Changes

The ketogenic diet [[Ketogenic Diet]] does not normally typically provide a complete intake of all required nutrients, so supplementation is recommended, especially salt, selenium, fiber, and vitamins.{{Skeleton}}=Sodium (Salt)=Some authorities recommend increased salt intake because low carbohydrate diets cause of the kidneys to excrete sodium. This "natriuresis of starvation" may be due to low insulin<ref name="Stenvinkel-1995"/>, increased dopamine excretion<ref name="Swaminathan-1983"/>, or elevated Glucagon<ref name="SaudekBoulter1973"/>. If both carbohydrate and sodium intakes are limited then the body will secrete 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 [[Cramps| Muscle Cramps]] and heart arrhythmias, as well has the loss of [[Muscle| Muscle Tissue]]. Personally I found higher salt intake to be critical during the Ketogenic Diet or my blood pressure would drop too low.

Insufficient intake of selenium can result in a weakening of the heart muscles (cardiomyopathy), and the ketogenic diet may not provide a sufficient intake<ref name="Kossoff-2011-1826"/>. Good sources of Selenium that could be used on a ketogenic diet include are Brazil nuts, tuna, beef, chicken and turkey, but supplementation is normally recommended. =Fiber and Constipation Supplements=Constipation is a common issue with low carbohydrate diets as they can be low in fiber. Recommended approaches to reducing constipation include [[MCT]] oil, avocadoes, prunes, exercise and good hydration, or even a mild laxative such as Miralax<ref name="Kossoff-2011-1790"/>. Personally, I've found the ketogenic diet to produce a change in stool consistency even with a comparable fiber intake, which may be due to the way that non-fiber carbohydrates pass through the digestive system and are metabolized by the intestinal flora. =Vitamins=For children using the Ketogenic diet for seizure control, daily supplementation with calcium, vitamin D, zinc, selenium and multivitamin/mineral is required<ref name="Kossoff-2011-1338"/> <ref name="Kossoff-2011-2490"/>. There are anecdotal reports of scurvy (Vitamin C deficiency) while on ketogenic diets. =Omega-3=For children on the Ketogenic diet for epilepsy, the recommended range of Omega-3 is 0.6-1.2% of their total fat intake<ref name="Kossoff-2011-1820"/>. The FDA recommends the Omega-3 intake from fish not exceed 3 grams/day.

[[MCT ]] can be added to a ketogenic diet to improve the ketone levels by adding 5-25 grams per meal or per day<ref name="Kossoff-2011-1812"/>. (Coconut oil it can be 80is normally 60-10070% MCT(verify) <ref name="Kossoff-2011-1812"/>.) =Omega-3=For children on the Ketogenic diet for epilepsy, the recommended range of Omega-3 is 0.6-1.2% of their total fat intake<ref name="Kossoff-2011-1820"/>. The FDA recommends the Omega-3 intake from fish not exceed 3 grams/day (verify). =Fiber and Constipation Supplements=Constipation is a common issue with low carbohydrate diets as they can be low in fiber. Recommended approaches to reducing constipation include MCT oil, avocadoes, prunes, exercise and good hydration, or even a mild laxative such as Miralax<ref name="Kossoff-2011-1790"/>. Personally, I've found the ketogenic diet to produce a change in stool consistency even with a comparable fiber intake, which may be due to the way that non-fiber carbohydrates pass through the digestive system and are metabolized by the intestinal flora.  

Carnitine is critical for the metabolism of fat, and generally the body will make enough, but there may be cases where supplementation is required<ref name="Kossoff-2011-1793"/>. It is possible to test for carnitine deficiency, which, if used, should be repeated every 3-6 months<ref name="Kossoff-2011-1799"/>. If carnitine levels are <15, then extra carnitine is often given, especially if combined with symptoms of sleepiness or slugishnesssluggishness<ref name="Kossoff-2011-2258"/>.

Taking Potassium citrate (Polycitra K) to can reduce the risk of kidney stones by 7x<ref name="Kossoff-2011-1778"/>. This reduces the , probably by reducing urine acidity. =Vitamins=For children using the Ketogenic diet for seizure control, daily supplementation with calcium, vitamin D, zinc, selenium and multivitamin/mineral is required<ref name="Kossoff-2011-1338"/> <ref nameSee Also="Kossoff-2011-2490"/>. There are anecdotal reports of scurvy (Vitamin C deficiency) while on ketogenic diets. {{KetoSeeAlsoKetoList}} 

<ref name="KossoffSwaminathan-20111983"> R. Swaminathan, G. Cope, M. Sheltawy, MR. Lee, JK. Wales, Dopamine excretion during natriuresis of starvation., Int J Obes, volume 7, issue 1, pages 31-24905, 1983, PMID [http://www.ncbi.nlm.nih.gov/pubmed/6840964 6840964]</ref><ref name="SaudekBoulter1973">EricC. D. KossoffSaudek, P. R. Boulter, R. A. Arky, The Natriuretic Effect of Glucagon and Its Role in Starvation, Journal of Clinical Endocrinology & Metabolism, volume 36, issue 4, 1973, pages 761–765, ISSN [http://www.amazonworldcat.comorg/issn/Ketogenic0021-Diets972X 0021-972X], doi [http://dx.doi.org/10.1210/jcem-Eric36-H4-Kossoff761 10.1210/dpjcem-36-4-761]</1936303108 Ketogenic diets : treatments for epilepsy ref><ref name="Stenvinkel-1995">P. Stenvinkel, A. Ottosson-Seeberger, A. Alvestrand, J. Bolinder, Effect of insulin on renal sodium handling and other disorders]renal haemodynamics in insulin-dependent (type 1) diabetes mellitus patients., date 2011Acta Diabetol, publisher Demos Healthvolume 32, location New Yorkissue 4, isbn 1pages 230-936303-10-84, Dec 1995, Kindle Offset 2490PMID [http://www.ncbi.nlm.nih.gov/pubmed/8750761 8750761]</ref><ref name="Kossoff-2011-1338Lote2012">EricChristopher J. Kossoff, Lote [http://www.amazon.com/KetogenicPrinciples-DietsRenal-EricPhysiology-HChristopher-KossoffLote/dp/1936303108 Ketogenic diets 0792360745 http: treatments for epilepsy and other disorders//www.amazon.com/Principles-Renal-Physiology-Christopher-Lote/dp/0792360745] Principles of Renal Physiology], date 201122 June 2012, publisher Demos HealthSpringer, location New York, isbn ISBN 978-1-9363034614-103785-8, Kindle Offset 13387</ref>