Ketogenic diets and chronic disease: weighing the benefits against the risks
Open accessAbstract
Very-low-carbohydrate ketogenic diets have been long been used to reduce seizure frequency and more recently have been promoted for a variety of health conditions, including obesity, diabetes, and liver disease. Ketogenic diets may provide short-term improvement and aid in symptom management for some chronic diseases. Such diets affect diet quality, typically increasing intake of foods linked to chronic disease risk and decreasing intake of foods found to be protective in epidemiological studies. This review examines the effects of ketogenic diets on common chronic diseases, as well as their impact on diet quality and possible risks associated with their use. Given often-temporary improvements, unfavorable effects on dietary intake, and inadequate data demonstrating long-term safety, for most individuals, the risks of ketogenic diets may outweigh the benefits.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
There is currently insufficient evidence on the efficacy or safety of very low carbohydrate ketogenic diets in individuals with MASLD.
“There is currently insuf fi cient evidence on the ef fi cacy or safety of very low carbohydrate ketogenic diets -characterised by extreme carbohydrate restriction to < 20-50 g/day (10-25% of total calories) and high fat and protein contents -in individuals with MASLD, 291 taking into consideration potential cardiovascular, kidney and other side effects. 292”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [292]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Younossi, Z. M., Koenig, A. B., Abdelatif, D., Fazel, Y., Henry, L., & Wymer, M. (2016) · Hepatology · doi:10.1002/hep.28431 · Cited by 10,781 · see citing works
The Warburg Effect: How Does it Benefit Cancer Cells?
Liberti, M. V., & Locasale, J. W. (2016) · Trends in Biochemical Sciences · doi:10.1016/j.tibs.2015.12.001 · Cited by 5,150 · see citing works
Alzheimer disease in the United States (2010–2050) estimated using the 2010 census
Hebert, L. E., Weuve, J., Scherr, P. A., & Evans, D. A. (2013) · Neurology · doi:10.1212/wnl.0b013e31828726f5 · Cited by 2,642 · see citing works
Aune, D., Giovannucci, E., Boffetta, P., Fadnes, L. T., Keum, N., Norat, T., Greenwood, D. C., Riboli, E., Vatten, L. J., & Tonstad, S. (2017) · International Journal of Epidemiology · doi:10.1093/ije/dyw319 · Cited by 2,419 · see citing works
Health Benefits of Fruits and Vegetables
Slavin, J. L., & Lloyd, B. B. (2012) · Advances in Nutrition · doi:10.3945/an.112.002154 · Cited by 2,140 · see citing works
Prevalence and incidence of epilepsy
Fiest, K. M., Sauro, K. M., Wiebe, S., Patten, S. B., Kwon, C., Dykeman, J., Pringsheim, T. M., Lorenzetti, D., & Jetté, N. (2016) · Neurology · doi:10.1212/wnl.0000000000003509 · Cited by 1,916 · see citing works
Carcinogenicity of consumption of red and processed meat
Bouvard, V., LOOMIS, D. P., Guyton, K. Z., Grosse, Y., Ghissassi, F. E., Benbrahim‐Tallaa, L., Guha, N., Mattock, H., & Straíf, K. (2015) · The Lancet Oncology · doi:10.1016/s1470-2045(15)00444-1 · Cited by 1,887 · see citing works
Dietary fiber and prebiotics and the gastrointestinal microbiota
Holscher, H. D. (2017) · Gut Microbes · doi:10.1080/19490976.2017.1290756 · Cited by 1,808 · see citing works
A Randomized Trial of a Low-Carbohydrate Diet for Obesity
Foster, G. D., Wyatt, H. R., Hill, J. O., McGuckin, B. G., Brill, C., Mohammed, B. S., Szapary, P. O., Rader, D. J., Edman, J. S., & Klein, S. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022207 · Cited by 1,794 · see citing works
Dansinger, M. L., Gleason, J. A., Griffith, J. L., Selker, H. P., & Schaefer, E. J. (2005) · JAMA · doi:10.1001/jama.293.1.43 · Cited by 1,726 · see citing works
Treatment of NAFLD with diet, physical activity and exercise
Romero-Gómez, M., Zelber-Sagi, S., & Trenell, M. (2017) · Journal of Hepatology · doi:10.1016/j.jhep.2017.05.016 · Cited by 1,347 · see citing works
Health-promoting components of fruits and vegetables in the diet.
Liu, R. H. (2013) · Advances in Nutrition · doi:10.3945/an.112.003517 · Cited by 1,310 · see citing works
MIND diet associated with reduced incidence of Alzheimer's disease
Morris, M. C., Tangney, C. C., Wang, Y., Sacks, F. M., Bennett, D. A., & Aggarwal, N. T. (2015) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2014.11.009 · Cited by 1,162 · see citing works
Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis
Dattilo, A., & Kris-Etherton, P. (1992) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/56.2.320 · Cited by 1,055 · see citing works
Gardner, C. D., Kiazand, A., Alhassan, S., Kim, S., Stafford, R. S., Balise, R. R., Kraemer, H. C., & King, A. C. (2007) · JAMA · doi:10.1001/jama.297.9.969 · Cited by 1,051 · see citing works
Yancy, W. S., Olsen, M. K., Guyton, J. R., Bakst, R. P., & Westman, E. C. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-10-200405180-00006 · Cited by 946 · see citing works
β-Hydroxybutyrate: A Signaling Metabolite
Newman, J. C., & Verdin, E. (2017) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-071816-064916 · Cited by 872 · see citing works
Stern, L., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, M., Gracely, E. J., & Samaha, F. F. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-10-200405180-00007 · Cited by 831 · see citing works
Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013) · British Journal of Nutrition · doi:10.1017/s0007114513000548 · Cited by 778 · see citing works
Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses
Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018) · PLOS ONE · doi:10.1371/journal.pone.0194127 · Cited by 713 · see citing works
Nutritional Management of Chronic Kidney Disease
Kalantar-Zadeh, K., & Fouque, D. (2017) · New England Journal of Medicine · doi:10.1056/nejmra1700312 · Cited by 636 · see citing works
Stem, L., Iqbal, N., Seshadri, P., & Chicano, K. L. (2004) · ACC Current Journal Review · doi:10.1016/j.accreview.2004.07.103 · Cited by 629 · see citing works
Dietary Fats and the Risk of Incident Alzheimer Disease
Morris, M. C., Evans, D. A., Bienias, J. L., Tangney, C., Bennett, D. A., Aggarwal, N. T., Schneider, J. S., & Wilson, R. S. (2003) · Archives of Neurology · doi:10.1001/archneur.60.2.194 · Cited by 530 · see citing works
Jannasch, F., Kröger, J., & Schulze, M. B. (2017) · Journal of Nutrition · doi:10.3945/jn.116.242552 · Cited by 503 · see citing works
Briel, M., Ferreira-Gonzalez, I., You, J. J., Karanicolas, P. J., Akl, E. A., Wu, P., Blechacz, B., Bassler, D., Wei, X., Sharman, A., et al. (2009) · BMJ · doi:10.1136/bmj.b92 · Cited by 491 · see citing works
Mora, S., Otvos, J. D., Rifai, N., Rosenson, R. S., Buring, J. E., & Ridker, P. M. (2009) · Circulation · doi:10.1161/circulationaha.108.816181 · Cited by 490 · see citing works
Westman, E. C., Yancy, W. S., Mavropoulos, J. C., Marquart, M., & McDuffie, J. R. (2008) · Nutrition & Metabolism · doi:10.1186/1743-7075-5-36 · Cited by 475 · see citing works
Ketogenic diets for drug-resistant epilepsy
Martin-McGill, K. J., Bresnahan, R., Levy, R. G., & Cooper, P. N. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001903.pub5 · Cited by 452 · see citing works
Dietary fat and carbohydrates differentially alter insulin sensitivity during caloric restriction
Kirk, E., Reeds, D. N., Finck, B. N., Mayurranjan, M. S., Patterson, B. W., & Klein, S. (2009) · Gastroenterology · doi:10.1053/j.gastro.2009.01.048 · Cited by 440 · see citing works
Goldenberg, J. Z., Day, A., Brinkworth, G. D., Sato, J., Yamada, S., Jönsson, T., Beardsley, J., Johnson, J. A., Thabane, L., & Johnston, B. C. (2021) · BMJ · doi:10.1136/bmj.m4743 · Cited by 428 · see citing works
Freedman, M. R., King, J., & Kennedy, E. (2001) · Obesity Research · doi:10.1038/oby.2001.113 · Cited by 421 · see citing works
Hallberg, S. J., McKenzie, A. L., Williams, P. T., Bhanpuri, N. H., Peters, A. L., Campbell, W. W., Hazbun, T. L., Volk, B. M., McCarter, J. P., Phinney, S. D., et al. (2018) · Diabetes Therapy · doi:10.1007/s13300-018-0373-9 · Cited by 406 · see citing works
Early‐ and Late‐onset Complications of the Ketogenic Diet for Intractable Epilepsy
Kang, H., Chung, D. E., Kim, D. W., & Kim, H. D. (2004) · Epilepsia · doi:10.1111/j.0013-9580.2004.10004.x · Cited by 391 · see citing works
Kirkpatrick, C. F., Bolick, J. P., Kris-Etherton, P. M., Sikand, G., Aspry, K. E., Soffer, D. E., Willard, K.-E., & Maki, K. C. (2019) · Journal of Clinical Lipidology · doi:10.1016/j.jacl.2019.08.003 · Cited by 390 · see citing works
Dietary fat content modifies liver fat in overweight nondiabetic subjects
Westerbacka, J., Lammi, K., Häkkinen, A.-M., Rissanen, A., Salminen, I., Aro, A., & Yki-Järvinen, H. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1983 · Cited by 379 · see citing works
Ketogenic Diet and Epilepsy: What We Know So Far
Meira, I. D., Romão, T. T., do Prado, H. J. P., Krüger, L. T., Pires, M. E. P., & da Conceição, P. O. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.00005 · Cited by 369 · see citing works
Do ketogenic diets really suppress appetite? A systematic review and meta‐analysis
Gibson, A. A., Seimon, R. V., Lee, C. M. Y., Ayre, J., Franklin, J., Markovic, T. P., Caterson, I. D., & Sainsbury, A. (2015) · Obesity Reviews · doi:10.1111/obr.12230 · Cited by 366 · see citing works
Qian, F., Liu, G., Hu, F. B., Bhupathiraju, S. N., & Sun, Q. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.2195 · Cited by 366 · see citing works
Dietary ketosis enhances memory in mild cognitive impairment
Krikorian, R., Shidler, M. D., Dangelo, K. N., Couch, S. C., Benoit, S. C., & Clegg, D. J. (2010) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2010.10.006 · Cited by 365 · see citing works
Low-carbohydrate nutrition and metabolism.
