Is The Ketogenic Diet Safe?
In this article I’m going through the most common reasons that people object to the ketogenic diet on safety grounds and find out if there is any evidence to support these.
The ketogenic diet is considered a fad by some and down right dangerous by others. But is it really?
I’ve been following a ketogenic diet for much of the last 6 years and I’ve found it to be nothing but positive for my weight loss and overall health and wellbeing.
But that is just my personal experience and my opinion… it’s not evidence.
Plenty of people have opinions on the safety of the ketogenic diet, but in this article we’re looking for actual scientific evidence where it is available.
Table of Contents
I was already pretty overweight at that point but the diet was working really well and I’d seen a significant improvement in my body composition in a very short space of time. Yes, I still had a way to go but I was definitely heading in the right direction.
So why did I stop?
Well, I was eating lunch at work one day when one of my senior colleagues told me that if I continued eating like that my cholesterol levels would go through the roof!
I was feeling great and losing weight but that comment from my colleague planted a concern in my brain about my future heart health and it was enough for me to stop.
I carried on gaining weight during my stressful junior doctor years and was officially obese a couple of years later.
It wasn’t until 2016 when a chance conversation while I was away skiing led me to the ketogenic diet.
Over the following 6 month period I’d gone from officially obese to a normal weight for the first time in my adult life. But the worries over my long term health remained.
How could eating so much fat be healthy? It went against everything I thought I knew about cholesterol and heart health.
Surely there had to be consequences.
And if you’re reading this article, maybe you’ve shared the same concerns.
However, this time was different. During that 6 months I became a sort of an accidental academic.
I became fascinated with the subject and read loads of books and medical journals on the subject.
I needed to know that what I was doing, that was working so well and making me feel great, was actually safe for the longer term.
I wasn’t the only one asking these questions either.
Many of you might be aware that the ketogenic diet has long been used to treat epilepsy in children.
I co-authored this video with Claire, from the Carb Dodging team.
Claire was interested in using a Ketogenic Diet to help with her toddler daughter’s seizures as an alternative to prescribed anti epileptic medication because these medications are known to have loads of side effects.
Of particular concern to Claire was the way that these drugs would affect her daughters brain development during those critical childhood years.
Naturally, when considering a ketogenic diet as an alternative she started looking into the safety concerns such as:-
- Reduced bone density;
- increased bone fractures;
- limited child growth;
- kidney problems;
- nutritional deficiencies –
- And others.
- improved seizure control
- avoiding side effects of epilepsy medications – of which there are many.
- and the potential for additional benefits through a Ketogenic Diet including improved cognitive function
When balanced against the alternative (the Antiepileptic drugs) the ketogenic diet offered far fewer potential side effects. By choosing carefully created meal plans, they could reduce the chances of any other problems occuring. At 2 years old she started her Keto diet. The results were wonderful.
Her seizures reduced dramatically, her health improved, and she still enjoys her diet – 8 years on.
Claire’s story highlights two points which are important to remember as we go through this article. Firstly, The risk of action must be balanced against the risk of inaction.
High quality scientific evidence tells us that the ketogenic diet is a valid option to improve your health. Whether you are looking to lose weight, control health conditions, reverse diseases such as type 2 diabetes, or reduce disease risk markers. The evidence is there.
A Ketogenic Diet can be considered a better option for many of us than the alternatives such as taking medications, going on low calorie diets or having weight loss surgery.
And certainly better than the option of doing nothing.
We absolutely need to consider the risks of not taking action, not losing excess weight, not getting our blood glucose under control and continuing to gain more weight over time.
We need to consider the impact of health conditions that are associated with this:-
- High Blood Pressure
- Type 2 Diabetes
- Cardiovascular disease
- Osteoarthritis caused by excess weight on the joints
- Sleep Apnea
- And Certain types of cancers to name just a few
The long term consequences of not taking action can be enormous.
Secondly, any negative effects can often be avoided (or at the very least minimised) What I mean by this is that the type of foods, the approach you take to your nutrition, is hugely important – and can head off any potential problems.
There are definitely good ways and bad ways to follow a ketogenic diet.
So what are the issues that people say are indicators that the ketogenic diet is not safe?
Quick disclaimer: This article is for information only and is not intended as medical advice. I’m a doctor but I’m not your doctor… so please discuss with your doctor if you have any concerns.
We’ve linked to all the research papers at the end of the article if you want them.
You may get ‘Keto flu’
Many people will experience symptoms when they first start out on a ketogenic diet.
They can include fatigue, headaches, constipation, muscle aches. These symptoms are collectively known as “Keto Flu”!
These effects are TEMPORARY, usually lasting only for the first few days as you transition.
But the fact that people get these symptoms is often cited as a reason why a ketogenic diet must be bad for us.
So, what causes keto flu?
Keto flu mainly happens because we’re no longer producing significant amounts of insulin.
Our pancreas doesn’t produce as much as we’re consuming fewer carbs.
Insulin is important for helping us to control our blood glucose levels, but it also has many other effects throughout the body, including on the kidneys.
Elevated insulin levels signal the kidneys to retain fluid.
Less insulin means our kidneys hold onto less fluid, so pass more fluid out as urine…
When this happens rapidly, because of a sudden dietary change, this can throw out our electrolyte balance and make us a little dehydrated.
This fluid loss is the ‘water weight’ that people often lose in the first few days of a ketogenic diet.
The loss of this fluid also means many people appear visibly less bloated after a very short period of time.
Despite ‘keto flu’ often being cited as a reason not to undergo a keto diet, I’m not aware that these short-lived symptoms have ever actually caused any significant harm to anyone’s health.
And what’s more, these symptoms can easily be significantly reduced or even completely avoided by following these two simple rules:
1. Keep hydrated
2. Include extra electrolytes during your transition.
That’s a very quick overview of “keto flu”. If you want to learn more about this and the strategies for dealing with this then I made a guide that you can download for free that talks about this in much more detail.
It’s called the “Common Side Effects Of Ketosis & How To Manage Them”.
Does the Ketogenic Diet Increases Risk of Nutritional Deficiencies?
The basic argument behind this is that whenever we limit certain food groups or ingredients then it leads to vitamin or mineral deficiencies.
So let’s clear up some of the most common misconceptions here.
Does a ketogenic diet cause nutrient deficiencies?
Well no, a real food ketogenic diet will often increase micronutrient consumption.
Most people eating a standard western diet will be consuming an excessive amount of high carbohydrate foods and drinks, much of which will be Ultra Processed and nutritionally poor.
Usually the first foods to be eliminated when we switch to a ketogenic diet are things like cakes, biscuits, chips, sweets, basically all the junk foods that are all very high in carbs and very low in micronutrients.
But don’t we need to consume carbohydrates?
One of the things I see popping up quite commonly in the comments section is “But we need to eat carbs”!
The reason carbohydrates are limited on a keto diet is so that your body has reduced glucose from carbs circulating in the bloodstream. The body can then adapt to burning ketones from fats for energy instead.
Humans evolved to have this metabolic flexibility, which was needed to survive in different environments and through seasons when we lived as hunter gatherers.
Many people consider carbohydrates to be an ‘essential’ nutrient, this is not the case.
An “Essential Nutrient” is one which must be consumed, and can’t be made by the body.
Yes, we need glucose in our body, but we can make glucose (a process called gluco-neo-genesis), therefore we don’t need to consume carbohydrates to get glucose….
Humans can survive, and indeed thrive without consuming carbohydrates.
Anyway, a Ketogenic Diet is a low carb diet, not a NO carb diet.
Is the ketogenic diet too high in protein?
There is some concern that a diet high in protein could reduce calcium in bones, lead to osteoporosis, and damage your kidneys. Or even elevate blood lipids, increasing heart disease risk.
Many commenters still think that a Ketogenic Diet is overloaded with protein, all bacon and eggs and it is easy to get stuck in a rut with food and end up eating bacon and eggs every day..
It’s not that I have anything against a high protein diet… but the perception that Ketogenic Diets is a protein heavy one is a throwback to the 80s, from the Atkins approach to ketosis.
Ketogenic Diets are generally based on moderate (or indeed adequate) not high protein intake. But like any diet there are good and bad ways to eat.
Protein is an essential macronutrient and whilst you’d think we would have a good idea of how much is the right amount to eat, it’s actually the subject of a lot of debate.
While the recommended daily intake may be enough to prevent deficiency, some experts believe it’s insufficient to optimise health and body composition.
In fact evidence shows that older individuals might benefit from a higher protein intake and long-term studies show that a higher protein intake may also improve bone health.
Bottom line is that a ketogenic diet is not necessarily a high protein diet and that eating enough protein is important for building and maintaining muscle mass and bone health.
Danger of low blood sugar (Hypoglycemia)
Could a Ketogenic Diet put you in danger of Hypoglycaemia?! Again, this sort of comes back to the idea that because you’re not eating any carbohydrate your blood glucose levels will drop.
Hypoglycemia (often called a hypo) is the medical term for when your blood glucose levels drop too low and you become symptomatic. The symptoms may include: confusion, heart palpitations, shakiness, anxiety. It’s usually caused by medications that us doctors have given to lower blood glucose.
As I mentioned earlier our blood glucose levels don’t just drop completely because we’re not eating carbohydrates.
Our bodies are not solely reliant on carbs – good job as carbohydrate foods would not have always been available to our ancestors.
So.. When you are on a ketogenic diet your body will be able to make the glucose it needs.
But if you’ve been consuming carbohydrates all day, every day for most of your life then you might find that your body takes a bit of time to adjust.
So yes, I have however encountered people who have had symptomatic hypoglycemia in the days after transitioning to a ketogenic diet.
People Taking Blood Glucose Lowering Medications
This is where we need to be really careful… People who are taking blood glucose lowering medications (such as Insulin..) will need to be very careful.
As blood glucose levels improve on Ketogenic Diet – taking regular blood glucose lowering meds could drop blood glucose levels down too low, to the point of Hypoglycaemia.
Anyone taking any glucose lowering medications should speak to their medical practitioner before starting a Ketogenic Diet as they may need medications adjusting.
In the description of this video you’ll find the link to a practical guide to making those medication changes that you can give to your clinician in case they are not familiar with doing this.
People Taking Blood Pressure Lowering Medictaions
It’s just worth mentioning that the same is true for those of you on Blood Pressure lowering medications. A ketogenic diet can lead to rapid improvements in blood pressure, and so those medications will need to be monitored and may need reducing or even stopping.
Does Following a Ketogenic Diet Trigger Eating Disorders?
Some experts level safety warnings that Ketogenic Diet could lead to eating disorders, or social isolation.
While there’s no scientific evidence that links Ketogenic Diets with causing eating problems – it is possible… as with any significant lifestyle or food behaviour change.
If you are someone with a history of disordered eating or food challenges, then any dietary changes may not be suitable for you to do unsupervised.
This is one of the reasons you’ll often see the standard disclaimer…. “Before embarking on any diet or exercise program please consult with your doctor.”
That said…I am aware of a number of psychiatrists with specialist interests in eating disorders who are using the ketogenic diet to help people with eating disorders.
There is also some positive news coming out of small observational studies into eating behaviours with Ketogenic Diet.
Patients were observed to reduce their binge eating and food addiction, while also losing weight. They also found improved satiety, reduced appetite and improved hormonal control.
Further studies have documented Ketogenic Diets improving mental health conditions linked to eating disorders, such as reduced anxiety and depression.
We’re at very early stages with research into this area and I am excited to see this develop.
Bottom line: There are potential advantages that for many will outweigh any negatives. But a Ketogenic Diet may not be suitable for those vulnerable to or with a history of disordered eating without specialist supervision.
Is the ketogenic diet harmful during pregnancy and breastfeeding?
There are concerns that the Ketogenic Diet may be potentially dangerous during pregnancy and breastfeeding due to sudden diet changes or following a very restrictive carb intake.
Pre-conception & early pregnancy
Let’s start before the baby is actually conceived.
There have been concerns raised about removing processed carbohydrates from your diet in relation to Neural Tube Defects (such as spina bifida.) These defects are strongly associated with a lack of folic acid.
Cereals and breads often have vitamins and minerals added to them, because they are often so nutritionally poor on their own they wouldn’t be considered food without these additives. This is a process known as fortification and often includes Folic acid.
It is claimed that removing these foods from your diet could lead to insufficient folic acid and therefore lead to an increased risk of Neural Tube Defects.
However, the standard medical advice for any woman considering pregnancy and in the early weeks of pregnancy is to take folic acid supplementation, regardless of her diet.
Consuming a real food diet, with plenty of dark leafy green veggies will also help to boost folic acid intake.
The data does not suggest an association between low carbohydrate diets and neural Tube Defects – independently from folic acid content.
But women planning pregnancy are advised to take appropriate conception and early pregnancy supplements containing folic acid anyway.
Whilst we can safely say that removing sugar and highly processed food during pregnancy is a good thing… The science regarding what is a safe level of carbohydrate consumption in pregnancy is absent. This isn’t surprising… as scientists don’t do experiments on pregnant women for obvious ethical reasons.
I’m aware of a number of women who have been on long term ketogenic diets prior to pregnancy, who have continued throughout their pregnancies and everything has been fine.
And you might be thinking “why would anyone even think about starting a ketogenic diet during pregnancy?” – well we know that ketogenic diets are good for diabetes… and many women develop gestational diabetes.
So it’s possible that a ketogenic diet may help…but I don’t see us ever really being able to say that it’s definitely a safe option for managing gestational diabetes.
I often get asked whether it’s safe to go onto a ketogenic diet when breastfeeding. It’s not uncommon for women to want to lose some weight after having a baby.
Again, it’s vital to get enough nutrients while breastfeeding. Breastfeeding uses a lot of energy and nutrients. Your need for specific nutrients, including protein, calcium, iron, and many vitamins, goes up as well and many women take specific supplements to support breastfeeding.
According to advice from La Leche League, a low carb eating style is compatible with breastfeeding as long as you take a sensible approach. Including “eating regularly, and including a wide variety of healthy foods, such as vegetables, fruits and proteins, to ensure sufficient nutrition” (Lauwers & Swisher, 2015).
Eliminating unhealthy carbs with little nutritional benefit can be very helpful for many mothers, foods like sugary snacks, junk foods, crackers, chips etc.
But importantly those considering a strict ketogenic diet should be aware of a very small number of cases reported, of non-diabetic breastfeeding women ending up in ketoacidosis. The reasons that these cases have occurred are not clearly understood.
Diabetic Ketoacidosis is a serious, life threatening complication of type 1 diabetes and, much less commonly, of type 2 diabetes.
It’s important to note here that Ketoacidosis should not be confused with ketosis – but often is – even by doctors. A Ketogenic Diet induces ketosis, but is not an established cause of clinically significant ketoacidosis. It does seem that increased nutritional demand from milk production combined with extremely low carbohydrate intake, along with illness in some of the cases, may have triggered these metabolic changes.
Extremely low carb intake may in rare cases lead to ketoacidosis when breastfeeding. Although, it is so rare that we have very little research or cases to go on. That said it’s probably best to exercise caution before reducing carbohydrates during breastfeeding and perhaps a more moderate approach with a focus on good nutrition would be appropriate.
For those with health challenges that make fat more difficult to break down or digest, such as if you are recently post bariatric surgery or have some other rarer disorders that interferes with normal fat metabolism, then a Ketogenic Diet is not advised without medical supervision.
Most commonly for those who have had their gallbladder removed may have issues with the increased fat in their diet. The gallbladder produces bile, and one of the key functions of bile is to break down fat.
I do know of some clients who have done well on a ketogenic diet with no gallbladder, however it seems everyone will be different in the amount of fat that they can tolerate.
It’s probably worth being cautious with the added fats initially and just focusing on the additional fats that occur naturally along with your protein sources such as salmon, tuna, eggs and meat. Then, adjusting your fat intake according to your response would be sensible.
Weakened bone health
Ketogenic Diets are sometimes linked to an increased risk of bone breaks, fractures or reduced bone density- safety concerns that Claire mentioned earlier.
The majority of studies into this area are based on children with severe epilepsy. But there are some complicating factors that make it difficult to point the finger at the ketogenic diet.
Children with severe epilepsy may have a number of contributors to poor bone health. From
- anti-epilepsy drugs;
- reduced mobilisation,
- reduced food quality and
- Vitamin D levels.
Some larger scale more comprehensive studies have found no detrimental impact on bone health. Including a large research project conducted over 2 years following diabetic patients on a keto diet.
Bottom line is that there is no compelling evidence of increased risk to bone density or breakages, without additional risk factors.
