Changes

They are many potential benefits to the ketogenic diet, but there are also a number of potentially serious health risks. It appears that most of these health risks can be mitigated with care.

=HypoglycemiaPerspective=Hypoglycemia (low blood sugar) seams to predominantly a All diets have risk if the ketogenic diet is started with a fast.;

=AcidosisContext=Talk about mild and serious acidosisMy of the data on KD risks come from KD epilepsy, monitoring urine pH routinelyobesity, starvation.

=HyperketosisHealth Risks=The underlying cause is probably acidosis.

=Sodium Loss and Hypotension=Death==Natriuresis There have been two reported cases of sudden death of starvationchildren on the Ketogenic Diet, probably due to low insulinselenium deficiency causing heart failure<ref name="BankShemie2008"/>. Selenium deficiency can occur rapidly; one child was diagnosed with selenium deficiency and related heart problems before their scheduled 3 month selenium test<ref name="Sirikonda-2012"/>. In addition, associated loss a study of Potassium 20 children on the Ketogenic Diet found heart rhythm abnormalities and heart enlargement in 3 (15%, diet duration 13 ± 8.4 months), and one had severe dilated cardiomyopathy<ref name="Best-2000"/>. The effected children has normal selenium levels, but there was a significant correlation was found between the heart rhythm abnormality (QTc) and both bicarbonate and reduced blood volumeketones, suggesting the level of acidosis or ketosis may be important factors.

=Vitamin or mineral deficiency=Sodium Loss and Hypotension==The ketogenic diet Low carbohydrate diets cause of the kidneys to excrete more sodium. This is frequently deficient in some vitamins known as "natriuresis of starvation", and may be due to low insulin<ref name="Stenvinkel-1995"/>, increased dopamine excretion<ref name="Swaminathan-1983"/>, or elevated Glucagon<ref name="SaudekBoulter1973"/>. If carbohydrate and mineralssodium intakes are both limited, so supplementation is requiredthen the body will secrete the hormone aldosterone<ref name="Phinney-2011-p312"/> which will cause the kidneys to excrete potassium and conserve sodium<ref name="Lote2012">. This loss of potassium can cause muscle cramps and heart arrhythmias, as well has the loss of muscle tissue.

=Kidney Stones=Vitamin or mineral deficiency==Occurrence The ketogenic diet is frequently deficient in vitamins and minerals, so supplementation is 5%required with a carbohydrate free multivitamin/mineral<ref name="Kossoff-2011-p137"/>. * Separate supplementation of Calcium and Vitamin D is also recommended. * Selenium is important to prevent heart problems (see above). * Carnitine may also be required, depending on the results of testing. * There are case reports of scurvy with the ketogenic diet<ref name="Willmott-2008"/>, talk about need for urine monitoringso additional supplementation with Vitamin C may be appropriate.

==Constipation==Constipation is a common issue as the ketogenic diet is generally low in fiber. Even with supplementary fiber, constipation can still be a problem. This may be partly due to changes in the intestinal flora that occur with the ketogenic diet. There are also indications that some non-fiber carbohydrate parses far enough through the digestive tract to supply fuel to bacteria for fermentation. ==Kidney Stones==5% of the children on the ketogenic diet for epilepsy suffer from kidney stones<ref name="Sampath-2007"/>. A study showed that oral potassium citrate significantly decreased the occurrence of kidney stones<ref name="McNally-2009"/>. It has been shown that while [http://en.wikipedia.org/wiki/Carbonic_anhydrase_inhibitor carbonic anhydrase inhibitors] are also a risk factor for kidney stones, carbonic anhydrase inhibitors while on the ketogenic diet does not further increase the risk<ref name="Kossoff-2002"/>. (Carbonic anhydrase inhibitors are a type of antiepileptic drug.) Maintaining a good level of hydration is important, and Oral citrates may be appropriate. The urine should be [[Health Checks for the Ketogenic Diet| tested for blood]] at least once a week<ref name="Kossoff-2011-p109"/>.  ==Hypoglycemia==Hypoglycemia (low blood sugar) seems to predominantly a risk if the ketogenic diet is started with a fast, and blood sugar levels should be checked every 6–8 hours during the first few days of the diet. Generally the ketogenic diet helps stabilize, and normalize blood sugar. ==Acidosis==Uncontrolled diabetic patients can suffer from diabetic ketoacidosis, a life-threatening condition where very high levels of ketones are produced. In diabetic ketoacidosis not only are their high levels of ketones, but also their blood glucose is high, and there is often potassium depletion and dehydration (citation required.) Acidosis is not a common problem on the ketogenic diet, but it can occur and symptoms are lethargy, nausea, vomiting, and headache<ref name="Kossoff-2011-p318"/>.  ==Elevated cholesterol and blood lipid changes==

