The Keto diet has long been a leading wellness trend, with loads of people ditching carbs for fats. The paradox of savouring fried cheese or salmon actually slimming your waist quadruples the excitement. However, a recent study published in the journal Science Advances warns that following a keto diet for long periods of time can cause hyperlipidemia, liver dysfunction, and glucose intolerance.
The shocking revelation is based on experiments on mice that were fed a ketogenic diet —high in fat and low in carbohydrates —for extended periods. The rodents developed these medical conditions due to impaired insulin secretion. Intrigued by this revelation, we reached out to a few medical experts to fully understand the impact of following long-term keto diets in humans.
Q1. What happens to key organs such as the liver and pancreas when someone follows a keto diet long-term?
“A ketogenic (keto) diet, being high in fats and very low in carbohydrates, puts additional stress on organs like the liver and pancreas,” says Dr Bhushan Bhole, Senior Consultant GI Surgery and Liver Transplantation, PSRI Hospital.
He explains that the liver is responsible for converting fats into ketones for energy, and thus, prolonged keto intake can increase “fat accumulation” in the liver, potentially leading to “fatty liver or elevated liver enzymes” in some individuals.
Similarly, the pancreas, which helps regulate blood sugar and produce digestive enzymes, may also undergo changes due to reduced carbohydrate load. “While insulin demand drops, chronic high-fat intake may lead to insulin resistance over time if not balanced properly,” he cautions.
Q2. What is the impact of a long-term keto diet on cardiovascular health?
The effects of prolonged keto diets on cardiovascular health can be mixed, according to Dr CM Nagesh, Honorary Secretary of the Indian College of Cardiology and Founder of Cardea Super Speciality Hospital. Since keto is typically high in saturated fats and very low in carbohydrates, it can “elevate LDL cholesterol in some individuals”, which is a risk factor for heart disease. “However, others may experience an improvement in HDL cholesterol and triglyceride levels,” he further highlights the paradox.
Dr Nagesh explains that the key concern with long-term keto is sustainability and balance. When carbohydrates are severely restricted for prolonged periods, it can limit intake of fibre, fruits, and certain micronutrients that protect heart health. “Over time, this nutritional imbalance and increased intake of saturated fats may strain the cardiovascular system,” he warns.
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Q3. How does prolonged low-carb, high-fat intake affect glucose metabolism and insulin response?
“When carbohydrates are drastically reduced, the body adapts by using fat as the main source of energy, leading to lower insulin secretion,” Dr Bhole points out, adding that this initially helps in better blood sugar control, especially in diabetics.
However, he warns that prolonged carbohydrate restriction can blunt the body’s natural glucose tolerance. “When carbs are reintroduced suddenly, the body may not respond efficiently, leading to blood sugar fluctuations.” He further cautions that long-term high-fat intake, especially from saturated fats, may reduce insulin sensitivity and affect overall metabolic flexibility.
In a recent experiment, mice that were feda keto diet for long periods of time developed hyperlipidemia, liver dysfunction, and glucose intolerance
Q4. Is there a way to follow keto safely for a prolonged period without these risks?
Dr Bhole affirms that one can continue keto safely for prolonged periods but only if there is proper medical supervision and a well-balanced approach. “A safer version of the keto diet includes healthy fats such as olive oil, nuts, seeds, and avocados, while avoiding processed meats and saturated fats.” He also recommends periodic reintroduction of complex carbohydrates and fibre-rich foods to maintain gut health and metabolic balance. “Regular monitoring of liver function, lipid profile, and kidney health is essential for anyone following keto for more than a few months,” he finally adds.
Q5. Are the health effects of long-term keto reversible if someone stops or modifies the diet?
Dr Bhole assures that in most cases the effects can be reversible. “Once the diet is modified to include balanced macronutrients, the liver and pancreas gradually return to normal function, provided no severe damage has occurred,” he explains.
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According to him, restoring moderate carbohydrate intake, hydration, and fibre helps the body regain metabolic flexibility. “However, reversing long-term effects like fatty liver or cholesterol imbalance may take time and require lifestyle changes, including regular exercise and a balanced diet plan,” he concludes.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine