Before you kick carbs out of your diet in favor of the keto craze, make sure you know the full story.

You can’t pick up a men’s magazine these days without seeing an article extolling the virtues of the keto diet for losing weight fast. And there’s no denying the dramatic weight loss success many men have experienced. No surprise, considering the initial keto weight loss studies were done on men. But, there’s a cost many men have paid for that weight loss, and it might not be worth paying for the long term.

Studies show that in the short-term, the keto diet leads to fat loss and decreased risk of heart disease and diabetes. This is great news! However, meta-analyses of long-term randomized studies of over 400,000 people for more than 25 years are showing an association between shorter life spans and low carb diets. Those with a shorter life span were primarily male, young, college graduates with a higher income, who exercised less, and replaced the carbs with animal proteins.

The more serious issues with keto for men seem to stem primarily from not understanding the specific nutrient issues that come with this diet. As I mentioned in this article about keto concerns for women, severe carb restriction causes changes to the balance of our thyroid, sex, stress, and blood sugar balancing hormones. It is, in essence, a type of starvation, and your entire body chemistry changes while in this starvation mode. This is especially of concern for athletes with increased muscle mass and men with iron overload.

Athletes: Mind Your Minerals

The combination of Keto and Crossfit is all the rage. But, when you regularly exercise with high intensity, as you do with Crossfit, then the ketogenic diet poses special concerns for you.

First of all, your body makes ketones when your carbohydrate intake drops below approximately 20 percent of your total calories. When you decrease carbs, your insulin level also drops, which triggers you to breakdown muscle to release the glycogen stored inside – your sugar storage – to be burned for fuel. When you exercise heavily and severely restrict carbs, breakdown of muscle can become excessive and may lead to muscle fiber death, which is a serious condition.

Secondly, this diet is diuretic in nature, meaning it causes fluid loss. Electrolytes, which are the minerals your body uses to conduct electricity throughout every cell, also help regulate nerves and muscles, rebuild damaged tissues, keep your body hydrated, and regulate blood sugar and blood pH. The fluid loss from the keto diet also flushes electrolytes out with it, primarily sodium, potassium, and magnesium.

The breakdown of muscle combined with electrolyte loss can set up the perfect storm, so to speak, that leads to a life-threatening problem. Let me give you an example. The typical scenario goes like this:

An athlete who has regular, intense workouts goes on the keto diet. He makes sure to increase his water intake and supplements with magnesium and feels like everything is going well. A few months into the diet, he starts to develop leg cramps. He doesn’t think much of it because he’s been feeling great otherwise, so he just increases his water intake.

Within 24 hours, the cramps become extremely painful and aren’t relieved with massage or drinking water. He goes to the ER and is admitted to the hospital. Diagnosis: Rhabdomyolysis.

Rhabdomyolysis is a dangerous condition where the muscles are breaking down, dying, and releasing their contents into the bloodstream. You often feel weak, tired, and have muscle cramping. Urine output tends to decrease and become darker. The more muscle mass you have, the worse it can be. And this puts a tremendous strain on the kidneys and can lead to kidney failure, and even death. Rhabdomyolysis is not a condition you can treat at home – you must go to the hospital for treatment.

Because of this, many doctors who recommend the keto diet now recommend supplementing with key minerals – in addition to what’s already in the diet – to prevent deficiency. Typical recommendations are 1 gram of potassium, 300 milligrams of magnesium, and up to 5 grams of sodium per day.

Iron Overload: Keto Adds Insult to Injury

If your blood tests show you have hemochromatosis or iron overload, then you need to take extra measures to lower the iron in your diet. Keto can make this difficult. First, the diet is diuretic, so blood tends to become more concentrated, at least until you understand how to keep your electrolyte minerals balanced.

Secondly, many of the foods people commonly associate with the keto diet are rich in iron, like red meat. Someone who does not have hemochromatosis might absorb only a fraction of the iron in what they eat, while someone who has the disease will absorb most, if not all, of the available iron. Men are especially prone to iron overload, whether they have the genetic trait or not.

This excess iron is stored in organs like your heart and liver, and is a primary cause of heart disease. A blood test for your ferritin level gives an idea of how much iron you have stored and whether it’s increasing while you are on the keto diet. If the diet is causing your iron overload to increase, take the measures your health care provider recommends to get your levels back to normal, and change your protein and fat sources. I am also a big fan of taking UNI KEY Health’s Bile Builder, as both liver and heart health support. Ingredients like beetroot help increase nitric oxide to the heart, while also encouraging healthy bile production and complete fat digestion.

How to Live Longer – with Keto

It’s very concerning to me that longevity goes down when you are on a carb-restricted diet like keto for the long-term. As I dug further into the research, I came to the realization that a few small changes can be made that allow you to go keto but keep your longevity:

1. Replace red meats with plant-based proteins and essential fats from organic nuts, seeds, and their cold-pressed oils. While study participants who replaced carbs with animal proteins decreased their longevity, it turns out that men who chose more plant-based protein and fat sources lived as long as those in what we call the Blue Zones – areas of the world where people routinely live healthy beyond 100 years of age. Organic nuts and seeds are rich in essential Omega 3 and Omega 6 fats, which are well known for their anti-inflammatory, health promoting effects. Organic, free range chicken and wild caught deep sea fish are also healthy sources of fats and protein that can be added into the diet and don’t appear to decrease longevity.
2. Supplement with Missing Minerals. Anytime you drastically restrict an entire macronutrient from the diet, deficiencies of vitamins and minerals are bound to happen, unless properly supplemented. In addition to the electrolytes that athletes need, I recommend an iron-free multiple, like UNI KEY Health’s Male Multiple, and plenty of clean, filtered water.
3. Take a Break to Reboot. Your hormones need carbs, and restricting them for too long leads to reduced production and imbalances. Take a break from keto every few months and re-introduce some of your favorite healthy carbs. I recommend doing the 25-day Radical Reboot in my Radical Metabolism plan. Your body will continue to burn fat as its primary fuel while you add nutrient-rich carbs that have been carefully chosen to feed your hormones without causing weight gain or inflammation.

See also: What the Keto Diet Does to a Woman’s Body

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