Westman, E., Feinman, R., Mavropoulos, J. C., Vernon, M. C., Volek, J., Wortman, J. A., Yancy, W., & Phinney, S. (2007) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/86.2.276 · Cited by 363 · see citing works
Martinez‐Outschoorn, U., di Prisco, M., Ertel, A., Tsirigos, A., Lin, Z., Pavlides, S., Wang, C., Flomenberg, N., Knudsen, E. S., Howell, A., et al. (2011) · Cell Cycle · doi:10.4161/cc.10.8.15330 · Cited by 339 · see citing works
Hall, K. D., Chen, K. Y., Guo, J., Lam, Y. Y., Leibel, R. L., Mayer, L. E., Reitman, M. L., Rosenbaum, M., Smith, S. R., Walsh, B. T., et al. (2016) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.116.133561 · Cited by 330 · see citing works
Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes
Hussain, T. A., Mathew, T. C., Dashti, A. A., Asfar, S., Al-Zaid, N., & Dashti, H. M. (2012) · Nutrition · doi:10.1016/j.nut.2012.01.016 · Cited by 329 · see citing works
Athinarayanan, S. J., Adams, R. N., Hallberg, S. J., McKenzie, A. L., Bhanpuri, N. H., Campbell, W. W., Volek, J. S., Phinney, S. D., & McCarter, J. P. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00348 · Cited by 324 · see citing works
Lindefeldt, M., Eng, A., Darban, H., Bjerkner, A., Zetterström, C. K., Allander, T., Andersson, B., Borenstein, E., Dahlin, M., & Prast-Nielsen, S. (2019) · npj Biofilms and Microbiomes · doi:10.1038/s41522-018-0073-2 · Cited by 310 · see citing works
Haufe, S., Engeli, S., Kast, P., Böhnke, J., Utz, W., Haas, V., Hermsdorf, M., Mähler, A., Wiesner, S., Birkenfeld, A. L., et al. (2011) · Hepatology · doi:10.1002/hep.24242 · Cited by 307 · see citing works
Role of ketogenic diets in neurodegenerative diseases (Alzheimer's disease and Parkinson's disease)
Włodarek, D. (2019) · Nutrients · doi:10.3390/nu11010169 · Cited by 301 · see citing works
Marchesini, G., Petta, S., & Grave, R. D. (2015) · Hepatology · doi:10.1002/hep.28392 · Cited by 291 · see citing works
Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer's disease
Taylor, M., Sullivan, D. K., Mahnken, J. D., Burns, J. M., & Swerdlow, R. H. (2017) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1016/j.trci.2017.11.002 · Cited by 273 · see citing works
A low-carbohydrate, ketogenic diet to treat type 2 diabetes
Yancy, W. S., Foy, M. E., Chalecki, A. M., Vernon, M. C., & Westman, E. C. (2005) · Nutrition & Metabolism · doi:10.1186/1743-7075-2-34 · Cited by 270 · see citing works
Saslow, L. R., Mason, A. E., Kim, S., Goldman, V., Ploutz-Snyder, R., Bayandorian, H., Daubenmier, J., Hecht, F. M., & Moskowitz, J. T. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.5806 · Cited by 265 · see citing works
Ketogenic Diet and Microbiota: Friends or Enemies?
Paoli, A., Mancin, L., Bianco, A., Thomas, E., Mota, J. F., & Piccini, F. (2019) · Genes · doi:10.3390/genes10070534 · Cited by 265 · see citing works
Goday, A., Bellido, D., Sajoux, I., Crujeiras, A. B., Burguera, B., García-Luna, P. P., Oleaga, A., Moreno, B., & Casanueva, F. F. (2016) · Nutrition & Diabetes · doi:10.1038/nutd.2016.36 · Cited by 258 · see citing works
Haring, B., Selvin, E., Liang, M., Coresh, J., Grams, M. E., Petruski-Ivleva, N., Steffen, L. M., & Rebholz, C. M. (2017) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2016.11.004 · Cited by 254 · see citing works
Effect of 6-month adherence to a very low carbohydrate diet program
Westman, E. C., Yancy, W. S., Edman, J. S., Tomlin, K. F., & Perkins, C. E. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(02)01129-4 · Cited by 253 · see citing works
Yuan, X., Wang, J., Yang, S., Gao, M., Cao, L., Li, X., Hong, D., Tian, S., & Sun, C. (2020) · Nutrition & Diabetes · doi:10.1038/s41387-020-00142-z · Cited by 240 · see citing works
Hall, K. D., Guo, J., Courville, A. B., Boring, J., Brychta, R., Chen, K. Y., Darcey, V., Forde, C. G., Gharib, A. M., Gallagher, I., et al. (2021) · Nature Medicine · doi:10.1038/s41591-020-01209-1 · Cited by 238 · see citing works
Overweight and diabetes prevention: Is a low-carbohydrate-high-fat diet recommendable?
