There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[54]

Hypoglycemia: Though the diet can lower A1c levels, that may mean you’re at a higher risk of blood sugar that dips too low, especially if you’re also taking medicine for your diabetes. Let your doctor or diabetes educator know if you try the keto diet. They can advise you about checking your blood sugar, taking your medicines, and what to do when your blood sugar drops too low.
As low-carb dietitian Franziska Spritzler, RD, CDE, who’s based in Orange County, California, points out, when you cut back on carbs, blood sugar and insulin levels generally go down, which can be a good thing for some people. “Carbs are broken down into glucose, which raises your blood sugar and prompts your pancreas to produce insulin to drive sugar into your cells,” says Spritzler. “When you’re overweight or obese, your blood sugar goes up and your pancreas sends out insulin, but your cells may not be responsive, leading your pancreas to overproduce insulin,” she says. High insulin increases hunger and prompts fat storage, she explains.
In addition to keeping you adequately hydrated -- which can also help alleviate constipation -- drinking lots of water can also help offset still another low-carb diet problem: bad breath. The ketones produced during the diet can lead to what is sometimes described as a fruity odor although it is often described as having an almost "chemical" odor similar to acetone or nail polish remover.
Dukan Diet This option also includes four phases: two weight loss and two maintenance. For instance, the first phase of the Dukan diet focuses on high-protein foods, the second adds vegetables back in, the third allows two “celebration” meals per week, and the fourth is about keeping your weight stable. Because you can follow the diet from the book, it also appeals to people who need a planned approach.
Because some cancer cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer.[59][60] A 2018 review looked at the evidence from preclinical and clinical studies of ketogenic diets in cancer therapy. The clinical studies in humans are typically very small, with some providing weak evidence for anti-tumour effect, particularly for glioblastoma, but in other cancers and studies, no anti-tumour effect was seen. Taken together, results from preclinical studies, albeit sometimes contradictory, tend to support an anti-tumor effect rather than a pro-tumor effect of the KD for most solid cancers.[61]
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That’s not to say everyone starting out on a keto diet ends up wholly incapacitated for days. “You might find that you fatigue more quickly or that exercise seems harder than normal,” says Seattle-based nutritionist and Academy of Nutrition and Dietetics spokesperson Ginger Hultin, MS, RDN. Your body might also have an easier time transitioning (read: fewer symptoms) if you were already eating a relatively low-carb diet, Mancinelli explains.

No matter what your diet has been before now, keto will be a big change. If you're coming from a standard American diet (SAD), your carbs will go way down, your protein may either go up or down, and your fat will go way up. If you're coming from a bodybuilding-style diet, your fat intake will jump to alarming levels, and your protein will likely drop significantly.
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.[42]
Louise holds a Bachelors and Masters in Natural Sciences from Cambridge University (UK). She attended Columbia University for her JD and practiced law at Debevoise & Plimpton before co-founding Louise's Foods, Paleo Living Magazine, Nourishing Brands, & CoBionic. Louise has considerable research experience but enjoys creating products and articles that help move people just a little bit closer toward a healthy life they love. You can find her on Facebook or LinkedIn.
Note that the term “reversal” in this context simply means that the disease gets better, improving glucose control and reducing the need for medications. In the best case, it can be so much improved that blood glucose returns to normal without medication, long term. In this context, reversal means the opposite of the disease progressing or getting worse.
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