Data from the International Food Information Council, 23 million Americans chose to follow a ketogenic, or “keto”, diet last year to work towards these goals. This number has more than doubled since 2018

30% more likely
 to
have a child with a neural tube defect, speci cally 
anencephaly
 or 
spina bi da
. Additionally,
in the 
40%
of pregnancies that are unplanned, there is an 89% increase in risk of neural tube
defects if a carbohydrate-restricted diet was followed for the preceding year. This is 
likely
related
 to decreased folate intake, since many carbohydrates are forti ed with folate. 
Finally, a long-term health metric that many people who choose to lose weight are concerned
about is cardiovascular risk, since it is 
well-established
 that obesity directly contributes to
many incident cardiovascular risk factors. Unfortunately, emerging research shows that a
ketogenic diet actually increases the risk of cardiovascular disease. In a young, t population
of CrossFit athletes, following a keto diet for 12 weeks led to an average weight loss of 6
pounds but 
increased
“bad cholesterol” (LDL-C) by a whopping 35%. Typically, you would
expect to see LDL-C levels 
drop
when you lose weight. LDL-C has long been associated with
cardiovascular risk because it forms arterial plaques (a cholesterol build-up in the inner lining
of arteries), and 
emerging research
 that followed people for 12 years has now directly linked
long-term ketogenic dieting with a 2x higher risk of heart disease or other negative cardiac
events. More longitudinal research is being done on these risks, but many doctors are now
stepping up and 
advising
 people to follow other weight-loss approaches to preserve their
cardiovascular health. 
Figure 2. Graphic summary of long-term
health risks associated with a ketogenic diet,
including nutrient de ciencies, impaired
intestinal function, increased bad
cholesterol, increased risk of negative
cardiovascular events, impaired kidney
function, and birth defects.