Brouns, F. (2018) · European Journal of Nutrition · doi:10.1007/s00394-018-1636-y · Cited by 235 · see citing works
Noto, H., Goto, A., Tsujimoto, T., & Noda, M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0055030 · Cited by 233 · see citing works
Red meat intake and risk of ESRD
Lew, Q.-L. J., Jafar, T. H., Koh, H. W. L., Jin, A., Chow, K. Y., Yuan, J.-M., & Koh, W.-P. (2017) · Journal of the American Society of Nephrology · doi:10.1681/asn.2016030248 · Cited by 222 · see citing works
Meng, Y., Bai, H., Wang, S., Li, Z., Wang, Q., & Chen, L. (2017) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2017.07.006 · Cited by 221 · see citing works
Impact of Nutritional Changes on Nonalcoholic Fatty Liver Disease
Perdomo, C. M., Frühbeck, G., & Escalada, J. (2019) · Nutrients · doi:10.3390/nu11030677 · Cited by 217 · see citing works
Associations of Diet with Albuminuria and Kidney Function Decline
Lin, J., Hu, F. B., & Curhan, G. C. (2010) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.08001109 · Cited by 216 · see citing works
High Dietary Acid Load Predicts ESRD among Adults with CKD
Banerjee, T., Crews, D. C., Wesson, D. E., Tilea, A. M., Saran, R., Burrows, N. R., Williams, D. E., & Powe, N. R. (2015) · Journal of the American Society of Nephrology · doi:10.1681/asn.2014040332 · Cited by 211 · see citing works
Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies
Kosinski, C., & Jornayvaz, F. R. (2017) · Nutrients · doi:10.3390/nu9050517 · Cited by 210 · see citing works
Ketogenic diets for drug-resistant epilepsy
Martin-McGill, K. J., Jackson, C. F., Bresnahan, R., Levy, R. G., & Cooper, P. N. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001903.pub4 · Cited by 210 · see citing works
Low-carbohydrate-diet score and risk of type 2 diabetes in women
Halton, T. L., Liu, S., Manson, J. E., & Hu, F. B. (2008) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.2.339 · Cited by 200 · see citing works
Diet-microbiota interactions and their implications for healthy living
Jeffery, I., & O'Toole, P. (2013) · Nutrients · doi:10.3390/nu5010234 · Cited by 199 · see citing works
Hyperketonemia and ketosis increase the risk of complications in type 1 diabetes
Marie, P. K., & Jain, S. K. (2016) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2016.03.020 · Cited by 199 · see citing works
Association of Low-Carbohydrate and Low-Fat Diets with Mortality Among US Adults
Shan, Z., Guo, Y., Hu, F. B., Liu, L., & Qi, Q. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.6980 · Cited by 192 · see citing works
Chawla, S., Tessarolo Silva, F., Amaral Medeiros, S., Mekary, R., & Radenkovic, D. (2020) · Nutrients · doi:10.3390/nu12123774 · Cited by 185 · see citing works
Ore, A., & Akinloye, O. A. (2019) · Medicina · doi:10.3390/medicina55020026 · Cited by 180 · see citing works
Risk factors for urolithiasis in children on the ketogenic diet
Furth, S. L., Casey, J. C., Pyzik, P. L., Neu, A. M., Docimo, S. G., Vining, E. P. G., Freeman, J. M., & Fivush, B. A. (2000) · Pediatric Nephrology · doi:10.1007/s004670000443 · Cited by 179 · see citing works
McKenzie, A. L., Hallberg, S. J., Creighton, B. C., Volk, B. M., Link, T. M., Abner, M. K., Glon, R. M., McCarter, J. P., Volek, J. S., & Phinney, S. D. (2017) · JMIR Diabetes · doi:10.2196/diabetes.6981 · Cited by 176 · see citing works
Beneficial effects of ketogenic diet in obese diabetic subjects
Dashti, H. M., Mathew, T. C., Khadada, M., Al-Mousawi, M., Talib, H., Asfar, S., Behbahani, A. I., & Al-Zaid, N. S. (2007) · Molecular and Cellular Biochemistry · doi:10.1007/s11010-007-9448-z · Cited by 172 · see citing works
Dietary fat content alters insulin-mediated glucose metabolism in healthy men
Bisschop, P. H. L. T., de Metz, J., Ackermans, M. T., Endert, E., Pijl, H., Kuipers, F., Meijer, A. J., Sauerwein, H. P., & Romijn, J. A. (2001) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/73.3.554 · Cited by 163 · see citing works
Long Term Effects of Ketogenic Diet in Obese Subjects with High Cholesterol Level
Dashti, H. M., Al-Zaid, N. S., Mathew, T. C., Al-Mousawi, M., Talib, H., Asfar, S., & Behbahani, A. I. (2006) · Molecular and Cellular Biochemistry · doi:10.1007/s11010-005-9001-x · Cited by 148 · see citing works
The ketogenic diet as a potential treatment and prevention strategy for Alzheimer's disease
Broom, G. M., Shaw, I. C., & Rucklidge, J. J. (2018) · Nutrition · doi:10.1016/j.nut.2018.10.003 · Cited by 148 · see citing works
Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study
Voight, B. F., Peloso, G. M., Orho-Melander, M., Frikke-Schmidt, R., Barbalic, M., Jensen, M. K., Hindy, G., Hólm, H., Ding, E. L., Johnson, T., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60312-2 · Cited by 148 · see citing works
Long-term effects of a ketogenic diet in obese patients.
Dashti, H. M., Mathew, T. C., Hussein, T., Asfar, S., Behbahani, A. I., Khoursheed, M., Al-Sayer, H. M., Bo-Abbas, Y. Y., & Al-Zaid, N. S. (2004) · PubMed Central · Cited by 143 · see citing works
Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study
Farvid, M. S., Cho, E., Chen, W. Y., Eliassen, A. H., & Willett, W. C. (2014) · BMJ · doi:10.1136/bmj.g3437 · Cited by 143 · see citing works
Daïen, C., Pinget, G. V., Tan, J. K., & Macia, L. (2017) · Frontiers in Immunology · doi:10.3389/fimmu.2017.00548 · Cited by 142 · see citing works
Empiric Use of Potassium Citrate Reduces Kidney-Stone Incidence With the Ketogenic Diet
McNally, M. A., Pyzik, P. L., Rubenstein, J. E., Hamdy, R. F., & Kossoff, E. H. (2009) · PEDIATRICS · doi:10.1542/peds.2009-0217 · Cited by 130 · see citing works
Alferink, L. J. M., Jong, J. C. K., Erler, N. S., Veldt, B. J., Schoufour, J. D., de Knegt, R. J., Ikram, M. A., Metselaar, H. J., Janssen, H. L. A., Franco, O. H., et al. (2018) · Gut · doi:10.1136/gutjnl-2017-315940 · Cited by 130 · see citing works
Bao, W., Bowers, K., Tobias, D. K., Olsen, S. F., Chavarro, J., Vaag, A., Kiely, M., & Zhang, C. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.082966 · Cited by 129 · see citing works
Low-carbohydrate diet scores and risk of type 2 diabetes in men
de Koning, L., Fung, T. T., Liao, X., Chiuve, S. E., Rimm, E. B., Willett, W. C., Spiegelman, D., & Hu, F. B. (2011) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.110.004333 · Cited by 128 · see citing works
Yan, B., Su, X., Xu, B., Qiao, X., & Wang, L. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206134 · Cited by 127 · see citing works
The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence
Joshi, S., Ostfeld, R. J., & McMacken, M. M. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.2633 · Cited by 125 · see citing works
Cole, T. G., Contois, J. H., Csako, G., McConnell, J. P., Remaley, A. T., Devaraj, S., Hoefner, D. M., Mallory, T., Sethi, A. A., & Warnick, G. R. (2013) · Clinical Chemistry · doi:10.1373/clinchem.2012.196733 · Cited by 122 · see citing works
Zhang, B., Zhao, Q., Guo, W., Bao, W., & Wang, X. (2017) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2017.149 · Cited by 122 · see citing works
Leow, Z. Z. X., Guelfi, K. J., Davis, E. A., Jones, T. W., & Fournier, P. A. (2018) · Diabetic Medicine · doi:10.1111/dme.13663 · Cited by 115 · see citing works
An Overview of the Ketogenic Diet for Pediatric Epilepsy
Zupec‐Kania, B., & Spellman, E. (2008) · Nutrition in Clinical Practice · doi:10.1177/0884533608326138 · Cited by 112 · see citing works
Eslamparast, T., Tandon, P., & Raman, M. (2017) · Nutrients · doi:10.3390/nu9080800 · Cited by 108 · see citing works
Kephart, W., Pledge, C., Roberson, P., Mumford, P., Romero, M., Mobley, C., Martin, J., Young, K., Lowery, R., Wilson, J., et al. (2018) · Sports · doi:10.3390/sports6010001 · Cited by 107 · see citing works
Glucose and Lipid Homeostasis and Inflammation in Humans Following an Isocaloric Ketogenic Diet
ROSENBAUM, M. S., Hall, K. D., Guo, J., Ravussin, É., Mayer, L. S., Reitman, M. L., Smith, S. R., Walsh, B. T., & Leibel, R. L. (2019) · Obesity · doi:10.1002/oby.22468 · Cited by 105 · see citing works
Low-carbohydrate ketogenic diets, glucose homeostasis, and nonalcoholic fatty liver disease
Schugar, R. C., & Crawford, P. A. (2012) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0b013e3283547157 · Cited by 102 · see citing works
Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet
Bostock, E. C. S., Kirkby, K. C., Taylor, B. V., & Hawrelak, J. A. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.00020 · Cited by 102 · see citing works
Adolescent meat intake and breast cancer risk
Farvid, M. S., Cho, E., Chen, W. Y., Eliassen, A. H., & Willett, W. C. (2014) · International Journal of Cancer · doi:10.1002/ijc.29218 · Cited by 93 · see citing works
A Prospective Study of Dietary Meat Intake and Risk of Incident Chronic Kidney Disease
Mirmiran, P., Yuzbashian, E., Aghayan, M., Mahdavi, M., Asghari, G., & Azizi, F. (2019) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2019.06.008 · Cited by 93 · see citing works
Roehl, K., & Sewak, S. L. (2017) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2017.06.006 · Cited by 92 · see citing works
Resistant Starch Content in Foods Commonly Consumed in the United States: A Narrative Review
Patterson, M. A., Maiya, M., & Stewart, M. (2020) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2019.10.019 · Cited by 92 · see citing works
Tracy, C. R., Best, S., Bagrodia, A., Poindexter, J. R., Adams-Huet, B., Sakhaee, K., Maalouf, N., Pak, C., & Pearle, M. (2014) · Journal of Urology · doi:10.1016/j.juro.2014.01.093 · Cited by 84 · see citing works
Pattern of polyphenol intake and the long-term risk of dementia in older persons
Lefèvre‐Arbogast, S., Gaudout, D., Bensalem, J., Letenneur, L., Dartigues, J., Hejblum, B. P., Féart, C., Delcourt, C., & Samieri, C. (2018) · Neurology · doi:10.1212/wnl.0000000000005607 · Cited by 80 · see citing works
Grant, W. B. (2016) · Journal of the American College of Nutrition · doi:10.1080/07315724.2016.1161566 · Cited by 79 · see citing works
A short-term ketogenic diet impairs markers of bone health in response to exercise
Heikura, I. A., Burke, L. M., Hawley, J. A., Ross, M. L., Garvican-Lewis, L., Sharma, A. P., McKay, A. K. A., Leckey, J. J., Welvaert, M., McCall, L., et al. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00880 · Cited by 78 · see citing works
Ketogenic diets in medical oncology: a systematic review with focus on clinical outcomes
Klement, R. J., Brehm, N., & Sweeney, R. A. (2020) · Medical Oncology · doi:10.1007/s12032-020-1337-2 · Cited by 76 · see citing works
Low-carbohydrate diets: what are the potential short- and long-term health implications?
