People With a History of Eating Disorders Going on a strict diet that eliminates food groups could trigger a relapse if you have a personal history of having an eating disorder. And while there’s a growing popularity in treating binge eating disorder (BED) with keto, experts strongly advise against it. Treatment of BED requires regular, adequate food intake without restriction, says Sumner Brooks, MPH, RDN, a certified eating disorder dietitian in Portland, Oregon.
Before starting, ask yourself what is really realistic for you, Mattinson suggests. Then get your doctor’s okay. You may also work with a local registered dietitian nutritionist to limit potential nutrient deficiencies and talk about vitamin supplementation, as you won’t be eating whole grains, dairy, or fruit, and will eliminate many veggies. “A diet that eliminates entire food groups is a red flag to me. This isn’t something to take lightly or dive into headfirst with no medical supervision,” she says.
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The ketogenic diet is not a benign, holistic, or natural treatment for epilepsy; as with any serious medical therapy, complications may result. These are generally less severe and less frequent than with anticonvulsant medication or surgery. Common but easily treatable short-term side effects include constipation, low-grade acidosis, and hypoglycaemia if an initial fast is undertaken. Raised levels of lipids in the blood affect up to 60% of children and cholesterol levels may increase by around 30%. This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and if persistent, by lowering the ketogenic ratio. Supplements are necessary to counter the dietary deficiency of many micronutrients.
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Keatley has some…thoughts about those. “Dirty keto is a waste of your time since good habits have not been developed and it is simply too easy to fall back into a high-calorie diet,” he says. If you’re trying to do a lazy keto diet, he recommends following the USDA’s MyPlate instead and monitoring your meals based on proportions vs. macros. “It’s easier, more flexible, and has shown, when combined with moderate exercise, to be effective over the long term,” he says.
Metabolic Syndrome Limited research, including a study published in November 2017 in the journal Diabetes & Metabolic Syndrome: Clinical Research & Reviews, has suggested that adults with metabolic disease following keto shed more weight and body fat compared with those on a standard American diet, which is heavy in processed food and added sugars. (6)
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About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether. Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure-free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.
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Other potential risks include kidney stones, several vitamin and mineral deficiencies, decreased bone mineral density, and gastrointestinal distress. (7) Here’s why: When you’re eliminating certain food groups (like fruits, legumes, and whole grains) and severely limiting others (like many vegetables), it’s not uncommon to experience nutritional deficiencies. A lack of fiber, for instance, can make it more likely you’ll experience constipation.
Considering these risks, people who have kidney damage (including those with type 2 diabetes), plus individuals with or at risk for heart disease, and pregnant or breastfeeding women, shouldn’t try the keto diet. Also, people with type 1 diabetes shouldn’t follow the plan because of the risk for hypoglycemia (low blood sugar), and anyone who has had their gallbladder removed should avoid it because the diet is so high in fat.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.