Can You Eat Keto Long-Term? 7 Key Takeaways

The safety and sustainability of a long-term ketogenic diet is a hot topic with conflicting opinions. This article from Metabolic Mind explores the evidence behind staying in ketosis for extended periods. You can also check out my video on this topic for more information. Here are the key takeaways:

1. Keto Can Be Safe & Effective for Long-Term Use

For individuals who experience mental health improvements or remission of conditions like Type 2 diabetes through ketogenic therapy, there is no clear evidence that long-term ketosis is harmful. In fact, many studies and case reports suggest sustained benefits without major risks.

2. The Burden of Proof Shouldn’t Be One-Sided

Conventional medications for psychiatric and metabolic conditions often come with serious side effects but are still considered safe for long-term use because their perceived benefits outweigh the risks. Many of these medications are approved based on short-term studies lasting only weeks or months, yet they remain the standard of care. In contrast, ketogenic therapy, which can achieve similar or even better outcomes—often without these side effects—is frequently met with skepticism. This raises an important question: Why should keto be held to a higher burden of proof than many commonly accepted treatments?

3. Misinterpretations of Science Fuel Keto Skepticism

Some studies incorrectly define low-carb diets as consuming 25–40% of calories from carbohydrates, which is not ketogenic. Because these studies don’t distinguish between moderate carb, low-carb and true keto, the health risks they attribute to low-carb diets—such as heart disease or increased mortality—don’t accurately apply to properly formulated ketogenic diets.

4.  Hunter-Gatherer Populations Lived in Cyclical Ketosis

Although some argue that no historical populations lived in continuous ketosis, many hunter-gatherer societies experienced natural fluctuations between ketosis and glucose-based metabolism due to food availability. This suggests that our bodies are well-adapted to long-term ketone metabolism.

5. No Evidence That Keto Causes Nutrient Deficiencies

Critics claim that keto leads to nutrient deficiencies, but a well-formulated ketogenic diet includes plenty of nutrient-dense foods like meat, fish, dairy, nuts, and low-carb vegetables. Many commonly cited deficiencies—such as thiamin, folate, calcium, and potassium—are easily met within a ketogenic diet.

6. Heart Disease & Keto: No Proven Risk Increase

While some worry that keto raises LDL cholesterol, most studies show that ketogenic diets improve overall metabolic health, reducing inflammation, blood pressure, and triglycerides. And most do not see a rise in their LDL. A small subset of people, often called lean mass hyper-responders, experience a significant rise in LDL cholesterol on keto. However, they typically see improvements in other metabolic markers, such as lower insulin resistance and better overall lipid profiles. Ongoing research is exploring why this LDL increase occurs and whether it actually raises cardiovascular risk. Current evidence suggests that LDL alone is not the best predictor of heart disease, with inflammation, particle size, and overall metabolic health playing a more significant role.

7. There’s No Evidence That Keto Only Works Short-Term

A common claim is that ketogenic diets are only effective for about six months before their benefits plateau or diminish. However, this belief primarily stems from short-term weight loss studies rather than research on metabolic therapy for brain health or chronic disease management. In contrast, long-term studies on ketogenic therapy for conditions like Type 2 diabetes and mental health disorders show sustained benefits:

• Virta Health’s five-year study on patients with Type 2 diabetes demonstrated continued metabolic improvements, including blood sugar control, reduced medication use, and weight stability well beyond six months.

• Studies on psychiatric and neurological conditions suggest that patients who remain in ketosis continue to experience symptom improvement and cognitive benefits over extended periods.

Final Thoughts

Keto remains effective as long as it is maintained, and its benefits extend well beyond weight loss—particularly for those using it as a therapeutic intervention for brain health.

For those who thrive on keto, there is no strong evidence suggesting they need to stop. Like any medical intervention, ketogenic therapy should be monitored, adjusted, and personalized to ensure safety and efficacy.