Bilsborough, S., & Crowe, T. (2003) · PubMed · Cited by 75 · see citing works
Are ketogenic diets promising for Alzheimer’s disease? A translational review
Lilamand, M., Porte, B., Cognat, E., Hugon, J., Mouton‐Liger, F., & Paquet, C. (2020) · Alzheimer s Research & Therapy · doi:10.1186/s13195-020-00615-4 · Cited by 71 · see citing works
de Luis, D. A., Aller, R., Izaola, O., Sagrado, M. G., & Conde, R. (2010) · PubMed · Cited by 70 · see citing works
Shu, L., Shen, X., Li, C., Zhang, X., & Zheng, P.-F. (2017) · Nutrition Journal · doi:10.1186/s12937-017-0303-0 · Cited by 66 · see citing works
Efficacy and safety of very-low-calorie ketogenic diet: a double blind randomized crossover study.
Colica, C., Merra, G., Gasbarrini, A., LORENZO, A. D., Cioccoloni, G., Gualtieri, P., Perrone, M. A., Bernardini, S., Bernardo, Renzo, L. D., et al. (2017) · PubMed · Cited by 62 · see citing works
Optic neuropathy in ketogenic diet.
Hoyt, C. S., & Billson, F. A. (1979) · British Journal of Ophthalmology · doi:10.1136/bjo.63.3.191 · Cited by 59 · see citing works
Hübner, J., Marienfeld, S., Abbenhardt, C., Ulrich, C. M., Muenstedt, K., Micke, O., Mücke, R., & Löser, C. (2014) · PubMed · Cited by 58 · see citing works
Unintended pregnancy and interpregnancy interval by maternal age, National Survey of Family Growth
Ahrens, K. A., Thoma, M. E., Copen, C. E., Frederiksen, B. N., Decker, E. J., & Moskosky, S. B. (2018) · Contraception · doi:10.1016/j.contraception.2018.02.013 · Cited by 54 · see citing works
Low carbohydrate diets may increase risk of neural tube defects
Desrosiers, T. A., Siega‐Riz, A. M., Mosley, B., Meyer, R. E., & Study, N. B. D. P. (2018) · Birth Defects Research · doi:10.1002/bdr2.1198 · Cited by 52 · see citing works
Vilar-Gomez, E., Athinarayanan, S. J., Adams, R. N., Hallberg, S. J., Bhanpuri, N. H., McKenzie, A. L., Campbell, W. W., McCarter, J. P., Phinney, S. D., Volek, J. S., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-023597 · Cited by 50 · see citing works
Vegetarian diet, food substitution, and nonalcoholic fatty liver
Lin, C., Chiu, T. H. T., Lin, M., Pan, W.-H., & Chen, Y. (2018) · Tzu Chi Medical Journal · doi:10.4103/tcmj.tcmj_109_17 · Cited by 47 · see citing works
Martin-McGill, K. J., Srikandarajah, N., Marson, A. G., Smith, C. T., & Jenkinson, M. D. (2018) · CNS Oncology · doi:10.2217/cns-2017-0030 · Cited by 30 · see citing works
What Is the Role of Advanced Lipoprotein Analysis in Practice?
Robinson, J. G. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.04.067 · Cited by 26 · see citing works
Can a ketogenic diet be safely used to improve glycaemic control in a child with type 1 diabetes?
McClean, A.-M., Montorio, L., McLaughlin, D., McGovern, S., & Flanagan, N. (2018) · Archives of Disease in Childhood · doi:10.1136/archdischild-2018-314973 · Cited by 22 · see citing works
Shaw, G. M., & Yang, W. (2019) · Birth Defects Research · doi:10.1002/bdr2.1466 · Cited by 14 · see citing works
Okada, E., Takahashi, K., Nakamura, K., Ukawa, S., Takabayashi, S., Nakamura, M., Sasaki, S., Tamakoshi, A., & Takimoto, H. (2019) · Public Health Nutrition · doi:10.1017/s1368980019000120 · Cited by 14 · see citing works
A ketogenic diet for reducing obesity and maintaining capacity for physical activity
Murphy, E. A., & Jenkins, T. J. (2019) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000572 · Cited by 14 · see citing works
Response: Commentary: Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet
Bostock, E. C. S., Kirkby, K. C., Taylor, B. V., & Hawrelak, J. A. (2020) · Frontiers in Nutrition · doi:10.3389/fnut.2020.575713 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [5]Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies Press (2006).
