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Research · Diets

Keto diet

Keto is defined by cutting carbohydrates far enough to reach ketosis, not by which foods are eaten, so it can be vegetarian or all animal foods. Meta-analyses of randomized trials find ketogenic diets lower weight about 1 to 3 kg more than comparison diets, lower triglycerides and raise HDL and LDL cholesterol. HbA1c fell more at 3 to 6 months in type 2 diabetes but not reliably at 12. Children with drug-resistant epilepsy had fewer seizures. Reported risks include mineral shortfalls and kidney stones.

Add to Bio HackChecked 2026-11-13
Status
A dietary pattern, not a regulated product.
Also called
ketogenic diet, keto, KD, very-low-carbohydrate ketogenic diet, VLCKD, classic ketogenic diet, LCHF, keto diet
Followed for
weight loss, blood sugar, type 2 diabetes, triglycerides, heart health, epilepsy, inflammation, fatty liver, PCOS

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help8

Reported risks10

What people follow it for, and what was found

Shown to help8

Strong

Weight loss

Shown to produce about 1 to 3 kg more weight loss than comparison diets in adults, with the smallest gap in trials of a year or longer.

Compared with diets that did not restrict carbohydrates to the level of ketosis

The numbers and sources
Effect
In 13 trials with 12 months or more of follow-up, ketogenic diets lowered weight 0.91 kg more than low-fat diets (95% CI 0.17 to 1.65, 1,415 patients) [1]. Across 27 RCTs (1,278 participants), weight fell 2.59 kg more than on control diets (95% CI 1.28 to 3.90, I² 87.4%) [2]. When prescribed energy was matched, the gap was 1.49 kg (95% CI 0.58 to 2.41, 6 trials, 259 participants) [3]. In type 2 diabetes, weight fell 2.91 kg more at 3 months and 2.84 kg more at 6 months, and the difference was gone at 12 months [4].
Population
Adults, mostly with overweight or obesity [1][2][3]; 648 adults with type 2 diabetes in 8 RCTs [4].
Sources
[1], [2], [3], [4]
Caveats
Heterogeneity was high in [2]. Certainty was low in the energy-matched review, and in its 3 protein-matched trials the effect was imprecise and compatible with no difference [3]. Weight loss certainty in type 2 diabetes was low [4]. The comparison diets varied from low-fat to usual care.
Strong

Triglycerides and HDL cholesterol

Shown to lower triglycerides by about 0.2 to 0.3 mmol/L and raise HDL cholesterol more than comparison diets in adults.

Compared with diets that did not restrict carbohydrates to the level of ketosis

The numbers and sources
Effect
Against low-fat diets over 12 months or more, triglycerides fell 0.18 mmol/L more (95% CI 0.08 to 0.27) and HDL rose 0.09 mmol/L more (95% CI 0.06 to 0.12) [1]. Across 27 RCTs, triglycerides fell 0.20 mmol/L (95% CI 0.11 to 0.29) and HDL rose 0.16 mmol/L (95% CI 0.09 to 0.23) against control diets [2]. In 62 studies, triglycerides fell 19.96 mg/dL (95% CI 13.81 to 26.10) and HDL rose 3.61 mg/dL (95% CI 1.44 to 5.57) [5]. In pre-diabetes and type 2 diabetes, triglycerides were 0.28 mmol/L lower at 12 months (95% CI 0.11 to 0.44) [6].
Population
Adults with and without obesity or type 2 diabetes [1][2][5][6].
Sources
[1], [2], [5], [6]
Caveats
Heterogeneity was 72.2% for triglycerides and 86.7% for HDL in [2]. The same reviews found LDL cholesterol rose (see Risks).
Strong

Blood pressure

Shown to lower diastolic blood pressure about 1.4 mmHg more than comparison diets in adults.