Are you risking kidney damage..?
A great deal of the research showing that a Ketogenic Diet could increase risk of kidney stones, again, comes from studies with children suffering from epilepsy. Much like what we talked about with bone health, there are other factors at play, such as dehydration, the type of ketogenic diet, quality of foods and epilepsy drugs, which can also increase the risk of kidney stones.
Currently I have not seen evidence of an increased risk of kidney stones from a Ketogenic diet without additional contributory factors.
Kidney Disease & Protein
Much of the criticism citing risk to kidney health are based on assumptions around high protein intake. And as I’ve already said, keto diets are not necessarily high protein diets.
There’s actually no evidence that a high protein intake harms kidney function in people who don’t have kidney disease. Instead, it has plenty of health benefits and may even improve your health.
A study in 2021 found that high- normal protein intake is not associated with faster renal deterioration in patients with type 2 diabetes.
Two of the main risk factors for kidney failure, high blood pressure and diabetes, have been shown to improve with a ketogenic diet.
A study from last year led by Dr David Unwin of 143 patients with normal renal function or mild Chronic Kidney Disease – found evidence that a low carb diet may improve many renal and cardiovascular risk factors for people with T2D.
Chronic Kidney Disease
There are some small studies on patients with mild kidney disease that are promising. One study published in 2020 included 38 patients with early stage Chronic Kidney Disease. Interestly some of the participants reported “full recovery” of kidney function. This study suggests that a Ketogenic diet may be effective in improving renal function in mild kidney disease.
What remains to be shown is the effect of this dietary approach on people with moderate to severe Chronic Kidney Disease where the research is lacking.
For those with early stage kidney disease a ketogenic Diet may actually have a positive impact on renal health.
For those with significant chronic kidney disease (CKD), the advice currently is to avoid a Ketogenic Diet pending further studies which may or may not happen.
Does a ketogenic diet cause cardiovascular disease?
As I mentioned at the beginning this was my big worry.. How would a Ketogenic Diet affect my own cardiovascular health in the long term?
I’d say this is the biggest concern for people when starting a ketogenic diet.
One of my clients, Crystal, prior to working with me, had a scan which identified mild plaque formation and indicated coronary vessel disease.
Her main aim was to lose and maintain weight loss. But she had some big worries around her heart health.
In a period of just over 12 months her BMI improved dramatically, she’d lost an 8 inches from her waist, her bone density had improved, and she had reversed her pre-diabetes.
On top of all her exciting health improvements, was that her updated cardiac scans showed NO plaque, hardening or calcification present.
Yep, it actually went the other way. All those early signs of heart disease went away.
Crystal wrote to me and said – “I am reversing some of the ageing process. I couldn’t be more excited.”
So why do we get so worried about fat consumption? Well it comes down to this…
The Diet Heart Hypothesis
Dr Ancel Keys first proposed the diet-heart hypothesis in the 1950s.
This hypothesis postulates that reducing dietary saturated fat reduces blood cholesterol, thereby reducing the risk of cardiovascular disease.
Ancel Keys led one of the biggest studies into this subject, the Minnesota Coronary Experiment between (1968 and 1973).
They took nearly 10,000 people who were residents in one nursing home and six state mental hospitals in Minnesota in the United States.
Because of the nature of these institutions, the researchers were able to completely control the diets of these people. Now, we don’t do studies like this anymore, because it’s considered unethical. But this was a very high quality study.
The control group ate a diet that was high in saturated fats. The other group had a “cholesterol lowering diet” that replaced saturated fat with polyunsaturated fats.
And yes, the group on the cholesterol lowering diet did indeed have lower cholesterol
…so the first bit of the diet heart hypothesis is true
But it’s the second bit where it comes unstuck… it made no difference to the levels of heart disease.
So why didn’t this study, which was done by the guy who suggested the diet heart hypothesis, effectively disprove it?
Well they didn’t like the results so they never published it.
The results were eventually published in 2016 after a group of scientists reviewed the original unpublished data that was found in one of the researchers’ basements after his death.
Here is what they concluded:-
‘Available evidence from randomised controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes’.
Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.
If you want a comprehensive overview of how the misinformation about saturated fats took hold in the scientific community and the public imagination, and how recent findings have overturned these beliefs.