Cited by
Sorted by citations
Tacke, F., Horn, P., Wai-Sun Wong, V., Ratziu, V., Bugianesi, E., Francque, S., Zelber-Sagi, S., Valenti, L., Roden, M., Schick, F., et al. (2024) · Journal of Hepatology · doi:10.1016/j.jhep.2024.04.031 · Cited by 2,210 · see citing works
(2024) · Obesity Facts · doi:10.1159/000539371 · Cited by 510 · see citing works
Zhu, H., Bi, D., Zhang, Y., Kong, C., Du, J., Wu, X., Wei, Q., & Qin, H. (2022) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-021-00831-w · Cited by 412 · see citing works
“Due to the lack of sufficient clinical evidence of the longterm safety of the KD, the use of KD in chronic diseases remains debatable.(276) Moreover, due to the lack of sufficient clinical evidence demonstrating the efficacy and safety of KD, there still are debates on using KD in several diseases,(276) including diab…”
BackgroundSharma, S., Shree, B., Sharma, D., Kumar, S., Kumar, V., Sharma, R. C., & Saini, R. (2022) · Food Research International · doi:10.1016/j.foodres.2022.111038 · Cited by 127 · see citing works
The Therapeutic Role of Ketogenic Diet in Neurological Disorders
Pietrzak, D., Kasperek, K., Rękawek, P., & Piątkowska‐Chmiel, I. (2022) · Nutrients · doi:10.3390/nu14091952 · Cited by 125 · see citing works
Nutraceuticals: Pharmacologically Active Potent Dietary Supplements
Chandra, S., Saklani, S., Kumar, P., Kim, B., & Coutinho, H. D. M. (2022) · BioMed Research International · doi:10.1155/2022/2051017 · Cited by 102 · see citing works
“Ketogenic/Atkins diets (high protein and fat diet with low carbohydrates) Benefits against diabetes, cancer, epilepsy, and Alzheimer’s disease [55, 56]”
Patikorn, C., Saidoung, P., Pham, T., Phisalprapa, P., Lee, Y. Y., Varady, K. A., Veettil, S. K., & Chaiyakunapruk, N. (2023) · BMC Medicine · doi:10.1186/s12916-023-02874-y · Cited by 101 · see citing works
Diet and lifestyle impact the development and progression of Alzheimer’s dementia
Arora, S., Santiago, J. A., Bernstein, M., & Potashkin, J. A. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1213223 · Cited by 96 · see citing works
Role of diet and exercise in aging, Alzheimer’s disease, and other chronic diseases
Khemka, S., Reddy, A., Garcia, R. I., Jacobs, M., Reddy, R. P., Roghani, A. K., Pattoor, V., Basu, T., Sehar, U., & Reddy, P. H. (2023) · Ageing Research Reviews · doi:10.1016/j.arr.2023.102091 · Cited by 88 · see citing works
Ketogenic diet induces p53-dependent cellular senescence in multiple organs
Wei, S., Schell, J. R., Chocrón, E. S., Varmazyad, M., Xu, G., Chen, W. H., Martinez, G. M., Dong, F. F., Sreenivas, P., Trevino, R., et al. (2024) · Science Advances · doi:10.1126/sciadv.ado1463 · Cited by 89 · see citing works
The Influence of Ketogenic Diet on Gut Microbiota: Potential Benefits, Risks and Indications
Santangelo, A., Corsello, A., Spolidoro, G. C. I., Trovato, C. M., Agostoni, C., Orsini, A., Milani, G. P., & Peroni, D. G. (2023) · Nutrients · doi:10.3390/nu15173680 · Cited by 80 · see citing works
The Ketogenic Diet and Alzheimer's Disease
Hersant, H., & Grossberg, G. T. (2022) · The journal of nutrition health & aging · doi:10.1007/s12603-022-1807-7 · Cited by 75 · see citing works
“Another aspect of AD is impaired glucose metabolism in the brain, or glucose hypometabolism (8, 20).”
InfluentialDigesting the complex metabolic effects of diet on the host and microbiome
Carmody, R. N., Varady, K. A., & Turnbaugh, P. J. (2024) · Cell · doi:10.1016/j.cell.2024.06.032 · Cited by 71 · see citing works
Dietary strategies with anti-aging potential: Dietary patterns and supplements
Duan, H., Pan, J., Guo, M., Li, J., Yu, L., & Fan, L. (2022) · Food Research International · doi:10.1016/j.foodres.2022.111501 · Cited by 69 · see citing works
Ketogenic Diet: A Review of Composition Diversity, Mechanism of Action and Clinical Application
Malinowska, D., & Żendzian‐Piotrowska, M. (2024) · Journal of Nutrition and Metabolism · doi:10.1155/2024/6666171 · Cited by 68 · see citing works
“Initially, in addition to gastrointestinal complaints, there are also headaches, irritability, fatigue and dehydration [173, 174].”
BackgroundInfancy Dietary Patterns, Development, and Health: An Extensive Narrative Review
Martín-Rodríguez, A., Bustamante-Sánchez, Á., Martínez‐Guardado, I., Navarro-Jiménez, E., Plata-SanJuan, E., Tornero-Aguilera, J. F., & Clemente‐Suárez, V. J. (2022) · Children · doi:10.3390/children9071072 · Cited by 58 · see citing works
“, vegetables, fruits, legumes, whole grains) is typically decreased [219].”
BackgroundWearable Vertical Graphene-Based Microneedle Biosensor for Real-Time Ketogenic Diet Management
Wang, Q., Liu, Q., Zhong, G., Xu, T., & Zhang, X. (2024) · Analytical Chemistry · doi:10.1021/acs.analchem.4c00960 · Cited by 53 · see citing works
Lennerz, B. S., Mey, J. T., Henn, O., & Ludwig, D. S. (2021) · Current Developments in Nutrition · doi:10.1093/cdn/nzab133 · Cited by 52 · see citing works
Rong, L., Peng, Y., Shen, Q., Chen, K., Fang, B., & Li, W. (2024) · The journal of nutrition health & aging · doi:10.1016/j.jnha.2024.100306 · Cited by 52 · see citing works
“Longer-term effects can include decreased bone mineral density, nephrolithiasis, cardiomyopathy, anemia, and neuropathy of the optic nerve [53,54].”
Risks and Benefits of Different Dietary Patterns in CKD
Joshi, S., Kalantar‐Zadeh, K., Chauveau, P., & Carrero, J. J. (2023) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2022.08.013 · Cited by 50 · see citing works
Ahmad, Y., Seo, D. S., & Jang, Y. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25137076 · Cited by 49 · see citing works
“The KD modifies protein utilization, as many proteins are taken up by the body for the process of gluconeogenesis while the remainder contribute to tissue repair [2].”
BackgroundAstrocytic GLUT1 reduction paradoxically improves central and peripheral glucose homeostasis
Ardanaz, C. G., de la Cruz, A., Minhas, P. S., Hernández‐Martín, N., Pozo, M. A., Valdecantos, M. P., Valverde, Á. M., Villa, P., Elizalde-Horcada, M., Puerta, E., et al. (2024) · Science Advances · doi:10.1126/sciadv.adp1115 · Cited by 49 · see citing works
The case for a ketogenic diet in the management of kidney disease
Athinarayanan, S. J., Roberts, C. G. P., Vangala, C., Shetty, G. K., McKenzie, A. L., Weimbs, T., & Volek, J. S. (2024) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2024-004101 · Cited by 44 · see citing works
“…health focused on observational studies that compared low protein versus high protein diets that were not ketogenic or low carbohydrate diets, 126 and raised concern about the association of albuminuria with high animal fat but only referred to observational studies that assessed high animal…”
BackgroundThe cyclic metabolic switching theory of intermittent fasting
Mattson, M. P. (2025) · Nature Metabolism · doi:10.1038/s42255-025-01254-5 · Cited by 45 · see citing works
“The results of other epidemiological studies support the notion that KD can adversely affect health 172 .”
Newmaster, K. T., Zhu, Z., Bolt, E., Chang, R., Day, C., Mhanna, A. S., Paudel, S., Farooq, O., Swaminathan, A., Acharya, P. C., et al. (2022) · Children · doi:10.3390/children9091372 · Cited by 43 · see citing works
Ketogenesis promotes tolerance to Pseudomonas aeruginosa pulmonary infection
Tomlinson, K. L., Chen, Y.-T., Junker, A., Urso, A., Lung, T. W. F., Ahn, D. S., Hofstaedter, C. E., Baskota, S. U., Ernst, R. K., Prince, A. S., et al. (2023) · Cell Metabolism · doi:10.1016/j.cmet.2023.09.001 · Cited by 41 · see citing works
Risks of the ketogenic diet in CKD – the con part
Joshi, S., Shi, R., & Patel, J. (2023) · Clinical Kidney Journal · doi:10.1093/ckj/sfad274 · Cited by 40 · see citing works
“Despite the diet’s popularity in low carbohydrate circles, concerns have been raised regarding the safety, effectiveness and practicality of the diet over the long term [1 , 2 ].”
BackgroundKetogenic diet in children and adolescents: The effects on growth and nutritional status
Corsello, A., Trovato, C. M., Profio, E. D., Cardile, S., Campoy, C., Zuccotti, G., Verduci, E., & Diamanti, A. (2023) · Pharmacological Research · doi:10.1016/j.phrs.2023.106780 · Cited by 45 · see citing works
“There is limited research on the long-term effects of the diet on growth and development, bone health, and cardiovascular health [12, 13].”
