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Is the Ketogenic Diet and Intermittent Fasting Safe for Long-term Use? 7 Myths about Fasting and the Ketogenic Diet

It’s a question that comes up time and again, and one that I had myself before I started exploring the Keto diet and its trusty companion, Intermittent Fasting. But isn’t the Keto diet hard on your kidneys and gall bladder? Can’t that much dietary fat cause heart disease? Won’t you lose muscle mass and slow your metabolism down? These questions and more were on my mind when I had heard of others using Keto to lose weight or – ahem, get healthier (which at the time, sounded like a euphemism for “lose weight” to my ears).

But since then, I’ve learned more about the research into heart healthy diets and obesity (and diabetes type 2) treatment. I’ve come to understand that so much is wrong about what we’ve been taught about how our bodies respond to the low-calorie, low-fat diets that are pushed by traditional medicine, and that our bodies really do well on high-fat low-carb diets that feed our bodies adequate calories to grow and thrive.


Here is what I’ve learned about the common misunderstandings about the Keto diet:

  1. Isn’t the Keto diet unbalanced (ie: unhealthy)? A Keto diet can be done safely or unsafely. Just like any other diet, be it vegetarianism, paleo, carnivore, Mediterranean – what have you. You can do it in an unbalanced, junk-foody way, or you can do it in a balanced, whole foods (unprocessed) way. Ultimately it comes down to being conscious and intentional to support your long-term health and well-being.

2. Isn’t it hard on your kidneys? With this question, there may be some confusion between ketosis and ketoacidosis. Ketosis is a nutritional state that releases stored body fat for fuel when blood sugar (and insulin) is low. Ketoacidosis is a life-threatening condition that can happen to people with Type 1 Diabetes when insulin is not being produced normally, causing dehydration and electrolyte imbalance, and can – rarely – lead to kidney failure. Ketoacidosis is not a concern for people managing their blood sugars and insulin levels with diet.

That said, it is very important to stay well hydrated and manage your electrolyte balance. Carbohydrates have a property that make your cells retain fluids. When you start to eat low-carb, your body will naturally release excess stored fluid (leaving you feeling less bloated, puffy and usually see a nice initial drop on the scale). Being in ketosis can result in extra sodium being excreted in your urine, and this can lead to an electrolyte imbalance if you’re not mindful of adding more salt to your food, or even taking an electrolyte supplement if you’re going to start doing longer fasts.

3. Won’t eating that much fat cause gallstones? Actually, gallstones are PREVENTED by eating a high-fat diet, as it enables your body to actually use the bile it produces rather than sitting unused in the gallbladder as it would on a low-fat diet. Even those who have had their gallbladders removed or have history of gallstones can still do well on the keto diet if they pace themselves well. While they may initially experience some gallstone pain, over time high fat diets appear to prevent gallstone formation!

3. OK, what about the adrenal glands? I’ve heard it’s hard on the adrenals to be so low-carb. This is the one factor that COULD be a problem for some people. Those with Hashimoto’s need to pay attention to this as many of us have some degree of adrenal fatigue that goes along with a long-term under-functioning thyroid gland. Going very low-carb can cause additional stress on the body. In a healthy person, the adrenal glands can handle this, producing additional adrenaline and cortisol to manage it. However in those with some degree of adrenal fatigue, these glands may not be up to the challenge of the extra demand on them. This is all the more reason to go slowly into this. Heal first by feeding your body what it needs (ample calories, ample fat, lowER carbs, and adequate protein). Don’t over-exercise. Rest/sleep more. Reduce mental and emotional stress. Drink LOTS of water. Don’t jump too quickly into long fasts. Get the support of a doctor or nutritional coach with expertise in Keto, fasting, and adrenal fatigue.

5. But doesn’t your body need carbs for energy? Your brain can only use glucose! So, here’s how I have heard it said: There are essential fats (omega-3, omega-6, for example), and there are essential amino acids (aka: building blocks of protein). What makes them “essential” is that your body cannot manufacture them, they must be consumed via diet. But there are NO essential carbohydrates. Carbohydrates supply energy to the body in the form of glucose (blood sugar). Even complex carbs, eventually, are broken down into glucose. But glucose is not ESSENTIAL. Reason being, your body can in fact create glucose through a process call gluconeogenesis. AND, when glucose is low, the body can then start to tap into energy reserves in the form of body fat. This is the process of ketosis, where the body turns fat into a form it can use for energy. And studies show that the brain in fact LOVES ketones. Many people experience an enhancement in cognitive functions through ketogenic eating.

One caveat to point #4: While carbs / glucose is not essential, minerals and vitamins ARE. Our primary source of minerals and vitamins is vegetables (and fruit), and these food sources are in fact carbohydrates. So what does one do if they want to have a healthy supply of vitamins and minerals (aka: MICROnutrients) while remaining in ketosis? Focus on consuming NON-starchy veggies (basically all those veggies that grow above ground) and minimal fruit (particularly berries, which are the lowest-carb fruit).

6. Won’t eating that much fat cause high cholesterol and heart disease? Ok, this one is a much longer discussion and if you want to learn more about why this is NOT a risk, please read The Obesity Code or watch Fat Fiction, where they review the decades of research that proves that the idea that dietary fat (particularly saturated fat) does NOT cause heart disease or obesity. Short story: The high-fat keto diet has been shown to diminish inflammation, which is the key factor in developing cardiovascular disease (not to mention Autoimmune Disease).

7. Won’t you lose muscle mass when you don’t eat carbs? Won’t your body go into starvation mode? People worry that their bodies will burn muscle if they don’t eat enough calories / carbs. Ketosis and fasting are actually proven to help generate HGH (Human Growth Hormone) and studies show that people BUILD muscle on these dietary approaches. This is important for those with Hashimoto’s who have difficulty gaining muscle.

Also on that note, this really struck me when I read it in The Obesity Code: When we were cavepeople, we would naturally go through long periods when food was not abundant and we were forced to fast. If the body’s reaction to fasting / no sugar being consumed was to start feeding off its muscle supply, we would not exist as a species today. We would have become weaker and weaker, and eventually lacked the strength and stamina required to continue to hunt and forage for food. We survived because the body is designed to spare muscle tissue over and above body fat.


So there you have it!  My understanding of this WOE (way of eating) is that it is VERY health supportive and can be for the long-term, if done carefully, mindfully and in a balanced way. The traditional medical system and our governments have fed us misinformation (ahem) by promoting the low-fat, low-cal approach to obesity management, and all we’ve seen over the past 4 decades the result is a consistent climb in obesity, diabetes and cardiovascular disease. Stay Strong and Keto On!


The Obesity Code by Dr Jason Fung

Fat Fiction (documentary on Amazon Prime)

Diet Doctor website

7 Myths about the Ketogenic Diet

Long Term Effects of Keto Diet

Keto Diet Safety

Keto Without a Gallbladder


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