Compared with diets that did not restrict carbohydrates to the level of ketosis

The numbers and sources
Effect
Diastolic pressure fell 1.43 mmHg more than on low-fat diets (95% CI 0.37 to 2.49, 1,298 patients) [1] and 1.41 mmHg more than on control diets (95% CI 0.26 to 2.57) [2]. In type 2 diabetes, systolic pressure fell 2.85 mmHg (95% CI 0.71 to 4.99) and diastolic 1.40 mmHg (95% CI 0.13 to 2.66) [7].
Population
Adults with overweight or obesity [1][2]; adults with type 2 diabetes in 29 trials [7].
Sources
[1], [2], [7]
Caveats
Differences of 1 to 3 mmHg are small. Heterogeneity was 49.1% for diastolic pressure in [2].
Strong

Seizures in drug-resistant epilepsy

Shown to make a 50% seizure reduction about 5.8 times as likely as usual care in children with drug-resistant epilepsy, on low-certainty evidence, with adult results uncertain.

Compared with usual care [8]; control groups the source does not describe [9]; a further antiseizure medicine [10]

The numbers and sources
Effect
In children, ketogenic diets made seizure freedom more likely than usual care (RR 3.16, 95% CI 1.20 to 8.35, 4 studies, 385 participants) and a 50% or greater seizure reduction more likely (RR 5.80, 95% CI 3.48 to 9.65). Up to 55% of children were seizure free after 3 months on a classic 4:1 diet. In adults, no participant became seizure free, and seizure reduction was uncertain (RR 5.03, 95% CI 0.26 to 97.68, 2 studies, 141 participants) [8]. In 6 of 14 RCTs in children and adolescents, seizures fell by more than 50% against control over 3 to 4 months [9]. In 136 infants aged 1 to 24 months, seizures per day did not differ from a further antiseizure medicine at 8 weeks (IRR 1.33, 95% CI 0.84 to 2.11) [10].
Population
932 participants in 13 studies, 711 children aged 4 months to 18 years and 221 adults [8]; 1,114 children and adolescents in 14 RCTs [9]; infants at 19 UK hospitals [10].
Sources
[8], [9], [10]
Caveats
All 13 Cochrane studies were at high risk of bias from lack of blinding, and certainty was low to very low [8]. These are medically supervised diets in people whose seizures continued on medication. The infant trial ended early, and three infants on the diet died during it, deaths the investigators judged unrelated to treatment [10].
Moderate

HbA1c in type 2 diabetes

Shown to lower HbA1c about 0.6 points more than comparison diets at 3 to 6 months in type 2 diabetes, with mixed results at 12 months.

Compared with diets that did not restrict carbohydrates to the level of ketosis

The numbers and sources
Effect
Against guideline diabetes diets, HbA1c fell 0.61% more at 3 months (95% CI 0.40 to 0.82, moderate certainty) and 0.58% more at 6 months (95% CI 0.32 to 0.85, low certainty), with no difference at 12 months. Diabetes medication use fell more for up to 12 months [4]. Across 29 trials, HbA1c fell 0.29% (95% CI 0.14 to 0.44) [7]. At 12 months, four studies showed a difference of 0.01% (95% CI -0.22 to 0.25) and two showed 0.65% lower (95% CI 0.31 to 0.99) [6].
Population
648 adults with type 2 diabetes in 8 RCTs of 12 weeks or more [4]; 606 adults with pre-diabetes or type 2 diabetes in 8 RCTs of 6 months or more [6]; 29 trials in type 2 diabetes [7].
Sources
[4], [6], [7]
Caveats
The authors of [4] name poor adherence to carbohydrate restriction as a major limitation. The 12-month results disagree between analyses [6]. Review [7] pooled clinical trials, not only randomized ones.
Limited

Liver fat and insulin sensitivity

One trial found that at equal 10% weight loss, liver insulin sensitivity rose two to three times more than on Mediterranean or very-low-fat diets.

