Is Keto Healthy Long Term?

If you’re doing Keto for weight loss or maintenance, you’ve probably looked to the future. Is Keto sustainable long term?

It’s a reasonable question. The goal, after all, is to find a permanent eating pattern that keeps you healthy and strong for many years to come. 

Today we’ll answer questions about eating Keto long-term—questions on cholesterol, gut health, nutrient deficiencies, weight rebound, and more. First, though, let’s review some brief Keto context. 

The Keto Diet and Its Benefits

On a Keto diet, you consume primarily fat and protein while minimizing carbohydrates. Managing your macros in this way promotes the fat-burning state called ketosis. 

Being in ketosis has many potential benefits. Weight loss is among them. 

To be clear, eating fat isn’t a magical weight loss strategy. If you’re always stuffing walnuts into your mouth, you may begin to resemble a squirrel before winter. 

But folks on Keto usually eat less because ketosis suppresses hunger hormones.[*] And when you eat less, weight loss soon follows. 

Beyond weight loss, ketosis can also help:

• Stabilize energy levels
• Improve mental acuity
• Reduce blood sugar and insulin levels[*]
• Lower inflammation
• Enhance endurance

But are these benefits sustainable? Can you do Keto long-term?

Is Keto Healthy Long-Term?

We don’t have decade-long studies on people doing Keto. This research would cost millions, and nobody is busting out their checkbooks. 

But we do know our ancestors were no strangers to ketosis. After all, carbs were often scarce in Paleolithic times. 

So yes, ketosis is a natural, evolutionary state. That doesn’t prove it’s sustainable, per se, but it’s comforting.  

We can also look to the Inuit, a population that thrived for centuries on very low-carb diets of seal and whale.[*] These arctic inhabitants were Keto before Keto was popular. 

But let’s not rely on epidemiology. To determine if long-term Keto works for you, keep the focus on yourself. 

Are you losing fat? How’s your energy, mood, sleep, and exercise performance? Does your bloodwork look okay? 

If your current health metrics are improving, your long-term health will notice. They’re directly correlated. 

Long-Term Keto FAQ

Let’s get practical and cover long-term Keto questions, FAQ-style. 

Should you stay on Keto for weight maintenance after hitting your target weight?

It’s not a bad idea. Keto helps with weight loss and weight maintenance. 

In one study, low-carb dieters burned more calories and had lower hunger hormones than high-carb dieters on a weight-maintenance diet.[*] 

This doesn’t mean stopping Keto guarantees weight regain. But it’s probably easier to keep the pounds off on a low-carb template.  

Is Keto beneficial for managing long-term health conditions? 

It depends on the condition. For instance, multiple studies suggest that a Keto diet helps people with type 2 diabetes manage their blood sugar and lose weight.[*][*] 

Keto is also a well-established epilepsy therapy. We’ve known this since the 1920s.[*] 

Keto may also help with:

• Alzheimer’s disease and dementia[*]
• Certain cancers[*]
• Chronic inflammatory conditions like IBD and rheumatoid arthritis[*]

Standard disclaimer alert: this is not medical advice. Consult a medical professional for that. 

Are nutrient deficiencies a concern?

They can be. For example, you’ll have trouble maintaining muscle mass if you under-consume protein. (We recommend a high-protein Keto diet of 30% protein calories or more.)

And if you eat a “dirty Keto” diet devoid of vegetables, you won’t get all your micronutrients. Eating spinach, kale, broccoli, and other low-carb veggies mitigates that concern. 

Will all that fat affect my heart health?

In obese and diabetic populations, Keto generally improves heart health.[*][*][*] A subset of lean people, however, see spikes in LDL cholesterol after cutting carbs.[*][*] (Higher LDL translates to higher heart disease risk. [*])

It is unclear if higher LDL translates to higher mortality in all populations. In the Framingham Heart Study, researchers found that high HDL (good cholesterol) was cardio-protective against stroke and heart attack risk, regardless of LDL level. Triglyceride levels and HDL may in fact be more predictive of cardiac risk than LDL [*]. Transient increases in LDL cholesterol are common in fat loss, yet these numbers tend to trend back toward normal once the body reaches a new (lower) weight set point. Ongoing research may shed more light on this topic in the coming years.

If your cholesterol rises on Keto, try shifting to monounsaturated fats (olive oil, avocados, nuts) and see if it returns to normal levels.

Should I be worried about kidney or liver health?

You should diligently monitor these organ systems, but there’s no reason for special concern on Keto. Consider the following:

• A Keto diet may improve markers of liver health in patients with non-alcoholic fatty liver disease[*]
• Research suggests that Keto can reverse diabetic kidney disease[*]
• Keto might help reduce high blood sugar and high blood pressure[*][*]—both risk factors for chronic kidney disease. 

These findings wouldn’t exist if carb restriction harmed the liver or kidneys. 

Is lack of fiber a concern for gut health?

Possibly. Keto restricts many foods—yams, apples, carrots, etc.—high in soluble fiber. And soluble fiber helps gut bugs produce the anti-inflammatory compound, butyrate.[*] 

There are workarounds, though. Eating low-carb veggies can fulfill most of your fiber needs.

Also, only some benefit from high-fiber intakes. If you have gut issues, limiting fiber (especially soluble fiber) may help starve bad bacteria and reset your digestive system. 

Who should do Keto temporarily?

You might make Keto temporary (or stop entirely) if:

• You feel low energy, tired, or irritable
• You miss certain foods terribly and tear up when you smell freshly baked bread
• You notice your cholesterol rising
• You’re pregnant or nursing
• You need to gain weight or add muscle
• Your “Keto for Life” t-shirt is fading after too many washes

You don’t need to do Keto for life. You have other options. 

What eating patterns might work if Keto doesn’t?

If Keto isn’t working for you, consider these approaches. (Click links for deep dives.) 

• The Paleo diet
• The Mediterranean diet (or a Mediterranean Keto diet)
• A moderate-carb diet
• Whole30
• Intuitive eating

The fundamentals of healthy eating are simple. Eat whole foods, don’t overeat, and avoid processed Frankenfoods, especially refined sugar. That’s at least 80% of the battle. 

How To Make Your Keto Diet Sustainable

To succeed with Keto over time, you need to address both mind and body. You need a holistic approach.

Maybe Keto feels easy and natural for you. If so, that’s fantastic. 

But if not, don’t despair. There may be a simple fix.

For instance:

• Increasing electrolyte intake can fix headaches, cramps, and other “Keto flu” symptoms.[*] Are these Keto diet side effects long-term? Often, no.  
• Getting adequate protein can help with stubborn weight loss[*] 
• Consuming non-starchy vegetables keeps you regular and prevents nutrient deficiencies.

These are some physical approaches. Don’t forget your social and emotional life. 

Hopefully, your friends and family are encouraging. But if they aren’t, you’ll always have the community, technology, and support of Carb Manager. 

Keep at it until you find a diet that’s sustainable for you. We’ll be here to help.