BackgroundLow-Carbohydrate High-Fat Diet: A SWOC Analysis
Nuwaylati, D. A., Eldakhakhny, B. M., Bima, A. I. H., Sakr, H. F., & Elsamanoudy, A. Z. (2022) · Metabolites · doi:10.3390/metabo12111126 · Cited by 38 · see citing works
Nutritional management and autism spectrum disorder: A systematic review
Al‐Beltagi, M. (2024) · World Journal of Clinical Pediatrics · doi:10.5409/wjcp.v13.i4.99649 · Cited by 36 · see citing works
Aktary, N., Jeong, Y., Oh, S., Shin, Y., Sung, Y., Rahman, M., Santiago, L. R., Choi, J., Song, H. G., Nurkolis, F., et al. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1601712 · Cited by 34 · see citing works
Lilamand, M., Mouton‐Liger, F., Valentin, E. D., Ortiz, M. S., & Paquet, C. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2021.807970 · Cited by 33 · see citing works
Zhuang, Y.-P., Zhou, H., Chen, H., Zheng, M.-Y., Liang, Y., Gu, Y.-T., Li, W., Qiu, W., & Zhou, H. (2023) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2023.115040 · Cited by 33 · see citing works
Polycystic Kidney Disease Diet
Chebib, F. T., Nowak, K. L., Chonchol, M. B., Bing, K., Ghanem, A., Rahbari-Oskoui, F. F., Dahl, N. K., & Mrug, M. M. (2023) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.0000000000000326 · Cited by 33 · see citing works
Ketogenic Diet and Breast Cancer: Recent Findings and Therapeutic Approaches
Urzì, A. G., Tropea, E., Gattuso, G., Spoto, G., Marsala, G., Călina, D. C., Libra, M., & Falzone, L. (2023) · Nutrients · doi:10.3390/nu15204357 · Cited by 33 · see citing works
Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome
Khalid, K., Apparow, S., Mushaddik, I. L., Anuar, A., Rizvi, S. A. A., & Habib, A. (2023) · Journal of the Endocrine Society · doi:10.1210/jendso/bvad112 · Cited by 40 · see citing works
“In PCOS, supplementation of ketogenic diets with fiber and nondigestible carbohydrates, such as raw cornstarch and sourdough bread, is advisable to counteract the effects of very low-carbohydrate diets on the gut microbiota [12] that may result in gastric upset and constipation.”
BackgroundRóg, J., Wingralek, Z. J., Nowak, K., Grudzień, M., Grunwald, A., Banaszek, A., & Karakuła‐Juchnowicz, H. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13102819 · Cited by 31 · see citing works
Management of chronic kidney disease: The current novel and forgotten therapies
Pethő, Á. G., Tapolyai, M. B., Csongrádi, É., & Orosz, P. (2024) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2024.100354 · Cited by 38 · see citing works
“It has been suggested that KD could be considered a new strategy for managing and treating CKD [27].”
BackgroundFirman, C., Mellor, D. D., Unwin, D., & Brown, A. C. (2023) · Diabetes Therapy · doi:10.1007/s13300-023-01492-4 · Cited by 30 · see citing works
“This phenomenon primarily includes neurological symptoms such as headache, brain fog and dizziness and gastrointestinal symptoms such as nausea and constipation [87, 88] which is positively related to the degree of nutritional ketosis reached.”
BackgroundStorz, M. A., & Ronco, A. L. (2023) · British Journal of Nutrition · doi:10.1017/s0007114522001908 · Cited by 27 · see citing works
“The so-called ‘classic’ ketogenic diet is characterised by a 4:1 ratio of fat to carbohydrates(2,4).”
BackgroundInfluentialTian, W.-D., Cao, S., Guan, Y.-X., Zhang, Z.-H., Liu, Q., Ju, J., Xi, R.-X., & Bai, R. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1516086 · Cited by 26 · see citing works
Sripongpun, P., Churuangsuk, C., & Bunchorntavakul, C. (2022) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2021.00494 · Cited by 28 · see citing works
Epigenome Modulation Induced by Ketogenic Diets
Ungaro, P., Nettore, I. C., Franchini, F., Palatucci, G., Muscogiuri, G., Colao, A., & Macchia, P. E. (2022) · Nutrients · doi:10.3390/nu14153245 · Cited by 28 · see citing works
“Although KD and VLCKD are now widely used to prevent and treat various clinical conditions [1], the molecular mechanisms underlying the beneficial effects of these diets are still largely unknown.”
BackgroundThe Ketogenic Effect of SGLT-2 Inhibitors—Beneficial or Harmful?
Koutentakis, M., Kuciński, J., Świeczkowski, D., Surma, S., Filipiak, K. J., & Gąsecka, A. (2023) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd10110465 · Cited by 32 · see citing works
Liang, S., Mijatovic, J., Li, A., Koemel, N. A., Nasir, R., Toniutti, C., Bell-Anderson, K. S., Skilton, M. R., & O’Leary, F. (2022) · Nutrients · doi:10.3390/nu15010076 · Cited by 28 · see citing works
“High meat intake is consistent with an increased risk in cardiovascular events, eliminating dairy may have implications for bone health [62], and limiting intakes of grains, beans and legumes can result in dietary carbohydrate restriction [64,65].”
BackgroundImmune Modulatory Effects of Ketogenic Diet in Different Disease Conditions
Srivastava, S., Pawar, V. A., Tyagi, A., Sharma, K., Kumar, V., & Shukla, S. K. (2022) · Immuno · doi:10.3390/immuno3010001 · Cited by 26 · see citing works
Novel Therapeutic Approaches in the Management of Chronic Kidney Disease
Dąbek, B., Dybiec, J., Frąk, W., Fularski, P., Lisińska, W., Radzioch, E., Młynarska, E., Rysz, J., & Franczyk, B. (2023) · Biomedicines · doi:10.3390/biomedicines11102746 · Cited by 29 · see citing works
“It is suggested that KD could be considered a new strategy for managing and treating CKD [33].”
BackgroundHFpEF and MASLD: converging mechanisms and clinical implications
Capone, F., Häseli, S. P., Liu, L., Strocchi, S., Langenberg, C., Lusis, A. J., Pietzner, M., Muoio, D. M., Rider, O. J., Raman, B., et al. (2026) · Nature Reviews Cardiology · doi:10.1038/s41569-026-01257-z · Cited by 32 · see citing works
“Concerns about potential cardiovascular, renal and metabolic adverse effects have also been raised 320 , so caution is warranted when proposing these dietary interventions.”
Gasparre, N., Pasqualone, A., Mefleh, M., & Boukid, F. (2022) · Foods · doi:10.3390/foods11244095 · Cited by 24 · see citing works
“For K and K-LC, few products had claims related to fat reduction, as the ketogenic diet was typically defined as high in fat [60].”
BackgroundTong, X., Deng, Y. L., Liu, L., Tang, X., Yu, T., Gan, J., Cai, Q., Luo, R., & Xiao, N. (2022) · Seizure · doi:10.1016/j.seizure.2022.04.015 · Cited by 23 · see citing works
Ferraris, C., Guglielmetti, M., Neri, L. D. C. L., Allehdan, S., Albasara, J. M., Alawadhi, H. F., Trentani, C., Perna, S., & Tagliabue, A. (2023) · Foods · doi:10.3390/foods12091743 · Cited by 24 · see citing works
“Carbohydrate restriction varies in the different KDT protocols, with the CKD as the most restrictive one.”
BackgroundInfluentialJian, Y., Cheng, L., Hong, Y., Li, Z., Li, C., Ban, X., Zhu, L., & Gu, Z. (2023) · Nutrients · doi:10.3390/nu15245080 · Cited by 23 · see citing works
The impact of dietary interventions on cardiometabolic health
Gjermeni, E., Fiebiger, R., Bundalian, L., Garten, A., Schöneberg, T., Duc, D. L., & Blüher, M. (2025) · Cardiovascular Diabetology · doi:10.1186/s12933-025-02766-w · Cited by 25 · see citing works
“Typically, energy intake from dietary carbohydrates is limited to less than 10% of daily intake [148, 149].”
Xiao, X., Yan, X., Liang, C., & Yang, Y. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1772036 · Cited by 23 · see citing works
Are We What We Eat? The Moral Imperative of the Medical Profession to Promote Plant-Based Nutrition
Hull, S. C., Charles, J. A., & Caplan, A. L. (2022) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2022.10.006 · Cited by 22 · see citing works
Rees, J., Ryan, J. C., Laws, M., & Devine, A. (2023) · Nutritional Neuroscience · doi:10.1080/1028415x.2023.2233727 · Cited by 23 · see citing works
Very Low Calorie Ketogenic Diet: What Effects on Lipid Metabolism?