Compared with diets that did not restrict carbohydrates to the level of ketosis

The numbers and sources
Effect
Calories were adjusted so every group lost about 10% of body weight. Muscle insulin sensitivity rose about 50% on all three diets. Liver insulin sensitivity rose two to three times more on the very-low-carbohydrate ketogenic diet (p < 0.001), and liver fat, liver fat production, HbA1c and 24-hour glucose and insulin fell most on it. LDL cholesterol, apolipoprotein B and 24-hour triglycerides did not differ between diets [12].
Population
Adults with obesity, prediabetes and fatty liver. The abstract does not give the number randomized [12].
Sources
[12]
Caveats
One small trial. Food was supplied during weight loss, so it measures the diets eaten as written. It does not apply to people without prediabetes and fatty liver.
StrongStudied in women

Weight and insulin resistance in PCOS

Shown in pooled studies to lower weight and insulin resistance in women with PCOS. Against other diets, the reviews disagreed on weight.

Compared with other diets [21]; low-calorie diets [22]; before the diet, in the same women [21][22][23]

The numbers and sources
Effect
Against other diets, ketogenic diets lowered weight 4.98 kg more (95% CI 0.91 to 9.05), BMI 1.65 kg/m2 more and insulin resistance more (MD -1.71, 95% CI -2.98 to -0.43, I² 90%). From before to after the diet, weight fell 10.77 kg and BMI 3.38 kg/m2 [21]. In 2 RCTs against low-calorie diets, body weight did not differ significantly, while BMI, fat mass, glucose and HOMA-IR fell more on the ketogenic diets [22]. A third review of 7 studies found weight, BMI, glucose, insulin, HOMA-IR, LDL cholesterol and triglycerides fell from before to after the diet [23].
Population
Women with PCOS, most with BMI above 25, in 15 studies, 10 pooled [21]; 10 studies including 3 RCTs, 4 cohorts and 2 case series [22]; 7 studies [23].
Sources
[21], [22], [23]
Caveats
Heterogeneity was high for most outcomes [21]. Before-and-after results cannot separate the diet from weight loss or time. A published letter disputed whether the definition of real-world exposure in [21] matched its inclusion criteria [24].
ModerateStudied in women

Reproductive hormones and cycles in PCOS

Shown in pooled studies, mostly before and after the diet, to lower LH and testosterone and raise SHBG in women with PCOS. Against other diets, androgen results were inconsistent.

Compared with before the diet, in the same women [25][23][21][22]; other diets [21]; low-calorie diets [22]

The numbers and sources
Effect
After 45 days or more on a ketogenic diet, the LH to FSH ratio fell (d -0.851, 95% CI -1.015 to -0.686), free testosterone fell (d -0.223, 95% CI -0.328 to -0.119) and SHBG rose (d 9.086, 95% CI 3.379 to 14.792) [25]. A second review found lower LH, LH to FSH ratio, free and total testosterone and higher SHBG and FSH after the diet [23]. Menstrual cycle length shortened and LH fell from before to after the diet, while androgen results against other diets were inconsistent [21]. In 2 RCTs, LH was lower than on low-calorie diets [22].
Population
Women with PCOS in single- or double-arm clinical trials [25]; 7 studies [23]; 15 studies, 10 pooled [21]; 10 studies including 3 RCTs [22].
Sources
[25], [23], [21], [22]
Caveats
Diets lasted weeks to months, and all reviews were limited by small, mostly uncontrolled studies. Pregnancy and live birth data were too scarce to pool [23].

Mixed results1

Moderate

Inflammation markers

Mixed results: CRP fell 0.62 mg/dL in one review of short and long trials, and a review of trials lasting a year or more found no CRP difference.

