The Relevance of Adverse Reactions
I believe the potential for adverse reactions is important information for people to know when they are weighing a ketogenic diet versus other diets or therapeutic options. But, that doesn’t mean that everyone need avoid ketogenic diets. It’s a question of weighing the pros and cons for each individual. And certainly some of the above adverse reactions can be prevented with careful choice of foods and/or targeted supplementation (such as nutrient deficiency). And it’s important to emphasize that the above list of adverse events also points to a long list of tests that can be performed regularly by a supervising health professional to monitor for any potential detriment in the event that there are compelling reasons to undertake a ketogenic diet.
When you read reports expounding on the benefits of a ketogenic diet, purporting that there is no risk involved or at least no risk for most of us, the origin of this dogma is either a selective reading of the science (which may be unintentional—I’m not a conspiracy theorist) or a bias-motivated dismissal of any scientific studies to the contrary of this narrative. For example, I’ve heard these adverse reactions described as “minor” and “transient” or attributable in some way to “people doing keto wrong”, statements that are not actually substantiated by the scientific literature (although, those might be fair appraisals of side effects from short-term studies). As a second example, I’ve heard declarations that the long-term ketogenic diet studies in children with refractory epilepsy are irrelevant since these children are not robust, heathy kids and many of them (although certainly not all) are simultaneously taking anticonvulsant drugs while following a ketogenic diet to mitigate severe, frequent seizures. Because the overwhelming majority of the long-term ketogenic diet studies have thus far been performed in the context of epilepsy, this is the field of research that has most thoroughly reported adverse reactions. Certainly, these kids belong to a more sensitive population (why documented deaths as a result of adverse reactions to a ketogenic diet have occurred almost exclusively in epileptic children), but that doesn’t mean that these reports don’t provide extremely useful information, or a warning worth heeding (another double negative!). After all, it’s not typically the robust healthy person who experiments with ketogenic diets to improve their health—and while death is probably very unlikely, the potential harm to other body systems (cardiovascular, immune, endocrine, digestive) remains.