Several possible causes for these deaths have been suggested, including the direct
breakdown of the heart due to the low quality of protein used (42). A second, and more likely
cause was that the depletion of electrolytes caused fatal heart arrhythmias. As well, given high
quality protein and adequate mineral supplementation, no cardiac abnormalities appear in
individuals on a ketogenic diet (44).
“The Last Chance Diet” should be contrasted to a ketogenic diet based around whole foods.
The intake of whole protein foods will ensure some intake of the three electrolytes. Even so,
studies show that the amount of electrolytes consumed by most on a ketogenic diet is
insufficient. Some of the fatigue which was demonstrated in early ketogenic diet studies may
have occurred from insufficient mineral intake, especially sodium (26).
A known effect of ketogenic diets is a decrease in blood pressure, most likely due to sodium
excretion and water loss. In individuals with high blood pressure (hypertension), this may be
beneficial. Individuals with normal blood pressure may suffer from ‘orthostatic hypotension’
which is lightheadedness which occurs when moving from a sitting to standing posture (45). The
inclusion of sufficient minerals appears to be able to prevent symptoms of fatigue, nausea and
hypotension (26).
To counteract the excretion of minerals on a ketogenic diet, additional mineral intake is
required. Although exact amounts most vary, suggested amounts for the three primary
electrolytes appear below (26,46):
Sodium: 3-5 grams in addition to the sodium which occurs in food
Potassium: 1 gram in addition to the 1-1.5 grams of potassium which occur in food
Magnesium: 300 mg
Note: An excessive intake of any single mineral (especially potassium) can be just as dangerous
as a deficiency. Although the values listed above are averages, individuals are encouraged to
have mineral levels checked to determine the required level of mineral supplementation. At no
time should mineral supplements be taken in excess.
Calcium loss/Osteoporosis
A general belief states that high protein diets may be a causative factor in osteoporosis
but this is still highly debated (47,48). While studies have shown increased calcium excretion
with high protein intakes, this was typically with ‘purified’ proteins (37). It is thought that whole-
food proteins do not cause this to occur as the high phosphate content prevents calcium losses
(37). In any event, the ‘high protein’ nature of the ketogenic diet raises concerns about calcium
loss and osteoporosis. There is some evidence that the ketogenic diet causes disordered calcium
metabolism, especially if it is combined with drug treatment for epilepsy (49). This effect is
reversed when adequate Vitamin D is consumed. Additionally, depending on dairy intake, a
calcium supplement may be necessary to ensure positive calcium balance. The current
guidelines for calcium intake are 1200 milligrams/day for men and pre-menopausal women and
1500 mg/day for post-menopausal women.