Compared with diets that did not restrict carbohydrates to the level of ketosis

The numbers and sources
Effect
In 5 RCTs pooled, CRP fell 0.62 mg/dL (95% CI 0.40 to 0.84) and IL-6 did not change significantly (-1.31 pg/mL, 95% CI -2.86 to 0.25) [11]. In 13 trials of 12 months or more, CRP was measured and was not among the outcomes that differed from low-fat diets [1].
Population
218 adults with overweight or obesity in 7 RCTs of 8 weeks to 2 years [11]; adults in trials against low-fat diets [1].
Sources
[1], [11]
Caveats
Few small trials. The abstract of [11] does not say whether the CRP change was measured against the control diet or from baseline. CRP is a blood marker, not a disease outcome.

How trials defined it

Trials in adults defined a ketogenic diet as no more than 50 g of carbohydrate a day [1], or no more than 50 g or 10% of energy from carbohydrate a day [3][4][6]. Low-fat comparison diets restricted energy and kept fat under 30% of energy [1]. Durations ran from 8 weeks to 2 years [11], with weight trials of 12 months or more in [1]. In one trial, calories were adjusted on purpose so every diet produced the same 10% weight loss [12]. Epilepsy trials used the classic diet at a 4:1 or 3:1 ratio, a medium-chain triglyceride version, and the modified Atkins diet, some starting gradually and some after a fast [8].

Risks

Reported risks10

LimitedStudied in childrenVery common

Selenium

Limited evidence: low selenium in 20% of children on the diet for epilepsy at one center, with one case of heart muscle disease.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
At one center, 9 children on the diet had low selenium, including one with cardiomyopathy and no detectable whole-blood selenium. Of 39 more children tested, 8 had levels below the normal range, 6 at first test and 2 on later testing. Supplementation raised levels in all [13]. In 91 children over 12 months, mean plasma selenium fell from 0.95 to 0.88 μmol/L [14].
Population
Children treated for drug-resistant epilepsy [13][14].
Sources
[13], [14]
Caveats
Children on a medical ketogenic diet with prescribed supplements. No adult data on selenium were located.
ModerateVery common

LDL cholesterol and apolipoprotein B

Shown to raise LDL cholesterol over comparison diets in adults, by 0.12 to 0.35 mmol/L in most reviews and 1.08 mmol/L in normal-weight adults.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
LDL rose 0.12 mmol/L more than on low-fat diets over 12 months or more (95% CI 0.04 to 0.20) [1], 0.35 mmol/L more than on control diets (95% CI 0.20 to 0.50, I² 73.9%) [2], and 8.49 mg/dL more across 62 studies (95% CI 5.45 to 11.52) [5]. In 3 trials of normal-weight adults, LDL rose 1.08 mmol/L (95% CI 0.37 to 1.79) and apolipoprotein B 0.35 g/L (95% CI 0.06 to 0.65) [16]. In type 2 diabetes, LDL did not differ from control diets [7]. In one trial with weight loss held equal, LDL and apolipoprotein B did not differ from Mediterranean or very-low-fat diets [12]. Hyperlipidemia was reported in 12.8% of children treated for epilepsy [17].
Population
Adults with and without obesity [1][2][5]; normal-weight adults [16]; adults with type 2 diabetes [7]; children with epilepsy [17].
Sources
[1], [2], [5], [7], [12], [16], [17]
Caveats
Effect sizes differ several times over between populations. No trial measured heart attacks or strokes, and the authors of [5] note the lack of long-term cardiovascular outcome data.
LimitedStudied in childrenVery common

Digestive side effects

Limited evidence: gastrointestinal problems were the most common side effect in children treated for epilepsy, reported in 40.6% across 45 studies.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Across 45 prospective studies, gastrointestinal disturbances were reported in 40.6% of children, hyperlipidemia in 12.8% and high uric acid in 4.4%. Severe events such as respiratory failure and pancreatitis occurred in no more than 0.5% [17]. In Cochrane trials, vomiting, constipation and diarrhea were the most common adverse effects in both diet and usual care groups [8]. Serious adverse events were rare in 14 RCTs [9].
Population
Children with drug-resistant epilepsy [8][9][17].
Sources
[8], [9], [17]
Caveats
Mostly uncontrolled studies. Certainty for adverse effects in the Cochrane review was low to very low [8].
LimitedVery common