I highly recommend the book “The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet” by Nina Teicholtz.
(Please note, this is an affiliate link and we will earn a small commission if you purchase using this link, at no extra cost to you).
The Ketogenic Diet improves all markers of metabolic syndrome.
So during my junior doctor years I worked in coronary care, essentially a ward full of people who have just had heart attacks.
It shocked me to realise just how many of those people had Type 2 diabetes.
There have been many studies demonstrating the cardiovascular benefits of a ketogenic diet.
- Impressively reducing weight
- improving blood pressure
- blood glucose
- Reducing triglycerides
- Improving HDL – the good cholesterol
These are the five markers of metabolic syndrome… a condition which underlies poor metabolic health.
Individuals with metabolic syndrome are at significantly increased risk of cardiovascular disease.
High Risk Individuals
Research has started to examine the safety of the ketogenic diet more specifically, for people at high risk of heart attack and stroke, for example, those who have already suffered one.
So we don’t have any safety data for that particular group as yet.
Speaking of high risk groups. Approximately 1 in 200 people have a condition called Familial Hypercholesterolaemia – or FH. So it’s really quite common.
This is a genetic disease of cholesterol metabolism which puts people at high risk of heart disease.
Often people with this condition will know of individuals in their family who have died relatively young because of heart disease.
People with FH don’t respond in the normal way to a ketogenic diet and therefore shouldn’t do it.
It’s one of the reasons I always suggest people do baseline testing prior to starting a ketogenic diet.
To sum up.. A Ketogenic Diet absolutely is safe – for most people.
The Ketogenic Diet has been shown to be highly effective for weight loss and improving health parameters associated with carrying excess weight:
Symptoms experienced early on in the diet are TEMPORARY, occurring only while the body is transitioning from using glucose to using fat for fuel – they can be remedied and do not pose a safety risk.
Drastic reduction in carbohydrates with strict Ketogenic Diets may not be a healthy choice during pregnancy, while breastfeeding, or for people suffering from specific medical conditions.
If you are under-going medical investigations for current or new medical conditions or are experiencing changes to your health markers – then making drastic diet changes is probably not advisable as it can confuse the picture of what is going on.
And those of you on specific medications you will require monitoring to adjust medications.
So hopefully that’s helped you to decide on whether or not it’s right for you.
Ultimately whether a ketogenic diet is safe for you requires weighing up the potential health benefits with your own unique health circumstances. That can be occasionally quite tricky.
But even if you decide it’s not for you then making dietary changes such as eliminating highly processed and sugar laden foods is always a positive..
And if you do decide to give it a go… remember – there’s good and bad ways to eat on a keto diet. Your food choices are important to your long term health and the safety of any diet.
Low carb for Diabetes Type 2:
Diabetes management [Meta analysis https://pubmed.ncbi.nlm.nih.gov/29522789/]
Ketosis dietary approach found to inhibit polycystic kidney disease progression, a disease that leads to kidney failure. [Torres JA 2019]
Frontiers – elite athletes damage to bone health: https://www.frontiersin.org/articles/10.3389/fendo.2019.00880/full
A systematic review of randomised controlled studies in 2014 found that low carbohydrate diets improve cardiovascular risk factors and stated that dietary guidelines should be re-visited advocating a healthy low carbohydrate dietary pattern for the prevention of cardiovascular disease risk factors.
Various beneficial effects triglycerides, LDL cholesterol and blood glucose,
https://www.sciencedirect.com/science/article/pii/S1357272521001308#bib0330 The ketogenic diet as a therapeutic intervention strategy in mitochondrial disease
Ketogenic diets inhibit mitochondrial biogenesis and induce cardiac fibrosis
(rat study .. peritoneal injection of BHB. Human samples removed during mitral valve replacement surgery or cardiac catheterisation…. Pts had diagnosed AF, but presumably other underlying conditions to warrant surgery)
- La Leche League breastfeeding diet advice
- Lauwers, J. & Swisher, A. (2015). Counselling the Nursing Mother: A Lactation Consultants Guide. Burlington, MA: Jones & Bartlett Learning.
- Ketogenic Diet-Induced Severe Ketoacidosis in a Lactating Woman: A Case Report and Review of the Literature
- Case Report: Lactation Ketoacidosis Can Complicate the Ketogenic Diet