The safety of<unk>  from low-carbohydrate diets is often called into question by clinicians, researchers and the media. A common safety concern stems from the misunderstanding of the difference between physiological<unk>  and pathologic ketoacidosis. There is also continued debate whether chronic<unk>  is a healthy state or a stressor to be avoided. Some argue that humans evolved to avoid<unk>  and should not be in<unk>  long-term. The counter-argument is that there is no physiological requirement for dietary carbohydrate as adequate energy can be made via gluconeogenesis and ketogenesis indefinitely. Alternatively, the switching between a ketotic and fed state has been proposed to have beneficial effects on metabolic and neurologic health. The effects of sustaining<unk>  for up to two years are known from studies of people following a strict ketogenic diet for epilepsy or type 2 diabetes; these include short-term adverse effects leading to potential long-term ones. However, literature on longer term effects of intermittent<unk>  is lacking. Medication considerations Some medications require attention when in a state of<unk> , especially several classes of diabetes medication. SGLT2 inhibitor medications have been associated with cases of euglycemic ketoacidosis- a rare state of high ketones causing a metabolic acidosis with normal blood glucose levels. This usually occurs with missed insulin doses, illness, dehydration or adherence to a low-carbohydrate diet while taking the medication. Additionally, medications used to directly lower blood glucose including insulin and sulfonylureas may cause hypoglycemia if they are not titrated prior to starting a diet that results in<unk> . Adverse effects There may be side effects when changing over from glucose metabolism to fat metabolism. These may include headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, constipation, and nausea, especially in the first days and weeks after starting a ketogenic diet. Breath may develop a sweet, fruity flavor via production of acetone that is exhaled because of its high volatility. Most adverse effects of long-term<unk>  reported are in children because of its longstanding acceptance as a treatment for pediatric epilepsy. These include compromised bone health, stunted growth, hyperlipidemia, and kidney stones. Contraindications<unk>  induced by a ketogenic diet should not be pursued by people with pancreatitis because of the high dietary fat content.<unk>  is also contraindicated in pyruvate carboxylase deficiency, porphyria, and other rare genetic disorders of fat metabolism.
Ketosis
Ketoacidosis
Alkalosis
Acidosis
Alkaline tide
Hyperammonemia
Lactic acidosis
Syndemic