These genetic traits are not associated with reduced risk of myocardial infarction unless they also reduce LDL-C Treatment-induced HDL-C elevations were examined in a meta-analysis of studies including , participants, which found no associated reduction in the risk of coronary heart disease events, coronary disease mortality, or total mortality The evidence of the renal-specific effects of ketogenic diets is limited but worth noting, especially in the context of the unclear long-term benefits of such diets for diabetes and obesity For those without chronic kidney disease CKD , one of the biggest potential risks of the ketogenic diet is the development of kidney stones, a finding that has been frequently noted in the pediatric epilepsy literature , The ketogenic diet's emphasis on high-fat, animal-based foods while excluding many fruits and vegetables promotes a urinary milieu for kidney stones.
Dietary animal protein consumption is a well-established promoter of kidney stones The acidosis caused by the ketogenic diet may also encourage stone formation by lowering urinary citrate and pH levels while increasing urinary calcium levels.
Another potential risk of animal-based ketogenic diets for those without CKD is the development of CKD through the consumption of animal fat and protein. In observational studies of populations eating Western diets, high animal fat consumption, as is common with ketogenic diets, has been associated with increased risk of developing albuminuria Other observational studies of animal protein have shown similar findings , For those with CKD, the high protein content in some ketogenic diets is of concern.
Compared to control diets with higher protein content, low protein consumption has been associated with a reduction in the rate of kidney function decline in a meta-analysis of 14 randomized controlled trials High protein consumption facilitates hyperfiltration, a phenomenon of increased blood flow to the glomerulus, which is thought to lead to long-term damage in those with CKD Finally, the acid load from the ketogenic diet may worsen metabolic acidosis and kidney disease in those with CKD The ketogenic diet's acid load comes from the foods consumed especially those from animal-based sources , ketoacids associated with ketone production, and from the lack of natural alkali found in fruits and vegetables that are often avoided in the ketogenic diet.
As such, the ketogenic diet requires further research regarding its long-term renal safety in those with and without CKD. Low-carbohydrate diets followed prior to conception or during the periconceptual period are associated with an increased risk of birth defects and gestational diabetes, respectively. Use of folate supplements may not mitigate the risk seen with low-carbohydrate diets. In the above study, there was no effect measure modification by folic acid supplement use A study conducted using data that predated the era of folate-fortified grain products also found an increase in neural tube defects in the offspring of women consuming low-carbohydrate diets in the periconceptual period OR 2.
A prospective cohort study evaluating gestational diabetes risk scored women's diets for adherence to a low-carbohydrate diet pattern and dietary fat source. A vegetable-based low-carbohydrate dietary pattern was not associated with increased risk The most restrictive ketogenic diets used for epilepsy can cause fatigue, headache, nausea, constipation, hypoglycemia, and acidosis, especially within the first few days to weeks of following the diet 2.
Dehydration, hepatitis, pancreatitis, hypertriglyceridemia, hyperuricemia, hypercholesterolemia, hypomagnesemia, and hyponatremia can also occur 82 , In endurance athletes, 3.
Longer-term effects can include decreased bone mineral density, nephrolithiasis, cardiomyopathy, anemia, and neuropathy of the optic nerve 82 , Ketogenic diets have low long-term tolerability, and are not sustainable for many individuals 48 , Diets low in carbohydrate have also been associated with an increased risk of all-cause mortality , although recent data suggest that lower-carbohydrate diets can be linked to either higher or lower mortality risk, depending on the quality of the carbohydrate they contain and whether they rely more on animal protein and saturated fat or plant protein and unsaturated fat, respectively Ketogenic diets reduce seizure frequency in some individuals with drug-resistant epilepsy.
These diets can also reduce body weight, although not more effectively than other dietary approaches over the long term or when matched for energy intake. Ketogenic diets can also lower blood glucose, although their efficacy typically wanes within the first few months.
Very-low-carbohydrate diets are associated with marked risks. LDL-C can rise, sometimes dramatically. Pregnant women on such diets are more likely to have a child with a neural tube defect, even when supplementing folic acid.
And these diets may increase chronic disease risk: Foods and dietary components that typically increase on ketogenic diets eg, red meat, processed meat, saturated fat are linked to an increased risk of CKD, cardiovascular disease, cancer, diabetes, and Alzheimer's disease, whereas intake of protective foods eg, vegetables, fruits, legumes, whole grains typically decreases.
Current evidence suggests that for most individuals, the risks of such diets outweigh the benefits. LC and NDB contributed to the organization of the manuscript, reviewed, and approved the submitted version. LC composed the outline and drafted the manuscript. All authors had full access to data and revised and approved the manuscript for publication. LC is an employee of the Physicians Committee for Responsible Medicine in Washington, DC, a non-profit organization providing educational, research, and medical services related to nutrition.
