NB Common side effects on initiation and interactions with medications are not included here – see Implementation and De-prescribing
There are some examples of complications in the literature. These are rare and there is a paucity of articles which exist mostly in the form of case studies.
In the case of diet/starvation ketoacidosis, there are usually other factors involved such as illness or breastfeeding (or both) which create additional physiological challenges. For a prudent interpretation of the literature regarding breastfeeding, the link below to Dr. Andreas Eenfeldt – Diet Doctor, may be helpful – Breastfeeding on a low-carb diet – is it dangerous? Diet Doctor.
This may also be referred to as ‘keto rash’ in mainstream media articles. A helpful summary can be found on the Dr. Andreas Eenfeldt – Diet Doctor website: Keto Rash – Why You May Itch on Low Carb, and What to Do About It. Diet Doctor.
There is only one study referring to Incident Atrial Fibrillation currently, and some controversy over the methodology. The carbohydrate content exceeds what would be clinically described as low carb; only two Food Frequency Questionnaires (known to be problematic) were used over the study duration (~22yrs); presence of confounders.
A commentary on these issues can be found on the Dr. Andreas Eenfeldt – Diet Doctor website: Inaccurate news stories suggest low carb causes atrial fibrillation. Diet Doctor
In the following case study authors concluded that the implementation of a ketogenic diet triggered an increased number of arrhythmia events in a patient with congenital Long QT syndrome (LQTS)
In this case report two children are presented with growth failure using carbohydrate restriction in type 1 diabetes. In both cases they present as hypocaloric with no details apart from macronutrient percentage. These cases highlight the necessity of a well formulated diet in children along with sufficient monitoring and diet adjustments as required.
Studies in children with epilepsy constitute the majority of the data on this subject. Of note is that the medical ketogenic diet for epilepsy may be lower in protein due to high ketones being of therapeutic importance for seizure control (often 4:1 or 3:1 ratios).
In the following paper, appropriate growth was maintained in the ketogenic diet group consisting of participants less than 2 years old, which is a critical period for growth.
This study of older children with epilepsy or GLUT1-DS found the majority of participants (80%) maintained or improved their weight at one year follow-up.
For completeness the following articles are included. In both these cases a thiamine deficiency was found and recovery of optic nerve function occurred with appropriate treatment.
There are many books which may be useful in guiding our low carb journey, both as clinicians and patients. The list below is a sample and by no means exhaustive.
Updated 01 June 2021
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Latest Update: 01 August 2021