In the most comprehensive analysis yet of ketogenic (keto) diets, a review in Frontiers in Nutrition finds keto diets place pregnant women and kidney disease patients at risk of adverse health effects. The review, “Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks,” also found that for most people, the possible long-term risks of the keto diet, including heart disease, cancer, diabetes, and Alzheimer’s disease, outweigh its possible benefits.

“The typical keto diet is a disease-promoting disaster,” says lead review author Lee Crosby, RD, nutrition education program manager at Physicians Committee for Responsible Medicine. “Loading up on red meat, processed meat, and saturated fat and restricting carbohydrate-rich vegetables, fruits, legumes, and whole grains is a recipe for bad health.”

Five key findings of the Frontiers in Nutrition review paper are:

The term “ketogenic diet” generally refers to a diet that is very low in carbohydrate, modest in protein, and high in fat. This mix of fuels aims to induce ketosis, or the production of ketone bodies that serve as an alternate energy source for neurons and other cell types that cannot directly metabolize fatty acids.

Keto diets have been promoted for weight loss and, less commonly, for other health reasons—seizure disorders, obesity and weight management, type 1 and type 2 diabetes, fatty liver disease, cancer, Alzheimer’s disease, heart disease, kidney health, and prepregnancy and pregnancy—all of which were considered in this review. It also looked at potential long-term effects on health.

“In addition to the significant risks to kidney disease patients and pregnant women, keto diets are risky for others, too, as these diets can increase LDL cholesterol levels and may increase overall chronic disease risk,” Crosby explains. “While keto can reduce body weight short term, this approach is not more effective than other weight-loss diets.”

Researchers found that the only well-supported use for this dietary approach is to reduce seizure frequency in some individuals with drug-resistant epilepsy.

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