Ketogenic Diet and Nutrient Deficiencies: Should We Be Concerned


The ketogenic diet involves dramatically restricting carbohydrates, usually to below 50 grams per day while also increasing dietary fat intake. This is necessary to achieve the primary purpose of this diet – nutritional ketosis. But as is always the case with extreme and restrictive diets, nutrient deficiencies become a major concern.


Is there any evidence that carb restriction paired with higher fat and moderate protein intake can cause health problems associated with malnourishment? Or has the safety of ketogenic diets been long ago evaluated when it comes to nutritional deficiencies?


Initial Use of the Diet

The ketogenic diet is based on the ancient use of fasting as a treatment for childhood epilepsy. Fasting stimulates ketone production and ketones reduce seizure frequency. But prolonged fasting is not a sustainable treatment for any disease, let alone epilepsy in the developing human.


Luckily, in 1921 Dr. Rollin Woodyatt observed that the ketone bodies, acetone and beta-hydroxybutyric acid, rise in healthy patients both during starvation and a diet low in carbohydrate and high in fat. Soon enough, dr. Wilder at the Mayo Clinic proposed that the epilepsy-controlling benefits of fasting could be achieved by following Dr. Woodyatt's formula.


Once the diet was being implemented in clinics, doctors closely monitored their patients both for progress and nutrient deficiencies. Because the diet was practiced in a clinical setting and with a disease-reduction goal, nutrient deficiencies were not a major concern.


Experts Weigh In on Today's Use of the Diet

Nowadays, however, the ketogenic diet has reached the mainstream thanks to its potential to enhance weight loss and well-being. Dieters are following popular guidelines on health blogs and creating their personalized keto shopping list and meal plans based on this.


With more laymen following the ketogenic diet, widespread use of it is raising concern among physicians. But according to Antonio Paoli, Associate Professor at the Department of Biomedical Sciences, University of Padova: "Many of the concerns about the use of ketogenic diet as therapeutic tools could be attributed to a broad lack of knowledge about the physiological mechanisms involved."


According to Dr. Alan Barclay, Accredited Practicing Dietitian and Research Associate at The University of Sydney: "Following a ketogenic diet can be safe in the short-medium term if carefully planned and if the advice of a health professional is sought." Still, Dr. Barclay warns about the use of the diet as a long-term strategy.


What Does the Research Say?

According to a review published in a 2017 issue of the Journal of Postgraduate Medicine, when using the ketogenic diet as therapy for epilepsy or endocrine disorders, multivitamin and multimineral supplements should be administered in order to prevent nutrient deficiencies.


The same review cites studies showing that calcium, vitamin D, selenium, magnesium, zinc, and phosphorus are nutrients commonly deficient on this diet. However, these studies did not find a causal link between the ketogenic diet and deficiencies in these nutrients.


A study from Epilepsy Currents noted late-onset complications in children following the ketogenic diet after more than 4 weeks on the diet. These complications include osteopenia, renal stones, and heart problems, which could both indicate calcium and potassium deficiency along with deficiencies and iron leading to iron-deficiency anemia.


The same study noted that these complications were transient and easy to manage with careful follow-up and conservative strategies. What this means is that mistakes can, and do, happen when making dietary changes but that problems are easy to mitigate even with diets as restrictive as this one.


Bottom Line

There is no conclusive evidence showing that ketogenic or other low-carbohydrate diets cause nutrient deficiencies. This diet is deficient in carbohydrates, which are not an essential nutrient. When well-planned, a higher intake of fatty meats, fish, eggs, and plant foods relatively low in carbohydrates should provide essential and non-essential nutrients.


Paired with multimineral and multivitamin supplements, the keto diet can be a safe strategy to manage conditions like epilepsy, obesity, and other metabolic and endocrine conditions. But because careful monitoring is necessary to ensure dieters are not depriving themselves of key nutrients, its best to have regular check-ups with a health-care professional or follow the diet only in a clinical setting.


Article last time updated on 18.09.2018.

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