Suarez, R., Chapela, S., Llobera, N. D., Montalván, M., Vásquez, C. A., Martinuzzi, A. L. N., Katsanos, C. S., Verde, L., Frias-Toral, E., Barrea, L., et al. (2024) · Current Nutrition Reports · doi:10.1007/s13668-024-00556-6 · Cited by 20 · see citing works
“Additionally, hyperketonemia in type 1 diabetes is linked to insulin resistance, non-alcoholic fatty liver disease, inflammation, and oxidative stress [32, 35, 47].”
BackgroundResultInfluentialOliveira, T. P. D., Morais, A. L. B., dos Reis, P. L. B., Palotás, A., & Vieira, L. B. (2023) · Metabolites · doi:10.3390/metabo14010025 · Cited by 22 · see citing works
“Apart from the classic or standard KD, there is evidence that various KD variations can also yield positive results against AD in animal models [173,174].”
BackgroundAbboud, M., Anouti, F. A., Georgaki, E., & Papandreou, D. (2021) · Nutrients · doi:10.3390/nu13124463 · Cited by 20 · see citing works
The road ahead of dietary restriction on anti-aging: focusing on personalized nutrition
Duan, H., Li, J., Yu, L., & Fan, L. (2022) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2022.2110034 · Cited by 20 · see citing works
“Moreover, the safety and side effects of long-term KD have also been reported, including an increased risk of cardiovascular disease, cancer, and diabetes (Crosby et al. 2021).”
BackgroundMarinescu, S., Apetroaei, M.-M., Nedea, M. I., Arsene, A. L., Velescu, B. Ș., Hîncu, S., Stancu, E., Pop, A. L., Drăgănescu, D., & Udeanu, D. I. (2024) · Nutrients · doi:10.3390/nu16081213 · Cited by 19 · see citing works
“Consequently, individuals following low-carbohydrate diets susceptible to serious nutritional deficiencies [32,33].”
BackgroundInfluentialZhao, B., Wu, H., Yao, Q., Bai, W., & Kang, J. (2024) · Cell Communication and Signaling · doi:10.1186/s12964-024-01939-6 · Cited by 19 · see citing works
Ruani, M. A., & Reiss, M. J. (2023) · Nutrients · doi:10.3390/nu15020451 · Cited by 18 · see citing works
Dietary therapy to halt the progression of diabetes to diabetic kidney disease
Hu, H., Ding, G., & Liang, W. (2025) · Food & Function · doi:10.1039/d4fo06011c · Cited by 17 · see citing works
Xu, Y., Zheng, F., Zhong, Q., & Zhu, Y. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-230002 · Cited by 18 · see citing works
“The classic KD of 4:1 ratio supplies energy, 90% from fat, 2–4% from carbohydrate, and 6–8% from protein, and the 3:1 ratio supplies energy, 85–90% from fat, 2–5% from carbohydrate, and 8–12% from protein [80].”
Ye, Y., Chai, S.-F., Li, X.-R., Wu, M., Cai, H.-Y., & Wang, Z.-J. (2023) · Metabolic Brain Disease · doi:10.1007/s11011-023-01288-2 · Cited by 17 · see citing works
“Studies have found that KD increase the risk of a number of diseases, including heart disease, cancer, diabetes and Alzheimer's, beyond any possible benefits (Crosby et al. 2021).”
Mahabamunuge, J., Sekula, N. M., Lepore, C., Kudrimoti, M., Upadhyay, A., Alshowaikh, K., Li, H. J., Seifer, D. B., & AlAshqar, A. (2025) · Biomedicines · doi:10.3390/biomedicines13030709 · Cited by 22 · see citing works
“…hormone profiles, including a reduced LH/follicle stimulating hormone (FSH) ratio (d − 0.851; 95% CI − 1.015, − 0.686; p < 0.001), decreased serum free testosterone (d − 0.223; 95% CI − 0.328, − 0.119; p < 0.001), and increased SHBG levels (d 9.086; 95% CI 3.379, 14.792; p = 0.002) [153,154].”
InfluentialDrabińska, N., Juśkiewicz, J., & Wiczkowski, W. (2022) · Nutrients · doi:10.3390/nu14224805 · Cited by 16 · see citing works
“Another potential risk suggested after long-term adherence to KD is anaemia [48].”
BackgroundSánchez, E., Santos, M.-D., Núñez-García, M., Bueno, M., Sajoux, I., Yeramian, A., & Lecube, A. (2021) · Nutrients · doi:10.3390/nu14010033 · Cited by 16 · see citing works
“Although some reports suggest that ketogenic diets have been associated with higher CV risk [17], our data do not support this hypothesis and show a positive safety profile with this weight loss approach.”
BackgroundResultIdzikowska, K., Gątarek, P., Gajda, A., Safiński, P., Przysło, Ł., & Kałużna‐Czaplińska, J. (2025) · Nutrients · doi:10.3390/nu17182969 · Cited by 15 · see citing works
“Short-term benefits are often accompanied by transient side effects, such as fatigue, constipation, gastrointestinal discomfort, and electrolyte disturbances, which can be particularly burdensome in older patients or those with comorbidities [70,71].”
InfluentialLkhagva, B., Lee, T., Lin, Y., Chen, Y., Chung, C., Higa, S., & Chen, Y. (2022) · Cells · doi:10.3390/cells11182915 · Cited by 15 · see citing works
Micun, Z., Falkowska, M., Młynarczyk, M., Kochanowicz, J., Socha, K., & Konopińska, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610376 · Cited by 15 · see citing works
“Although KDs could be beneficial for many patients suffering from neurological, metabolic, or even oncological disorders, KD as a restrictive dietary treatment promotes a risk of nutritional deficiency [112,113].”
BackgroundGiannos, P., Prokopidis, K., Lidoriki, I., Triantafyllidis, K. K., Kechagias, K. S., Celoch, K., Candow, D. G., Ostojić, S. M., & Forbes, S. C. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03521-6 · Cited by 14 · see citing works
“However, ketogenic dietary approaches could lead to malnutrition [8], therefore, exogenous ketone supplementation may be a convenient way to induce a ketogenic state [9].”
BackgroundKetogenic Diet and Vitamin D Metabolism: A Review of Evidence
Detopoulou, P., Papadopoulou, S. Κ., Voulgaridou, G., Dedes, V., Tsoumana, D., Gioxari, A., Gerostergios, G., Detopoulou, M., & Panoutsopoulos, G. I. (2022) · Metabolites · doi:10.3390/metabo12121288 · Cited by 14 · see citing works
“Long-term adverse effects of KDs include high cholesterol levels, nephrolithiasis, growth retardation, and decreased bone mineral density [28].”
BackgroundYe, Y., Fu, C., Li, Z., Sun, J., Li, X., Chai, S.-F., Li, S., Hou, M., Cai, H.-Y., Wang, Z., et al. (2024) · Experimental Neurology · doi:10.1016/j.expneurol.2024.114920 · Cited by 14 · see citing works
James, S., Oppermann, A., Schotz, K. M., Minotti, M. M., Rao, G. G., Kleckner, I. R., Baguley, B. J., & Kleckner, A. S. (2024) · Current Oncology · doi:10.3390/curroncol32010003 · Cited by 14 · see citing works
Chouli, M., Bothou, Α., Kyrkou, G. A., Kaliarnta, S., Dimitrakopoulou, A., & Diamanti, A. (2025) · Metabolism Open · doi:10.1016/j.metop.2025.100353 · Cited by 17 · see citing works
Regulatory effects of ketogenic diet on the inflammatory response in obese Saudi women
Alkhorayef, N., Almutery, F. T., Rasheed, Z., Althwab, S. A., Aljohani, A. S. M., Alhawday, Y. A. N., Salem, T., Alharbi, A. M., Wahaq, A. A. A. B., Alharbi, F. S., et al. (2023) · Journal of Taibah University Medical Sciences · doi:10.1016/j.jtumed.2023.03.006 · Cited by 14 · see citing works
“Moreover, women often experienced amenorrhea or other complications associated with the menstrual cycle.(39,40) The obese females investigated in our present study also experienced similar complications as the levels of total cholesterol and LDL were slightly increased after 30 days of KD intake although these increas…”
ResultMetabolic Adaptations in Cancer Progression: Optimization Strategies and Therapeutic Targets
Dominiak, A., Chełstowska, B., & Nowicka, G. (2025) · Cancers · doi:10.3390/cancers17142341 · Cited by 14 · see citing works
Harnessing nutrition to combat MASLD: a comprehensive guide to food-based therapeutic strategies
Reytor-González, C., Simancas‐Racines, D., Campuzano-Donoso, M., Jimenez, J. C., Román-Galeano, N. M., Sarno, G., & Frías-Toral, E. (2025) · Food and Agricultural Immunology · doi:10.1080/09540105.2025.2496499 · Cited by 13 · see citing works
“…may influence gut microbiota 800 IU/day reduces steatosis; slight reduction in ALT/AST in trials; included in European MASLD guidelines Vitamin C (Crosby et al., 2021; Simancas-Racines et al., 2025a; Storz & Ronco, 2023; Zhang et al., 2024) Antioxidant, may prevent fibrosis, supports collagen…”
Wei, S., Schell, J. R., Qian, W., Silguero, M., Baseviciene, A., Chen, W. H., Trevino, R., Chocrón, E. S., Ogle, M. M., Varmazyad, M., et al. (2025) · Cell Reports · doi:10.1016/j.celrep.2025.116026 · Cited by 13 · see citing works
Liu, S., Chen, Y.-X., Tzeng, H.-P., & Chiang, M. (2022) · Nutrients · doi:10.3390/nu14091796 · Cited by 13 · see citing works
“Despite the wide use of low-carbohydrate/high-fat diets and ketogenic diets in many fields, there are some studies raising concerns about their adverse side effects in humans, such as impaired fetal growth, kidney stones, hyperlipidemia, and CV risks [10].”