==Bone fractures==Issue in Children on the ketogenic diet suffer a higher rate of bone fractures, with 20% of children – another impact on the diet for 6+ years having fractures<ref name="Kossoff-2011-p271"/>. Children on the ketogenic diet have poorer bone health, lower vitamin D levels, lower intakes of acidosis or reduced dairy intake?calcium and vitamin D, and lower Bone Mineral Content<ref name="BergqvistSchall2008"/>. However, epilepsy medications are associated with bone loss and calcium metabolism<ref name="Kossoff-2011-p174"/>, so this may also be a contributory factor.

==Growth reduction==Children treated with the ketogenic diet can have growth reduction<ref name="Kossoff-2011-2533"/>. PersonallyHowever, I wonder if this is due to early uses of the earlier ketogenic diet for epilepsy diets restricting caloriesincluded calorie restriction below the recommended level for the child, as partial starvation was believed to be important for reducing seizures.

=Constipation=Fat Intake Imbalance==Constipation When increasing the geometry fat intake, it is an issueeasy to get too much Omega-6. They are anecdotal reports that excessive Omega-6 can cause digestive problems, even with extra [[Fiber]]as well as longer-term health issues. The general recommendation is to avoid too much Omega-6, probably due to changes in intestinal floraand aim for saturated or monounsaturated fats.

=Fat Intake Imbalance=It's easy to get too much Omega-6.  =Insulin Resistance ==

==Thirst and Hydration==

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Kossoff, Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet., Pediatrics, volume 124, issue 2, pages e300-4, Aug 2009, doi [http://dx.doi.org/10.1542/peds.2009-0217 10.1542/peds.2009-0217], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19596731 19596731]</ref><ref name="Kossoff-2002"> EH. Kossoff, PL. Pyzik, SL. Furth, HD. Hladky, JM. Freeman, EP. Vining, Kidney stones, carbonic anhydrase inhibitors, and the ketogenic diet., Epilepsia, volume 43, issue 10, pages 1168-71, Oct 2002, PMID [http://www.ncbi.nlm.nih.gov/pubmed/12366731 12366731]</ref><ref name="BankShemie2008">Ilana M. Bank, Sam D. Shemie, Bernard Rosenblatt, Chantal Bernard, Andrew S. 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A Stallings, B. S Zemel, Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet, American Journal of Clinical Nutrition, volume 88, issue 6, 2008, pages 1678–1684, ISSN [http://www.worldcat.org/issn/0002-9165 0002-9165], doi [http://dx.doi.org/10.3945/ajcn.2008.26099 10.3945/ajcn.2008.26099]</ref><ref name="Kossoff-2011-, Kindle Offset 1864">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Location Offset 1864</ref><ref name="Kossoff-2011-, Kindle Offset 2218">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Location Offset 2218</ref><ref name="Kossoff-2011-, Kindle Offset 2533">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Location Offset 2533</ref><ref name="Kossoff-2011-, Page 174">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Page 174</ref><ref name="Kossoff-2011-, Page 271">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Page 271</ref><ref name="Kossoff-2011-, Kindle Offset 2522">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Location Offset 2522</ref><ref name="Kossoff-2011-, Kindle Offset 2512">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Location Offset 2512</ref><ref name="Kossoff-2011-, Page 318">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Page 318</ref><ref name="Kossoff-2011-, Page 109">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Page 109</ref><ref name="Kossoff-2011-, Page 137">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Page 137</ref><ref name="Phinney-2011-, Page 343">Phd Stephen D. Phinney MD, Rd Jeff S. Volek Phd, [http://www.amazon.com/The-Art-Science-Carbohydrate-Living/dp/0983490708 The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable], 2011, publisher Beyond Obesity LLC, isbn 978-0-9834907-0-8, Page 343</ref><ref name="Phinney-2011-, Page 312">Phd Stephen D. Phinney MD, Rd Jeff S. Volek Phd, [http://www.amazon.com/The-Art-Science-Carbohydrate-Living/dp/0983490708 The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable], 2011, publisher Beyond Obesity LLC, isbn 978-0-9834907-0-8, Page 312</ref></references>