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They are [[Ketogenic Diet as a Treatment| 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.
=Context=
The list of health risks for the [[Ketogenic Diet]] can be rather intimidating. It's worth remembering that all diets have risks associated with them, and many of these risks are severe. In some ways the health risks of the ketogenic diet are better understood than most diets because the ketogenic diet is typically given under medical supervision, and adverse effects are well documented. It should also be noted that the patients that have been studied on the ketogenic diet are often children with severe epilepsy or adults with morbid obesity. In fact, an important source of information on the ketogenic diet comes from obese subjects undergoing complete fasts. This may increase the relative risk of the ketogenic diet.
* There are case reports of scurvy with the ketogenic diet<ref name="Willmott-2008"/>, so 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 passes far enough through the digestive tract to supply fuel to bacteria for fermentation<ref name="Bergman-1990"/>.
==Kidney Stones==
About 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<ref name="Kossoff-2011-2452"/>. Generally the ketogenic diet helps stabilize, and normalize blood sugar.
There are case reports of children on the [[MCT Diet]] having fatty infiltration of the liver<ref name="Beverley-1988"/>. However, a study in rats suggests that MCTs may be a treatment for both non-alcoholic fatty liver disease<ref name="Ronis-2013"/> and alcoholic fatty liver<ref name="Theuer-1972"/>.
==Fat Intake Imbalance==
==Insulin Resistance ==
While the Ketogenic Diet can be beneficial for those suffering from [[Insulin Resistance]] or diabetes<ref name="Veech-2004"/>, there are also concerns that the Ketogenic Diet may also result in some insulin resistance<ref name="Jornayvaz2011"/><ref name="Robinson-1980"/>. There is conflicting evidence for the insulin resistance coming from a low carbohydrate<ref name="KanekoWang1998"/> or a high fat intake<ref name="Anderson-1975"/>. This would not be expected to be an issue while on a Ketogenic Diet, but it may mean that care should be taken when exiting the Ketogenic Diet. The Ketogenic Diet may also exacerbate reactive hypoglycemia<ref name="Anderson-1975"/>.
==Thirst and Hydration==
Ketones may reduce thirst<ref name="Kossoff-2011-2218"/>, which could impair hydration, but the details are unclear.
==Thyroid ==
The ketogenic diet has been shown to reduce the levels of the thyroid hormone [http://en.wikipedia.org/wiki/Triiodothyronine T3]<ref name="Phinney-1983"/><ref name="Phinney-1980"/><ref name="Fery-1982"/><ref name="Pasquali-1982"/>, and there is some evidence that T3 production is proportional to carbohydrate intake<ref name="Serog-1982"/>. It has been suggested that the ketogenic diet may not be suitable for those with thyroid deficiencies<ref name="Hite-2011"/>.
The ketogenic diet can produce an initial rise in the level of uric acid in the blood and the level of uric acid returns to baseline after 4-6 weeks, but some individuals can develop gout<ref name="Phinney-2011-p343"/>.
==Wound Healing==
I've found no studies concerning the effect of the ketogenic diet on wound healing. My personal experience is that wounds heal at a similar rate to a high carbohydrate diet. However, I've experienced far more problems on the Ketogenic Diet with my skin condition, [[Epidermolysis Bullosa]], with including more dystrophic scaring.
=Contraindications=
There are a number of contraindications for the ketogenic diet, including [http://en.wikipedia.org/wiki/Fatty-acid_metabolism_disorder genetic deficiencies in fat metabolism]<ref name="Kossoff-2011-1864"/>. A discussion of these contraindications is outside of the scope of this article.
<ref name="KanekoWang1998">Takashi Kaneko, Pei-Yu Wang, Masato Tawata, Akio Sato, Low carbohydrate intake and oral glucose-tolerance tests, The Lancet, volume 352, issue 9135, 1998, pages 1224, ISSN [http://www.worldcat.org/issn/01406736 01406736], doi [http://dx.doi.org/10.1016/S0140-6736(05)60565-X 10.1016/S0140-6736(05)60565-X]</ref>
<ref name="Anderson-1975"> JW. Anderson, RH. Herman, Effects of carbohydrate restriction on glucose tolerance of normal men and reactive hypoglycemic patients., Am J Clin Nutr, volume 28, issue 7, pages 748-55, Jul 1975, PMID [http://www.ncbi.nlm.nih.gov/pubmed/1146728 1146728]</ref>
<ref name="Bergman-1990">EN. Bergman, Energy contributions of volatile fatty acids from the gastrointestinal tract in various species., Physiol Rev, volume 70, issue 2, pages 567-90, Apr 1990, PMID [http://www.ncbi.nlm.nih.gov/pubmed/2181501 2181501]</ref>
<ref name="Kossoff-2011-1864">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 Offset 1864</ref>
<ref name="Kossoff-2011-2218">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 Offset 2218</ref>
