Table 2.
Definitions and reported adverse effects observed in ketogenic diets in different studies.
| Author | Different Types of Ketogenic Diet |
Side Effects/Complication of Ketogenic Diet besides Renal Stones |
|---|---|---|
| Holler A. et al. [36] | Classical KGD and MAD | Constipation, increased bromine level (3.2%) |
| Rener et al. [37] | KGD 2.5:1 to 4:1 | Vomiting |
| Attar H. et al. [38] | MAD | NR |
| Felix et al. [39] | MAD | Weight loss, hyperlipidemia |
| Lapp et al. [40] | KGD, MAD | Gallstones (3.8%), hyperlipidemia (3.8%) |
| Nerurkar et al. [41] | KGD not specified | Constipation (57%) |
| Nangia et al. [42] | KGD 3:1 to 4:1 | Constipation (39%), acidosis (21%), nausea/emesis (14%), increased seizures (7%). |
| Gainza et al. [43] | KGD not specified | Osteopenia (38.1%), severe metabolic acidosis (9.5%), recurrent pneumonia (21.4%), neutropenia (0.5%), fatty liver (0.1%), easy bruising (4.8%) |
| Mak et al. [44] | KGD—Protein + carb (<19%) of caloric requirements MCT 60–70% of caloric requirements |
Weight loss (46%), diarrhea (38%), bad temper (7.6%), abdominal cramps (15%), nausea (15%), bad body smell (7.6%) |
| Furth et al. [45] | NR | |
| Rios et al. [46] | KGD 4:1 (1.5:1 to 4.5:1) | Nausea and vomiting (26.3%), hypercholesterolemia (64.7%), anorexia (31.8%), constipation (40.9%), symptomatic acidosis (9.09%), carnitine deficiency (9.09%) |
| Sharma et al. [47] | Classical KGD 3:1 or 4:1 | Vomiting (75%), asymptomatic hypocalcemia, Constipation (75%), weight loss, hypoalbuminemia |
| Kang et al. [48] | Classical KGD 4:1 | Dehydration, GI discomfort, hyperlipidemia, hyperuricemia, symptomatic hypoglycemia, lipoid aspiration pneumonia, hypoproteinemia, hypomagnesemia, repeated hyponatremia |
| Wibisono et al. [49] | Classical KGD, MCT, MAD | Constipation, hypertriglyceridemia, hypercholesterolemia, diarrhea, lethargy, iron deficiency, GERD, vomiting, hypoglycemia |
| Simm et al. [50] | KGD 2:1 to 4:1 | Osteopenia, fracture |
| Guzel et al. [51] | KGD 2.5:1 and 4:1 | Hyperlipidemia (50.8%), selenium deficiency (26.9%), constipation (26.2%), sleep disturbances (20%), hyperuricemia (3%), hepatic effects (2.6%), hypoproteinemia (2.6%), hypoglycemia(1.5%) |
| Hassan et al. [52] | Classic 4:1 KGD or MCT diet | Constipation (85%), gall bladder stone (1.9%), hyponatremia (1.9%) |
| Takeoka et al. [53] | KGD not specified | Nausea/vomiting (7%), irritability (7%), lethargy (21%), sedation (14%) |
| Kossoff et al. [54] | KGD 3:1 to 4:1 | NR |
| Kossoff et al. [55] | KGD 3:1 to 4:1 | Sedation (27%), rash, irritability |
| Kossoff et al. [56] | KGD 3:1 to 4:1 | Severe GERD (13%), hip dislocation (0.4%) |
| Kang et al. [57] | Dehydration, GI discomfort, hyperlipidemia, hyperuricemia, hypoglycemia | |
| Mackay et al. [58] | Classical KGD 3:1 to 4.2:1 | Asymptomatic hypoglycemia (24%), poor linear growth (20%), hyperlipidemia (16%), vomiting (12%), hypocarnitinemia (8%), hypercalciuria (8%), constipation (8%), osteopenia (4%), pancreatitis (4%), Diarrhea (4%) |
| Groesbeck et al. [59] | 60.7% on classical KDT 7% MAD, 32% other KGD |
Fractures (21.4%), hyperlipidemia (7%), constipation (53%) |
| Sampath et al. [60] | KGD 3:1 (56%) or 4:1 | NR |
| Raimann et al. [61] | KGD 4:1 (3 pts 3.5:1 2 pts 3:1) | Hypercholesterolemia 64% (at 12 months) 15% (at 18 months), growth retardation |
| Caraballo et al. [62] | KGD | GI side effects (30.5%), hyperlipidemia (9.7%), weight gain (2.3%), hypocarnitinemia (3.7%), hypercalciuria (6.9%), hypoglycemia (5.5%), dehydration (6.4%) |
| Dressler et al. [63] | KGD 3:1, 4:1 or 2.5:1 | Carnitine deficiency (13%), growth deficit (5.2%), weight gain (1.7%), hypertriglyceridemia (29.5%), hypercholesterolemia (10.4%) |
| Hallbook et al. [64] | KGD 3:1 or 4:1 ratio | Hyperlipidemia (6%), bone fractures (0.9%) |
| Khoo et al. [65] | Classical KGD (81.2%), MAD (18.75%) | Constipation (43%), hunger (23%), excessive weight gain or loss (20%), vomiting (10%), hyperuricemia (30%), hypocalcemia (20%) |
| Lim et al. [66] | NR | GI side effects (nausea, vomiting, and constipation), Inadequate weight gain or significant weight loss, ketoacidosis, hepatotoxicity, renal dysfunction, sinus tachycardia, osteoporosis |
| McNally et al. [67] | KGD unspecified | NR |
| Park et al. [68] | KGD 4:1 (87.5%), KGD 3:1 (12.5%) | Regurgitation, constipation, aspiration, hypertriglyceridemia, hypoproteinemia, nausea, vomiting |
| Draaisma et al. [69] | Classic KGD (67.6%), MCT diet (2.9%) MAD (19.1%), LGID (7.4%), others (1.5%) |
Decrease in BMD 0.22 Z-score/year |
| Roehhl et al. [70] | Modified ketogenic diet 15 gm carb vs. 50 gm carb diet |
Constipation (9%) |
| Lambrechts et al. [71] | KGD | GI side effects (30%) |
Abbreviations: KGD—ketogenic diet; MAD—modified Atkins diet; MCT—medium chain triglyceride diet; NR—non-report; LGID—low glycemic index diet.