Staying on the diet

Limited evidence: in children treated for epilepsy, 45.7% stayed on the diet at 1 year and 29.2% at 2 years.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Retention was 45.7% at 1 year and 29.2% at 2 years. Nearly half who stopped did so for lack of seizure benefit, not side effects [17]. In type 2 diabetes trials, the authors name lack of adherence to carbohydrate restriction as a major limitation [4].
Population
Children with drug-resistant epilepsy [17]; adults with type 2 diabetes [4].
Sources
[4], [17]
Caveats
Retention in adults following the diet for weight loss was not reported in these abstracts.
LimitedStudied in childrenCommon

Kidney stones

Linked to kidney stones in about 6% to 14% of children treated for epilepsy in clinic cohorts.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
At one hospital, kidney stones occurred in about 6% of children started on the diet. Among 313 children, 11 of 105 (10.5%) not given potassium citrate developed stones, against 4 of 198 (2.0%) given it [18]. In another cohort, 11 of 80 children (13.8%) had kidney stones or calcium deposits, all on the classic diet and none on the modified Atkins diet [19]. One trial reported more high urine calcium on the classic diet than on the modified Atkins diet [8].
Population
Children with drug-resistant epilepsy, observational clinic cohorts [18][19].
Sources
[8], [18], [19]
Caveats
Observational studies in children on a medical diet, often alongside antiseizure drugs. Rates in adults following the diet for weight loss were not located.
LimitedStudied in childrenHow often is not known

Magnesium

Limited evidence: magnesium intake fell below reference values in adults over 12 weeks, and blood magnesium fell slightly in children over a year.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In 35 adults with obesity, magnesium intake stayed below reference values throughout a 12-week ketogenic diet, while serum levels stayed within the reference range [15]. In children on the classic diet, mean plasma magnesium fell from 0.87 to 0.83 mmol/L over 12 months [14].
Population
35 adults with BMI over 30 [15]; 91 children with epilepsy [14].
Sources
[14], [15]
Caveats
Small studies. Blood levels stayed in range in adults [15].
LimitedHow often is not known

Calcium

One small study found calcium intake below reference values in adults over 12 weeks, with blood calcium falling but staying in range.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In 35 adults with obesity, calcium intake stayed below reference values, and serum calcium fell from 2.52 to 2.36 mmol/L at 12 weeks, within the reference range [15].
Population
35 adults with BMI over 30 [15].
Sources
[15]
Caveats
One small uncontrolled study. The authors link the fall to fewer legumes and less dairy, or to the high fat intake [15].
LimitedHow often is not known

Iron

One small study found iron intake below reference values in adults with obesity over 12 weeks, with blood levels in range.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Iron intake stayed below reference values throughout a 12-week ketogenic diet, and serum levels stayed within the reference range [15].
Population
35 adults with BMI over 30 [15].
Sources
[15]
Caveats
One small uncontrolled study measuring intake, not iron stores.
LimitedHow often is not known

Potassium

One small study found potassium intake below reference values in adults with obesity over 12 weeks, with blood levels in range.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Potassium intake stayed below reference values throughout a 12-week ketogenic diet, and serum levels stayed within the reference range [15].
Population
35 adults with BMI over 30 [15].
Sources
[15]
Caveats
One small uncontrolled study.
LimitedHow often is not known

Low blood sugar and low blood pressure on medication

An expert consensus states that starting a low-carbohydrate diet on insulin, sulfonylureas or blood pressure drugs carries a risk of low blood sugar and low blood pressure.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
An international consensus on adjusting medication states that starting a low-carbohydrate diet on medication requires close monitoring and medication changes to reduce the risk of hypoglycemia and hypotension. It names insulin, sulfonylureas, SGLT2 inhibitors, blood pressure medications and diuretics as the most immediate adjustments [20]. In trials of ketogenic diets in type 2 diabetes, diabetes medication use fell more than on control diets [4].
Population
Adults with type 2 diabetes on medication [20].
Sources
[4], [20]
Caveats
A consensus document, not a trial measuring hypoglycemia rates.

