Table 1.
Side effects observed in ketogenic diets in different trials (table adapted from Acharya et al. 2021 with permission from author [59]).
| Author | Different Types of Ketogenic Diet * | Side Effects/ Complication of Ketogenic Diet besides Renal Stones |
|---|---|---|
| Holler A et al. [118] | Classical KD and MAD | Constipation, increased bromine level (3.2%) |
| Attar H et al. [119] | MAD | NR |
| Felix et al. [120] | MAD | Weight loss, hyperlipidemia |
| Mak et al. [121] | KD – Protein + carb (<19%) of caloric requirementsMCT 60–70% of caloric requirements | Weight loss (46%), diarrhea (38%), bad temper (7.6%), abdominal cramps (15%), nausea (15%), bad body smell (7.6%) |
| Rios et al. [122] | KD 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. [123] | Classical KD 3:1 or 4:1 | Vomiting (75%), asymptomatic hypocalcemia, constipation (75%), weight loss, hypoalbuminemia |
| Kang et al. [30] | Classical KD 4:1 | Dehydration, GI discomfort, hyperlipidemia, hyperuricemia, symptomatic hypoglycemia, lipoid aspiration pneumonia, hypoproteinemia, hypomagnesemia, repeated hyponatremia |
| Wibisono et al. [124] | Classical KD, MCT, MAD | Constipation, hypertriglyceridemia, hypercholesterolemia, diarrhea, lethargy, iron deficiency, GERD, vomiting, hypoglycemia |
| Simm et al. [77] | KD 2:1 to 4:1 | Osteopenia, fracture |
| Guzel et al. [125] | KD 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. [40] | Classic 4:1 KD or MCT diet | Constipation (85%), gall bladder stone (1.9%), hyponatremia (1.9%) |
| Takeoka et al. [126] | KD not specified | Nausea/vomiting (7%), irritability (7%), lethargy (21%), sedation (14%) |
| Kossoff et al. [56] | KD 3:1 to 4:1 | NR |
| Kossoff et al. [127] | KD 3:1 to 4:1 | Sedation (27%), rash, irritability |
| Kossoff et al. [128] | KD 3:1 to 4:1 | Severe GERD (13%), hip dislocation (0.4%) |
| Kang et al. [129] | Dehydration, GI discomfort, hyperlipidemia, hyperuricemia, hypoglycemia | |
| Mackay et al. [130] | 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. [131] | 60.7% on classical KD7% MAD, 32% other KD | Fractures (21.4%), hyperlipidemia (7%), constipation (53%) |
| Sampath et al. [57] | KGD 3:1 (56%) or 4:1 | NR |
| Caraballo et al. [132] | KD | 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. [61] | KD 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. [133] | KD 3:1 or 4:1 ratio | Hyperlipidemia (6%), bone fractures (0.9%) |
| Lim et al. [134] | 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. [60] | KGD unspecified | NR |
| Park et al. [135] | KD 4:1 (87.5%), KD 3:1 (12.5%) | Regurgitation, constipation, aspiration, hypertriglyceridemia, hypoproteinemia, nausea, vomiting |
| Draaisma et al. [136] | Classic KD (67.6%), MCT diet (2.9%)MAD (19.1%), LGID (7.4%), others (1.5%) | Decrease in BMD 0.22 Z-score/year |
| Roehl et al. [137] | Modified ketogenic diet−15 gm carb vs 50 gm carb diet | Constipation 9% |
| Lambrechts et al. [138] | KD | GI side effects (30%) |
* KD: Ketogenic Diet, MAD: Modified Atkins Diet, MCT: Medium Chain Triglyceride Diet, LGID: Low Glycemic Index Diet.