BackgroundYang, W., Pang, N., & He, X. (2025) · Lipids in Health and Disease · doi:10.1186/s12944-025-02693-5 · Cited by 13 · see citing works
“Short-term adverse effects such as hypoglycemia, fatigue, weight fluctuations, and digestive symptoms have also been observed in clinical practice [147].”
Castro, R., Kalecký, K., Huang, N., Petersen, K., Singh, V., Ross, A., Neuberger, T., & Bottiglieri, T. (2024) · Journal of Nutritional Biochemistry · doi:10.1016/j.jnutbio.2023.109562 · Cited by 14 · see citing works
Chandel, P., Thapa, K., Kanojia, N., Rani, L., Singh, T. G., & Rohilla, P. (2024) · Neuroscience · doi:10.1016/j.neuroscience.2024.05.002 · Cited by 12 · see citing works
Ketogenic Metabolism in Neurodegenerative Diseases: Mechanisms of Action and Therapeutic Potential
Pawłowska, M., Kruszka, J., Porzych, M., Garbarek, J., & Nuszkiewicz, J. (2025) · Metabolites · doi:10.3390/metabo15080508 · Cited by 13 · see citing works
“While clinically significant ketoacidosis is rare outside of type 1 diabetes, cases have been reported in older patients with type 2 diabetes and reduced insulin reserve [182–184].”
Kundu, S., Hossain, K. S., Moni, A., Zahan, M. S., Rahman, M. M., & Uddin, M. J. (2022) · Molecular Biology Reports · doi:10.1007/s11033-022-07460-8 · Cited by 12 · see citing works
“Acidosis can promote kidney stones either by lowering pH levels and urinary citrate while increasing urinary calcium levels and the risk of developing albuminuria [90, 91].”
BackgroundGreenwell, A. A., Saed, C. T., Dakhili, S. A. T., Ho, K. L., Gopal, K., Chan, J. S. F., Kaczmar, O. O., DYER, S. A., Eaton, F., Lopaschuk, G. D., et al. (2022) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00435.2021 · Cited by 12 · see citing works
Du, Y. N., Wang, J., Li, S., Dennis, B., Meireles, C. L., Siddiqui, N., Patel, D. I., Gelfond, J., Li, C., Faruqui, S. H. A., et al. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106845 · Cited by 12 · see citing works
“One of the concerns is the potential impairment on renal health [22].”
Lifestyle management approaches for obesity
Landry, M. J., & Bagha, Z. M. (2026) · Journal of clinical lipidology · doi:10.1016/j.jacl.2025.08.022 · Cited by 14 · see citing works
Habitual low carbohydrate high fat diet compared with omnivorous, vegan, and vegetarian diets
Jontez, N. B., Kenig, S., Novak, K. Š., Petelin, A., Pražnikar, Z. J., & Mohorko, N. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1106153 · Cited by 11 · see citing works
Pescari, D., Mihuţa, M. S., Bena, A., & Stoian, D. L. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1493954 · Cited by 13 · see citing works
Beliefs and Experiences of Individuals Following a Zero-Carb Diet
Protogerou, C., Leroy, F., & Hagger, M. S. (2021) · Behavioral Sciences · doi:10.3390/bs11120161 · Cited by 11 · see citing works
“The lack of consensus on the health benefits and risks of carbohydrate reduction could be explained, at least in part, by the absence of a singular low-carbohydrate diet [20].”
BackgroundChen, Y., Li, X., Yang, M., Wang, L., Lv, X., Shen, K., Wu, H., & Lu, Q. (2023) · Experimental Dermatology · doi:10.1111/exd.14932 · Cited by 11 · see citing works
“6 Therefore, safer and more effective dietary interventions, such as intermittent fasting (IF), have become a research focus.”
BackgroundCurrent Perspective About the Effect of a Ketogenic Diet on Oxidative Stress – a Review
Drabińska, N. (2024) · Polish Journal of Food and Nutrition Sciences · doi:10.31883/pjfns/185366 · Cited by 10 · see citing works
“Moreover, it is suggested that since it is a diet limiting the consumption of many food products, long-term adherence to KD may lead to nutritional deficiencies and consequences like anaemia and osteoporosis [Crosby et al. , 2021].”
BackgroundLow-Carbohydrate Diet and Human Health
Papadopoulou, S. Κ., & Nikolaidis, P. Τ. (2023) · Nutrients · doi:10.3390/nu15082004 · Cited by 9 · see citing works
“For example, when beginning a low-carbohydrate diet, several symptoms may be present, such as nausea and vomiting, headaches, and hypoglycemia, which may reduce adherence [3,6].”
BackgroundLodewijckx, I., Matthys, C., Verheijen, J., Verscuren, R., Devoogdt, N., der Schueren, B. V., Goffin, K. E., Fourneau, I., & Thomis, S. (2024) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.13330 · Cited by 9 · see citing works
Talib, W. H., Abed, I., Raad, D., Alomari, R. K., Jamal, A., Jabbar, R., Alhasan, E. O., Alshaeri, H. K., Alasmari, M. M., & Law, D. S. N. (2024) · Foods · doi:10.3390/foods13172687 · Cited by 9 · see citing works
Lim, S. L., Tay, M. H. J., Ang, S. M., Wai, S. N., Ong, K. W., Neo, W. J., Yap, Q. V., Chan, Y. H., & Khoo, C. M. (2024) · Nutrients · doi:10.3390/nu16244380 · Cited by 9 · see citing works
“…fat and omega-3 fatty acids [16,17]; (v) adequate protein (25–30% of energy intake; 1.0–1.2 g/kg body weight) [9,15]; (vi) adequate fiber (20–30 g/day) [18–20]; (vii) adequate fluid of at least 2 L a day [21,22]; and (viii) adequate micronutrient intake through supplementation [23].”
InfluentialXu, Q., Zou, Z., Lin, T., Guo, C., & Lin, D. (2025) · Biotechnology and Bioengineering · doi:10.1002/bit.28972 · Cited by 9 · see citing works
“However, these diets have notable limitations, including low adherence rates and potential adverse effects, such as increased risk of cardio-vascular disease, diabetes, and certain cancers (Crosby et al. 2021; Qu et al. 2024).”
- Authors
- Crosby, L., Davis, B., Joshi, S., Jardine, M., Paul, J., Neola, M., & Barnard, N. D.
- Affiliations
- Physicians Committee for Responsible Medicine (US)
- Bellevue Hospital Center (US)
- Corresponding author
- Crosby, Lee
- Venue
- Frontiers in Nutrition
- Publisher
- Frontiers Media SA
- Published
- 2021-07-16
- Volume
- 8
- Pages
- 702802-702802
- ISSN
- 2296-861X (ISSN-L)
- PMC
- PMC8322232
- OpenAlex
- W3185804297
- Cited by
- 229
- References
- 124
- Citations by year
- 2026: 32 · 2025: 56 · 2024: 48 · 2023: 47 · 2022: 40 · 2021: 6
- FWCI
- 4.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Physicians Committee for Responsible Medicine
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- ketogenic diet, very low carbohydrate diet, chronic disease, diet quality, obesity, diabetes mellitus, liver disease, seizure control, long-term safety, dietary intake, health risks
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