Supplements to consider

The nutrients research linked to this diet running short, each with its own page.

Selenium

Limited Limited evidence: low selenium in 20% of children on the diet for epilepsy at one center, with one case of heart muscle disease.

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Magnesium

Limited Limited evidence: magnesium intake fell below reference values in adults over 12 weeks, and blood magnesium fell slightly in children over a year.

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Calcium

Limited One small study found calcium intake below reference values in adults over 12 weeks, with blood calcium falling but staying in range.

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Iron

Limited One small study found iron intake below reference values in adults with obesity over 12 weeks, with blood levels in range.

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Potassium

Limited One small study found potassium intake below reference values in adults with obesity over 12 weeks, with blood levels in range.

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Claims tested and not found

  1. That a ketogenic diet keeps its weight-loss lead over the long term. Over 12 months or more, the difference from low-fat diets was 0.91 kg [1], and in type 2 diabetes the difference was gone at 12 months [4].
  2. That a ketogenic diet controls seizures better than another medicine in infants. Seizures per day did not differ from a further antiseizure medicine at 8 weeks [10].

Sources

  1. Bueno NB, de Melo IS, de Oliveira SL, et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition. 2013. https://doi.org/10.1017/s0007114513000548
  2. Wang Z, Chen T, Wu S, et al. Impact of the ketogenic diet as a dietary approach on cardiovascular disease risk factors: a meta-analysis of randomized clinical trials. The American Journal of Clinical Nutrition. 2024. https://doi.org/10.1016/j.ajcnut.2024.04.021
  3. Żurawski T, Bartosiewicz A. Do Ketogenic Diets Produce Greater Weight Loss than Higher-Carbohydrate Diets Under Comparable Prescribed Energy Conditions? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2026. https://doi.org/10.3390/nu18152525
  4. Rafiullah M, Musambil M, David SK. Effect of a very low-carbohydrate ketogenic diet vs recommended diets in patients with type 2 diabetes: a meta-analysis. Nutrition Reviews. 2022. https://doi.org/10.1093/nutrit/nuab040
  5. Chang C, Liu Y, Rohani P, et al. The Impact of the Ketogenic Diet on the Lipid Profile in Adults: A Comprehensive Review and Meta-Regression Analysis of Randomized Controlled Trials. Endocrine Practice. 2026. https://doi.org/10.1016/j.eprac.2026.01.009
  6. Parry-Strong A, Wright-McNaughton M, Weatherall M, et al. Very low carbohydrate (ketogenic) diets in type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes, Obesity and Metabolism. 2022. https://doi.org/10.1111/dom.14837
  7. Ghasemi P, Jafari M, Maskouni SJ, et al. Impact of very low carbohydrate ketogenic diets on cardiovascular risk factors among patients with type 2 diabetes; GRADE-assessed systematic review and meta-analysis of clinical trials. Nutrition & Metabolism. 2024. https://doi.org/10.1186/s12986-024-00824-w
  8. Martin-McGill KJ, Bresnahan R, Levy RG, et al. Ketogenic diets for drug-resistant epilepsy. Cochrane Database of Systematic Reviews. 2020. https://doi.org/10.1002/14651858.cd001903.pub5
  9. Desli E, Spilioti M, Evangeliou A, et al. The Efficacy and Safety of Ketogenic Diets in Drug-Resistant Epilepsy in Children and Adolescents: a Systematic Review of Randomized Controlled Trials. Current Nutrition Reports. 2022. https://doi.org/10.1007/s13668-022-00405-4
