Ricerc@Sapienza

First identified as a feasible treatment for intractable epilepsy, the ketogenic diet
(KD) has recently gained popularity thanks to growing evidence on applications such
as weight loss, most importantly, but also NAFLD, cancer, neurologic conditions and
chronic pain. As with any treatment, whether pharmacologic or not, the KD might
not be an appropriate intervention for every individual, and a number of contraindications
have been proposed, now deeply rooted into clinical practice, excluding de
facto many patients that could benefit from its use. However, many of these concerns
were expressed due to the absence of clinical studies conducted on fragile
populations, and an assessment of lately emerged evidence relative to KD safety is
currently lacking and much needed. We herein provide a critical revision of the literature
behind each safety alert, in order to guide through the treatment options in the
case of subjects with an indication to the KD and a borderline safe situation. Based
on available evidence, the possible use of this diet as a therapeutic intervention
should be assessed on a patient-to-patient basis by adequately skilled medical doctors,
keeping in mind current recommendations, but reading them through the knowledge
of the current state of the art.