What about a ketogenic diet (KD)?

From the Guidelines

A ketogenic diet is not recommended for everyone, especially those with certain medical conditions, such as diabetes, kidney disease, or heart disease, without consulting a healthcare provider first 1. Generally, a ketogenic diet should be approached with caution and under the guidance of a healthcare professional, as it can have potential side effects and interactions with medications.

Key Considerations

• The diet is a low-carbohydrate, normal protein, high-fat dietary approach designed to induce a metabolic state called ketosis, where the body primarily utilizes fat for energy production 1.
• It has been used to treat various conditions, including epilepsy, inflammation, metabolic syndrome, type 2 diabetes, and polycystic ovary syndrome 1.
• The suggested positive effects exerted by the ketogenic diet on health rely on the "physiological ketosis" described by Hans Krebs in 1966, which is characterized by normal pH, low but within physiological ranges of both insulin and blood glucose, and levels of ketone bodies between 0.3 up to 4 mmol/L 1.

Potential Risks and Benefits

• Potential side effects of a ketogenic diet include heart failure, neurological problems from thiamine deficiency, reduced intakes of folate, iron, and magnesium, and metabolic ketoacidosis, particularly with sodium−glucose cotransporter 2 (SGLT2) inhibitors 1.
• High protein intake has been associated with kidney diseases in several observational studies 1.
• Regular monitoring of blood work, including cholesterol and blood sugar levels, is crucial to ensure safe implementation 1. If considering a ketogenic diet, it's essential to discuss the potential risks and benefits with a healthcare provider, who can help determine if it's a suitable option and create a personalized plan.

From the Research

Ketogenic Diet Overview

• The ketogenic diet is a very low carbohydrate diet that has been used to treat type 2 diabetes and obesity 2.
• It has gained popularity for its potential health benefits, including weight loss and increased energy 3.

Potential Risks and Side Effects

• The ketogenic diet may increase the risk of heart disease due to its emphasis on fat, often from animal sources, which can increase saturated fat consumption 2.
• It may worsen metabolic acidosis by increasing dietary acid load and endogenous acid production through the oxidation of fatty acids 2.
• The diet has been associated with an increased risk of kidney stones in patients using it for the treatment of refractory epilepsy 2.
• Starvation ketoacidosis is a potential side effect, particularly when combined with prolonged fasting 3.
• The diet may have unfavorable effects on dietary intake, decreasing consumption of protective foods and increasing intake of foods linked to chronic disease risk 4.

Long-Term Safety and Efficacy

• The ketogenic diet may not be better than comparator higher carbohydrate diets over the long term 2.
• Its efficacy for weight loss and metabolic changes is not significant in long-term observations 5.
• The diet does not fulfill the criteria of a healthy diet and may have safety concerns, such as adverse events related to ketosis and potential pharmacological interactions 5.

Contraindications and Precautions

• Certain individuals, such as those with chronic kidney disease, may need to avoid the ketogenic diet due to potential risks and lack of safety data 2.
• Patients with comorbidities, such as diabetes mellitus type II, should consult their physicians before initiating the diet 3.
• The possible use of the ketogenic diet as a therapeutic intervention should be assessed on a patient-to-patient basis by skilled medical doctors, considering current recommendations and the latest evidence 6.