunch of weight and gaining it back over a short timeframe. This stresses your heart and can increase the risk of heart attack, stroke and death.

"People go on keto and in the short term lose a lot of weight, but it's not sustainable," Suzanne Steinbaum, the director of women's heart health prevention and wellness at Mount Sinai Hospital in New York City, told Everyday Health. "So when they go off it, they gain the weight back — and maybe even more."

"Ultimately what you're doing [with yo-yo dieting] is setting yourself up for developing metabolic syndrome."

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Why Epicurean ideas suit the challenges of modern secular life

Sure, Epicureans focused on seeking pleasure – but they also did so much more.

Antonio Masiello/Getty Images
Culture & Religion

'The pursuit of Happiness' is a famous phrase in a famous document, the United States Declaration of Independence (1776). But few know that its author was inspired by an ancient Greek philosopher, Epicurus. Thomas Jefferson considered himself an Epicurean. He probably found the phrase in John Locke, who, like Thomas Hobbes, David Hume and Adam Smith, had also been influenced by Epicurus.

Nowadays, educated English-speaking urbanites might call you an epicure if you complain to a waiter about over-salted soup, and stoical if you don't. In the popular mind, an epicure fine-tunes pleasure, consuming beautifully, while a stoic lives a life of virtue, pleasure sublimated for good. But this doesn't do justice to Epicurus, who came closest of all the ancient philosophers to understanding the challenges of modern secular life.

Epicureanism competed with Stoicism to dominate Greek and Roman culture. Born in 341 BCE, only six years after Plato's death, Epicurus came of age at a good time to achieve influence. He was 18 when Alexander the Great died at the tail end of classical Greece – identified through its collection of independent city-states – and the emergence of the dynastic rule that spread across the Persian Empire. Zeno, who founded Stoicism in Cyprus and later taught it in Athens, lived during the same period. Later, the Roman Stoic Seneca both critiqued Epicurus and quoted him favourably.

Today, these two great contesting philosophies of ancient times have been reduced to attitudes about comfort and pleasure – will you send back the soup or not? That very misunderstanding tells me that Epicurean ideas won, hands down, though bowdlerised, without the full logic of the philosophy. Epicureans were concerned with how people felt. The Stoics focused on a hierarchy of value. If the Stoics had won, stoical would now mean noble and an epicure would be trivial.

Epicureans did focus on seeking pleasure – but they did so much more. They talked as much about reducing pain – and even more about being rational. They were interested in intelligent living, an idea that has evolved in our day to mean knowledgeable consumption. But equating knowing what will make you happiest with knowing the best wine means Epicurus is misunderstood.

The rationality he wedded to democracy relied on science. We now know Epicurus mainly through a poem, De rerum natura, or 'On the Nature of Things', a 7,400 line exposition by the Roman philosopher Lucretius, who lived c250 years after Epicurus. The poem was circulated only among a small number of people of letters until it was said to be rediscovered in the 15th century, when it radically challenged Christianity.

Its principles read as astonishingly modern, down to the physics. In six books, Lucretius states that everything is made of invisible particles, space and time are infinite, nature is an endless experiment, human society began as a battle to survive, there is no afterlife, religions are cruel delusions, and the universe has no clear purpose. The world is material – with a smidgen of free will. How should we live? Rationally, by dropping illusion. False ideas largely make us unhappy. If we minimise the pain they cause, we maximise our pleasure.

Secular moderns are so Epicurean that we might not hear this thunderclap. He didn't stress perfectionism or fine discriminations in pleasure – sending back the soup. He understood what the Buddhists call samsara, the suffering of endless craving. Pleasures are poisoned when we require that they do not end. So, for example, it is natural to enjoy sex, but sex will make you unhappy if you hope to possess your lover for all time.

Epicurus also seems uncannily modern in his attitude to parenting. Children are likely to bring at least as much pain as pleasure, he noted, so you might want to skip it. Modern couples who choose to be 'child-free' fit within the largely Epicurean culture we have today. Does it make sense to tell people to pursue their happiness and then expect them to take on decades of responsibility for other humans? Well, maybe, if you seek meaning. Our idea of meaning is something like the virtue embraced by the Stoics, who claimed it would bring you happiness.

Both the Stoics and the Epicureans understood that some good things are better than others. Thus you necessarily run into choices, and the need to forgo one good to protect or gain another. When you make those choices wisely, you'll be happier. But the Stoics think you'll be acting in line with a grand plan by a just grand designer, and the Epicureans don't.

As secular moderns, we pursue short-term happiness and achieve deeper pleasure in work well done. We seek the esteem of peers. It all makes sense in the light of science, which has documented that happiness for most of us arises from social ties – not the perfect rose garden or a closet of haute couture. Epicurus would not only appreciate the science, but was a big fan of friendship.

The Stoics and Epicureans diverge when it comes to politics. Epicurus thought politics brought only frustration. The Stoics believed that you should engage in politics as virtuously as you can. Here in the US where I live, half the country refrains from voting in non-presidential years, which seems Epicurean at heart.

Yet Epicurus was a democrat. In a garden on the outskirts of Athens, he set up a school scandalously open to women and slaves – a practice that his contemporaries saw as proof of his depravity. When Jefferson advocated education for American slaves, he might have had Epicurus in mind.

I imagine Epicurus would see far more consumption than necessary in my own American life and too little self-discipline. Above all, he wanted us to take responsibility for our choices. Here he is in his Letter to Menoeceus:

For it is not drinking bouts and continuous partying and enjoying boys and women, or consuming fish and the other dainties of an extravagant table, which produce the pleasant life, but sober calculation which searches out the reasons for every choice and avoidance and drives out the opinions which are the source of the greatest turmoil for men's souls.

Do you see the 'pursuit of happiness' as a tough research project and kick yourself when you're glum? You're Epicurean. We think of the Stoics as tougher, but they provided the comfort of faith. Accept your fate, they said. Epicurus said: It's a mess. Be smarter than the rest of them. How modern can you get?Aeon counter – do not remove

This article was originally published at Aeon and has been republished under Creative Commons. Read the original article.


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