Contraindications and adverse effects

(J. Klepper, Aschaffenburg; updated01.2007)

The ketogenic diet must not be used in defects of fatty acid oxidation nor in defectsof ketone body production or ketolysis. These diseases are rare but need to be excluded before starting the ketogenic diet to avoid severe hypoglycemia andmetabolic decompensation in the fasting situation.

An acylcarnitine profile in blood and an organic acid profile in urine should be determined, but do not generally rule out these diseases. For this reason children should be admitted for the initial fast. A further contraindication is pyruvate carboxylase deficiency. Of note, expected non-compliance of patients and/or caretakers also is a contraindication to the ketogenic diet. Glycogen storage diseases are discussed controversially.

Potential side effects associated with the ketogenic diet are change in bowel habits, renal stones, and potentially hyperlipidemia. Because patients on the ketogenic diet are in a chronic acidotic state, bone-demineralization is a risk and supplements need to be strictly adhered to. Sporadic complications of the ketogenic diet have been reported in single patients.