What are the advantages/risks of the keto diet craze?

I’ve lost over 200 pounds on keto, and I did it about 9 years ago before it became a fad, so I can say without a doubt it works and the weight stays off effortlessly if you keep your carbs low.

The advantages of keto are, in a very broad and quick sense:

1. More energy as ketones don’t spike insulin the way glucose does. The constant spike of blood sugar resulting in an insulin spike drives energy boosts and crashes. This process also leads to weight gain, and potentially to type 2 diabetes. In addition, constantly circulating insulin causes systemic inflammation, which puts you at a greater risk for cancer, diabetes, heart disease, gout, PCOS, etc, etc. Keto stops this runaway train by stopping the insulinogenic processes that cause all of it.
2. Ketones suppress ghrelin, the hunger hormone. This makes it easier to simply eat less.
3. Ketones seem to have a neuroprotective quality that interacts favorably with epilepsy, Parkinsons, and other neurological disorders.
4. Once you’ve become fat adapted - that is, the metabolic shift that allows your body to use fat as easily as it uses glucose for fuel - you will get into ketosis faster and easier in the future. This also allows easier mobilization of stored fat for energy which will cause weight loss.
5. Ketosis lowers blood pressure, helps improves fasted blood sugar and can eventually lower A1C, triglycerides, and a host of other blood markers for inflammation and metabolic distress.
6. Keto helps reverse non-alcoholic fatty liver disease by giving the liver a break from processing sugar (particularly fructose) which leads to fat deposits in the liver in the first place. In fact, there are a lot of metabolic diseases that ketosis helps with, including evidence that ketones help with autoimmune diseases like rheumatoid arthritis, among others. (Note that the article linked above suggests ketosis and lower carb, lower processed food diets should be beneficial in absence of highly processed western diets.)

Disadvantages to keto are:

1. It’s pretty strict. Even though there are a lot of companies now pouring research into keto-friendly processed foods, one of the main reasons you want to do keto is to avoid processed foods.
   
   With that said, however, you can eat a wide variety of vegetables, just not starchy ones like corn, potatoes, sweet potatoes, or beets. You can eat low sugar fruits like the various berries and avocado (which is, itself, a berry so there’s your fun fact for the day).
   
   Keto is restrictive in the sense that you can’t eat the highly processed, unhealthy foods that have been normalized to us our entire lives. That will feel weird at first, but you’ll get used to it and once you realize how good you feel on keto versus a western diet, you won’t want to go back.
2. You’re going to get a million people who are basing their nutritional beliefs off 50 year old bad science (research Ansel Keys if you’re bored and want to know how badly our food science is in the US). Our food pyramid and government suggestions for good nutrition are based on agricultural lobbying, nothing else. Even with emerging, hard data that saturated fat in its natural forms (butter, bacon grease, coconut oil) is healthy for you, many governments (UK and US primarily) refuse to budge on recommendations that you should eat highly processed fats instead.
3. You’ll get a lot of other people telling you that “all that protein” will kill your kidneys. Firstly, keto is high fat, moderate protein, low carb, so you won’t really be eating too much more protein, but secondly unless you have kidney problems, they’ll process more protein no problem.
4. You’ll also have people telling you that you “need” carbs, but that’s nonsense. Our bodies are designed to work optimally on the long-burning fuel of fat, and get quick bursts of energy from carbs. 10,000 years ago we didn’t have Costcos to get Twinkies at 2 in the morning. We had to rely on hunting big game, foraging for roots and some vegetables, and very rarely did we find a bee hive or some berries to give us a quick rush of tasty sugar. Beyond that, your body has essential amino acids and essential fatty acids it needs to live, but there’s not one essential carb.
5. Keto takes a few days to a few weeks to adapt to. In that time period you might experience some “side effects”, such as:

• Headache
• Fatigue
• Irritability
• Stomach issues
• Other weird things like being overly hot or cold, difficulty sleeping, muscle cramps, etc.

The good news is that these things can be mitigated almost entirely by ensuring that you’re getting enough electrolytes. You want about 3500–5000mg of sodium per day, 400 mg of magnesium, and 3500–4200 mg of potassium.

You can get sodium from salting your food, and you can supplement about 200 mg of magnesium a day in pill form (after that you kind of just pee it out), but potassium and roughly half your magnesium really should come from foods, like pumpkin seeds, salmon, spinach, avocado, cocoa powder (no sugar added), kale, walnuts, almonds, broccoli, sardines, etc.

Keto makes you pee a lot, because when you stop eating sugar, your body stops converting glucose into glycogen. When you’ve used up all your stored glycogen, you pee out all the water that it was stored in. This is a reason people lose so much weight in the first 2 weeks of keto. Half might be fat, but you’re going to pee a lot. You need to replace those electrolytes or you’ll feel like garbage.

Basically, the biggest “disadvantages” of keto are getting over the fact that western foods are generally not healthy even though they’re delicious, and people telling you you’re going to get sick, get ketoacidosis (which really only happens to type 1 diabetics), or people judging you.

Keto is a great way to suppress your appetite and lose weight, dramatically lower systemic inflammation, and cut your risk of various metabolic diseases by a wide margin. Keto took me from 450 pounds to 250 pounds in about 13 months, also taking my total cholesterol from 312 to normal ranges in the same time. It helps calm my soul-crushing anxiety, helps me think more clearly, and lets me fast for long periods of time (and fasting has its own merits, too).

Anyway, this was way longer than I wanted it to be, but you should be able to skim and get the information you wanted. I highly recommend keto, even if you’re not overweight, because of the health benefits of dramatically reducing your processed food and carb intake overall.