Risks Associated with the Ketogenic Diet

 The Ketogenic diet has gained quite a popularity in past several years. The diet aims for very low carbohydrate intake,  about 5 % of calories to come from carbs or about 50 gm per day, which will transition your body into a ketotic state. When you are in ketosis you are using fat or ketone bodies as an energy sources rather than carbohydrate or glucose.  There is a sea of information on the internet and numerous books have been published about the weight loss benefits it promises.  But before excluding a whole food group from their diet, one has to ask himself few simple, but vitally important question:

Is the Ketogenic diet good for my overall health?

Does the Ketogenic diet come with unhealthy side effect? If so what are they and what are the risks?

How long can I be on the ketogenic diet before I face the risks? Is it a way of life or a short term solution?

Do I lose fat mass from my body or it is muscle and water that I am losing on the ketogenic diet?

When I am off the diet should I be expecting weight gain?

Here are some answers you have been looking for.

When switching from mostly carbohydrate metabolism to fat metabolism your body experiences stress as it goes to more acidic state due to the abundance of ketone bodies.

Keto Flu:

You may experience lethargy, nausea, vomiting or the so called Keto Flu, which is due to the high fat intake and the sudden shift of blood pH to the acidic spectrum caused by ketones which are acidic in nature. This concept is well studies number of investigators including  Dharija who explains it in the Canadian Journal of Neurological Science in 2013.  (1) (2)

Gastrointestinal Disturbances

High fat, low fiber increases gastrointestinal transit time which can lead to gastrointestinal disturbance such as constipation and increase in toxins absorption in the colon and small intestines.

Recommended fat intake by the health societies such as American Dietetic Association, Dietary Guidelines of Americans, Diabetic Association,  Clevlent Clinic, Mayo Clinic, American Heart Association, ranges from 20 to 35 % of your total calorie. The Keto diet ask for 70-90 % of calories to come from fat.  Do all of these health association have it all wrong and the Keto supporters got it right? (3), (4), (5)  In addition, the low fiber and high fat intake causes excessive burden to the liver and pancreatic, as these organs have to work overtime to metabolize/ break down the large amounts of fat.

Trace Element Deficiencies

Studies have also reported some micro-nutrient deficiencies such as potassium, magnesium, lack of these may contribute to the Keto Flu. In addition, trace minerals like copper, zinc and selenium are of a great concern with levels severely below normal range when people are following the keto diet. (6) Selenium is an essential nutrient due to its role in the production of antioxidant enzymes and cell protection from oxidative damage. Lack of selenium may lead to thyroid problems, cognitive decline, cancer. Therefore, if you are on the Keto diet ensure that trace elements are properly supplemented.

Elevated Lipid Panel, Cholesterol and Triglycerides

A prospective pilot study on ketogenic diets reported a substantial and progressive increase in the cholesterol levels in patients after 1 year. (7). In a 6-month study of adults on low-carbohydrate ketogenic diets, one of the adverse effects was an increase in low-density lipoprotein (LDL) cholesterol levels. The elevation of lipid panel comes with increased risk for arteriosclerosis, heart disease and stroke. Your doctor might recommend medications with levels of total cholesterol above normal. 

  1. Dhamija R., Eckert S., Wirrell E. Ketogenic diet. Canadian Journal of Neurological Sciences. 2013;40(2):158–167.
  2. https://www.health.com/syndication/jillian-michaels-slams-keto-diet
  3. https://health.gov/dietaryguidelines/dga2005/document/html/chapter6.htm
  4. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/fat-grams/faq-20058496
  5. https://my.clevelandclinic.org/health/articles/11208-fat-what-you-need-to-know
  6. Hayashi A., Kumada T., Nozaki F., Hiejima I., Miyajima T., Fujii T. Changes in serum levels of selenium, zinc and copper in patients on a ketogenic diet using Keton formula. No to Hattatsu. Brain and Development. 2013;45(4):288–293. 23951940 [PubMed] [Google Scholar] [Ref list])
  7. Mosek A., Natour H., Neufeld M.Y., Shiff Y., Vaisman N. Ketogenic diet treatment in adults with refractory epilepsy: a prospective pilot study. Seizure: The Journal of the British Epilepsy Association. 2009;18(1):30–33. 18675556 [PubMed] [Google Scholar] [Ref list]