He serves without compensation as president of the Physicians Committee for Responsible Medicine and Barnard Medical Center in Washington, DC, non-profit organizations providing educational, research, and medical services related to nutrition. He writes books and articles and gives lectures related to nutrition and health and has received royalties and honoraria from these sources.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Newman JC, Verdin E. Annu Rev Nutr. Roehl K, Sewak SL. Practice paper of the academy of nutrition and dietetics: classic and modified ketogenic diets for treatment of epilepsy. J Acad Nutr Diet. Very-low-carbohydrate ketogenic diet v. Br J Nutr. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate including ketogenic diets for the management of body weight and other cardiometabolic risk factors: a scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force.
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Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies. Brouns F. It also happens during pregnancy, infancy, fasting and starvation 3 , 4 , 5 , 6. For ketosis to start, you generally need to eat fewer than 50 grams of carbs per day and sometimes as little as 20 grams per day.
However, the exact carb intake that will cause ketosis varies between individuals. When eating a very low carb diet, levels of the hormone insulin go down and fatty acids are released from body fat stores in large amounts. These molecules can provide energy for the body.
Unlike fatty acids, ketones can cross the blood-brain barrier and provide energy for the brain in the absence of glucose.
Ketosis is a metabolic state where ketones become an important source of energy for the body and brain. This happens when carb intake and insulin levels are low.
However, a large portion of your brain can also use ketones for energy, such as during starvation or when your diet is low in carbs 7. In addition, your body can use protein or other molecules to produce the glucose the brain still requires during ketosis. This process is called gluconeogenesis. The glucose it still needs can be produced from protein or other sources.
While ketosis is part of normal metabolism, ketoacidosis is a dangerous metabolic condition that can be fatal if left untreated. In ketoacidosis, the bloodstream is flooded with extremely high levels of glucose blood sugar and ketones. Ketoacidosis is most often associated with uncontrolled type 1 diabetes.
It may also occur in people with type 2 diabetes, although this is less common In addition, severe alcohol abuse may lead to ketoacidosis Most people with epilepsy use anti-seizure medications to help manage seizures.
It has primarily been used in children, with some studies showing benefits. Many children with epilepsy have seen significant reductions in seizures while following a ketogenic diet, and some have seen complete remission 15 , 16 , 17 , The ketogenic diet is a popular weight loss diet, and research has shown it can be effective Some studies have found that ketogenic diets are more helpful for weight loss than low fat diets 20 , 21 , One study reported 2.
For this reason, it is generally not necessary to count calories on this diet 24 , Some individuals may find it easy to adhere to the ketogenic diet, while others may find it unsustainable. Some research suggests that the keto diet may not be the best way to lose weight. People can typically obtain glucose from dietary carbs, including sugars and starchy foods. The body breaks these down into simple sugars. Afterward, it either uses glucose as fuel or stores it in the liver and muscles as glycogen.
If there is not enough glucose available to provide enough energy, the body will adopt an alternative strategy to meet those needs. Specifically, it begins to break down fat stores and use glucose from triglycerides. Ketones are a byproduct of this process. These are acids that build up in the blood and leave the body in the urine. In small amounts, they indicate that the body is breaking down fat. However, high levels of ketones can poison the body, leading to a condition called ketoacidosis.
Ketosis refers to the metabolic state in which the body converts fat stores into energy, releasing ketones in the process. As ketosis breaks down fat stores in the body, some keto diets aim to facilitate weight loss by creating this metabolic state. Keto diets are usually high in fat. However, there are different versions. The nutrient proportions will depend on the version of the diet a person follows.
Adhering to the keto diet can lead to short-term weight loss. This is partly because people are usually able to consume fewer calories without feeling hungry. These health benefits may occur due to the loss of excess weight and the inclusion of more healthful foods in the diet, rather than the reduction in carbs.
Doctors have also prescribed the keto diet to reduce the number of seizures in children with epilepsy who do not respond to other forms of treatment.
Some studies have suggested that the diet could also benefit adults with epilepsy, though more research is necessary to confirm these findings. However, sticking to the keto diet on a long-term basis does not appear to provide many benefits. Researchers are now studying other conditions to see if a keto diet might be beneficial, including:.
In people with diabetes, ketosis can occur due to a person not having enough insulin to process glucose in the body. The presence of ketones in the urine indicates that a person needs to work on better controlling their diabetes. Some dietitians recommend a keto diet for people with type 2 diabetes. With this condition, the body still produces some insulin, but it does not work as effectively. Those with type 2 diabetes should aim to consume fewer carbs, as these convert to glucose and increase blood sugar levels.
People with diabetes who follow a keto diet need to monitor their ketone levels carefully. If levels get too high, ketoacidosis can occur. DKA is a condition wherein the levels of ketones become extremely high, poisoning the body.
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