Food and Nutrition

Is the Ketogenic Diet Meant To Be a Long-Term Plan?

Photo: Stocksy/Laura Stofli
Three years ago, the ketogenic diet was on the tip of everyone’s tongue. Cafes started selling coffee spiked with butter. People swapped recipes for low-sugar cacao “fat bombs” and low-carb dinners. Brands capitalized on the popularity and everything from keto protein bars to brownies started taking over store shelves. It. Was. Everywhere. And still is, in many circles.

If you’re in need of a refresher, the ketogenic diet is a very low-carb, moderate protein, and high-fat eating plan. Registered dietitian Tracy Lockwood Beckerman, RD, previously shared with Well+Good that this way of eating is done to force the body to burn fat for energy instead of carbs (a metabolic state known as ketosis). This way of eating was actually invented in the 1920s as a way to help treat children with severe, drug-resistant epilepsy, but was later adapted to be used as a way to manage weight and improve hormone and energy levels in adults.

Watch the video below to learn more about the ketogenic diet:

Many experts in the wellness world are divided on the ketogenic diet; some are all for it and some aren’t. One big question that keeps popping up is, how long should you do keto?

Everyday Ketogenic Kitchen ($22) author Carolyn Ketchum and Read It Before You Eat It: Taking You From Label to Table ($16) author Bonnie Taub-Dix, RD, CDN, represent two sides of the keto debate. Ketchum is all for staying keto long-term. She herself has been committed to the eating plan for over four years and says sticking to it long-term is crucial for managing her diabetes. But registered dietitian Taub-Dix not only cautions against doing keto long-term, but she also doesn't think it's all that great to do for a short while, either. Here, both argue their cases, leaving you to be the judge.

How long should you do keto? Here's what experts think

What it means to truly follow the ketogenic diet

As mentioned, following the ketogenic diet means severely cutting back on carbs to focus more on protein and healthy fats. The recommended breakdown is for 70 to 80 percent of daily calories to come from fat, 10 to 20 percent from protein, and 5 to 10 percent from carbs.

As mentioned, the goal of this is to get the body into ketosis, which is when the body starts burning fat for energy instead of carbs. Taub-Dix says the amount of time it takes to reach ketosis varies from person to person. “Our digestive systems are each different, so the time it takes you to go into ketosis could vary from two days to one week,” she says.

How strict someone is adhering to the keto plan affects how long it takes for them to go into ketosis too. For example, some people gravitate to the eating plan as a way to reduce carbs, but not to the extent of cutting them to between the 5 to 10 percent of daily calories range. While this may be completely in line with someone’s individual health goals, they may not actually reach ketosis if their carb intake stays above the threshold.

But let’s say someone does reach ketosis. Then comes the question of how long they should stay in this fat-burning zone—and that’s where the debate gets heated.

The case for staying in ketosis long-term

Even though Ketchum has written a book on keto, keeps on top of the scientific research about it, and has been living the keto life for years, she stresses that she is not a medical expert. "I read a lot of studies, but I'm not the person doing the research," she says.

In her case, she says she uses keto to manage her diabetes."In my case, [since I have diabetes], I have a visual representation of why it works, which is my blood glucose meter," she says. She believes that without this eating plan, she would have to take insulin. (Research has shown that ketogenic eating may potentially benefit people with type 2 diabetes, although there is an increased risk of cardiovascular issues because of the fat intake.)

But even if you don't have diabetes, Ketchum says that many people have found success following keto long-term. "People use it for weight control, anxiety, and other neurological disorders, and also for sustained energy and to combat brain fog," she says. And even though the word "diet" has a temporary connotation, she believes it's absolutely sustainable—as long as you like the food. "The key is having recipes for dishes you love on hand," she says.

Even though Ketchum is an all-out keto advocate and, for her, there's no turning back, she does offer up one caveat: "Because the diet is newly popular, there haven't been any substantial long-term studies done," she says. "I would love for someone to do one, following people on keto for 20 years!" But as for herself, she hasn't seen any negatives to the diet, only positives.

The case for staying in ketosis short-term (if at all)

While Taub-Dix says the ketogenic diet can be an effective way to lose weight in the short term, it's not something she advises, let alone recommends, for a lifelong eating plan. "Carbs are not bad for you," she says of the food group demonized by devout keto followers. "They've really gotten a bad rap over the years, but it's more about choosing the right carbs."

Taub-Dix says whole grains, for example, are a great source of vitamin B and fiber, a nutrient that's even more important than you might realize. Another reason why she's pro-carbs: They make you happy. "Studies have shown that they boost serotonin levels," she says. "I know people who have started doing keto and have become really moody because they're missing out on that."

While the ketogenic diet has become popular for people with diabetes, Taub-Dix warns against it, saying it can lead to some serious health problems. "It can cause DKA, diabetic ketoacidosis," she says. "This happens when your body is producing a lot of ketones and can lead to vomiting, diarrhea, feeling faint, and being [excessively] thirsty." This is a dangerous, sometimes life-threatening condition that requires immediate medical attention. "Why take a risk of that happening?" Taub-Dix asks.

Another potential downside of the ketogenic diet is that such a low carb intake might disrupt the hormones of people with uteruses, affecting one's menstrual cycle and fertility. It also is an incredibly strict diet that might be difficult for people to follow.

Okay, so she's not into keto. What does she advocate instead? Good old-fashioned moderation. "It's boring and common sense, but eating a wide variety of foods and using portion control is really what works in the end," she says.

How to transition off keto—if you choose to do so

If you had a nice love affair with the ketogenic diet but think it’s time to end your relationship, it can take a bit of time for your body to readjust—especially if you stuck with the eating plan for a long time. “According to The Cleveland Clinic, transitioning off the keto diet should take a few weeks,” Taub-Dix says. “Fourteen days is pretty reasonable for your body to adjust to the change.”

While some people may be able to jump right back into the carb-filled way they ate before keto, Taub-Dix says for others, it may be best to transition off it in baby steps. Otherwise, it could cause some digestive problems. “Some people find it helpful to increase their carb intake each day by about 10 percent,” she says.

The main tip to keep in mind, Taub-Dix says, is avoiding going from super low-carb to eating large quantities of carbs in one setting; it’s better to spread your intake out over the course of the day. “Some people who consume lots of fiber from carbs—like whole-grain breads, cereals, and beans—especially when they’re not used to consuming these foods— may experience flatulence or bloat. But don’t let that be a turn-off — those symptoms will dissipate with increased use and the benefits of carb consumption certainly outweighs the temporary discomforts,” she says.

Here’s what you might not be used to when transitioning off keto: spikes in blood sugar, caused by consuming simple carbs. This can cause your energy and mood to go up and down, like a rollercoaster. “To prevent blood sugar spikes, try to combine carbs with protein or healthy fats,” Taub-Dix says. “A hefty spoon of crunchy almond butter schmeared on a slice of whole grain toast, for example, would cause those carbs to be absorbed more slowly than eating them alone.”

Even when transitioning off keto, many of the foods you’re used to eating—vegetables, nuts, meat, and eggs—can remain central to your diet. The difference is that you start working in other foods that are higher in carbs, but still rich in nutrient value. This can include: beans, legumes, fruit, whole grains, and starchy vegetables.

As with any eating plan, deciding how long to stick with the ketogenic diet comes down to how what you're eating makes you feel. When finding the best diet for you—and whether that includes a plate full of eggs, avocado, and a side of bone broth (or not)—you are your greatest advocate.

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