  10. Schoeler NE, Marston L, Lyons L, et al. Classic ketogenic diet versus further antiseizure medicine in infants with drug-resistant epilepsy (KIWE): a UK, multicentre, open-label, randomised clinical trial. The Lancet Neurology. 2023. https://doi.org/10.1016/s1474-4422(23)00370-8
  11. Rondanelli M, Gasparri C, Pirola M, et al. Does the Ketogenic Diet Mediate Inflammation Markers in Obese and Overweight Adults? A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients. 2024. https://doi.org/10.3390/nu16234002
  12. Petersen MC, Smith GI, Farabi SS, et al. Effect of diet macronutrient content on the cardiometabolic response to weight loss: A randomized clinical trial. Cell Metabolism. 2026. https://doi.org/10.1016/j.cmet.2026.07.020
  13. Bergqvist AG, Chee CM, Lutchka L, et al. Selenium deficiency associated with cardiomyopathy: a complication of the ketogenic diet. Epilepsia. 2003. https://doi.org/10.1046/j.1528-1157.2003.26102.x
  14. Christodoulides SS, Neal EG, Fitzsimmons G, et al. The effect of the classical and medium chain triglyceride ketogenic diet on vitamin and mineral levels. Journal of Human Nutrition and Dietetics. 2012. https://doi.org/10.1111/j.1365-277x.2011.01172.x
  15. Kenig S, Petelin A, Poklar Vatovec T, et al. Assessment of micronutrients in a 12-wk ketogenic diet in obese adults. Nutrition. 2019. https://doi.org/10.1016/j.nut.2019.06.003
  16. Joo M, Moon S, Lee YS, et al. Effects of very low-carbohydrate ketogenic diets on lipid profiles in normal-weight (body mass index < 25 kg/m2) adults: a meta-analysis. Nutrition Reviews. 2023. https://doi.org/10.1093/nutrit/nuad017
  17. Cai QY, Zhou ZJ, Luo R, et al. Safety and tolerability of the ketogenic diet used for the treatment of refractory childhood epilepsy: a systematic review of published prospective studies. World Journal of Pediatrics. 2017. https://doi.org/10.1007/s12519-017-0053-2
  18. McNally MA, Pyzik PL, Rubenstein JE, et al. Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet. Pediatrics. 2009. https://doi.org/10.1542/peds.2009-0217
  19. Amer F, Alotaibi W, Bashir S, et al. Incidence and risk factors of ketogenic diet-associated nephrolithiasis in children with drug-resistant epilepsy: A tertiary care center experience. Epilepsy Research. 2026. https://doi.org/10.1016/j.eplepsyres.2026.107871
  20. Cucuzzella M, Riley K, Isaacs D. Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet. Frontiers in Nutrition. 2021. https://doi.org/10.3389/fnut.2021.688540
  21. Arsenaki E, Stathi D, Triantafyllidis KK, et al. The effects of ketogenic diet on polycystic ovary syndrome: A systematic review and meta-analysis. Clinical Nutrition. 2026. https://doi.org/10.1016/j.clnu.2025.11.019
  22. Cannarella R, Rubulotta M, Leonardi A, et al. Effects of ketogenic diets on polycystic ovary syndrome: a systematic review and meta-analysis. Reproductive Biology and Endocrinology. 2025. https://doi.org/10.1186/s12958-025-01411-1
  23. Turetta C, Giannini A, Tarsitano MG, et al. Impact of Ketogenic Diet on Weight, Metabolic, and Endocrine Parameters in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Gynecologic and Obstetric Investigation. 2025. https://doi.org/10.1159/000543941
  24. Zhu H, Lu C, Shen L. Inconsistency Between the Definition of "Real-World Exposure" and the Predefined Inclusion Criteria in a Systematic Review on the Ketogenic Diet for Polycystic Ovary Syndrome. Clinical Nutrition. 2026. https://doi.org/10.1016/j.clnu.2026.106732
  25. Khalid K, Apparow S, Mushaddik IL, et al. Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome. Journal of the Endocrine Society. 2023. https://doi.org/10.1210/jendso/bvad112

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